Solving Psychiatry

Psychiatric suffering cries out for understanding: state of the art management predicts an effective treatment in a meager 30% of cases: another third will respond to a later trial and the last third will remain treatment resistant in both psychosis and depression. 

In an attempt to clarify, psychiatry has subdivided diagnoses (schizoaffective disorder vs. schizophrenia, schizophrenia subtypes) and medications (first or second generation, SSRI vs. SNRI), but neither has proved helpful. New treatments are often represented as being part of a new drug class, further fragmenting the psychotropic landscape.

In contrast, symptoms and treatment responses are clearly connected. Like a Rubik's cube, bluntly solving one side can create problems on another side (changing mania into depression or psychosis into metabolic syndrome). 

Rather than considering receptors or neuronal reuptake, this new theory considers purine imbalance to be the chemical imbalance of common parlance and aims to address them.

Purine metabolism changes one purine to another via complicated cyclical pathways with multiple rate-limiting steps, susceptible to a variety of logjams. In the brain, purine metabolism enzymes are spread out among multiple cell types requiring coordination and balance to perform basic cell functions. Relative concentrations of different purines control effects.

Disrupted purine metabolism is present in a variety of psychiatric disorders including bipolar, depression, psychosis/ schizophrenia, substance use, autism, and dementia. Some proposed psychiatric treatments target purine metabolism: others have later been shown to strongly affect purine metabolism.

Although purine profile testing is not available, certain psychiatric and physical symptoms correlate with specific purines. These can be used to formulate an individualized purine metabolism disruption hypothesis, which can be matched with purine-mimic treatments to create a treatment plan that holistically targets both psychiatric and physical symptoms, including chronic medical disorders. Commercially available genetic testing may also identify purine metabolism enzyme variation.

With a purine framework, treatment experience (effects and side-effects) can do more than simply include or exclude one agent: it can refine the working hypothesis, provide potential explanations for treatment resistance, and guide selection of the next agent.