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Depression

Drugs

Wellbutrin

Ascher JA, Cole JO, Colin JN, et al: Bupropion: A review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995; 56(9):395-401.

Low response - suggested supplemental folate

¹Fava M, Borus JS, Alpert JE, Nierenberg AA, Rosenbaum JF, Bottiglieri T. Folate, vitamin B12, and homocysteine in major depressive disorder. American Journal of Psychiatry. 1997;154:426-428. ²Andrews G, Neilson M, Hunt C, Stewart G, Kiloh LG. Diagnosis, personality, and the long term outcome of depression. British Journal of Psychiatry. 1990;157:13-18. ³Fava M, Bouffides E, Pava J. Personality disorder comorbidity with major depression and response to fluoxetine treatment. Psychotherapy and Psychosomatics. 1994;62:160-167.

Herbs

Chaste Tree Berry

This herb--also known as Vitex agnus castus, hemp tree and monk's pepper--has been called the single most important herb in the treatment of PMS. 4 It has been used for the treatment of menstrual irregularities, painful menstruation, and breast pain.5

Chaste Tree Berry affects primarily the pituitary gland and the hypothalamus.4 Although several hormones have been identified in other parts of the plant, in the fruit, there is an active principle that has dopamine-like activity and inhibits prolactin release, thus increasing progesterone in the luteal phase of the menstrual cycle.5 During a normal menstrual cycle, progesterone production should outstrip estrogen production in the half of the cycle following ovulation. It has been speculated that if it does not women develop a condition called "estrogen dominance" and PMS symptoms.

Two surveys of its efficacy were done on 1,542 women who took a liquid extract (42 drops daily) for spans up to 16 years. The patients' doctors rated its effectiveness as either very good, good or satisfactory in 92% of cases.4 Further clinical confirmation of it's effectiveness for PMS can be found in the work of Hardy6 and Gaster7.

Evening Primrose Oil

Evening primrose oil, Oenothera biennis, is derived from the plants' seeds and is valued for its oil-containing essential fatty acids. These include linoleic acid and gamma-linoleic acid (GLA). Women with PMS have been shown to have impaired conversion of linoleic acid to GLA.8 Because a deficiency of GLA might be a factor in PMS and because evening primrose oil (EPO) contains significant amounts of GLA, researchers have studied EPO as a potential way to reduce PMS symptoms. In several double blind studies, EPO was found to be beneficial,9, 10, 11, 12 whereas in other studies it was no more effective than placebo.13, 14

Despite these conflicting results, many nutritionally-oriented doctors do recommend EPO. The usual amount recommended is 3–4 grams per day. EPO seems to work best when used over several menstrual cycles and may be more helpful in women with PMS who also experience breast tenderness or fibrocystic breast disease.15 As purely anecdotal evidence, your Guide had relief of all PMS symptoms, including mood swings, after just one month of using EPO.

Natural Progesterone

As was mentioned previously, it is suspected that estrogen dominance in the luteal phase may be responsible for PMS symptoms. Following this line of reasoning, several physicians, including John R. Lee and Jesse Hanley, have recommended natural progesterone creams for PMS. Although this practice is somewhat controversial, many women do report relief.

Natural progesterone is manufactured from a substance found in wild yams called diosgenin. Its name does not come, however, from the fact that it is plant-derived. Unlike the synthetic hormones available by prescription, natural progesterone is chemically identical to what is found in the human body. Hence, it is exactly the same substance as our own natural progesterone.

There has been quite a bit of controversy as to whether natural progesterone creams are actually absorbed through the skin and thus available to the body. One study which John Lee cites as evidence that it is absorbed is a 1995 study conducted by K. J. Chang, in which women used various combinations of hormone creams before breast surgery. This study revealed that not only did hormone levels in the breast rise, but estrogen-induced proliferation of breast cells (the first step towards breast cancer) was inhibited by the natural progesterone creams.16

The arguments for using natural progesterone to enhance women's health are very compelling, but too complex to properly address in this article. If you desire to learn more about natural progesterone, it is recommend that you read What Your Doctor May Not Tell You About Premenopause, by Dr. John Lee.17

Other Herbs

There are several other herbs that have been traditionally used for women's health throughout history, but have been less well-studied. These include Dong Quai (Angelica sinensis), a traditional Chinese medical herb used for cramps, irregularity, retarded flow, and weakness related to the menstrual cycle and for menopausal symptoms1; Licorice (Glycyrrhiza glabra), which is thought to raise progesterone levels4; and Black Cohosh (Cimicifuga racemosa), which has components that exhibit estrogen-like activity and are precursors to progesterone.5

Additional herbs that may be of interest include Kava Kava (Piper methysticum), which exhibits anxiolytic and sedative properties1, 2, 6 and Valerian (Valeriana officinalis), which may aid with sleep and relaxation.18

Diet and Nutrition Women who have PMS typically have very poor diets. A physician named Guy Abrahamson did an analysis in which he discovered that PMS patients ate 62% more refined carbohydrates, 275% more refined sugar, 79% more dairy, 78% more sodium, 53% less iron, 77% less manganese and 52% less zinc.4 Furthermore, excess caffeine consumption has been associated with breast tenderness and fibrocystic breasts.19 These findings indicate that women with PMS would probably benefit from cutting down on refined starches and sugars (white bread, pasta, sugar), dairy products, sodium and caffeine and taking a good vitamin and mineral supplement. Because of the potential that PMS is caused by estrogen dominance, one might also consider steps that eliminate or reduce the consumption of xenoestrogens (estrogenic compounds from the hormones and pesticides in our food supply). A vegetarian diet or consumption of organically grown meats, eggs and dairy products are two avenues one might take to reduce xenoestrogen exposure.17 Stress Chronic stress has two very important effects on the body as far as PMS goes: it increases cortisol, a hormone produced by the adrenal glands, that keeps you going through times of stress and it increase production of prolactin. Cortisol competes for progesterone receptor sites. If it is chronically elevated, you end up with the symptoms of progesterone deficiency, even though your body may be producing enough for your needs. Further, cortisol can stimulate feelings of irritability, anger and rage, familiar territory to many women with PMS. Prolactin is the hormone that stimulates milk production in the breasts. It also has the effect of decreasing progesterone production. As progesterone is decreased, a feedback loop is initiated that further raises prolactin levels. These two hormonal effects together may be enough to aggravate or even cause PMS.20 Stress reduction techniques such as biofeedback training, exercise, time management skills and meditation may all be useful to the woman who is chronically stressed. Putting it All Together Although PMS is not yet fully understood, it appears to be a multi-faceted problem. Under the supervision of a naturopath, a comprehensive plan for PMS treatment would probably include all of the following steps. Please consult a qualified health practitioner for appropriate dosages and administration if you intend to use the methods discussed in this article to treat your own PMS. Dietary changes including a reduction of processed sugar and starches, dairy, caffeine and sodium. Elimination or reduction of xenoestrogens from the diet by vegetarianism and/or organically grown foods. A multi-vitamin and mineral supplement if your regular diet does not provide adequate nutrition. Stress reduction. Exercise. Treatment of underlying hormonal imbalance through herbs. Treatment of symptoms of depression and anxiety through herbs. Herbs for Health at About Everything you ever wanted to know about using herbs to maintain health and wellness. A Drug by Any Other Name: How Safe Is Sarafem? More about the prescription drug Sarafem. St. John's Wort Revisited Everything I've learned about the safe and effective use of St. John's Wort. How Modern Eating Habits May Contribute to Depression Could poor diet be responsible for your depression?

A Vitamin a Day Keeps Depression Away Treating your depression may be as simple as supplementing with a good multivitamin. The B-Complex Vitamins The B-complex vitamins are essential to mental and emotional well-being. They cannot be stored in our bodies, so we depend entirely on our daily diet to supply them. B vitamins are destroyed by alcohol, refined sugars, nicotine, and caffeine so it is no surprise that many people may be deficient in these. Here's a rundown of recent finding about the relationship of B-complex vitamins to depression: Vitamin B1 (thiamine): The brain uses this vitamin to help convert glucose, or blood sugar, into fuel, and without it the brain rapidly runs out of energy. This can lead to fatigue, depression, irritability, anxiety, and even thoughts of suicide. Deficiencies can also cause memory problems, loss of appetite, insomnia, and gastrointestinal disorders. The consumption of refined carbohydrates, such as simple sugars, drains the body's B1 supply. Vitamin B3 (niacin): Pellagra-which produces psychosis and dementia, among other symptoms-was eventually found to be caused by niacin deficiency. Many commercial food products now contain niacin, and pellagra has virtually disappeared. However, subclinical deficiencies of vitamin B3 can produce agitation and anxiety, as well as mental and physical slowness. Vitamin B5 (pantothenic acid): Symptoms of deficiency are fatigue, chronic stress, and depression. Vitamin B5 is needed for hormone formation and the uptake of amino acids and the brain chemical acetylcholine, which combine to prevent certain types of depression. Vitamin B6 (pyridoxine): This vitamin aids in the processing of amino acids, which are the building blocks of all proteins and some hormones. It is needed in the manufacture of serotonin, melatonin and dopamine. Vitamin B6 deficiencies, although very rare, cause impaired immunity, skin lesions, and mental confusion. A marginal deficiency sometimes occurs in alcoholics, patients with kidney failure, and women using oral contraceptives. MAOIs, ironically, may also lead to a shortage of this vitamin. Many nutritionally oriented doctors believe that most diets do not provide optimal amounts of this vitamin. Vitamin B12: Because vitamin B12 is important to red blood cell formation, deficiency leads to an oxygen-transport problem known as pernicious anemia. This disorder can cause mood swings, paranoia, irritability, confusion, dementia, hallucinations, or mania, eventually followed by appetite loss, dizziness, weakness, shortage of breath, heart palpitations, diarrhea, and tingling sensations in the extremities. Deficiencies take a long time to develop, since the body stores a three- to five-year supply in the liver. When shortages do occur, they are often due to a lack of intrinsic factor, an enzyme that allows vitamin B12 to be absorbed in the intestinal tract. Since intrinsic factor diminishes with age, older people are more prone to B12 deficiencies. Folic acid: This B vitamin is needed for DNA synthesis. It is also necessary for the production of SAM (S-adenosyl methionine). Poor dietary habits contribute to folic acid deficiencies, as do illness, alcoholism, and various drugs, including aspirin, birth control pills, barbiturates, and anticonvulsants. It is usually administered along with vitamin B12, since a B12 deficiency can mask a folic acid deficiency. Pregnant women are often advised to take this vitamin to prevent neural tube defects in the developing fetus. Vitamin C Subclinical deficiencies can produce depression, which requires the use of supplements. Supplementation is particularly important if you have had surgery or an inflammatory disease. Stress, pregnancy, and lactation also increase the body's need for vitamin C, while aspirin, tetracycline, and birth control pills can deplete the body's supply. Minerals Deficiencies in a number of minerals can also cause depression. Magnesium: Deficiency can result in depressive symptoms, along with confusion, agitation, anxiety, and hallucinations, as well as a variety of physical problems. Most diets do not include enough magnesium, and stress also contributes to magnesium depletion Calcium: Depletion affects the central nervous system. Low levels of calcium cause nervousness, apprehension, irritability, and numbness. Zinc: Inadequacies result in apathy, lack of appetite, and lethargy. When zinc is low, copper in the body can increase to toxic levels, resulting in paranoia and fearfulness. Iron: Depression is often a symptom of chronic iron deficiency. Other symptoms include general weakness, listlessness, exhaustion, lack of appetite, and headaches. Manganese: This metal is needed for proper use of the B-complex vitamins and vitamin C. Since it also plays a role in amino-acid formation, a deficiency may contribute to depression stemming from low levels of the neurotransmitters serotonin and norepinephrine. Manganese also helps stabilize blood sugar and prevent hypoglycemic mood swings. Potassium: Depletion is frequently associated with depression, tearfulness, weakness, and fatigue. ~ Nancy Schimelpfening Sponsors - about.com Quality Chinese Herbs High Quality & low price guarantee. Over 400 Pages of Information! www.QualityChineseHerbs.com Herbs & Health Remedies Supplements, Tea, Oils, Aroma, etc. Alternative Therapies for Healing www.herbalremedies.com Food The causes of depression may vary as much as our individuality, yet we often fail to consider our eating habits as possible culprits. With each passing year's increased understanding of the biological complexities of the human animal, more data suggesting dietary factors are unveiled. The use of drugs such as SSRIs (selective serotonin re-uptake inhibitors) and herbal extracts such as St. John's Wort (1, 2, 3) and 5-hydroxytryptophan (4) to manipulate quantities of serotonin at the synapses within the brain has demonstrated that available serotonin beyond the blood brain barrier (BBB) is an important factor in alleviating depression for many people. The brand name of one such drug, Prozac, has become a household word in our North American culture. Protein, if consumed in excessive quantity, suppresses CNS serotonin levels. Carbohydrate intake, as well as alcohol and cocaine abuse increase levels initially, but if use is chronic, such use dramatically lowers CNS serotonin, resulting in depression, carbohydrate cravings, sleep disturbances, and proneness to argumentativeness, irritability. Violence can also be used to manipulate serotonin levels. Additionally, the morphine-like substances derived from the incomplete digests of dairy and cereal grain proteins are other dietary factors which may alter mood by depressing CNS serotonin, dopamine and norepinephrine levels (5). The reduced number of platelet receptors for serotonin found in patients with celiac disease, which is also caused, at least in part, by dietary factors, again points to food as a factor in some cases of depression. Such a propensity for depression, as is now seen in our modern world, seems to run counter to the process of natural selection. It is of more than passing interest that many of the foods which seem to be implicated in depression are also foods which Humanity has had only a relatively short time, on the evolutionary calendar, to adapt to (6). And we have been consuming more and more of these new foods during this century. Regardless of the causes of the high frequency of depression in our contemporary world, we now have fairly effective drugs to treat this condition. One such group of drugs, SSRIs, act to reduce the rate of re-uptake of serotonin at the synapses, working to conserve serotonin and increase its synaptic concentration for longer periods of time. Serotonin is an important neurotransmitter which is needed for sleep onset, mood regulation, carbohydrate craving and consumption, and a host of other functions (7). But there are other means to manipulate its presence in the brain. If we have recently digested protein, resulting in an increased level of large neutral amino acids (LNAA) in the blood stream, and we subsequently eat enough carbohydrate to induce a significant rise of circulating insulin, most of these amino acids will be transported across cell walls, for storage or energy. Due to tryptophan's resistance to insulin, this will result in an increase of circulating tryptophan. Since LNAAs compete for transport across the BBB, and since its competitors have been reduced, the relative increase in tryptophan leads to increased quantities of tryptophan being moved into the brain. Since the BBB is the primary limiting factor in conversion of tryptophan to serotonin, this results in increased levels of serotonin within the brain (8). Since such manipulations of serotonin are difficult to regulate, and unlikely to have long-lasting effects (although some of the mystery of obesity may be revealed in this dynamic) a much more important dietary factor in depression may be the morphine-like substances which derive from the incomplete digests of proteins in cereal grains and dairy products. These were first reported by Christine Zioudrou et al. who dubbed such peptides "exorphins"(9). Further elucidation of this issue has been provided through the extensive work of Fukudome and Yoshikawa, published over the last decade (10,11) who have identified and characterized five distinct exorphins in the pepsin digests of gluten. Eight distinct exorphins have also been identified in the pepsin digests of milk (12). This work has given us a clearer sense of the morphine-like psychoactive nature of the peptides which result from the incomplete digests of these dietary proteins, as well as offering a possible explanation for some of the reported psychiatric reactions to these proteins (13,14,15) including the sense of "brain fog" that often accompanies immune reactions to these foods. The field of serology has also provided us with some very clear evidence that such peptides, and the proteins from which they derive, can be absorbed through the intestinal mucosa, and into the circulation of a significant minority of apparently healthy members of the general population (16). Investigations of abnormal electrical activity in more than two thirds of untreated children with celiac disease has indicated that most of them normalize following dietary restriction (17, 18). These findings suggest that caseomorphin and gluten-derived exorphins are at the root of such abnormal electrical activity in the brain. Since such substances act as depressants, slowing neurotransmission, it should not be surprising if the intestinal permeability, and digestive enzyme deficiencies found in celiac disease were also found in many folks suffering depression. This is underscored by the reports that depression is a very common symptom of celiac disease (19, 20, 21, 22, 23, 24, 25, 26). More on this point can be found at: http://www.gluten-free.org/reichelt.html Please don't misunderstand us. We do not mean to suggest that all, or even most people suffering from depression have celiac disease. Quite the contrary, we suspect that only a small minority will demonstrate celiac disease when tested (although screening this population for celiac disease makes good sense). It is my suspicion that many folks suffering from depression may have underlying intestinal permeability combined with digestive enzyme deficiencies. To have celiac disease, they would also need to have some degree of damage to, or lymphocyte infiltration of, their intestinal mucosa. So celiac disease would probably be found in a relatively small, but significant percentage, of those afflicted. The prior two conditions of enzyme deficiency and intestinal permeability are abundantly found when sought, and it is these features which, we suspect, dominate the segment of the population which is chronically depressed. Humans have spent millions of years being naturally selected, in part, on the basis of a diet that included vegetables, seeds, fruit, insects, and subsequently, meat. Yet, at most, we have had only ~12,000 years to adapt to consumption of significant quantities of problematic cereal grains, with cultivation originating in southeastern Europe, and spreading to the northwest very slowly. The Romans spread it throughout their empire, reaching far flung parts of Europe, but places they never conquered, such as Ireland, Scotland, and Finland, have been consuming significant quantities of grains for less than 2,000 years. A Danish friend told me that prior to the end of World War II, many Danes considered wheaten bread to be a special treat, because wheat does not grow well in Denmark. North American natives have had a similarly limited exposure to gluten. Humanity has also had a relatively short time to adapt to post-infancy consumption of significant quantities of milk from other species. This dietary practice probably arose out of animal husbandry. For a more extensive discussion of this topic, go to: http://www.PaleoDiet.com and http://www.gluten-free.org/hoggan/. Our frequent difficulty with these recent foods seems congruent with the evolutionary data. Many of us simply have not had sufficient time to adapt to these recent additions to the human food supply. We would likely fare much better on foods to which our ancestors have adapted. The dramatic increase in our consumption of these recent foods during this century may have a very ominous element. Such dietary habits may well have been paving the way for Prozac. The treatment for many cases of depression should begin with serological testing, and be followed by approximately the same treatment as that in celiac disease and milk protein intolerance. Dietary exclusion of the offending proteins will often mean exclusion of gluten-containing grains and/or dairy proteins. Such a diet would, in some cases, result in a few days of withdrawal symptoms, followed by a substantial improvement in mood. While we only know of anecdotal reports of such improvements, we find the above data, in combination with these anecdotal reports, to be quite compelling. For more information on changing diet see: The Gluten-Free Page: http://www.gluten-free.org/hoggan/ The No Milk Page: http://www.NoMilk.com/ The Paleolithic Diet Page: http://www.PaleoDiet.com/ PaleoFood Recipe Collection: http://www.PaleoFood.com/ References Ernst E. St. John's Wort, an antidepressant? A systematic, criteria-based review. Phytomed; volume 2: pages 67-71, 1995. Linde K, et al. St. John's Wort for depression: an overview and meta-analysis of randomized clinical trials. British Journal of Medicine; volume 313: pages 253-258, 1996. Perovic S and Muller WEG. Pharmacological profile of hypericum extract [St. John's Wort]. Effect of serotonin uptake by post-synaptic receptors. Arzneim Forsch; volume 45: pages 1145-1148, 1995. Fibromyalgia and the serotonin pathway. Juhl JH Altern Med Rev, 1998 Oct, 3:5, pages 367-375. Hallert C et al. Psychic disturbances in adult coeliac disease III. Reduced central monoamine metabolism and signs of depression. Scand J Gastroenterol, 1982; volume 17: pages 25-28. Lutz W, The Colonization of Europe and Our Western Diseases. Medical Hypotheses 1995; 45: 115-120 Tortora & Grabowski _Principles of Anatomy & Physiology_ Harper Collins, N.Y. 1996; p. 417 Young S, The Effect on Aggression and Mood of Altering Tryptophan Levels. _Nutrition Reviews_ 1986; May Supplement: 112-122 Zioudrou C, Streaty RA, Klee WA, Opioid peptides derived from food proteins. The exorphins. J Biol Chem. 1979 Apr 10;254(7): 2446-9. Fukudome S, Shimatsu A, Suganuma H, Yoshikawa M Effect of gluten exorphins A5 and B5 on the postprandial plasma insulin level in conscious rats. Life Sci. 1995;57(7):729-34. Fukudome S, Yoshikawa M Opioid peptides derived from wheat gluten: their isolation and characterization. FEBS Lett. 1992 Jan 13;296(1):107-11. Mycroft FJ, et al. MIF-like sequences in milk and wheat proteins. N Engl. J Med. 1982 Sep 30;307(14):895. Dohan FC. Genetic hypothesis of idiopathic schizophrenia: its exorphin connection. Schizophr Bull. 1988;14(4):489-94. Saelid G, Haug JO, Heiberg T, Reichelt KL Peptide-containing fractions in depression. Biol. Psychiatry. 1985 Mar;20(3):245-56. Hoggan, R. Absolutism's Hidden Message for Medical Scientism. Interchange. 1997; 28(2/3): 183-189. Husby S, Jensenius JC, Svehag SE Passage of undegraded dietary antigen into the blood of healthy adults. Quantification, estimation of size distribution, and relation of uptake to levels of specific antibodies. Scand J Immunol. 1985 Jul;22(1):83-92. Kozlowska ZE. [Evaluation of mental status of children with malabsorption syndrome after long-term treatment with gluten-free diet]. Psychiatr Pol. 1991 Mar-Apr;25(2):130-4. Paul K, Todt J, Eysold R, [EEG Research Findings in Children with Celiac Disease According to Dietary Variations] _Zeitschrift der Klinische Medizin_ 1985;40: 707-709 Corvaglia L, et al. Depression in adult untreated celiac subjects: diagnosis by the pediatrician. Am J Gastroenterol. 1999 Mar;94(3):839-43. Ciacci C, et al. Depressive symptoms in adult coeliac disease. Scand J Gastroenterol. 1998 Mar;33(3):247-50. Addolorato G, et al. Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive illness? Hepatogastroenterology. 1996 Nov-Dec;43(12):1513-7. Pellegrino M, et al. Untreated coeliac disease and attempted suicide. Lancet. 1995 Sep 30;346(8979):915. Cheliout W. [A misleading depression]. Encephale. 1994 Sep-Oct;20(5):531-4. French. Hernanz A, et al. Plasma precursor amino acids of central nervous system monoamines in children with coeliac disease. Gut. 1991 Dec;32(12):1478-81. van Praag HM. Affective disorders and aggression disorders: evidence for a common biological mechanism. Suicide Life Threat Behav. 1986 Summer;16(2):103-32. Review. Hallert C, et al. Psychic disturbances in adult coeliac disease. I. Clinical observations. Scand J Gastroenterol. 1982 Jan;17(1):17-9. 5-efiaj What is 5-HTP? 5-HTP is an amino acid produced by the human body from the essential amino acid L-tryptophan (LT), which is found in dietary proteins. It's clinical value is in it's ability to increase production of serotonin, and it has been use clinically for more than 30 years. 5-HTP occurs naturally in two places -- the human body and the seeds of the Griffonia Simplicifolia, a West African medicinal plant. Let's see if I can simplify this a bit: Food that contains LT in the proteins —> 5-HTP —> serotonin. Why is serotonin so important? Serotonin (also called 5-hydrotryptophan) is found in the cells of the brain and intestine and in the platelets of our blood. When the walls of blood vessels are damaged, serotonin is released from the platelets to constrict the blood vessel and prevent hemorrhage. In the tissue of the intestine, it acts as a stimulant to make the smooth muscle contract. Most people are probably most familiar with serotonin as it acts in the brain — as a neurotransmitter that aids in the transmission of nerve impulses between synapses. All of these functions make serotonin very important to all of the body's systems. Serotonin deficiency has been implicated in mood disorders, appetite control, premenstrual syndrome, autism, eating disorders, fibromyalgia, appetite control, the pain phase of migraine, and other conditions and disorders. Some serotonin is converted by our pineal gland into melatonin, the hormone that controls our sleep cycle. Thus, serotonin deficiency is also linked to insomnia and other sleep disorders. Increasing 5-HTP Levels Since eating foods that contain L-tryptophan won't significantly increase 5-HTP levels, it is processed from the seeds of the Griffonia Simplicifolia and marketed as a dietary supplement. The amounts of 5-HTP recommended vary significantly depending upon the condition being treated. Why Check Before You Swallow? There are a couple of factors at work with "headachers" and supplements, including 5-HTP: Sometimes, we're so tired of the pain that we'll "try anything." Haven't we all said or thought that? When we're in pain and overwrought with it, we sometimes take risks that we might not if we were thinking more clearly. Then there's the "It's Natural" factor — "If it's 'natural,' it won't hurt anything." Don't you believe it. Everything interacts with everything else, and it can be good or bad. Stop and think. Stop and get information. 5-HTP should not be taken with Carbidopa (used for Parkinson's Disease); SSRI antidepressants; Tramadol; any of the triptans — Imitrex, Zomig, Maxalt, or Amerge; and some other prescription medications. If you are taking any medications, please check with your doctor or pharmacist before using 5-HTP. An early study in the New England Journal of Medicine reported the possibility that 5-HTP may cause seizures in children with Down's Syndrome. Safety during pregnancy or nursing has not been established, nor has safety for those with kidney or liver disease. The American Heritage Dictionary defines a drug as "a substance used in the diagnosis, treatment or prevention of a disease or as a component of a medication." When considering 5-HTP or any "natural" supplement, it is important that we consider that they have the potential to affect our bodies as much as any other drug, particularly if we are taking other prescription or over-the-counter drugs. Since dietary and herbal supplements don't come under the same scrutiny and testing as drugs, there have not been the same studies conducted to prove their effectiveness or their safety. In addition, there have been cases of contaminants in some supplements. For this reason, it is important that any supplement always be purchased from a well known, reputable source. Before you take 5-HTP or any other supplement, consult your physician about the potential for them to interact with any medications you may be taking as well as whether they may be potentially harmful because of any illness you may have. more--- Ask Your Guide: 5-HTP By Nancy Schimelpfening Q. What's the lowdown on 5-HTP? I guess I am looking to see what both sides have to say (pro and con) about using it in lieu of an antidepressant. A. 5-HTP is a naturally occurring substance derived from the plant Grafonia simplicifolia. Chemically speaking, 5-HTP is a transitional compound produced when the body converts the amino acid Tryptophan into other compounds such as Serotonin and Melatonin. Serotonin is a type of brain chemical called a neurotransmitter. It acts as a messenger between neurons in the brain and helps regulate mood. A deficiency in this important messenger can cause depression. Melatonin is a hormone that is produced naturally in our bodies as well. Melatonin is made by the pineal gland, which is a small, pea-sized structure in the middle of the brain. Our bodies produce Melatonin naturally during the hours of darkness. As darkness falls, the pineal gland produces a surge of Melatonin that goes to all parts of the body and when light hits the retina, neural impulses signal the pineal gland to slow Melatonin production. Because 5-HTP is converted into both Serotonin and Melatonin this makes it an excellent antidepressant and sleep aid. Decreased brain serotonin levels are also associated with obesity due to overeating. A relative deficiency of serotonin is believed to be associated with the brain's perception of starvation and hunger. Tryptophan is one of the most rare of the essential amino acids, one that the body cannot produce. Consequently, the dietary depletion of tryptophan, a serotonin precursor, is an ideal homeostatic mechanism in the brain for regulating the desire for food intake. 5-HTP--which also increases serotonin levels--is an appetite suppressant at low doses (50 to 100 milligrams) if taken one-half hour before meals. At high doses a common side effect of 5-HTP is nausea. During clinical trials in obese subjects, the intake of 5- HTP caused a voluntary decrease in caloric intake of both carbohydrates and fats, but not of protein. A significant loss of weight occurred, due to a voluntary decrease in caloric intake and not because of a restrictive diet. Just how safe is 5-HTP, however? L-Tryptophan, once readily available as a nutritional supplement, was banned by the FDA in November of 1990. The FDA's decision to remove all tryptophan-containing supplements from store shelves was in response to an outbreak of Eosinophilia - Myalgia Syndrome (EMS) that was linked to the use of tryptophan. EMS is a dangerous and potentially deadly blood disease that is usually associated with parasitic infections or severe allergy. From July of 1989 to December of 1990, more than 1500 cases of EMS and 27 deaths were associated with the outbreak in the United States. In a report released by the Centers for Disease Control (CDC) in August of 1992, researchers revealed the tryptophan was not the cause of the EMS outbreak. The CDC, working with scientists from the Mayo Clinic, the Oregon State Health Division, and the Minnesota Department of Health, traced the cause of the EMS crisis to a contaminant found only in batches of tryptophan manufactured by a single Japanese company, Showa Denko. Showa Denko, the source of up to 60% of all the tryptophan sold in the United States, had produced an untested manufacturing process that reduced the amount of activated charcoal used to filter fermented raw tryptophan. Recent reports suggest that purity may a potential problem for 5-HTP as well. Researchers at the Mayo Clinic and the U.S. Food and Drug Administration have urged caution in the use of 5-HTP. In the September 1998 issue of the journal Nature Medicine (at this time the latest issue availble online is August 1998), scientists at the Mayo Clinic reported finding low levels of impurities in retail samples of some dietary supplements containing 5-HTP. One of these impurities was identified as "peak X", an impurity reported several years ago in a product containing 5-HTP that was used by two siblings who developed eosinophilia and their mother who developed the eosinophilia-myalgia syndrome (EMS). Mayo Clinic scientists notified FDA about their findings shortly before publication of this report. FDA analyzed several samples of bulk 5-HTP and finished product. FDA investigation has confirmed the presence of "peak X," as reported in the Nature Medicine article. Moreover, additional analyses by FDA, although limited in scope, found that some 5-HTP-containing dietary supplement products or ingredient sources of 5-HTP contained one or more additional impurities. No cases of EMS resulting from 5-HTP use have been reported, however. While 5-HTP, in a pure form is not a risk for EMS, there are some cautions to be observed in it's use. 5-HTP should not be used if you have the following medical conditions: Cardiovascular Diseases (high blood pressure, post-stroke, post-heart attack); Extremely Elderly Persons; those with Parkinsons; Disease, Cancer or Autoimmune Diseases (Scleroderma, Rheumatoid Arthritis, Multiple Sclerosis, Lupus); Lung Diseases; Chronic Alcoholism; Liver diseases (hepatitis or cirrhosis); parasitic infection; AIDS; Anorexia Nervosa; Low protein Diets; Allergies (severe); Myalgia (persistent pain and weakness of the muscles); Peripheral Neuropathy (pain weakness of the muscles); Rash or Flushing; Edema; Nausea; Diarrhea; Sickle cell anemia; hemophilia; Pregnancy Do not use 5-HTP is you are currently taking any of the following medications: Anti-depressant drugs; Monoamine oxidase inhibitors; Selective Serotonin Reuptake Inhibitors (SSRI's e.g., Prozac); Tricyclic medications; Weight Loss medications (i.e., dextenfluramine); Anti-parkinson medications (e.g., L-dopa); Barbiturates and other tranquilizing drugs; Antihistamines and cold medications; Alcoholic beverages; Intravenous (illegal I.V.) drugs; Cancer chemotherapy or antibiotic medications. Warning: Dosages of 5-hydroxy L-tryptophan (5-HTP) greater than 100 milligrams per day should be taken only under the guidance of a physician. 5-HTP use at doses greater than 100 mg per day should be taken with the prescription drug carbadopa to prevent excessive levels of serotonin production in the peripheral blood circulation. 5-HTP can increase the effect of tranquilizing drugs and can impair the ability to drive an automobile. The hormonal system that regulates the body’s response to stress, the hypothalamic-pituitary-adrenal (HPA) axis, is overactive in many patients with depression, and NIMH researchers are investigating whether this phenomenon contributes to the development of the illness. The hypothalamus, the brain region responsible for managing hormone release from glands throughout the body, increases production of a substance called corticotropin releasing factor (CRF) when a threat to physical or psychological well-being is detected. Elevated levels and effects of CRF lead to increased hormone secretion by the pituitary and adrenal glands which prepares the body for defensive action. The body’s responses include reduced appetite, decreased sex drive, and heightened alertness. NIMH research suggests that persistent overactivation of this hormonal system may lay the groundwork for depression. The elevated CRF levels detectable in depressed patients are reduced by treatment with antidepressant drugs or ECT, and this reduction corresponds to improvement in depressive symptoms. Scientists are investigating how and whether the hormonal research findings fit together with the discoveries from genetics research and monoamine studies. NIMH Depression Index Articles and publications from the National Institute National Institute of Mental Health with the latest research about depression. More on Depression Depression is a even bigger problem for families dealing with alcoholism. Here are more articles dealing with this serious disorder. Information furnished by National Institute of Mental Health