Can high doses of niacin (B3) effectively treat psychosis?

Question

Does high doses of vitamin B3 treat or stop psychosis effectively?

The DOCTOR YOURSELF NEWSLETTER (Vol. 3, No 12) May 5, 2003

VITAMIN CURE FOR PSYCHOSIS

Simply put, it is niacin, and plenty of it.

In the film "Masks of Madness; Science of Healing," psychiatrist Abram Hoffer, MD, PhD says:

"Mental illness is usually biochemical illness. Mental illness is a disorder of brain dysfunction. Schizophrenia is vitamin B-3 (niacin) dependency. http://rawfoodinfo.com/articles/art_niacinforpsychosis.html

Somebody claiming it works for them:

Hi, I am 27 and have had been hearing voices off and on (but fairly consistently) for the past few years. I used to have bipolar symptoms starting at 19, but the symptoms began to become more like schizophrenia after a few years. I also recently stumbled upon the dr. hoffer niacin therapy. I slowly have been raising the niacin dose and am up to 1.5grams a day and the voices seem to have gone. I still get them a little, but they now seem to be more like thoughts than voices. I have been reducing the seroquel every two weeks to no detrimental effect. I now take around 50mg/day Why isn't this treatment given to everyone!? http://ehealthforum.com/health/niacin-treatment-for-schizophrenia-t314742.html

Answer 1

I haven't found a credible source which says that it is effective, by looking at the types of web sites returned by the https://www.google.com/search?q=psychosis+niacin search and similar searches for related terms (i.e. "B3" and "schizophrenia").

Wikipedia on Abram Hoffer says,

Hoffer's theories on schizophrenia and nutrition were generally discredited because of methodological flaws and negative findings by scientists who tried to replicate his work.
[...]Though Hoffer and Osmond reported nicotinic acid could help with the treatment of schizophrenia, these results could not be replicated by others. Despite the apparent face validity of Hoffer's "transmethylation hypothesis" (in which it was thought that the production of catecholamines could sometimes go awry and produce a hallucinogenic neurotoxin), it was ultimately rejected for two reasons: the alleged neurotoxins were never identified and the cause of schizophrenia became attributed to dysfunctions in neurotransmitters.
[...] In 1973, the American Psychiatric Association reported methodological flaws in Hoffer's work on niacin as a schizophrenia treatment and referred to follow-up studies that did not confirm any benefits of the treatment,[22] prompting at least two responses.[23][24] Multiple additional studies in the United States,[25] Canada,[26] and Australia[27] similarly failed to find benefits of megavitamin therapy to treat schizophrenia.

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The Mayo Clinic lists several uses for Niacin, none of which are for psychosis.

Similarly its list of medications for schizophrenia doesn't include Niacin.

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Extreme Niacin deficiency causes Pellagra, some whose symptoms include,

Aggression, Insomnia, Mental confusion, Eventually dementia

Clinical pellagra has obvious symptoms.

Hoffer et. al. had a theory that psychosis may be caused by "subclinical pellagra" but again Google doesn't find reputable-looking (i.e. academic or government) web sites using that search term.

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The closest I've come to finding (using Google) its being used by orthodox practitioners is that they are still investigating (haven't proven) whether a niacin skin test a.k.a. "flush test" may be useful in diagnosing schizophrenia. For example a study from 2010 says,

Heritability estimates established in several studies support niacin skin flush response as a vulnerability trait for the development of psychosis. However, the exact mechanism of a reduced skin flush, the possible influence of the long-term use of antipsychotics, and the usefulness of the test for diagnostic purpose are not clear yet.

Answer 2

The research on nutritional causes of mental illnesses, including schizophrenia, bi-polar and more, was continued by William Walsh.

His science is incomplete (and he acknowledges this himself) in that it didn't include more formal forms of testing (i.e. randomized, double-blind, placebo-controlled).

However, it is in-depth in that he developed a database of 30,000 patients with a variety of mental health diagnoses, and tested the blood and urine of each for various conditions, and drew correlations between them, and the result of supplementation.

He and his predecessors identified 5 biotypes (a collection of symptoms and nutritional imbalances) underlying many mental illnesses.

For some of these biotypes, they recommended Niacin, but not all.

They would test blood and urine to verify, and not rely on a single symptom like psychosis, which is a symptom of multiple biotypes.

Walsh published a book called Nutrient Power, which is a summary of his work.