If you or a loved one has schizophrenia, you may wonder whether medication alone is enough to treat or prevent symptoms like hallucinations, delusions, and aggression. Eighty percent of people with this condition have a relapse within 5 years of their first episode.
“A lot of family members come to patient visits and ask what supplements they can take to help protect both their brain and body,” says Elaine Weiner, MD, an assistant professor of psychiatry at the University of Maryland Medical System. Research shows that some can help, but results on others are more mixed.
Keep in mind that it’s always best to talk to your doctor before starting any supplements. Even though they don’t require a prescription, not all of them may be safe. It’s really important for your doctor to make sure there won’t be any interactions with your medicine or any unwanted effects.
Here’s a look at what the research shows and what psychiatrists recommend.
Omega-3 fatty acids. A review of eight studies of people with schizophrenia found that taking omega-3 fatty acids led to a drop of about 25% in positive symptoms (such as hallucinations and delusions) as well as negative symptoms like withdrawal from others and a flat affect (showing no emotions). “It makes sense, as we do know that omega-3 fatty acids are important for overall brain health,” Weiner says.
People with schizophrenia also have a higher risk of getting heart disease, she notes. A daily omega-3 supplement may help with cardiovascular health, too. The American Psychiatric Association recommends a supplement with both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Opt for a gram a day, and look for one with about 60% of the total amount from EPA.
Vitamin D. Research has shown that babies born with low vitamin D levels have a 44% higher risk of getting schizophrenia later in life. Another large 2014 review found that people who don’t get enough vitamin D were more than twice as likely to have schizophrenia as those who have higher levels. But this may be partly due to other things, like people with schizophrenia being more likely to stay indoors, notes Weiner. A large study known as DFEND is now looking at this very issue.
Pinpointing a “healthy” vitamin D level is tricky, but Weiner advises her patients who have schizophrenia to get theirs checked every year. If they’re under 25 nanograms per milliliter (ng/mL), she has them take a supplement for 8 weeks and then get tested again.
B vitamins. A large review of over 800 patients found that people who took high-dose B-vitamins like B6, B8, and B12 in addition to their medications significantly reduced symptoms of schizophrenia, compared with those who took medicines alone. These supplements seem most helpful when people start them early in their illness. Your genes may also play a part: Researchers have found a link between a gene change that helps your body process folate (vitamin B9); those who have it appear to have a bigger drop in negative symptoms when they take B vitamins.
A certain type of folate, l-methylfolate, may actually be more effective because it appears to lower negative symptoms no matter what’s going on with your genes, says Joshua Roffman, MD, an assistant professor of psychiatry at Harvard Medical School and director of the Brain Genomics Laboratory at Massachusetts General Hospital in Boston. MRI scans also show that it causes changes in the medial orbitofrontal cortex, the part of the brain linked to negative schizophrenia symptoms.
Roffman recommends that all of his patients take 2 milligrams (mg) of folic acid or 15 mg of l-methylfolate every day. “Patients and families often ask whether they should consider l-methylfolate as an alternative to folic acid or whether patients should be genotyped prior to treatment,” he says. But since there are no head-to-head comparisons of the two, and folic acid is less expensive, Roffman says it makes sense to start there.
Vitamin E. People with schizophrenia are usually treated with antipsychotic drugs. These meds can have side effects like tardive dyskinesia (TD), which causes stiff, jerky movements of your face and body that you can't control. But taking vitamin E at the same time may help, Weiner says. A 2018 review found that vitamin E may help protect against TD, but there’s no good evidence that it can help treat the condition once it starts.
Some studies have found benefits in people taking around 1,600 international units (IU) a day, adds Weiner. But keep in mind that high levels of vitamin E are linked to a larger risk of bleeding.
Probiotics. These good bacteria live in your digestive tract and keep it healthy. “They help your gut absorb nutrients such as vitamins and minerals from our food more effectively and efficiently, which in turn helps keep your brain membranes healthy,” explains Thomas Milam, MD, chief medical officer at Iris Telehealth and an associate professor of psychiatry at the Virginia Tech Carilion School of Medicine & Research Institute.
A 2017 Johns Hopkins study found that probiotics ease delusions and hallucinations in some people with schizophrenia. One way they may do this is by lowering levels of Candida albicans, a type of fungus that causes yeast infections and is found at higher levels in people with schizophrenia.
There are many kinds of probiotics on the market, so look for ones with Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus reuteri, and Lactobacillus fermentum. People with schizophrenia who took a probiotic that had all those strains daily for 12 weeks, along with high doses of vitamin D, reported large improvements in their symptoms, according to a 2019 study.
Melatonin.Sleep disorders like insomnia are often major problems for people with schizophrenia. But doctors don’t usually recommend prescription medications because, in rare cases, they can also trigger psychosis, Weiner notes. In these cases, melatonin, a hormone your brain makes to regulate your sleep cycle, is a safer option. It also seems to prevent some side effects of schizophrenia drugs, like weight gain, according to a 2014 study. Weiner recommends taking 1 to 3 milligrams, 2 hours before bedtime. Your body’s levels naturally rise at this time too, so you’ll slowly feel sleepy and will nod off faster.