Clinical Responses with Vitamin B3: Report of Two Cases of Schizophrenia

Ratan Singh, Ph.D1
1 Consultant in Nutritional and Clinical Psychology, Jaipur Hospital, India. Email:

Abstract Two cases of schizophrenia are reported. In case #1, the patient quickly stabilized after taking large
doses of niacin. As a result of side effects, the patient discontinued niacin and rapidly regressed. When this
patient resumed niacin for approximately 1 year, he normalized and did not require the vitamin any longer.
In case #2, the patient stabilized quickly from large doses of niacinamide, but discontinued due to vomiting.
“is patient became fearful of niacinamide’s side effects and went on antipsychotic medication, but unfortunately
his level of functionality declined. Both cases highlight the rapidity of therapeutic responses that are
possible when niacin or niacinamide are given to atypical antipsychotic-naïve schizophrenic patients. Given
the track record and low cost of vitamin B3 vitamin supplementation, having few worrisome side effects and
good recovery rates, there is an urgent need to promote orthomolecular medicine in India.

The idea that high doses of niacin or niacinamide could act quickly to stabilize
schizophrenic patients occurred to me upon
reading Hoffer’s interview in which he described
immediate amelioration of auditory
hallucinations in a female schizophrenic
patient that consumed 60 grams (g) of
niacin in one day.1 Here, I report on two
schizophrenic cases. !e patient in Case
#1 consulted me once, and then moved to
another city over 1,000 kilometres away.
In this case, the patient took high doses of
niacin himself, and much like the case that
Hoffer reported, had a favourable therapeutic
!e patient in Case #2 consulted me
for a few days and also moved to another
city. Even though this patient experienced
some notable and fairly immediate improvements
from niacinamide, his outcome
was poor since he discontinued the
vitamin and went on antipsychotic medication

Case #1
J, male, 18 years of age, consulted with
me in the hospital. His father accompanied
him since J was unmanageable, violent, and
aggressive. J was paranoid, believing that his
mother was purposely disrupting his plan to
pass the Indian Institute of Technology (IIT)
entrance exam. He had broken a window, cut
his wrist with a broken piece of glass, and
had written a letter in his blood in which he
described murdering his mother because she
sent him running errands which was distracting
him from his studies. According to
J’s father, he was not really studying. J would
just make plans, buy books, and photocopy
several pages to be read later which he would
never do. He could hardly sit at his desk to
study. At night, he would try to study but
dozed off intermittently. J was living with his
father in a city thousands of kilometres from
his mother, in order to get away from her alleged
disruptions. J needed to move back to
where his mother lived since he was to appear
in class 12 exams in that city. Although his father had promised to keep him in a hotel
and away from his mother, J didn’t believe
his father.
I advised J to take 1 g of niacin, three
times daily. I also added that it would give
him a cutaneous flush, which is a good sign
of blood flowing to the remote areas of the
brain, and that it would increase his focus
and sharpen his mind. J liked it and cooperated—
rather over-cooperated—because he
wished to increase his brain power to pass
the IIT entrance exam. His father purchased
100 g of niacin to test over time, and intended
to buy more if J’s response was good.
Upon reaching the city where his mother
lived, J was given his first dose, 1 g of niacin.
!e next morning, the dose was increased to
5 g, and another 5 g was given in the late evening
because the expected cutaneous flush
did not happen. In the morning of the third
day, J packed his bag, took the niacin bottle,
and barged out of the house without a word
to anyone. His parents became extremely
worried. In a panic, J’s father made a long
distance call to me. I was also worried given
J’s history of paranoia and aggression. !erefore,
I advised J’s father to report the matter
to police and take his son to a psychiatrist
when he was found. All of us were relieved
when J on his own called his father in the
evening and explained that he was staying in
the hotel just opposite his mother’s house. J’s
father asked if he was taking niacin, and if he
had experienced the cutaneous flush. J denied
having had any cutaneous flush. !at night,
desperate to pass the IIT entrance exam, J
took 8 g of niacin as single dose. He had a
deep uninterrupted sleep of eight hours that
night. !e next morning, J’s father went to
the hotel. J was much better. He was obedient,
calm, went home to his mother, and
then greeted her in the typical Indian style.
J requested that she provide some drink and
breakfast, and even asked for permission to
watch television. He watched television for
four hours, and studied as well.
Unfortunately, J was unable to remain
on his current dose of niacin (8 g twice daily)
since he developed severe problems in his
eyes. He reported that his eyes were burning burning,
that white fluid was oozing out, and that
he could not open them. Fearing that niacin
would turn him blind, J and his family
decided to stop niacin. His father called me,
and I advised him to take his son to an ophthalmologist.
His eyes had started recovering
when niacin was discontinued, and they
didn’t need to see any doctor. (Editor’s note:
Niacin has never been shown to cause blindness.
Infrequently, niacin can cause blurred
vision due to cystoid macular edema, which
is completely reversible when the vitamin is
Shortly thereafter, his father called me
and complained that J was relapsing, gradually
getting aggressive, and unmanageable
again. Once again, J fled his home to live in a
hotel. !e next day the hotel manager called
J’s father and complained that J was opening
his shirt, disturbing the hotel guests, and going
to the rooftop. He would also walk until
late in the night without any shirt or trouser.
!e hotel manager requested that J’s father
get his son, or the hotel staff would forcibly
throw him out.
J’s father called me, and asked if he could
restart his son on niacin mixed in yogurt
because J refused to take niacin for fear of
going blind. Because J liked yogurt, his father
opted to hide the niacin in it. At this
point J was not eating and was aggressive
and stubbornly negative. So, I encouraged
the mixing of niacin and yogurt, but added
that this time J’s father should give measured
amounts of niacin, increasing it slowly from
1g three times daily until a cutaneous flush
happens, and then to remain on that dose for
several days before consulting me about the
next steps. J used 100 g of niacin over the
course of a year and stopped since he became
normal. J was now taking private coaching to
prepare for the IIT entrance exam, and was
also getting a helping hand from a student at
IIT. J was a changed person, calmly adjusting
with his mother and studying for the exam.

Case #2
V, a recently graduated medical doctor,
was accompanied by his caregiver when he
consulted me in early April 2010. V and his caregiver were living away from home, preparing
for examinations with the hope of
further study and training overseas. Apparently,
V became aloof, too serious, reticent,
and stopped eating and taking care of his
hygiene. He also reported to his caregiver
that some people were following him, were
tinkering with his motorbike, or that some
people had secretly planted microphones inside
his helmet to keep track of their conversations.
His sleep was disturbed such that
his sleep-wake cycle was reversed. When V
tried to sleep in the night, he would wake
up at 2 AM, and was then unable to sleep
I observed that V’s gait was wobbly and
unstable. I gave him 125 mg niacinamide (I
didn’t have niacin in stock that day) in juice
and waited for 10 minutes to see if there was
nausea and vomiting. When no nausea occurred,
I gave him 1 g niacinamide in juice.
In 5-10 minutes there was a visible change.
His posture softened in the sofa and V gave
a relaxed smile. His gloomy face, poor eye
contact, and difficulty conversing had vanished.
I provided instructions to the caregiver
and both of them left to find a hotel since
they had come from another city to consult
with me. His caregiver said he was seeing a
smile on V’s face for the first time in weeks.
I requested that the dose of niacinamide be
slowly increased to the point of nausea. My
aim was to settle on a dose just below the
nausea-inducing amount. !at night, V took
his meal and slept peacefully. Seeing an improvement,
the caregiver provided 2 g of niacinamide
the next morning. Unfortunately,
V vomited and I instructed him to temporarily
stop the niacinamide. It was stopped
for a day pending the results of liver function
tests. !e enzymes were raised, double their
normal values. V regressed to being gloomy,
shut-in, aloof, not willing to talk, and confined
to bed due to feeling weak. His sleep
became disturbed again and he tossed the
whole night.
As a result of V’s destabilization, I restarted
the niacinamide and some other vitamins.
V was instructed to take 500 mg of niacinamide
in morning and afternoon, and 1 g at night with some juice. He vomited once,
and then developed a mild fever and diarrhoea.
!ese physical symptoms were easily
controlled in two days with an oral isotonic
rehydration drink and probiotics. !e following
day V stabilized on 1 g niacinamide
three times daily in capsules. Capsules were
used instead of tablets since juice was unable
to hide the bitter taste of niacinamide
tablets. V stabilized on 1 g 3 times daily of
niacinamide and traveled to another city to
prepare for his exams.
On April 30, 2010, V’s caregiver sent
me an email. “After today morning’s episode
(where he did not take any other medications
other than niacinamide due to intense sleep)
V has asked me to just bring all the medication
(that is, vitamins) to him and he would
decide the serial order of taking them. We
tried this in the late afternoon and he took
all his medicines on his own. I encouraged
him for that. !is means very soon he will be
observing his regimen on his own. I am very
happy for him about it. He described that
he is for the first time experiencing his body
properly and is getting a general feeling of
and associated weakness. He has stayed
awake for the longest time in the last seven
days today (about hours hours at a stretch
and about six hours in all by now).”
At this stage, I also prescribed 5-hydroxytryptophan
(5-HTP) for V’s sleep
problems, but he vomited. I am uncertain
if the vomiting was due to the 5-HTP or
niacinamide, or both. As a result of the
vomiting, V and his caregiver panicked and
stopped all the vitamins and 5-HTP. !e
two of them were now fearful of the consequences
of vomiting, and started intravenous
rehydration fluid. V’s caregiver reported:
“Presently V is reporting some fear
and suspicion but he is not getting excited
due to that. He is just reporting that those
(paranoid) thoughts are coming more easily
in his mind than before.”
Since V and his caregiver were afraid,
they traveled back to V’s parental home.
When they reached home, they were warned
that vitamins cause central nervous sys-tem toxicity by a family friend, a professor
of medicine. V was promptly referred to a
psychiatrist and subsequently prescribed
antipsychotic medication. In an email correspondence
from his caregiver, V apparently
developed extra-pyramidal symptoms, gait
difficulties, and has gradually worsened since
stopping the niacinamide and 5-HTP. V also
had a return of psychotic symptoms that were
much worse than when he first presented to
my office. His caregiver reported increased
symptoms of schizophrenia, including paranoid
ideation (i.e., being monitored by some
agency all the time), self-talking, being more
guarded, agitation, singing to himself, confining
himself to his room, poor hygiene, and
having no insight into his condition.
In case #1, the pre-niacin baseline stage
when J first came to me, can be labelled as
“A.” !e “B” stage was when J had an immediate
recovery after his deep and uninterrupted
sleep following the high-dose niacin
consumption. !is was followed by another
“A” stage since J regressed from stopping the
niacin because of eye problems. !us, in a
way J’s case followed an ABA design.2 It was
these events that enabled J’s father to clearly
observe that niacin, and not some other factor,
had helped his son.
Why did J not require niacin after the
100 g was consumed? !is was likely a case
of early psychosis and was therefore more
treatable with niacin since the patient was
not on prior psychiatric medication, nor did
the patient have a long protracted course
of mental illness. J might have had a niacin
deficiency, and not a dependency, and therefore
would not necessarily require niacin for
the remainder of his life. J was also receiving
quality psychosocial support from his
parents, and later on from a student already
attending the IIT. !e effectiveness of psychosocial
support in mental illness cannot be
understated. Hoffer described the outcomes
by the Quakers’ psychosocial treatments over
150 years ago with a reported 50 percent recovery
rate – far better than the present day
recovery rates from psychiatric medications.3 Clearly, with the disruptive behaviours gone,
J’s pleasant adaptive behaviours emerged,
which were being sustained by positive psychosocial
influences in his environment.
Moreover, J was now eating regular meals,
such that, whatever little amounts of niacin
he might be getting in foods was sufficient
for him.
In Case #2, I had no follow-up with
V or his caregiver since May 2010, but did
hear about V some 11 months later from a
mutual acquaintance. She informed me that
V was having side effects caused by the antipsychotic
medication given to him and
was still not well. !us, the outcome was not
satisfactory in this case for obvious reasons.
Unfortunately, V was unable to continue the
niacinamide and 5-HTP due to vomiting.
V’s case highlights the potential benefits
from niacinamide, and how atypical antipsychotic
medication can sometimes make
patients worse and less functional than they
were prior to medication.
Both cases highlight the rapidity of therapeutic
responses that are possible when niacin
or niacinamide are given to atypical antipsychotic-
naïve schizophrenic patients. Hoffer reported
that vitamin B3 is more effective when
administered to patients not on atypical antipsychotic
medications since this class of medication
prevents vitamin B3’s therapeutic effects.
4 Hoffer also reported quicker therapeutic
responses to vitamin B3 when it is given early
in a patient’s course of schizophrenia.5 Both
patients were not on any atypical antipsychotic
medication when they were under my care, and
both patients presented early in the course of
their mental illness.
I certainly don’t intend to imply that all
cases of schizophrenia will respond quickly
to niacin or niacinamide as these patients
did. I have had other cases of paranoid
schizophrenia, for example, that responded
within 2 weeks to a gluten free diet. !ere
are many additional orthomolecular treatments
of value if needed.6,7
In a continent like India where the
majority of individuals would be unable to
afford and/or access standard psychiatric
care, orthomolecular medicine is very much needed and it is not cost-prohibitive. India’s
population is 1.119 billion, next to China
with population of 1.337 billion.8 In India,
an estimated 22% of individuals will develop
one or more mental or behavioural disorders
in their lifetime.9 !ere are approximately
3.5 psychiatrists for every one million persons
in India.10 Nearly all psychiatrists are
based in the cities, yet 75% of the population
live in villages and have little-to-no
access to standard psychiatric medical care.
Psychiatrists in India use the full range of
psychotropic drugs with their typical side
effects. Complementary and alternative
medical providers, such as naturopathic
practitioners, Ayurvedic and homoeopathic
physicians, and nutritionists are seldom
aware of the possibility of treating the
mentally ill with orthomolecular medicine,
and their focus is on general practice. !e
non-governmental organizations working
for the mentally ill in India focus on
psychosocial support, and employ the services
of psychiatrists when needed. In the
majority of cases, the preferred method of
treatment is faith healing.11 Even exorcism
is used as a treatment on mental health patients.
12 !ere are less than a handful of orthomolecular
practitioners in India: two are
clinical psychologists (including me), and
one is a psychiatrist who focuses his clinical
practice on pervasive developmental disorders.
Given the track record, easy access
to vitamin supplementation, affordability,
safety, and good recovery rates afforded by
orthomolecular medicine, especially when
combined with adequate psychosocial supports,
there is an urgent need to promote
this therapy in India.
Statement of Informed Consent
Verbal consent was provided for publication
of case #1. Consent was not obtained
for publication of case #2 since the author
lost contact with the patient and his caregiver.
!e editor provides his assurance that all
identifying characteristics have been altered
to protect patient anonymity, but, while doing
so, care has been taken not to affect the
technical aspects of this article.

Lett Doctors Patients, 2001;
213: 88-91.
5. Hoffer A: Healing Schizophrenia. Toronto, ON.
CCNM Press Inc. 2004;169.
6. Pataracchia RJ: Orthomolecular treatment for
schizophrenia: a review (part one). J Orthomol
Med, 2008; 23: 21-28.
7. Pataracchia RJ: Orthomolecular treatment for
schizophrenia: a review (part two). J Orthomol
Med, 2008; 23: 95-105.
8. Global Statistics/Population Statistics. Retrieved
from: [].
9. Mental health in India. Retrieved from: [www.
10. Basic needs. Retrieved from: [
11. Kennedy M: India’s mentally ill turn to faith, not
medicine. Retrieved from: [
12. Seeking comfort from faith healers in India. Retrieved
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