![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 30 to 54 of 84. Go back in thread:
Posted by Dinah on April 24, 2003, at 20:58:29
In reply to Re: about the chemical imbalance concept » stjames, posted by Larry Hoover on April 24, 2003, at 19:26:32
I've printed out that article. Thanks so much! It really describes how I had actually experienced SSRI's. I think I'll sit down and try to figure out what psychological states my various meds might have induced.
Posted by McPac on April 25, 2003, at 0:57:58
In reply to Re: What are the best Natural Serotonin enhancers? » McPac, posted by Ron Hill on April 23, 2003, at 2:41:41
"Hi McPac,
>>>>>>>>>>>>Hi Ron. Sometimes I'll post and then not even be around here for days/weeks at a time. Sometimes I'm gone for months so don't feel bad if you don't see a response.
I hear ya; I threw my SSRI’s away several years ago. There are a couple things that you can try. I can share with you the little I know on the subject, but Larry would know much more.
However, before I say anything, please tell me:
What is your dx?
>>>>>>>>>>>bipolar (mostly terrible depression) AND OCD (plus the usual anxiety that tags along as well)
What meds (and at what dosages) are you currently taking?
Zoloft (100 mg/day is my "best" dose but I'm trying to see if 50 will do) AND lithium (just 1 a day, very low dose) AND 7.5 mg Remeron (very low dose for insomnia)
What meds have you tried in the past and what were the primary effects each of the medications had on you?
Wow, let me think....I've been on Zoloft for 10+ years..it works for my dep/ocd but lots of side effects...the side effect I detest is it makes me VERY angry/irritable...Prozac was a NIGHTMARE for me!...same thing only WORSE (RAGE!ANGER!IRRITABILITY!)....I really believe that one reason, the MAIN reason, that I have to take the lithium is BECAUSE OF the Zoloft!!! Without the lithium I don't think I could ever manage on Zoloft...the lithium balances the rage...and I am NOT an angry/rageful/high-tempered person WITHOUT the Zoloft...YET I'm on it because 1) It works for my ocd 2) It works for my depression 3) It's HELL to get off!......I'm in a bind because I can't just choose ANY anti-dep---I HAVE to have one that will work for OCD as well and the ssri's dominate the choices for ocd...Anafranil for ocd worked but terrible side effects (terrible sedation (felt comatose), terrible sweating (you wouldn't believe how bad), totally ended all thoughts of sex (my "member" was a member of the D.O.A.C.---Dead On Arrival Club....Here is a question Ron: Remeron has been used by some to work for ocd...I tried to switch the Zoloft w/Remeron except my GP increased my Remeron from a tiny 7.5 mg to a MUCH higher 45 mg IN ONE JUMP...made my heart pound out of my chest/terrible adrenaline effect, very nervous/jumpy (but see, I was NOT angry though!) I really think the SSRI's cause this anger/rage/irrit. in me and I'm forced to counter that w/ lithium.......NOT a lot of choices (that I'm aware of due to my ocd..most AD's won't help that)...so it's a very, very frustrating dilemma!....have you heard of many folks that the SSRI's cause to have a terrible temper/anger? Is this even a little common?
About 15-20 years ago I took meds like Nardil (worked great but the diet thing scared me, I was always fearful of eating something wrong)...took imipramine way back when (can't remember if it was powerful enough for me; not sure if it worked well enough...Desyrl (years ago) was too weak and inneffective...BUT, the one thing I always say is that THOSE meds caused little, minor side effects---dry mouth, slight dizziness when standing up..minor stuff compared to the God-Awful major side effects of the SSRI's!!! Folks have been brainwashed by the MASS Marketing that tells them that the reverse is true! The 'old' AD's had trivial, minor, few s/e's....Ron, I'm thinking of possibly trying this: 1) perhaps SLOWLY increase my Remeron (could that make a difference if I increase it SLOWLY, as opposed to the BIG jump my GP did last time? I think so....AND, IMPORTANTLY, I may not even need the full 45 mg (Remeron IS very activating for most at that dose; I may try to see if perhaps 30 mg could be enough to do the job and it may not be too activating for me...that's what I've been seriously considering just recently...it would be AWESOME to get rid of the Zoloft!...so you see, I could handle the older AD's MUCH better...NO RAGE/TEMPER prob's!...(but the older ones weren't nearly as good for my ocd...though, IF I recall correctly I believe the Nardil did a pretty decent job for my ocd).How much do you exercise and at what intensity level?
Ron, Worked out at the gym tonight...I always played sports in my younger days...have weightlifted for years...lift weights very hard (my heart is PUMPING when I work out)...bench-pressed almost 400 lbs a few years back...run somewhat but not often (occassionally I'll go on a LONG run)...so mostly vigorously lift weights now (but when I'm feeling depressed/anxious I often don't work out simply because I feel too shitty).
I REALLY appreciate ANY/all thoughts that you and anybody else here can give me. I've never been too proud to take good advice from other people. I appreciate anybody's responses here. Just don't feel bad if I "disappear" a lot from this board (I'll definitely read all replies to this post though, for sure)....there are times when I've disappeared for many weeks, even many months when my schedule gets crazy....best of health to you and everyone else here Ron! I'll be looking for your reply!!!! McPac
Posted by McPac on April 25, 2003, at 1:14:02
In reply to Re: about the chemical imbalance concept » stjames, posted by Larry Hoover on April 24, 2003, at 19:26:32
Larry, first off, THANK YOU for ALL of your previous replies to me over the past week or so! I appreciate IMMENSELY every reply of yours (most have been saved on my computer for future reference).
From the article that you just posted here,.........."Thirty mg. of dextroamphetamine was found to ameliorate OCD symptoms (Joffe 1991)".
What is dextroamphetamine? (Is this a legal or illegal drug?) THANKS!
Posted by Caleb462 on April 25, 2003, at 2:28:55
In reply to Larry, Re: about the chemical imbalance concept, posted by McPac on April 25, 2003, at 1:14:02
> Larry, first off, THANK YOU for ALL of your previous replies to me over the past week or so! I appreciate IMMENSELY every reply of yours (most have been saved on my computer for future reference).
>
> From the article that you just posted here,.........."Thirty mg. of dextroamphetamine was found to ameliorate OCD symptoms (Joffe 1991)".
>
> What is dextroamphetamine? (Is this a legal or illegal drug?) THANKS!
Dextroamphetamine is a so-called psychostimulant. Amphetamines are probably the most well-known and most used and abused psychostimulants around. There's dextroamphetamine, levoamphetamine, methamphetamine, methylenedioxy-methamphetamine (ecstasy), and so on.The basic action of dextroamphetamine is to cause the release of the neurotransmitters dopamine and noradreaniline. This "speeds up" the mind and body. Increases energy, increases stamina, helps with concentration and cognition, decreases hunger and fatigue, brightens mood and induces euphoria (at higher doses), etc.
Dextroamphetamine is a Schedule 2 drug, meaning it's legal if prescribed to you by an MD. Without a prescription or liscence, it is illegal.
I've never heard of amphetamines helping OCD until I read that, so I wanna check out that study. Large doses of amphetamines can CAUSE obsessive-compulsive behavior, so it is somewhat suprising.
Posted by Ron Hill on April 25, 2003, at 9:42:20
In reply to Ron Hill, Natural Serotonin enhancers?, posted by McPac on April 25, 2003, at 0:57:58
Hi McPac,
Wow, thanks for the detailed response. You have a rather complicated case, huh? The topic at the top of this thread is "natural serotonin enhancers" and after reading your Rx history, my gut reaction is that the natural supplements might not have enough power to keep your OCD under control (just a guess). Have you ever tried 5-HTP? What about SAM-e? St. John’s Wort?
I find it very interesting and unusual that SSRI's induce irritability for you. The SSRI's do just the opposite for me. Initially, they make me happy-go-lucky, content, laid-back, and they take away my somewhat “anal” personality trait. However, over time they adversely affect my dopaminergic pathways and cause apathy, low motivation, and emotional blunting.
McPac, hypothetically speaking, if you were not taking any ADs, what symptoms would best characterize your depression? For example, the depressive phase of my bipolar disorder is best characterized as atypical depression since my symptoms include anergy, anhedonia, hypersomnia, and etc. What about you; how would you characterize your depressive symptoms?
I’m glad to see that you workout as hard as you do. That’s got to help manage your depression and OCD, right?
Other than the basics, I don’t know much about Remeron. Just a thought, but have you ever considered Serzone? I don’t know how good it is for OCD. Maybe you could talk to Ace about medications for your OCD. He has been trying several things lately and he might have some insight for you.
-- Ron
Posted by Larry Hoover on April 25, 2003, at 9:56:30
In reply to Larry, Re: about the chemical imbalance concept, posted by McPac on April 25, 2003, at 1:14:02
> Larry, first off, THANK YOU for ALL of your previous replies to me over the past week or so! I appreciate IMMENSELY every reply of yours (most have been saved on my computer for future reference).
Does that mean I don't get to change my mind? <sarcasm>
Since I've got your attention here, I'd just like to emphasize (as was presented so well in this article) that nutritional treatment for depression depends on there having been a nutritional component in the etiology of the disorder itself. I could probably give you 100's of different biochemical disruptions that might lead to depression, many of which have nothing whatsoever to do with diet. You just have to figure out whether diet is a factor in your mood disorder, and learn what you can do about it. The bonus is that many of the suggested dietary interventions are also good for you in other ways. For example, omega-3 fatty acids cut the risk of coronary artery disease, and reduce the likelihood of senility. If your mood is more stable too, bonus.
> From the article that you just posted here,.........."Thirty mg. of dextroamphetamine was found to ameliorate OCD symptoms (Joffe 1991)".
>
> What is dextroamphetamine? (Is this a legal or illegal drug?) THANKS!Dextroamphetamine is one enantiomer, or one of the mirror-image pair of molecules, in racemic amphetamine. The dextro-/levo- and +/- designations are old nomenclature, having been replaced by R-/S- (e.g. escitalopram (Lexapro) for the S-enantiomer of citalopram).
It is a street drug, but it also a prescribed medication, often used for ADD/ADHD. One brand is Adderal.
The Joffe study was a preliminary study, with only 11 subjects. Dextroamphetamine was compared with methylphenidate (Ritalin). I'd say the results were interesting, but inconclusive. I see no evidence of any follow-up, by Joffe, or anybody else.
Lar
Posted by Larry Hoover on April 25, 2003, at 10:49:10
In reply to Re: Thank you! » Larry Hoover, posted by Dinah on April 24, 2003, at 20:58:29
> I've printed out that article. Thanks so much! It really describes how I had actually experienced SSRI's. I think I'll sit down and try to figure out what psychological states my various meds might have induced.
You're welcome, Diana.
What I found most powerful about this essay was how he brought out the effect of assumptions on treatment protocols. I think it's human nature to extrapolate from assumptions. Then, we use our observations to "prove" our assumptions. So, you end up with a theory chasing itself, a logical fallacy known as petitio principii, or begging the question.
The best example I have ever seen of this is the modelling of stomach ulcers. Back in the '70s, everybody knew that stress caused ulcers. They were associated with Type A personalities. Treatment involved acid reduction and the bland ulcer diet. The problem was, nobody ever got cured.
Then along came a courageous Australian doctor who proposed that ulcers were caused by a bacterial infection. Presenting his ideas at conferences, he was vocally ridiculed. Everybody knew that stomach acid would kill any bacteria! (Aside: food poisoning is proof of the contrary.) But now, we all know that Helicobacter pylori infection causes ulcers. And, the so-called genetic tendency to ulcers, once taken as proof of the Type A influence, can be better explained by transmission of infection between family members.
My own odyssey towards wellness has been motivated by the failure of standard antidepressant therapy. If they had worked, I doubt I'd be on this board right now. I was forced to think outside the standard assumptions. My success has led my care-givers to ask me what I'm doing (outside the box).
Lar
Posted by sapphiredragon on April 25, 2003, at 11:38:34
In reply to Re: Larry, Re: about the chemical imbalance concept » McPac, posted by Larry Hoover on April 25, 2003, at 9:56:30
Thanks to all who have posted on this thread. I would like to especially thank Larry for posting the link to Sobo's article.
There is multi-generational mental illness in my family: bipolar (with psychotic mania), suicidal depression and various forms of anxiety disorders.
Our 24 y.o. son has been seriously depressed since his late teens. He has passionately researched many possibilities for his physical and mental symptoms, and tried out a number of nutritional supplements (including the Pffeifer Center). Some of these were modestly helpful, but none were, in and of themselves, the "magic bullet" he was seeking.
Recently, his depression deepened and my husband and I had to call the police to intercept our son's suicide attempt. We got to him in time and he agreed to hospitalization. For the first time, he was willing to try antidepressant drugs, and within 2 weeks we saw a remarkable improvement. (For the record, he is on 20 mg Lexapro and 10 mg Adderall & uses Ambien as needed for sleep).
It has been almost two months since his hospitalization now, and he said that he feels like the meds give him "space" so that he feels less constricted by the kind of compulsive negative thinking that predominated in his depression. He has begun to venture out socially again, and also has begun an unpaid job internship.
But he's has been continuing to "tweak" his nutritional supplements, and interestingly, like Larry, has found fish oil, vitamin B6 and digestive enzymes to be particularly helpful.
We are fortunate to be working with a psychiatrist who is knowledgeable about the nutritional factors contributing to mental illness. He has been very supportive to our son and respectful of his independent thinking.
I have also really appreciated the PB posters who are exploring multi-faceted approaches to living with mental illness.
Please keep sharing!
Posted by Ron Hill on April 25, 2003, at 11:55:59
In reply to Re: Larry, Re: about the chemical imbalance concept, posted by Caleb462 on April 25, 2003, at 2:28:55
> I've never heard of amphetamines helping OCD until I read that, so I wanna check out that study. Large doses of amphetamines can CAUSE obsessive-compulsive behavior, so it is somewhat suprising.
Caleb and McPac,
Yeah, that's the same reaction I had when I read it. However, if the study is correct and pstims do in fact help OCD, and if one wants to use a natural supplement treatment approach (as previously indicated by McPac), then Enada NADH might be worth a trial. As I understand it, the primary neurochemical action of both Enada NADH and the pstims is along dopaminergic pathways.
I take several supplements, but (as it stands right now) Enada NADH is at the core of my "natural-Rx" for the treatment of the atypical depressive side of my bipolar II disorder.
-- Ron
Posted by Larry Hoover on April 25, 2003, at 12:12:38
In reply to Re: Pstims for OCD?? Really? McPac and » Caleb462, posted by Ron Hill on April 25, 2003, at 11:55:59
> > I've never heard of amphetamines helping OCD until I read that, so I wanna check out that study. Large doses of amphetamines can CAUSE obsessive-compulsive behavior, so it is somewhat suprising.
>
> Caleb and McPac,
>
> Yeah, that's the same reaction I had when I read it. However, if the study is correct and pstims do in fact help OCD, and if one wants to use a natural supplement treatment approach (as previously indicated by McPac), then Enada NADH might be worth a trial. As I understand it, the primary neurochemical action of both Enada NADH and the pstims is along dopaminergic pathways.Lots of if's there, Ron. Here's the study abstract:
J Clin Psychopharmacol 1991 Aug;11(4):237-41
Acute psychostimulant challenge in primary obsessive-compulsive disorder.
Joffe RT, Swinson RP, Levitt AJ.
Department of Psychiatry, Toronto General Hospital, Ontario, Canada.
The effects of acute oral administration of methylphenidate 40 mg versus dextroamphetamine 30 mg versus matched placebo were compared in 11 patients with primary obsessive-compulsive disorder. Dextroamphetamine but not methylphenidate had a significantly greater antiobsessive-compulsive effect as measured by the Comprehensive Psychiatric Rating Scale--Obsessive-Compulsive Subscale, as compared with placebo. This effect appeared unrelated to their effect on depression although a differential effect of the two psychostimulants on anxiety was observed. Although both these stimulants affect serotonin, the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder.
The following abstract shows dopamine agonism is indeed a potential *cause* of OCD-like behaviour in laboratory animals.
Pol J Pharmacol 1999 Jan-Feb;51(1):55-61
Role of dopamine systems in obsessive-compulsive disorder (OCD): implications from a novel psychostimulant-induced animal model.
Szechtman H, Culver K, Eilam D.
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Ontario, Canada.
OCD was once considered a rare psychiatric disorder, but recent studies estimate that, in the general population, the lifetime prevalence of OCD is 1 to 2%, twice that of schizophrenia or panic disorder. The most common form of OCD is compulsive checking. Our studies show that the behavior of rats treated chronically with the dopamine agonist, quinpirole, meets the ethological criteria of compulsive checking in OCD; may have a similar motivational basis as compulsive checking in the human; and is partially attenuated by the anti-OCD drug, clomipramine. Thus, the behavioral changes induced by chronic treatment with quinpirole may constitute an animal model of OCD checking. Since behavioral sensitization is an associated effect of quinpirole treatment, the induction of compulsive checking by quinpirole may involve the same mechanisms as the induction of drug-induced sensitization. In this respect, we demonstrated that the MAO inhibitor clorgyline, not only prevented the development of locomotor sensitization to quinpirole, but also reversed it in sensitized rats. To the extent that the quinpirole treatment is an animal model of OCD with strong face validity, it strengthens the hypothesis that dopamine systems play a role in OCD and raises the possibility that MAO inhibitors, which are used clinically for OCD, may exert their effects by acting at the MAO inhibitor displaceable quinpirole binding site.
> I take several supplements, but (as it stands right now) Enada NADH is at the core of my "natural-Rx" for the treatment of the atypical depressive side of my bipolar II disorder.
>
> -- RonSo, is your pattern still the same, with respect to the NADH?
My response has kind of settled into the following pattern. The day I take it, I feel somewhat unwell, though I'd have trouble defining that. I just don't feel motivated. After maybe 12 hours, that wears off, and I feel enhanced cognitive clarity and motivation.
By and large, and notwithstanding the serious illness I've recently endured, I would say that I did not have my fatigue/crash last month. That breaks a pattern that has existed for 18 months. I go back on the road next week, so it will be extremely interesting to me to see how I do in June. I *love* doing experiments, particularly when they seem to go well. <grinnage>
Lar
Posted by McPac on April 25, 2003, at 12:38:27
In reply to Re: Natural Serotonin enhancers? » McPac, posted by Ron Hill on April 25, 2003, at 9:42:20
You have a rather complicated case, huh?
>>>Sure seems that way at times.
....my gut reaction is that the natural supplements might not have enough power to keep your OCD under control (just a guess). Have you ever tried 5-HTP? What about SAM-e? St. John’s Wort?
>>>>>> While I haven't tried those particular supp's, I am being treated by a very highly regarded treatment center that specializes in natural treatments (so far though their plan has had little effect on me...we'll see in time how that all goes)
I find it very interesting and unusual that SSRI's induce irritability for you.
>>>>> Let's just say that after being put on Prozac especially (Zoloft too to a lesser degree), I COMPLETELY understand the cases from time to time in the past about Prozac causing a certain population of people to go ballistic...it definitely had that effect on me, without question.
McPac, hypothetically speaking, if you were not taking any ADs, what symptoms would best characterize your depression? For example, the depressive phase of my bipolar disorder is best characterized as atypical depression since my symptoms include anergy, anhedonia, hypersomnia, and etc. What about you; how would you characterize your depressive symptoms?
>>>>>>>>>My ocd would become unbearable, which would cause extreme agitation, panicky feelings....as for the depression, I wouldn't eat a thing, I wouldn't sleep, wouldn't feel like even moving at all (my ocd & depression---see how they cause 2 completely different types of feelings? ocd---NERVOUS, panicky...depression---lifeless
I’m glad to see that you workout as hard as you do. That’s got to help manage your depression and OCD, right?
>>>>>>It helps
Other than the basics, I don’t know much about Remeron. Just a thought, but have you ever considered Serzone?
>>>>I've heard of it...but don't know anything about it...is it an AD? (DON'T want ANY neuroleptics (AP's)
I don’t know how good it is for OCD.
>>>>Unfortunately, the SSRI's DOMINATE the meds that work for OCD, there isn't much else to choose from....I may try increasing the Remeron in an attempt to ditch the Zoloft...not many other things I could try....
Maybe you could talk to Ace about medications for your OCD.
>>>>>Ace is too cool! Yes, we've chatted. I really wish him well.
Posted by McPac on April 25, 2003, at 12:56:48
In reply to Re: Larry, Re: about the chemical imbalance concept » McPac, posted by Larry Hoover on April 25, 2003, at 9:56:30
Since I've got your attention here, I'd just like to emphasize (as was presented so well in this article) that nutritional treatment for depression depends on there having been a nutritional component in the etiology of the disorder itself.
>>>>>Exactly! That's been my feeling all along. I was HOPING that I WOULD have a simple nutritional deficiency (i.e. magnesium) that, upon taking the supplement, would be the "missing ingredient" that would solve my situation.....however, I NEVER thought I'd be so lucky!
I could probably give you 100's of different biochemical disruptions that might lead to depression, many of which have nothing whatsoever to do with diet. You just have to figure out whether diet is a factor in your mood disorder, and learn what you can do about it.>>>>>Yep...again, I wish it were a dietary problem because I'd have no problem avoiding the foods that were the culprit....in my case it's more likely that something in my brain is flipping when it should be flopping and zigging when it should be zagging, lol....how do you like that incredibly scientific explanation!
The bonus is that many of the suggested dietary interventions are also good for you in other ways. For example, omega-3 fatty acids cut the risk of coronary artery disease, and reduce the likelihood of senility. If your mood is more stable too, bonus.
>>>>Yep....the fish oil may well help me keep a much more even "keel"...hard to say due to many various factors...
Dextroamphetamine is one enantiomer, or one of the mirror-image pair of molecules, in racemic amphetamine. The dextro-/levo- and +/- designations are old nomenclature, having been replaced by R-/S- (e.g. escitalopram (Lexapro) for the S-enantiomer of citalopram).>>>>>>>Wow-----just off the top of my head that is EXACTLY what I thought it was!! <<<LOL!! joking! After reading that I STILL wonder what it is, lol!
Thanks Lar!
Posted by McPac on April 25, 2003, at 13:09:04
In reply to thinking outside the box, posted by sapphiredragon on April 25, 2003, at 11:38:34
Our 24 y.o. son has been seriously depressed since his late teens. He has passionately researched many possibilities for his physical and mental symptoms, and tried out a number of nutritional supplements (including the Pffeifer Center).
>>>>>>I am going to Pfeiffer myself. So they didn't help him too much, huh?
(For the record, he is on 20 mg Lexapro and 10 mg Adderall & uses Ambien as needed for sleep).>>>>>>Just for future reference, if the Ambien ever loses its ability as a sleep aid for him, he could try LOW-DOSE Remeron (7.5 mg). It works great for terrible insomnia.
But he's has been continuing to "tweak" his nutritional supplements, and interestingly, like Larry, has found fish oil, vitamin B6 and digestive enzymes to be particularly helpful.
>>>>>>Fish oil seems to help me too and I'm also taking vitamin B-6. What specific digestive enzymes does he take?
Thanks!
Posted by Larry Hoover on April 25, 2003, at 13:13:37
In reply to Ron, Re: Natural Serotonin enhancers?, posted by McPac on April 25, 2003, at 12:38:27
I'm going to hijack this thread a bit, if you don't mind.
The question of the utility of 5-HTP and/or tryptophan as antidpressant therapies came up, and it would seem that poor quality research has been the norm. If you use the stringent criteria employed in the following meta-analyis, only 2 0f 108 relevant studies provide meaningful outcomes. Nonetheless, it would seem that serotonin precursors are effective, based on limited data.
Cochrane Database Syst Rev 2002;(1):CD003198
Update of:
Cochrane Database Syst Rev. 2001;(3):CD003198.Tryptophan and 5-hydroxytryptophan for depression.
Shaw K, Turner J, Del Mar C.
School of Population Health, University of Queensland, Public Health Building, Herston Rd, Herston, Queensland, Australia, 4006. k.shaw@sph.uq.edu.au
BACKGROUND: 5 Hydroxytryptophan (5-HTP) and tryptophan are so-called natural alternatives to traditional antidepressants, used to treat unipolar depression and dysthymia. OBJECTIVES: To determine whether 5-HTP and tryptophan are more effective than placebo, and whether they are safe to use to treat depressive disorders in adults. SEARCH STRATEGY: Trials were searched in computerized general (Medline, Psychlit, and Embase) and specialized databases (Cochrane Controlled Clinical Trials Register, Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trial Register); by checking reference lists of relevant articles; by handsearching relevant specialist journals; and by contacting relevant authors where appropriate. Publications in all languages were sought. SELECTION CRITERIA: Trials were included if they were randomized, included patients with unipolar depression or dysthymia, compared preparations of 5-HTP or tryptophan with placebo, and included clinical outcomes assessed by scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS: Data was extracted independently by the three reviewers, onto data collection forms. Inclusion criteria were applied to all potential studies independently and a coefficient of agreement (Kappa) was calculated for them. Disagreement was resolved by reaching consensus. Trial quality was scored according to risk of bias. Analysis for 5-HTP and tryptophan were combined due to the small number of included trials. MAIN RESULTS: 108 trials were located using the specified search strategy. Of these, only two trials, involving a total of 64 patients, were of sufficient quality to meet inclusion criteria. The available evidence suggests these substances were better than placebo at alleviating depression (Peto Odds Ratio 4.10; 95% confidence interval 1.28-13.15; RD 0.36; NNT 2.78). However, the evidence was of insufficient quality to be conclusive. REVIEWER'S CONCLUSIONS: A large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present.
Posted by McPac on April 25, 2003, at 13:35:35
In reply to Re: Ron, Re: Natural Serotonin enhancers? » McPac, posted by Larry Hoover on April 25, 2003, at 13:13:37
"I'm going to hijack this thread a bit, if you don't mind".
>>>PLEASE respond whenever you can/wish to---your responses are always appreciated by me!
I thought that Pfeiffer might try trytophan with me (I read about a safety issue w/ regards to 5HTP).....I've got a lot of questions to ask Pfeiffer when I go back to them....Take care!
Posted by Ron Hill on April 25, 2003, at 15:09:40
In reply to Re: Pstims for OCD?? Really? Not!, posted by Larry Hoover on April 25, 2003, at 12:12:38
> So, is your pattern still the same, with respect to the NADH?
Larry,
I've wanted to find time to post to you and give you an update. Some of your writings prompted me to do some reading on TMG (betaine) and several days ago I started taking about 250 mg/day of it. I'll write more at a later date, but the short version is that TMG seems to work in a favorable synergistic way with the Enada NADH. As a result, I am now taking 2.5 mg of Enada NADH only once per week. It’s too early to know how this will all shake out, but so far so (very) good.
As you know, Enada NADH has been very beneficial in the treatment of the atypical depressive side of my BP II. But when I was taking 2.5 mg every four days without the TMG I would get irritable on the day I took it and begin to lose my motivation and become depressed on day four of the dosing schedule. Further, it seemed that as time passed the irritability on the front-end and the depression on the tail-end both were getting worse. The recent addition of the TMG has solved this problem (at least for now).
I also have added a few milligrams of 5-HTP administered sublingually on a PRN basis for treatment of any breakthrough irritability. I don't seem to need the 5-HTP very often, and certainly not every day, but when I do need it, it seems to take the edge off nicely. I have adopted the position that one of the keys to using supplements successfully is to minimize the dose and to take periodic "supplement holidays".
By the way, when I was at the nutritional store purchasing the TMG, I bought a bag full of other supplements that you and others refer to regularly (e.g., Borage oil, R(+)-lipoic acid (kinda spendee stuff), pregnenolone, DMAE, choline, etc). My plan is to add-on one at a time very slowly so that I can determine which one does what to my mood disorder and my general wellbeing.
Thanks for your willingness to share your expertise with so many of us here in pbabbleland. I'm glad to hear that your periodic crash has apparently taken a sabbatical as of late.
-- Ron
Posted by McPac on April 25, 2003, at 15:27:31
In reply to Re: Pstims for OCD?? Really? Not!, posted by Larry Hoover on April 25, 2003, at 12:12:38
"the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder".
>>>>>>What kinds of natural treatments might affect these catecholamines in a way that would be good for someone w/ ocd?
Posted by McPac on April 25, 2003, at 15:38:00
In reply to Re: Serotonin:good for some depressions,bad for others, posted by linkadge on April 23, 2003, at 14:36:46
You mentioned that Remeron made you worse...how so?
thnx
Posted by sapphiredragon on April 25, 2003, at 16:13:42
In reply to sapphiredragon, Re: thinking outside the box, posted by McPac on April 25, 2003, at 13:09:04
The Pfeiffer Center's treatment didn't do much to alleviate my son's very deep depression. He went through a lot of preliminary testing, and they found a few nutritional deficiencies, but nothing dramatic. He tried out their supplements for a month or so, but after noting little effect, decided to stop buying their special vitamins.
As a previous poster said, if nutritional factors are not the primary cause(s) of mental disturbances, nutritional supplementation alone won't solve the problem.
My son was not able to overcome the suicidal thinking of his depressed state until he started on the SSRI and Adderal.
Re your question about digestive enzymes: For general digestion, my son takes betaine HCl and pancreatin. For helping with the assimilation of the fish oil, he has been using an ox bile supplement. Without the ox bile, the fish oil makes him nauseous, he says.
Posted by Larry Hoover on April 25, 2003, at 17:03:54
In reply to Lar, Re: Ron, Re: Natural Serotonin enhancers?, posted by McPac on April 25, 2003, at 13:35:35
> "I'm going to hijack this thread a bit, if you don't mind".
>
> >>>PLEASE respond whenever you can/wish to---your responses are always appreciated by me!
>
> I thought that Pfeiffer might try trytophan with me (I read about a safety issue w/ regards to 5HTP).....I've got a lot of questions to ask Pfeiffer when I go back to them....Take care!Well, if your mare is really skittish, and difficult to breed, you may want to try some supplemental tryptophan to calm her down. Go to:
http://www.buygpdirect.com/gpefeed.htmYou can get fish oil for about $14 a gallon, too.
Lar
>
Posted by McPac on April 25, 2003, at 18:15:31
In reply to Re: thinking outside the box » McPac, posted by sapphiredragon on April 25, 2003, at 16:13:42
Lar, I just found this info. elsewhere:
"High histamine metabolism
High histamine is associated with depression, especially suicidal depression (Walsh, 1992).
What is histamine and why is it so important? Histamine is integral in balancing the electrical activity of the nucleus accumbens, which is an area of the brain responsible for behavioral responses, filtering incoming sensory information, and communicating with the hypothalamus, ventral tegmentum, and amygdala (Shoblock & O'Donnell, 2000; Otake & Nakamura, 2000; Chronister et al, 1982).
It has been reported that people with obsessive compulsive 'tendencies', seasonal depressions, and oppositional defiant behavior (ODD) have high whole blood histamine levels (Walsh, P.T.C.- Ref.B).
The importance of taking detailed patient histories on the first visit is key (Jackson et al, 1998; Edelman, 1996; Jaffe & Kruesi, 1992; Pfeiffer, 1988; Walsh, Ref. B). People with high histamine have been found with typical symptoms of high intelligence, thought blanking, perfectionism, competitiveness, obsessions, compulsions, suicidal and seasonal depression, defiance, and phobia (Jackson et al, 1998; Edelman, 1996; Jaffe & Kruesi, 1992; Pfeiffer, 1988; Walsh, Ref. B).
These patients do well with certain nutrients and herbs but must strictly avoid B-12 and folic acid. These patients need to avoid store-bought multi-vitamins".
***I'm emphasizing THIS: "These patients do well with certain nutrients and herbs but must strictly avoid B-12 and folic acid".
Why the Hell does Pfeiffer have me ON vitamin-B12 then???????? I'm really sick of this baloney. The best anti-depressant is a Smith & Wesson. No need for any response as I know that you don't know why Pfeiffer has me on it....I'm just looking for ANY possible explanation. Take care!
Posted by Larry Hoover on April 25, 2003, at 22:39:52
In reply to Larry..........., posted by McPac on April 25, 2003, at 18:15:31
> Lar, I just found this info. elsewhere:
> ***I'm emphasizing THIS: "These patients do well with certain nutrients and herbs but must strictly avoid B-12 and folic acid".
>
> Why the Hell does Pfeiffer have me ON vitamin-B12 then???????? I'm really sick of this baloney. The best anti-depressant is a Smith & Wesson. No need for any response as I know that you don't know why Pfeiffer has me on it....I'm just looking for ANY possible explanation. Take care!If you look hard at any recommendations, you are bound to find contradictions and inconsistencies, even with those of other theorists who seem to otherwise be in agreement on the main arguments.
I think I best fit the high-histamine protocol, but I've found good reasons for supplementing with B-12, and a B-complex.
Statistically, you're probably most likely to be deficient in magnesium, and then, about equally likely to be deficient in zinc or B-12, followed closely by selenium and the other B-vitamins (my belief, based on evidence I've seen over time).
I think that, overall, Pfeiffer has given you good advice.
Lar
Posted by Ron Hill on April 26, 2003, at 1:17:29
In reply to Re: Lar, Re: Ron, Re: Natural Serotonin enhancers?, posted by Larry Hoover on April 25, 2003, at 17:03:54
> You can get fish oil for about $14 a gallon, too.
Larry, how can I find out the percentage of EPA, DHA, and other omega-3 fatty acids in the Su-Per Fish Oil?
-- Ron
Posted by Simon Sobo, M.D. on April 26, 2003, at 6:51:22
In reply to Re: Larry, Re: about the chemical imbalance concept » McPac, posted by Larry Hoover on April 25, 2003, at 9:56:30
It is interesting that almost all of the posts in reaction to my article have suggested still more medicines and herbs to try to treat "the chemical imbalances" they are dealing with. Actually my article is challenging the automatic assumption that the problem is necessarily chemical. It may be but it may not be. The fact is this. WE DON'T KNOW! I am not against using medications in my practice. They are often very helpful but I am claiming they exert their effect through the more general psychological effects that they have on a person and not through a specific correction of a specific chemical imbalance for a specific diagnosis. Many of you commented on the article that I cited about using amphetamines for OCD. I have never used them for OCD but I am surprised that no one mentioned the other article claiming morphine helps OCD. Actually what I was saying is that intoxicants of all varieties may help OCD symptoms. I am not advocating this as a treatment but many people with OCD lose their OCD when they get drunk (others get worse).
I became interested in the amphetamine article after one of my patients told me cocaine had helped his OCD. Here is the portion of the article that you have reacted to and then I have one further bit of clinical information,"In Obsessive Compulsive Disorder (OCD) similar problems emerge. Originally, the fact that serotonin enhancing drugs were uniquely effective led to a belief that there was a causal connection, but as early as 1991 there was confounding evidence. Thirty mg. of dextroamphetamine was found to ameliorate OCD symptoms (Joffe 1991). Moreover, while I am not advocating this as treatment, I have had patients report to me that intoxicants such as marijuana, alcohol, and cocaine have given them temporary relief from OCD symptoms. Indeed, a recent study has shown that oral morphine is reasonably effective (Franz, 2001). Once again it is possible to speculate that there is a downstream effect on serotonin, but if we use this argument we have come full circle in a tautological trap. The original reason for the serotonin-OCD chemical imbalance model was that serotonergic agents were believed to be unique in their effectiveness"
Here is the other clinical tidbit. The patient who found cocaine helpful for his OCD lost his symptoms completely when he became a Jehovah's Witness. This cure disappeared after about 6 months when he became disillusioned with the cult but it is nevertheless fascinating. OCD has something to do with uncertainty. If you can take that away, give a feeling of completeness or innocence or something like that there will be improvement. I guess morphine, SSRI's, and many intoxicants can do that for certain people, but the primary problem is probably psychological not chemical.
Posted by Larry Hoover on April 26, 2003, at 8:41:17
In reply to Re: On-line Fish Oil Product EPA/DHA Content? » Larry Hoover, posted by Ron Hill on April 26, 2003, at 1:17:29
> > You can get fish oil for about $14 a gallon, too.
>
> Larry, how can I find out the percentage of EPA, DHA, and other omega-3 fatty acids in the Su-Per Fish Oil?
>
> -- Ron
I have no idea, Ron. I doubt they're too concerned. It doesn't mention preservatives, either. How much rancidity might there be? Still, where else can you get fish oil at that price? It might be worth the $14 just to find out.Lar
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