Curcumin in Psychiatry

Decades ago, I had the opportunity to study Ayurvedic medicine with Dr. Vasant Lad, one of the foremost Ayurvedic practitioners and teachers of his time. Part of his treatments included prescribing various herbal powders, and one particular yellow colored herb showed up in practically everyone's prescription. In this way, I was first introduced to the wonders of turmeric, a common ingredient of curries and other flavorful foods of India. Dr. Lad extolled its healing properties, telling me that it was common that Indian families to take a little turmeric daily as an aid to staying healthy and free of pain, digestive disturbances and fatigue.

Years later, I also have learned to include turmeric (or curcumin, as we refer to its major constituent, in medical terms) in my prescriptions. We know of curcumin as an anti-inflammatory, and thus it is proven useful as a treatment for pain, arthritis, and inflammation of all sorts. Curcumin has become the highest selling herbal ingredient in the world, and one of the most studied in the medical literature (over 1500 PubMed listings in 2015 were for curcumin related articles).

Alzheimer’s Disease is another condition that curcumin has shown to help.  It’s a major component of my protocol for treating this terrible condition.  Some of those PubMed articles show that, in animals and in the laboratory, curcumin protects our brains from the inflammatory processes associated with dementia.  Furthermore, it has a positive effect on the metabolism of beta amyloid, which makes up the deposits in the brain that are a hallmark of Alzheimer’s. As if this isn’t enough, there also is a body of literature supporting the use of curcumin in cancer both as an adjunct to existing treatments, or as a treatment that can lower the side effect profile.

But I have recently become aware of a new and potentially widespread use of curcumin: as an anti-anxiety and antidepressant treatment.  Much of my awareness of this was the result of a recently published comprehensive review entitled: “Curcumin for neuropsychiatric disorders: a review of in vitro, animal and human studies” by Dr. Adrian Lopresti.  This exhaustive review of the world’s literature turned up some astounding facts about this remarkable herb and its effects on mood disorders.  The reason that curcumin can be so effective in these conditions (including Bipolar Disorder, Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder ) is that these conditions show many of the same biochemical characteristics as other major illnesses.  They are the results of inflammation that has become uncontrolled, of imbalances in the message centers of the brain and nervous systems that lead to that inflammation, and of oxidative stress. 

In my practice, I see many patients with a diagnosis of anxiety who do not feel that their anxiety is triggered by psychological issues or situational events.  They may get so-called panic attacks that occur out of nowhere, or low-level chronic anxiety that is not triggered by anything stressing them.  Most frequently, these patients also have signs of inflammation elsewhere: in the joints (arthritis),  stomach (gastritis), the skin (dermatitis), the breathing passages (sinusitis and bronchitis), or even the gums (gingivitis).   My explanation to them is simple.  They have unchecked inflammation and, since everything in the body is connected, each of their organs manifests the inflammation differently.    The skin becomes red and itchy, the stomach suffers from heartburn, the gums are swollen and sore, and the joints become tender and painful.  And anxiety (and other behavioral dysfunctions) what the brain can look like when it’s inflamed.  So it makes sense that an herb that can affect all of these other body tissues positively will also have a positive effect on the neurotransmitter system. 

The authors of the review looked at the world’s literature and chronicled the studies which met strict criteria of the world standards for acceptable research.  They reviewed 122 studies of curcumin for various psychiatric disorders, and 58 studies were deemed to have the proper methodology for inclusion.  Of these, 41 studies looked at the antidepressant and anti-anxiety effects of curcumin.  All studies were written in English, and published in peer-reviewed journals.  Most were studies performed in a laboratory,   or with animals, but some were human clinical studies as well.   The animal studies were usually performed by doing something to the animal (largely mice or rats), to cause extreme stress, leading to depressive or anxious behavior.  The “something” included cold-induced, chemical or surgical stresses.   Curcumin (in a wide variety of forms) was given, mostly after the stressors were administered.  In a few cases the curcumin was given before the stressors, to see whether it had a preventive effect.  Many of the studies also tried to explain the mechanisms of positive effects.  And, there were a number of interesting findings.

In one mouse study, pretreating with curcumin not only reduced the anxiety response, but “marked increases in serotonin and norepinephrine in both the frontal cortex and the hippocampus” of the brain were demonstrated.  Dopamine levels also increased and “curcumin inhibited monoamine oxidase (MAO)” in the mouse brain. In another mouse study, it was demonstrated that curcumin may have a direct effect on 5-hydroxytyramine (serotonin) levels in the brain.  Since almost all antidepressant drugs in use today function by either raising the levels of  the neurotransmitters or inhibiting MAO, finding a safer and more natural way of doing this is very exciting.

Another study looked at the ill effects of sleep deprivation.  Starting curcumin therapy 2 days before the sleep deprivation significantly reduced the negative effects, including weight loss, difficulty in movement, and anxiety-behavior when performing common tasks.  Still other studies focused on the ability of curcumin to lower the release of stress chemicals such as Corticotropin Releasing Factor and cortisol levels, thus controlling the stress response which would otherwise manifest as anxiety and depression.

In addition to pretreatment with curcumin and treatment of symptomatic depression and anxiety, the question of whether curcumin could be used in conjunction with pharmaceutical antidepressants to enhance the effects.  In one study, again with mice, curcumin was added to a subclinical dose of fluoxetine (generic Prozac), and significantly improved the antidepressant and antianxiety effect.  Combining curcumin with other natural treatments also proved effective.  One positive study combined curcumin with a diet high in alpha linoleic acid (precursor for omega 3 fatty acids, which makes sense since fish oil and other omega 3 fatty acids are anti-inflammatory also).  In another, curcumin in conjunction with piperine, an extract of black pepper with medicinal properties, worked better than curcumin alone in reversing the effects of stress. 

There have been several human trials to look at curcumin in the case of depression.  Curcumin helped depression in three out of three studies, versus a placebo.  When the combination of pharmaceutical antidepressants with curcumin was studied, the results remained generally positive.  In one trial, curcumin plus escitalopram (Lexapro) was more helpful than the drug alone in fighting depression.  In that study, mechanism was looked at, and curcumin lowered levels of the inflammatory substances IL-1 beta and TNF-alpha as well ask serum cortisol.

Anxiety and depression are not the only psychiatric conditions to show positive effects with curcumin.  For bipolar illness, curcumin was deemed to be as effective as the drug lithium chloride.  For post-traumatic stress disorder (PTSD) curcumin lowered the elevated cortisol (stress hormone) levels at least as much as generic Prozac.  Similar findings were reported when looking a curcumin versus Prozac for obsessive-compulsive disorder (OCD).  There has even been a study of curcumin and autism, finding an improvement in social behavior and decrease in inflammatory messengers.

And in a schizophrenic study model, curcumin lowered the side effects of the antipsychotic medication haloperidol, and demonstrated numerous modulating effects on brain chemistry and stress response messengers.

Of course, more research will need to be done.  But given the safety of curcumin as a supplement, we’ve begun to add this to our ‘bag of tricks’ to treat mood disorders.  One issue the authors raised is that normally, curcumin doesn’t readily absorb from the digestive tract into the blood stream orally.  We use a liposomal form that improves absorption somewhat.  And, in my office, we’ve begun to use a protocol of intravenous curcumin for fibromyalgia and inflammatory disorders.  We haven’t used it intravenously in depression, anxiety or OCD, but we may give it a try, and the evidence for its usefulness accumulates for this remarkably versatile herbal medicine.