Tissue Injury Induced By Candida Albicans Mental and Neurologic Manifestations C. Orian Truss, M.D.I Introduction body complexes or the presence of "auto- Medical research of the past several decades antibodies" to one's own tissues are but two has greatly expanded our knowledge of the examples. deranged chemistry and physiology that The same "dead end" is reached, however, characterize many individual disease states. Yet when the search for a virus or other antigenic most diseases have stubbornly resisted the agent is unfruitful. The evidence indicates that massive effort to unlock the secret of their an immunologic response is taking place and etiologies. We learn more and more about the is in some way involved in the disease abnormalities of function that result in clinical process, but the antigenic agent continues to symptoms and signs, but continue to be frustrated elude discovery. in our effort to discover the identity of the factor Or we may postulate that the immunologic initiating the departure from normal function. It is process occurs secondary to toxic damage to a unfortunate that the list of such diseases is headed tissue, leading to autoantibodies and perhaps by those that are the most frequent cause of to antigen-antibody complex deposition. But disability and death. Among them would be again, such a toxin escapes detection, if it atherosclerosis, most often clinically expressed as exists. hypertension, heart attacks, and strokes; In presenting selected, cases treated during malignancies, "auto-immune" diseases, arthritis, the past 16 years, I hope to call attention to muscle-wasting diseases, mental and neurologic Candida Albicans as a possible candidate for disorders, and many others. the role of etiologic agent in diseases that Frequently the evidence suggests that seem to have an immunologic or toxic basis, immunologic mechanisms of tissue injury are but for which no such factor has been involved. The deposition of antigen-anti- discovered. This yeast probably exists in all humans as well as in many animal species. Anti-Candida antibodies are present in 100 percent of humans, as will be discussed later. 2614 Highland Avenue, Birmingham, Alabama 35205. If studied serially, a high percentage also will Presented at the eighth annual Scientific Symposium of the Academy of Orthomolecular Psychiatry held in Toronto yield a positive culture of mucous membrane April 30 • May 1,1977. surfaces, as well as a positive delayed skin test to Candida. 17 ORTHOMOLECULAR PSYCHIATRY, VOLUME 7, NUMBER 1, 1978, Pp. 17-37 The very fact of its universal presence probably tension. accounts in large part for the neglect in My interest then evolved to depression and attempting to relate this yeast to serious disease. anxiety not limited to the premenstrual period, Instead, it is today relegated to the role of an and to their relationship to the chronic allergic aggravating nuisance when it infects mucous state and to Candida in particular. I noted that membranes, skin, and nails; the one exception is in certain women the premenstrual depression the rare septicemic dissemination to internal would become so intense that in appearance organs in the chronically ill, often immuno- and response they brought to mind patients compromised host. Since culture, skin test, and with catatonic schizophrenia. I remember serology fail to distinguish between a well person remarking at the time that I would like to treat and one in whom Candida is causing illness, there the yeast infection in a schizophrenic patient has been no reason to suspect that it may, by an to see whether there would be any entirely different mechanism, play a far more improvement in the mental status if the yeast important role as an agent of tissue injury. By problem could be brought under control. Four treating yeast infection and yeast allergy years after the initial incident this opportunity intensively where found, it has been possible to was afforded me, and this patient is presented demonstrate the relationship between mucous as Case No. 1. membrane infection and abnormal function in organs distant to the yeast infection and not Case #1 actually themselves infected. The cases selected In 1965 a 36-year-old woman with allergic for presentation also demonstrate the variety of sinus headaches was brought to see me. tissues that may be injured by this mechanism, as However, her case was distinctive in that for judged by the diversity of symptoms and signs six years she had been treated for schizo- that ceased when the mucous membrane infection phrenia. After many courses of drug and cleared. electroshock therapy, her condition had deteriorated to the point that permanent Case Presentations commitment to the state mental hospital had been recommended by her psychiatrist. On An incident that occurred in 1961 was the first checking with him regarding any objection he indication that this organism perhaps is capable might have to my treating her headache of causing disorders much more severe than problem, I was told to go right ahead—that conventionally attributed to it. A 40-year-old nothing could aggravate her already grave woman whom I was treating for allergic rhinitis mental condition. and migraine headaches walked into the office The patient was withdrawn, managing a yes with one of her severe headaches. It was readily or no answer to questions only after much apparent that she was also quite depressed, which effort and hesitation, so that the history was was characteristic of the severe premenstrual obtained from her neighbor and long-time symptoms that she experienced for one week friend. Two weeks after the first injection of each month. Candida Albicans was one of her extract of Candida Albicans, she was more allergens, and chronic yeast vaginitis worse alert and better able to answer questions. The premenstrually was a prominent complaint. A second injection resulted in marked small dose of Candida extract relieved the improvement, such that four weeks after headache, but the most startling result of the beginning treatment she was doing her own injection was the rapid and complete housework, was cheerful, and "even able to disappearance of the depression. Her initial get mad again." At seven weeks she stated unsmiling, agitated manner was suddenly "I'm myself again"—an appraisal to which her replaced by a relaxed, smiling countenance. In husband acquiesced. Chronic yeast vaginitis subsequent months it was possible to duplicate and menstrual spotting had stopped with the this experience, both in her and in other similar first injection, a normal cases of severe premenstrual depression and 18 TISSUE INJURY INDUCED BY CANDIDA ALBICANS menstrual period occurring on the 26th day of "she's more active," "doesn't sit and hold her treatment. Stelazine and Elavil had been hands—not as clumsy; before her period she discontinued at five weeks, the only remaining drops almost everything she picks up." "After medication being one Librium capsule in the her period starts it is easier to rouse her." morning, "but not every day." She had returned to "When I fuss at her, I think she hears me." her church activities, and stated that "I'm looking Physical symptoms by this time included pain for a job." She was totally asymptomatic except in the left shoulder and back, episodes of for mild, mid-morning "nervousness" for which marked abdominal distention, sore throat and she used the Librium capsule when needed. headaches, fungus infection between the Normal menstrual cycles continued. At 12 weeks fingers, chronic nausea and puffiness of the she was "taking in ironing" to supplement the eyelids, and the chronic yeast vaginitis. family income, in addition to her housework and The next two years saw progression of these church activities. Her husband stated "she's sassy mental and physical symptoms. Shock now." treatment would seem to help for three to four A careful history led to the choice of treatment weeks only. One month before her first visit to that resulted in this rapid recovery after six years me eight shock treatments helped "for a few of progressing, chronic mental illness. hours—then right back down." At this point Her health had been remarkably good until age they were discontinued. Premarin, because of 25 years. At that time her second pregnancy was three months of menstrual spotting, Stelazine, complicated by hypertension and urinary Elavil, and Librium were the prescribed frequency and burning. Following delivery, she medications at the time her allergy treatment developed vaginal discharge and a fungus was begun. infection between the fingers of both hands, both This woman was treated for one year with conditions recurring repeatedly thereafter. nothing other than the Candida Albicans ex- tract. Follow up 10 years later found her well. Between ages 25 and 30 years she remained Three years after her Candida treatment was active and well, and "very energetic." During this discontinued, she had a transient episode of interval she continued to have the vaginal mild depression which cleared quickly when discharge and itching and the fungus infection her psychiatrist gave her three shock between the fingers. She also began to note treatments as an outpatient. She had remained repeated sore throat and postnasal drainage. well for the next seven years. Developing hormone problems were signaled by This case will be discussed further later. It is the onset of excessive menstruation and cramps, of note that vaginitis and fungus infections of loss of libido, and seven to 10 days of the fingers, both following her second premenstrual anxiety and depression. These pregnancy, were the earliest indicators of a symptoms would typically abate once her period change from her previously normal started and gradually increase as she moved farther physiologic state, and heralded 10 years of into the next cycle. steady deterioration in hormone function and At age 30 years pain and tenderness in one breast mental status.