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Metabolism and mental health symptoms
     The work of Dr. Richard E. Hicks
       

The following is summarized from materials forwarded to me by Dr. Hicks in November 2002 (all errors in summary are mine).  His involvement is explained on a previous page in this story.  Most of the following was presented to the Philadelphia Psychiatric Society in 1978, but never published because the necessary research to confirm these impressions was interrupted by the removal from the market of the medication Dr. Hicks was using at the time. 

Here are his conclusions, as I understand them, adapting them to this particular issue:

  1. Disturbances of insulin metabolism can cause mental health symptoms (listed below).

  2. Such metabolic disturbances can also make underlying mental health conditions worse, including both mood problems and psychosis. 

  3. These disturbances can be treated using standard medications for diabetes, leading to clear improvement in the "mental health" symptoms.

The symptoms most frequently listed by people with insulin-related metabolic disturbances were:

  • Anxiety

  • Depression

  • Fatigue

  • Restlessness

  • Loss of Emotional Control

  • Awakening During Sleep

  • Irritability

  • Insomnia

  • Impaired Concentration

  • Confusion

The rest of the list, including a total of 42 symptoms, looks like the typical list of symptoms primary care doctors fear -- symptoms they know from experience they're going to have a tough time figuring out or helping with.  These symptoms, when a bunch of them occur together, are termed in psychiatry "somatization disorder".   

This is not meant to imply that "metabolic syndrome", the current term for the phenomenon Dr. Hicks was investigating, is the answer to such symptoms.  There are some extremely complicated relationships involving weight gain, stress hormones, and symptoms -- which I believe can amplify one another.  

Dr. Hicks was not only an observant physician, he was a systematic researcher as well.  He actually conducted a study of phenformin as a treatment for symptoms such as those above.  Preliminary results showed that of 59 patients given phenformin, 66% were moderately or markedly improved.  Of a smaller sample who continued the medication for 3 months or more (of course they probably would if they were better...), 84% were moderately or markedly improved -- 36% in the "markedly" group.  

Dr. Hicks prepared a grant proposal for a formal study of phenformin as a treatment for these symptoms.  But just then phenformin was taken off the market, and his work was halted.  However, these very high response rates should make us all consider, even 20 years later, that Dr. Hicks might have found an important relationship and an important treatment.  Indeed, he surely would have continued this work -- but metformin did not become available until several years later, and by that time this wise psychiatrist had many other responsibilities.

However, we are now in a position to look at metformin in just the same way Dr. Hicks was looking at its precursor.  Here's the metformin page, and the metabolic syndrome main page.