The document discusses the case of a 16-year-old teenager with a long history of treatment-resistant depression and anxiety. Previous medication trials with SSRIs, SNRIs, atypical antipsychotics, and lamotrigine had failed to provide sustained relief. Upon further evaluation, the doctor found potential contributing factors including an undiagnosed MTHFR gene mutation and hormonal imbalances. The doctor adjusted the teenager's supplements and medications, focusing on addressing the underlying functional issues. At follow-up several months later, the teenager reported significantly improved mood with only brief periods of low mood, though menstrual irregularities persisted.

1. The Moral Imperative of
Integrative Medicine
Louis B. Cady, MD, LFAPA
CEO, Founder – Cady Wellness Institute
Presented for Psychiatry Redefined – September 10, 2022
[The Rookery Building – 209 S. Lasalle St., Chicago (1888) – Burnham & Root, architects]

2. I, Louis Cady, have the following current and historical conflicts
to declare….
• Speaker’s bureaus (active) for:
• Corium Pharmaceuticals
• Supernus
• Speaking Faculty – National Procedures Institute, Austin, TX.
• Historical data – speaker’s bureau for Allergan (Aventis), Arbor, Bristol-
Myers Squibb, Celltech, Cephalon, Eli Lilly, Glaxo-Smith Kline, Janssen,
McNeil, NEOS, Pfizer-Roerig, Sanofi~aventis, Searle, Sepracor,
Shionogi, Shire, Sunovion, Takeda, Vaya Pharma, Wyeth-Ayerst
• Speaker honoraria previously received from:
• Immunolaboratories, Great Plains Diagnostic Labs, LABRIX,
• Distributor – Pharmanex supplements & Biophotonic scanner

3. “The beginning of wisdom is the definition of
terms.” Socrates
• Moral [mores (L) = HABITS]:
– “a person’s standards of behavior or beliefs concerning what is and is
not acceptable for them to do.”
• Imperative:
– “of vital importance; crucial.” “An essential or urgent thing.”
• Integrative:
– “serving or intending to unify separate things.”
• Medicine:
– “the science or practice of the diagnosis, treatment, and prevention of
disease.”

4. Organization of this presentation
• Illustration of need for optimum range of focus in diagnosis &
treatment of ALL psychiatric disorders
• CAVEATS:
• Can’t cover every nutritional intervention, hormone, or diagnosis
• Some of the fine points will clarify for you over time, and with
practice. 
• The purpose is to expose you to the concepts.
• Further study will be required to master this
material.

5. Orientation
“Tell me the facts and I’ll learn.
Tell me the truth and I’ll believe.
But tell me a story and it will live in my heart
forever.”
- Native American Proverb

6. Three stories& three objectives
• 1) Never miss an MTHFR polymorphism again, and be a hero in your
own time. (And get your patients WELL). Subpoints…
– Always take a TARGETED medical hx, minimum, to identify
potential causes for trouble.
– Always take a precise and inclusive past psychiatric hx of
“failed treatments.”
• 2) Never consider a case “hard core biological psychiatry
that needs more antipsychotic” and neglect the functional,
integrative aspects.
• 3) Never underestimate the importance and significance of
functional, integrative medicine techniques.

7. The first story…
• 12 year old 7th grader. Intake Nov 15, 2019.
• “Worried about food being contaminated and that he is going to
have a heart attack.”
• “Worried about the lead in his pencils hurting him.”
• Things “getting stuck in his head – “like tunes, sports, good stuff.”
• Holding saliva in his mouth constantly.
• Admits to “getting bored some times.”
• Math teacher comments about “careless errors.”
• Already started on Escitalopram 10 mg by pediatrician Oct 26.
Increased to 20 mg Nov. 4.

8. On exam:
• From intake: “Alert, pleasant, remarkably poised, self-confident,
mature and communicative. He is a straight talking, ‘put it all out
on the table’ kind of kid. He is extremely refreshing. He clearly
wants to get better.”
• Childhood depression inventory relevant positives:
– “I worry that bad things will happen to me.”
– “Many bad things are my fault.”
– “I cannot make up my mind about things.”
– “There are some bad things about my looks.”
– “I have to push myself all the time to do my schoolwork.”
– “I worry about aches and pains many times.”
– “I can never be as good as other kids.”

9. DSM5 review (at intake)
Anxiety
• Constant worry
• Repetitive, senseless
thoughts
• Fearful feelings
• Keyed up/on edge
• Trouble concentrating
Depression:
• Sad/depressed/down in the
dumps
• Lack of/loss of interest in things
• Decrease in appetite and weight
(due to obsessionality)
• Trouble concentrating
• Frequent thoughts of death. Of
suicide he says, “oh, no. I don’t
want to do that.”
Miscellaneous
•Feeling life is not worth
living
•Fear of dying
•Frequent crying or weeping

10. Questions
• Diagnoses:
– Psychotic disorder?
– AD(H)D?
– Mixed depression/anxiety?
– Other?
• What to do?
– (already on max adult dose of
escitalopram)
• Add antipsychotic?
• Add concomitant antidepressant?
• Add ADD medication?
• Refer for even more intense
psychotherapy?
• How long do you think it will take to
get him better?

11. • Differential/case management ideas:
– OCD
– Mixed depression/anxiety
– Features of mild ADHD
– Doubt psychotic disorder
– Potential MTHFR polymorphism as a fundamental weakness
– Possible cytochrome p450 2D6 hypermetabolic genotype (“SSRI pathway”)
• Tx:
– Leave escitalopram alone
– L-methylfolate 800 ug – ½ q am x 3-5 d, then 1 q am
– 5-HTP 50 mg + P5P supplement before bedtime.
– Haloperidol 0.1 mg – ½ or 1 before bedtime, or ½ - 1 twice daily ONLY AS NEEDED
FOR SEVERE OCD SYMPTOMS. DO NOT FILL FOR ONE WEEK UNLESS
NEEDED.
• LABS – cheek swab for pharmacogenomic testing
• FOLLOW UP – one month.

12. The follow up – Dec 13, 2019
Miscellaneous
• Feeling life is not worth living
• Fear of dying
• Frequent crying or weeping
Only 2 symptoms remained:
- “a tiny bit” of constant worry
- Increase in appetite (which was
HEALTHY)
Current Rx :
• Escitalopram 20 mg
• L-methylfolate – 800 ug daily
• 5HTP with P5P before bedtime.
• NO HALOPERIDOL WAS USED.

13. RELEVANT LABS & status
GENE
SLC6A4 (SERT) S/S SSRI’s don’t work well
MTHFR
- C677T
- A1298C
C/C
C/C
Perfect. This is the major gene.
Worst POSSIBLE genotype at minor gene =
needs L-MF (This minor gene is OMITTED by
one of the major purveyors of this type of test.)
COMT Val/met The best genotype “right down the middle.”
Cyp 2D6 2/4 NORMAL SSRI metabolizer (escitalopram)
Cyp 2B6 1/1 Bupropion would work if ever needed.
OPRM1 – a
“lagniappe”
G/G Worst POSSIBLE genotype – opioids will not
work for pain (if ever needed). This gene is also
omitted by one of the major players in gene
testing.

14. STATUS – 12/13/2019
• Fully resolved “OCD + mixed depression/anxiety”***
• MTHFR polymorphism – “homozygous at the
A1298C gene”
• Poor SLC6A4 – might not even need escitalopram in
the future.
• Plan is taper the escitalopram as able and see back
in four months.
*** more like: MOOD DISORDER DUE TO A GENERAL
MEDICAL CONDITION

15. June 24, 2022
• “Tell’em my name is Landon Black.” (mom approved)
• No psychiatric symptoms. NONE.
• Finished freshman year of high school. Playing soccer.
Will be studying pre-calc and normal English, AP Euro Hx,
AP Bio, and Literature.
• Exercising and Weight lifting.
• Failed escitalopram taper (?!)
– Note discussion point: gene testing is not an infallible fortune
teller.
• Will try again in future.

17. Stahl SM. L-methylfolate: a vitamin for your monoamines.
J Clin Psychiatry. 2009 Sep;69(9):1352-3
Strategy: test for “MTHFR genotype.”
References:
www.genomind.com www.genesight.com

18. “If you just know the names of
the terms you absolutely know
nothing, and nothing about it.”
- Richard P. Feynman, Ph.D.

19. Let’s take it again – new case May 28th, 2022
• “ANGIE”: 16 year old high school junior. Ref by
pediatrician.
• Chief complaint: “I’m depressed. I’m anxious. I’m
having a rough time with life, and I don’t always feel
like I want to be here anymore. My mood is up and
down.” [for three years]
• Mother: “major depression, anxiety to the point of
having panic attacks and missing school every week.”
• PREVIOUS LABS REVIEWED: TFT’s – wnl, low
Vitamin D. Normal CBC.

20. More granular review
• Leading up to 6th grade: hard to focus. (continued as straight A
student, however.)
• 6th grade: depressed. Thoughts of “I don’t want to be here
anymore.” Anxious and tired.
• No reasons for depression. Good psychosocial
baseline.
• Current:
– “I have a hard time with daily things – like getting out of bed.
– Hard to find words in conversation.
– Varying moods.
– “racing thoughts”
– “I feel like crying all the time.”

21. Previous FAILED Rx history
• Jan 2020 – 10 mg of fluoxetine. Worked for three
weeks, then stopped.
• Nov 2020 –fluoxetine increased to 20 mg. “it was
helpful for a short time, and then it wasn’t.”
– Mother : “It always seemed to appear on the outside that it
would work for a while, but then it wouldn’t be effective.”
• 2021 –fluoxetine increased to 40 mg – did absolutely
nothing.
• Nov 2021 – saw the “medication specialist” at Riley.
Fluoxetine d/c’ed – Bupropion started.

22. Bad Rx, continued
• Bupropion – 100 mg SR daily. Worked a couple of weeks, then
stopped.
• Dec 2021 – Trazodone added for sleep. Worked for a while, then stopped.
• Jan 2022 – Bupropion increased to 100 mg SR twice daily. Worked for a
couple of weeks and then stopped.
• March 2022 – nothing working. Aripiprazole was added. Worked for a
while, then stopped.
• April 2022: “I’m not good. I’m depressed. I don’t want to be here
anymore.”
– So….Aripiprazole increased to 5 mg daily. (of course!)
– Made her faint and dizzy at school. (of course!) Cut to ½ tablet.
– Father noted his championship soccer-playing daughter was now “clumsy on the field.”

23. Targeted psych/med family hx:
• Psych:
–Mother – post-partum depression.
–Numerous relatives with ADHD
–Father – anxiety/depression.
• Medical:
–PGM – five miscarriages.
–MGM – had at least one miscarriage.
–Maternal great aunt – never had kids, though married.

24. Childhood Depression Inventory, a FEW of the
relevant responses.
• I am sad all the time.
• Nothing will ever work out for me.
• I do many things wrong
• Nothing is fun at all.
• I am sure that terrible things will happen to me.
• I hate myself (frustrated that she hasn’t been able to get through this).
• Many bad things are my fault.
• I think about killing myself but would not do it. (She
ASSURES me and her mother that she would not act on this.)

25. CDI – just a FEW more
• I feel like crying every day
• Things bother me all the time
• I do not like being with people many times
• I cannot make up my mind about things.
• I look ugly.
• I have to push myself all the time to do my schoolwork.
• I have trouble sleeping many nights.
• I am tired all the time
• + eight more symptoms.

26. Previous testing by “Rx Specialist”
• SLC6A4 (SERT) L/S decreased SSRI effect t
• HTR2A G/G increased sensitivity
• ADRA2a C/C moderately reduced response
• HLA A 3101 and HLA B 1502 - optimum = decreased risk for skin
reactions from medications
• Pharmacokinetic genes
– Cyp 2D6 (fluoxetine) 1/1 NORMAL
– Cyp 2 B6 (bupropion) 1/1 perfect, normal
– Cyp 3A4 1/1 NORMAL
• MTHFR not checked –????

27. Diagnoses:
–Unspecified mood disorder.
–Possible mild ADD – masked by intelligence.
–POSSIBLE bipolar disorder type II
–Hormone imbalance - with delayed menarche and
very irregular periods.
–Failed menstrual cycles.
–MTHFR polymorphism until proven otherwise –
no previous MTHFR testing (and this was not
ordered/not done on the Genesight testing).

28. If in doubt, stop digging yourself deeper…
1. Cut Aripiprazole to 1/4/ tablet x 3-4 days, then stop
2. Continue Bupropion at 100 mg SR twice daily (with plans to taper)
3. Start Lamotrigine 25 mg -1/2 tablet daily x 7, then one tablet daily x 14,
then two tablets.
4. NO further antidepressants, nor stimulant, nor atypical antipsychotics.
5. START: L-methylfolate at 800 ug,& then 1600 ug (Omega 3’s
planned later)
6. Plan on using a medical food with L-MF, fish oil, and co-factor if favorable
response.
7. Continue on MVI and 2000 IU D3 for now.
8. GENOMIND testing ordered.

29. Follow-up testing reviewed (6/6/2022)
• TFT’s
– TSH 1.73 {0.27 – 4.2}
– Free T4 1.46 (0.86-1.76)
– Free T3 4.00 {2.3 – 5.0}
– REV T3 25.9 (!!} {10 – 24}
• ADRENALS:
– A.m cortisol 6.6 {6.0 – 18.4}
– Aldosterone 12.1 {4.0 – 31.0}

31. June 25, 2022
• Med and supplements changes:
– Off Aripiprazole. Clumsiness
gone.
– Couldn’t tolerate Lamotrigine
– On Bupropion 100 mg SR bid
– Supplements:
– Vitamin D3 1000 IU twice daily
– MVI for teen
– 1600 ug of l-methylfolate per day.
• STATUS: subtly better.
• Changes:
– Move to 15 mg of l-methylfolate
– Increase Bupropion to 300 mg
XL
– Low dose Trazodone (sleep)
– Start Rhodiola for COMT
– Start adrenal
supplementation
– Spironolactone 50 mg for acne
• REFER: workup of menstrual
irregularities

32. PAUSE…
• What have we learned so far?
• How do you think this case is going to turn out?
• Why didn’t the “medication specialist” get this one
right?
• How much better can this teen get?

33. “If you can only read one article
in your entire career at Mayo on
psychotherapy, read this one.”
- John Graf, MD
Greben, S.
Can Psychiatr. Assoc
Journ. Vol 22 (1977):
371-380
“On Being
Therapeutic”

34. Greben’s “Seven Habits”
• Empathy & concern
• Warmth
• Interaction
• Ability to arouse hope
• Expectation of improvement
• “Not to despair”
• Reliability & Friendliness
*Requires clinical depth and breadth of knowledge
*
“On Being Therapeutic” - Stanley Greben, MD [Canadian Psychiatric
Association Journal. Vol. 22(1977) 371-380].

35. So what happened to the teen?? (8/26/2022)
• SYMPTOMS:
– “Mood is a lot better.” But DID decide to give up soccer….
– “I still get down in those slumps every once in a while. Usually they
would last 4 – 5 days. Now I just have one for one or two days.”
– “My period is still being weird.”
– Shaky and unsettled two days before a test.
• MEDS & SUPPLEMENTS: the same
– Notably, on adrenal supplementation… “It’s working. I have more
energy. I don’t really take naps after school.”
• MOM REPORT: “there have been some really big changes. Now she
comes home, and then goes out to games with her friends.”

36. 8/26/2022 Surprises/ Strategies
• PROFOUND family hx of ADHD discovered and reviewed.
• Profound dislike of body image.
• “Star” sister - with a photo wall…. ?!
• HOLISTIC Strategies:
– Trial of Viloxazine SR (new branded ADHD Rx)
– Refer for photo shoot with super-competent photographer.
– Start her OWN photo wall in the family home. 
• Continue – all prescriptions and supplements as is.

37. • Fatigue Severity Scale - (scores of 36 or more on this standardized and
normed questionnaire suggest significant fatigue .Patient's score is:
– 24 - 6/25/2022
– 15 - 8/26/2022
• Epworth Sleepiness Scale - scores over 10 are considered to indicate
that the patient may be suffering from excess daytime sleepiness:
– 17 - 6/25/2022
• (she has been sleepy for two years.)
– 8 - 8/26/2022
• CDI (# of abnormal responses)
– 24 - 5/28/2022
– 23 - 6/25/2022
– 13 - 8/26/2022

38. “Cady 0 – 10,” and Stahl hobbies (depression)
• “0 – 10 scale, where 0 is ‘rather be dead,’ and 10 is
deliriously happy, where are you?”
– Angie:
• “7 – 8 as a child.”
• “2 - 3” in the midst of recent problems.
• “7 – 8” now – August 26, 2022
• Stephen Stahl, MD, Ph.D.
– What are your top three favorite hobbies?
– Are you doing them?
– REMISSION is when they are.

39. TODAY: SEPTEMBER 10, 2022
(telephone check with Mom.  )
• RX:
– Mood improved. Weight up on 1/16th mg of Risperidone (off label)
– All other Rx as is.
– Great school functioning – missed one week due to death of
beloved PGF Y& grades are good. No concentration issues.
– No trial of Viloxazine SR. Patient was doing well.
• Told her parents: “You know, I think I’m going back to
soccer.”
– Mom: “We about fell off our chairs!”

40. THE REFERENCES AND THE MEAT
“Show me da money.”

41. MTHFR polymorphisms
(146 citations on PubMed as of September 9, 2022)
• MTHFR polymorphisms “significantly
related to schizophrenia and major
depression in the overall population.”
–Homozygous C677T with TT genotype –
linked to increase risk of bipolar model.
Zhang, Yu-Xin. Association between variants of MTHFR genes and psychiatric
disorders: a meta analysis. Front Psychiatry. 2022 Aug 18;13:976428

42. MTHFR polymorphisms and pregnancy loss

43. MTHFR polymorphisms and pregnancy loss
• 90 women with two or more consecutive pregnancy losses
with MTHFR polymorphisms. Age 18 – 35 yoa.
• NINE FOLD increased risk in unexplained pregnancy
loss with ONE C677T (major gene) MTHFR
polymorphism.
• C677T + A1298C changes may have synergistic effect.
Ngoc, NN et al. Evaluating the association between genetic polymorphisms related
to homocysteine metabolism and unexplained recurrent pregnancy loss in women.
Appl Clin Genet. 2002;15:55-62.

44. MTHFR polymorphisms may keep men from getting their
wives pregnant
CAUSE: elevated homocysteine. (Known to be detrimental to
spermatogenesis)
Clément A et al. MTHFR SNP’s C677T and A1298C prevalence and serum homocysteine
levels in >2100 hypofertile Caucasian male patients. Biomolecules 2002 Aug 7;12(8:1086

45. Another case – the best of integrated
medicine & biological psychiatry
• Alan – presents on Feb 16, 2007, diagnosed with
depression vs. psychosis.
–Previous treatment at Pfeiffer Treatment Center
(vitamins)
• He appeared notably fatigued and grossly over-
sedated.
• Morose and depressed. Lucid. Intelligent.
• Clear history of psychosis and paranoia.

46. 2007- June 30, 2009
• MULTIPLE
FAILED
MEDICATIONS
• RX:
– Olanzapine 30 mg at
9 pm
– Aripiprazole 20 mg
a.m.
– Topiramate 100 mg
HS
– Lamotrigine 200 mg
in a.m.
– Duloxetine – 120 day
– Modafinil – 100 mg
daily
– 5HTP 100 mg in the a.m.
INTEGRATIVE MEDICINE TESTING
finally ordered!

47. Integrative (“functional”) medical testing
done
• Micronutrient analysis (functional intracellular
analysis) – deficiencies in:
–Vitamins A & D, zinc, Oleic acid, antioxidant
capacity
• IgG food allergy testing 7/22/2009
–12 total sensitivities
• 2+ to eggs, cow’s milk, wheat, brewer’s yeast
• 1+ to cheese, mung bean, oat, pork, pumpkin, sesame, tuna
& baker’s yeast.

48. SCHIZOPHRENIA AND
GLUTEN

49. “ Gluten schizophrenia” search
as of September 8, 2022
“schizophrenia gluten” search 09/08/2022 142 results

50. • “1/3rd of people with schizophrenia have elevated IgG
antibodies to Gliadin & increased inflammation.”
• Glutamate ionotropic receptor (NMDA type) has similar
protein structure to gliadin – representing a potential
target for cross-reactivity.
• “Mimicry through the process of cross-reactivity
between and gliadin and the glutamate ionotropic
receptor might disrupt the functions of the glutamate
system and relate to illness pathophysiology.”

51. Differential antibody responses to gliadin-derived
indigestible peptides in patients with schizophrenia
• Evaluation: IgG and IgA antibodies against indigestible
gliadin-derived peptide antigens by ELISA
• 169 patients with schizophrenia; 236 controls.
• RESULTS:
–Patients with schizophrenia had increased
levels of plasma IgG against the gamma-
gliadin-derived fragment (AAQ6C)
compared to control subjects.
– No difference against NATIVE gliadins between patient and control
groups.
McLean RT et al. Translational Psychiatry. 2017 May 9;7(5):e1121.

52. Gliadin – a definition
“GLIADIN is the alcohol soluble fraction of gluten
and is the primary antigen leading to an
inflammatory reaction in the small
intestine, characterized by chronic inflammatory
infiltrate and villous atrophy.”
From Chapter 17 – Molecular Basis of Diseases of Immunity. Beenhouwer, DO.
Molecular Pathology, © 2009, pages 291-304.
(https://www.sciencedirect.com/science/article/pii/B9780123744197000172)

53. January 21, 2010
• ONE medication. Clozapine.
• On IgG diet. “He has been doing well on it.”
• At Christmas, however, he “went off of it.” Had cookies
everywhere – couldn’t keep him out of the wheat.
Following that gluten feast he exploded on New Year’s
eve.
• After the outburst, Alan specifically wanted to go back on
the diet program. “He seems really good [now].”

54. April 15, 2013
Low dose Lithium orotate started

56. Repeat testing 13 months later – May 21, 2014
(after lithium orotate)

57. Putative role of trace element
deficiencies in mental disorders
Diagnosis Relevant elements
Depression: Zn,Cr, Se, Fe, Co, I
PMDD, binge eating Cr
Schizophrenia Zn, Se, (and, per other articles, Li.)
Cognitive deterioration/
dementia
B, Zn, Fe, Mn, Co (Se)
Autism Zn, Mn, Cu, Co
Attention deficit disorder Fe (check FERRITIN and Fe)
Excess quantity (overexposure, genetic error) can also lead to
mental disturbances.
Janka Z. Ideggyogy Sz. 2019 Nov 30;72(11-12):367-379.

58. Trace elements: two more citations
• In schizophrenia:
– Therapeutic potential of lithium cited in terms of the AKT1-GSK3
signaling pathway.
• Luo, Da-Zhong. Sci Rep. 2020 Jan 20;10(1):647 Lithium for schizophrenia: supporting
evidence from a 12-year nationwide health insurance database and from Akt-1 deficient mouse
and cellular models.
• In cognitive deterioration:
– In cognitive dysfunction: Se, Cr, Co, and Fe levels (serum) found
associated with improved cognitive function.
– Negative correlation with Copper and Aluminum
• Smorgon C, et al. Trace elements and cognitive impairment: an elderly cohort study. Arc
Gerontol Geriatr Suppl. 2004;(9):393-402.

59. “Lithium schizophrenia” search 09/08/2022 1,379 results

60. A mashup from the literature…
• “MTHFR deficiency schizophrenia” – 8 citations
• “Vitamin D deficiency schizophrenia” – 163
• “B12 deficiency schizophrenia” – 49
• “B-vitamin deficiency schizophrenia” - 114
• “PUFA deficiency schizophrenia” – 20
• “omega 3 deficiency schizophrenia” – 54
• “lithium deficiency schizophrenia” – 30
PubMed Search – September 8, 2022

61. November 18, 2012
Mild elevation – probiotic started

63. 3 of 5 papers in the literature
“schizophrenia candida”
• 1. Clozapine found to inhibit yeast budding to hyphal
transition. This and other antifungals might have
therapeutic activity in the future.
– Midkif J et al. Small molecule inhibitors of the Candida albicans budded-to-hyphal
transition act through multiple signaling pathways. PLoS One. 2011;6(9):e25395.
• 2. Cyclic dipeptides from food and intestinal yeast cyclic dipeptides
may play a role in causing psychiatric disorders such as schizophrenia.
From cancer research, cyclic dipeptides such as cyclo (proline-
phenylalanine) have been found to activate the pathways of apoptosis
and to cause programmed cell death.
– Semon BA. Dietary cyclic dipeptides, apoptosis and psychiatric disorders: a hypothesis.
Med Hypotheses. 2014 Jun;82(6):740-3.

64. 3. Odds ratio of schizophrenia with candida
albicans seropositivity
• Case control differences investigated regarding candida
albicans.
• 947 individuals studied
– 261 with schizophrenia (139 of which had 1st episode
schizophrenia)
– 270 with bipolar disorder
– 277 non-psychiatric controls
• C. albicans seropositivity conferred increased
odds for a schizophrenia diagnosis (OR 2.04-
9.53, P⩽0.0001).
– Severance EG et al. Candida albicans exposures, sex specificity and cognitive deficits
in schizophrenia and bipolar disorder. NPJ Schizophr. 2016; 2: 16018.

65. How to order the labs (Lab Corp, Quest):
• Candida antibodies:
– IgG, IgA, Ig M with QUANTITATIVE TITERS
• Gluten:
– Anti-gliadin antibodies - IgG, IgA, IgM with quantitative titers
– Tissue trans-glutaminase
• Integrative – Organic Acid Test

67. Off-target effects of psychoactive drugs revealed by
genome-wide assays in yeast
Drug effect
81 compounds “inhibited wild-type yeast growth”
Fluoxetine “interfered with establishment of cell polarity
Cyproheptadine Targeted essential genes with chromatine-remodeling roles
Paroxetine Interfered with RNA metabolism genes
Clozapine
Haloperidol
Pimozide
All had “off target” effects in yeast
Ericson E et al. PLoS Genet. 2008 Aug 8;4(8):e1000151. doi:
10.1371/journal.pgen.1000151.on

68. What happened to Alan? April 14, 2022
• “Every year is better and better. I almost feel like
I’m going to be ready to go out and get a job.”
• No TRACE of psychosis or paranoia. Euthymic.
• RX: Clozapine 300 mg at night. 10 mg Trintellix
daily (added in last few years).
–From PCP: Atenolol and rosuvastatin
• Supplements: Coenzyme Q10, Vitamin D
• Dietary restrictions: dairy and gluten.

69. Palace of Fine Arts – 1893. Daniel Burnham, architect
(Now part of the Museum of Science and Industry)

70. “Make no little plans
…they have no magic to stir men's blood and
probably themselves will not be
realized. Make big plans; aim high in hope
and work, remembering that a noble, logical
diagram once recorded will never die, but long after
we are gone be a living thing, asserting itself with
ever-growing insistency.”
Daniel Burnham (1846-1912)
World famous Chicago architect and the single reason
that Chicago was named the site of the Columbian
Exposition (World’s Fair) in 1893.

71. Three thoughts to leave you with.
Make no little plans. Make BIG plans.
“Aim high in hope and work.”
(REMISSION)
And remember – your treatment will
have effects that will have
impact for GENERATIONS.
Daniel Burnham (1846-1912)

72. Louis B. Cady, MD
Cady Wellness Institute
4727 Rosebud Lane – Suite F
Newburgh, IN 47630 USA
Office (812) 429-0772
www.cadywellness.com
info@cadywellness.com
www.facebook.com/cadywellness
Twitter: @LouisCadyMD
www.cadywellness.com
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