Advertisements

Considering Immune Response as a Factor in the Development of Schizophrenia and Bone Marrow Transplantation as Treatment

In 1927 a man named Julius Wagner-Jauregg did something fascinating, he began treating patients with severe psychiatric illness by inoculating them with malaria virus. He went on to win the Nobel Prize in 1927. And while Jauregg mainly treated patients with illnesses like syphilis and dementia, he was the first to identify how immune response and fever affected psychiatric illnesses like psychosis and catatonia. The patients who survived long enough for the treatment to work eventually recovered or had significantly improved quality of life.

It would be a leap to say that he cured them. He didn’t. What he did do, however, is set the stage for later research into the immune response is a factor in the development of Schizophrenia. Further, it may no longer be an unwarranted leap to suggest that bone marrow transplantation and low dose antibiotic treatment may help or even eliminate Schizophrenia and its symptoms.

If you’ve ever known anyone with Schizophrenia or, like me, have it yourself, you understand how difficult the condition can be and what it can take away from you. Most frequently developed in a person’s early twenties, the condition is one of the most disabling diseases documented and for some may even be degenerative.  Ranging from effective to severe and manifesting in several subtypes including catatonic, paranoid, disorganized, early onset (childhood), and Schizoaffective Disorder, it affects everyone equally with no racial or sexual preference. Schizophrenia can have genetic components, with the chances of development increasing in the children of parent(s) who have it but can also affect a person with no family history of psychiatric illness.

Until recently, the typical treatment for Schizophrenia consisted of antipsychotic medication, sedatives, mood stabilizers, and antidepressants. These medications, while integral to the process of recovery, often come not without severe and/or damaging side effects. Antipsychotics can have lasting damage to the body if taken over a long period of time. Antipsychotics can also cause significant weight gain which can lead to cardiovascular disease risk and diabetes. However, scientists now have a new treatment to consider: bone marrow transplants.

Incredibly, in 2017, a man who had been diagnosed with Paranoid Schizophrenia at twenty-three, developed cancer at twenty-four, and in an effort to treat his cancer, a bone marrow transplant ended up curing both his cancer AND his schizophrenia. Similarly, a man without schizophrenia developed the illness after receiving a bone marrow transplant from his schizophrenic brother. If a bone marrow transplant can cure or induce psychosis, naturally, the immune system must play a role in the development and symptomology of schizophrenia and other psychotic disorders, as bone marrow transplants essentially reboot a person’s immune system.

Historically there is a great deal of evidence that points to the immune system playing a huge role in schizophrenia.  In their case report, which reviews the evidence that supports a bone marrow transplant causing a remission of schizophrenia, Miyaoka wrote, “Although schizophrenia is regarded as a syndrome with different biological backgrounds, involvement of immune system disturbances could be one of the common mechanisms. The association between maternal infection and neurodevelopmental disorders is long-standing but not without controversy. After the 1964 rubella pandemic, the incidence of schizophrenia rose from less than 1% in the unexposed population to about 20% in the exposed population. Subsequent studies charting historic outbreaks of flu, measles, mumps, chickenpox, and polio have revealed an association with schizophrenia.” The New York Times has even reported about a recent study in which a woman with schizoaffective disorder was relieved from her psychotic and depressive symptoms after a dangerously high fever. 

But this doesn’t come without risk, as bone marrow transplants are extremely risky and require weeks of chemotherapy and isolation. This idea of treating schizophrenia with something other than heavy medication and long-term hospitalization feels like a step in the right direction. Furthermore, the possibility that we might come to fully understand the mechanism behind the development of schizophrenia would, automatically, help us to understand how to prevent people from developing it all.  Of course, scientists can’t confirm if the immune response is the cause of all types of schizophrenia. Some schizophrenias maybe be driven solely on the dysfunction of serotonin and norepinephrine, while other types may be autoimmune diseases masquerading as schizophrenia or psychosis. In the previous case study highlighted, Miyaoka wrote, and it is important to remember that, “…[a] single case report, we apparently cannot confirm an immune pathogenesis of schizophrenia. However, several reports support the theory that immunological system is one key factor of pathogenesis of schizophrenia.” As time goes on people with or affected by schizophrenia can only hope that these possibilities become more solidified.

Psychosis can be beautiful, but there isn’t a single day I wouldn’t prefer to live without it. Would I try something as risky as a bone marrow transplant to cure me? I’m relatively high functioning. But I’m only high functioning on my medications. Off my meds and I’m sure many people wouldn’t even recognize me. I would very much prefer not to have to take all of these medicines for the rest of my life. And even on my medications, I’m still hearing voices constantly. I’ve been hearing voices for so long now I don’t even really remember what it was it was like to not hear them. I would risk a procedure like this if it meant security and protection from schizophrenia. If I wouldn’t ever have to worry about my medications stopping working. If the world could be quiet again. Then I’d do it.

I can’t imagine living in a world not haunted by mental illness, not stalked by twinges of paranoia, not exhausted by an utter lack of motivation to do anything more than breathe, not living a noisy life even when it’s actually quiet, not living under the thumb of psychosis, or held down by the big, wet blanket of depression, not waiting to be tossed into a manic episode. To avoid never having another hallucination or delusion again I’d do anything.

These are things someone with schizophrenia lives with. We live with the fear that our symptoms bring and fear of stigmatization. Schizophrenia and it’s related disorders impact every part of the person who has it.  And any glimmer of hope, any sign of a cure, is reason enough to pursue the possibility to its end.

 

 

Chen, S., Tvrdik, P., Peden, E., Cho, S., Wu, S., Spangrude, G., & Capecchi, M. R. (2010, May 28). Hematopoietic origin of pathological grooming in Hoxb8 mutant mice. Retrieved April 6, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/20510925

Miyaoka, T., Wake, R., Hashioka, S., Hayashida, M., Oh-Nishi, A., Azis, I. A., . . . Horiguchi, J. (2017, September 21). Remission of Psychosis in Treatment-Resistant Schizophrenia following Bone Marrow Transplantation: A Case Report. Retrieved April 6, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613125/#B26

Sommer, I. E., Bekkum, D. W., Klein, H., Yolken, R., Witte, L. D., & Talamo, G. (2014, October 06). Severe chronic psychosis after allogeneic SCT from a schizophrenic sibling. Retrieved April 6, 2019, from https://www.nature.com/articles/bmt2014221?draft=journal

Velasquez-manoff, M. (2018, September 29). He Got Schizophrenia. He Got Cancer. And Then He Got Cured. Retrieved April 6, 2019, from https://www.nytimes.com/2018/09/29/opinion/sunday/schizophrenia-psychiatric-disorders-immune-system.html

person first lang

Esketamine to be Rolled Out, with Caution.

Last week, the FDA cleared Esketamine, a fast-acting antidepressant for people who have severe, treatment-resistant depression. Esketamine is derived from Ketamine, a commonly used reactional drug with psychotropic side effects, though researches as that the Ketamine base in Esketamine is in such low doses that typical side effects seen with Ketamine will be non-existent. However, this landmark decision by the FDA to clear a new antidepressant comes not without barriers. The new drug is costly, more expensive than most would be able to afford, and because of the addictive nature of Ketamine, Esketamine can only be administered and taken in a doctor’s office, hospital, or clinic. It must be inhaled, like a nasal spray, and you have to stay put for two hours after you’ve taken the drug for observation. Additionally, you are also not allowed to drive on the two days a week you’re required to take it.

Doctors will administer Esketamine at the steep cost of $4,720 to $6, 785 per dose, follow up appointments costing between $2,360 to $3,540. Despite the cost being comparable to something like Electroconvulsive Therapy(ECT), Esketamine sounds far less intimidating. It’s worth noting that prior to this approvable by the FDA there have been very few options for people with treatment-resistant depression, aside from years and years of trial and error. Eventually, people with this kind of depression, typically severe and disabling, are left with only extreme measures like ECT or even off label prescriptions for actual Ketamine infusions under the care of a doctor.

But transportation, time, and money are all barrier, while concerns over long term effects remain valid. While doctors aren’t precisely sure which kind of patients would benefit most from a course of Esketamine, the new drug might serve its purpose even further by providing people with depression relief as they wait for traditional antidepressants to do their job. Esketamine could possibly help people who are acutely suicidal and pose a serious risk to themselves or others. Working alongside antidepressant, Esketamine would work as a helping hand, a team member rather than a sole player.

Radical Acceptance is cool