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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by spiritgirlhere on September 23, 2005, at 19:34:57
Which one is better for anxiety and mild depression? I was on Lexapro for one year, and withdrew in July. On Monday, I had a panic atack while weight-lifting at the gym. Since then, I have been tense and afraid of back-sliding into my anxious place. I really can't stomach the thought of going on an SSRI - the withdrawal was so difficult. Any advice?
Posted by med_empowered on September 23, 2005, at 19:34:57
In reply to 5 htp vs. sam-e, posted by spiritgirlhere on September 21, 2005, at 21:26:08
well...SAMe is more expensive, but may work faster (at least in some people). Plus, it doesn't really have very many side effects. 5-HTP worked well for me at least (better on anxiety than depression, but it did help depression). The problems are...3X daily dosing, adjusting the dose properly, upset stomach, and sedation (which might be a good thing). I think I ended up up dividing it up into 50-50-100mgs segments; the PM dose helped somewhat with sleep with minimal hangover. The upset stomach thing only lasted a little while for me, but I think some people stop taking it b/c of that. The SAMe has been linked to a couple cases of mania, but..unless you're bipolar, I wouldn't worry too much about that. In terms of tolerability, I'd recommend SAMe first; if you're looking for a bit of appetite suppression, help with sleep, and don't mind the 3X daily dosing, 5-HTP could be a good 1st option. You can also mix them, since 5-HTP affects serotonin and SAMe affects *LOTS* of things (for the better). Good luck!
Posted by Declan on September 23, 2005, at 19:34:57
In reply to Re: 5 htp vs. sam-e, posted by med_empowered on September 21, 2005, at 21:37:58
SAMe would be better for depression unless you find it agitating. 5htp would be better for anxiety. IMO.
Declan
Posted by maddy4 on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e, posted by med_empowered on September 21, 2005, at 21:37:58
> well...SAMe is more expensive, but may work faster (at least in some people). Plus, it doesn't really have very many side effects. 5-HTP worked well for me at least (better on anxiety than depression, but it did help depression). The problems are...3X daily dosing, adjusting the dose properly, upset stomach, and sedation (which might be a good thing). I think I ended up up dividing it up into 50-50-100mgs segments; the PM dose helped somewhat with sleep with minimal hangover. The upset stomach thing only lasted a little while for me, but I think some people stop taking it b/c of that. The SAMe has been linked to a couple cases of mania, but..unless you're bipolar, I wouldn't worry too much about that. In terms of tolerability, I'd recommend SAMe first; if you're looking for a bit of appetite suppression, help with sleep, and don't mind the 3X daily dosing, 5-HTP could be a good 1st option. You can also mix them, since 5-HTP affects serotonin and SAMe affects *LOTS* of things (for the better). Good luck!
where do you buy SAMe and 5htp? can you tell me more - my main prob is anxiety panic. how well did it work for you? TIA
Posted by TommyIsland on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e, posted by maddy4 on September 21, 2005, at 21:59:53
You can buy Sam-E in a place called Costco. I'm in Jersey so I don't know where your at. They have it there and the brand is called Nature Made and it says Mood Plus under that. My doc recommended that brand. You can go to www.Costco.com and prob order it there too. Good Luck buddy......
Tommy!!!!!!!!
Posted by Declan on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e, posted by TommyIsland on September 21, 2005, at 23:53:38
I get mine from life extension foundation, www.lef.org
You pay to be a member, but hey have good stuff.
Declan
Posted by med_empowered on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e, posted by Declan on September 22, 2005, at 0:21:51
You can get 5-HTP and SAMe at most health food stores (GNC and locally owned places), a lot of drugstores (especially the chains like CVS/Eckerds), over the net, etc. Puritan's Pride has low-cost supplements, including 5-HTP (and I think SAMe)...I avoided them for a while b/c I was afraid their products might be inferior, but some independent tests I've seen (where they tste the supplements for contaminants and quality of the contents) seem to indicate that they're just as good as the more expensive places. 5-HTP was good for me, but it is *much* better for anxiety, insomnia, and relatively mild depression than it is for people with more severe problems with depression. I think the standard starting dose for 5-HTP is one 50mgs caplet 3X daily; taking it before a meal can help reduce appetite, and taking it with a meal might reduce nausea and upset stomach. My advice would be to start w/ 50mgs at night, work up to 100mgs (or more) at night, and then start taking it during the day; that way, you'll be a little more adjusted to the sedating properties of it, and you'll also see whether or not the upset stomach issue is going to be a big problem for you or not (its usually not, but some people do avoid it b/c of that issue). SAMe I believe requires at least 400mgs/day, but you might want to take more for a more pronounced effect...I think 800mgs , divided up into a couple dosings, is pretty standard. Its *very* good for depression and overall health (SAMe is apparently involved in lots and lots of really important processes in your body), but there is a bit of problem with inducing mania in those with bipolar disorder, so please keep that mind. Also, you can mix the two if you feel so inclined; just keep in mind that its kind of like mixing antidepressants, so the risk of mania would (theoretically) be higher, so you'll want to watch out for that. Although saint John's wort has fallen out of favor, I find it effective. The problems, I think, are dosing (900mgs is supposed to be *everyone's* dose--there needs to be more flexibility) and standardized extracts...most extracts have .3% hypercin. Although hypercin was once thought to be *the* antidepressant component of saint john's wort, the plant is really complicated chemically, so lots of components could be playing a part in its effectiveness. I take 1,200mgs (600AM/300afternoon/300PM) standardized extract, plus a capsule of just plain saint john's wort, not standardized. If you go that way, watch out for increased sensitivity to light; if you don't already wear a sunscreen of SPF 15 , it'd be a good idea to start doing so. B-Vitamins also help me a lot, and they're super-cheap...they seem to help both lift my mood in combo w/ st. john's wort and help me deal with anxiety (the panic is reduced, and the remaining anxiety isn't nearly as emotionally or physically exhausting as it was before). Anyway, whatever you choose, do keep in mind that it might be a little while (3-6 weeks) before you see major improvement. 5-HTP starts to calm you down or sedate you (depending on dose) pretty much immediately though. Now and then I take some Valerian for daytime anxiety and/or sleep...it works pretty quickly, doesn't cloud my thinking, and also doesn't require long-term use like antidepressant drugs or supplements do, so its a good add-on (the pills smell awful though). Gotu Kola helps a lot of people, too...if I'm stressed out, I take a bit before I meditate to help me keep my focus..it seems to work. There's lots of other inexpensive, safe stuff you could try...antioxidant combo vitamins, for instance. Since you seem to be having a really rough time right now with anxiety, it might be good to focus in on that...maybe 5-HTP, some B-vitamins, and Valerian now and then. One more thing...some 5-HTP supplements come in combo with a lot of other stuff, like vitamins and what not. These brands might be worth trying, but you'll probably get similar results using supplements that just have 5-HTP without anything else in them (the combo-supplements are usually a bit more expensive, too). Please keep me posted on how you're doing, and I wish you the best of luck.
Posted by Ktemene on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e, posted by med_empowered on September 22, 2005, at 17:09:09
I started taking SAM-e about 4 weeks ago, and I did a little research on it before I started. Two forms of SAM-e are available, sulfate-p-toluenesulfonate (also called tosylate) and butanedisulfonate. The oral bioavailability of the tosylate salt is 1%, and the oral bioavailability of the butanedisulfonate salt is 5%. (Stramentinoli G, Gualano M, Galli-Kienle M. Intestinal absorption of S-adenosyl-L-methionine. J Pharmacol Exp Ther 1979;209:323-6.) For this reason lots of people have recommended the butanedisulfonate form, and GNC and Nature Made both used to sell that form. But they have both switched to selling the tosylate form as far as I can tell. The only source I have been able to find for the butanedisulfonate salt is a site called Young Again, which sells it for arthritis (http://www.youngagain.com/same.html). It costs about 50 cents per 400mg pill. You can reduce the price a bit by buying two bottles at a time, for which they will give you a third bottle at no extra charge. Of course, that still works out to be quite a lot, since for many people the antidepressant effect does not kick in until the 1600 mg per day level. If you do start taking SAM-e, but sure to get enough B vitamins, especially folate, B6 and B12. There is some evidence that SAM-e does not work as well without enough B vitamins. And take SAM-e on an empty stomach about half an hour before a meal to increase absorption. You might also try supplementing with a gram or so of methionine. There was a recent animal study that indicated that taking methionine might increase the level of SAM-e in the brain. (http://www.pubmedcentral.gov/articlerender.fcgi?artid=543840&rendertype=abstract)
There is a lot of information about SAM-e in a 2003 Current Psychiatric Report (http://www.current-reports.com/article.cfm?PubID=PR05-6-1-05&Type=Article&KeyWords=) and in a 2001 issue of Psychiatric Times (http://www.psychiatrictimes.com/p010501b.html).
After a month of taking 1600 SAM-e a day, my impression is that the SAM-e is having a noticeable antidepressant effect. When I started the SAM-e a month ago, I had already been taking selegiline (5mg per day) and Wellbutrin (150mg per day) for many months. Of course, one month is not much time. But it has been a very stressful month and I feel better than I would have expected. I will post about it if I still feel an antidepressant effect after three months.
Posted by Declan on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e, posted by Ktemene on September 22, 2005, at 19:14:30
Ktemene, has SAMe affected your sleep at all?
I think it made mine worse, but you know how it's hard to tell what's causing what.
Declan
Posted by maddy4 on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e, posted by med_empowered on September 22, 2005, at 17:09:09
hey Med - listen, ive been reading some stuff online today that says 5htp causes anxiety and it made me afraid to try it...thoughts? oh heres the link:
http://www.vanderbilt.edu/AnS/psychology/health_psychology/5htp_myth.htm
tell me what you think abt that article. also thanks for your lenghty post btw! very nice! please tell more.
Posted by med_empowered on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e med_empowered, posted by maddy4 on September 22, 2005, at 21:43:06
hey! 5-HTP helped my anxiety, and I know other people who have been helped by it...my guess would be that since it works on serotonin, you're likely to get a lot of the same effects you would with, say, Paxil or Celexa...some anti-anxiety effects, but also the possibility of drug-induced anxiety (especially at start-up). But..that's just a guess.
Posted by Ktemene on September 23, 2005, at 19:34:58
In reply to Re: 5 htp vs. sam-e » Ktemene, posted by Declan on September 22, 2005, at 20:45:23
Hi Declan,
Yes, I have had the feeling that SAM-e is affecting my sleep. My insomnia has definitely gotten worse in the month that I have been taking SAM-e (I take 1600 mg a day, divided into two doses, both before 1:00pm). But, on the other hand, I have had much more stress in the last month as well. Another change that could have affected sleep is that I switched from using generic selegiline (5mg per day) to using the Somerset Brand, Eldeprenyl, which some people think is more effective. If Eldeprenyl is more effective, it could be increasing the insomnia, because insomnia is definitely a side effect of selegiline for me even at the low 5mg per day level.
The SAM-e seems to have a rapid effect on mood for me. In less than an hour I feel calmer and less angry and more energetic and focused.
Ktemene
> Ktemene, has SAMe affected your sleep at all?
> I think it made mine worse, but you know how it's hard to tell what's causing what.
> Declan
Posted by KaraS on September 24, 2005, at 2:27:05
In reply to Re: 5 htp vs. sam-e, posted by Ktemene on September 22, 2005, at 19:14:30
... since for many people the antidepressant effect does not kick in until the 1600 mg per day level.
I had never heard that. I tried SAM-e and got up to 1200 mg. per day. I figured that since I didn't feel anything at all after several weeks at that level, that it just wasn't going to work for me. Maybe I shouldn't have thrown in the towel so quickly.
Posted by nolvas on September 24, 2005, at 7:04:52
In reply to Re: 5 htp vs. sam-e » Ktemene, posted by KaraS on September 24, 2005, at 2:27:05
I see sam-e is contraindicated if you are a person who suffers from over methylation. Are over methylation , under methylation and pyroluria regarded as pseudo science or actually getting some respect for being valid science now?
This page shows potentionally harmful supplements for each subtype. sam-e is said to be good for under methylated persons and bad for over methylated persons.
Should I be skeptical of these subtypes? It's hard to get an objective answer when searching the net.
Posted by Ktemene on September 25, 2005, at 13:39:06
In reply to Re: 5 htp vs. sam-e » Ktemene, posted by KaraS on September 24, 2005, at 2:27:05
> ... since for many people the antidepressant effect does not kick in until the 1600 mg per day level.
>
>
> I had never heard that. I tried SAM-e and got up to 1200 mg. per day. I figured that since I didn't feel anything at all after several weeks at that level, that it just wasn't going to work for me. Maybe I shouldn't have thrown in the towel so quickly.
>Hi Kara,
I am using 1600mg per day because several of the clinical trials happened to use that dosage. But the sad truth is that even 1600mg may not be enough. I have copied below a post of Dr. Kramer on SAMe in which he says that more than 16 grams a day may be required! Part of the problem with SAMe is the exceedingly low bioavailability of the oral version. (A lot of the clinical trials with positive results used injected SAMe.) For that reason I think it is worthwhile to try to get the kind of SAMe that such evidence as there is suggests is the most bioavailable kind. As it happens, I was able to find a source for that kind that also was among the cheapest. But it still costs a lot! Oh well...
Ktemene
URL: http://www.dr-bob.org/babble/20020327/msgs/101374.html
Re: Kramer: SAMe and omega-3Posted by Dr. Kramer on April 1, 2002, at 21:26:36
In reply to Kramer: SAMe and omega-3, posted by Anyuser on April 1, 2002, at 9:56:57
I like both SAM-e and Omega-e fatty acids because they work. The dosage of Omega-3 is less clear to me, but SAM-e, for most people, requires 1200-16600 mg/day.
Posted by Franz on September 25, 2005, at 17:24:24
In reply to Re: 5 htp vs. sam-e, posted by med_empowered on September 21, 2005, at 21:37:58
Posted by KaraS on September 25, 2005, at 20:22:23
In reply to Re: 5 htp vs. sam-e » KaraS, posted by Ktemene on September 25, 2005, at 13:39:06
> > ... since for many people the antidepressant effect does not kick in until the 1600 mg per day level.
> >
> >
> > I had never heard that. I tried SAM-e and got up to 1200 mg. per day. I figured that since I didn't feel anything at all after several weeks at that level, that it just wasn't going to work for me. Maybe I shouldn't have thrown in the towel so quickly.
> >
>
> Hi Kara,
>
> I am using 1600mg per day because several of the clinical trials happened to use that dosage. But the sad truth is that even 1600mg may not be enough. I have copied below a post of Dr. Kramer on SAMe in which he says that more than 16 grams a day may be required! Part of the problem with SAMe is the exceedingly low bioavailability of the oral version. (A lot of the clinical trials with positive results used injected SAMe.) For that reason I think it is worthwhile to try to get the kind of SAMe that such evidence as there is suggests is the most bioavailable kind. As it happens, I was able to find a source for that kind that also was among the cheapest. But it still costs a lot! Oh well...
>
> Ktemene
>
>
> URL: http://www.dr-bob.org/babble/20020327/msgs/101374.html
> Re: Kramer: SAMe and omega-3
>
> Posted by Dr. Kramer on April 1, 2002, at 21:26:36
>
> In reply to Kramer: SAMe and omega-3, posted by Anyuser on April 1, 2002, at 9:56:57
>
>
> I like both SAM-e and Omega-e fatty acids because they work. The dosage of Omega-3 is less clear to me, but SAM-e, for most people, requires 1200-16600 mg/day.
Wow, 16+ grams a day! Who could afford that? I tried SAM-e a few years ago and used one of the best brands (Nature Made?) that at the time contained the most bioavailable form. I guess my trial wasn't complete though because of the dosage I used. Someday maybe I'll be able to afford to try more of it or maybe there'll be a better delivery system.Thanks for the information.
Kara
Posted by maddy4 on September 26, 2005, at 8:09:54
In reply to 5HTP, SAMe can cause anxiety (nm), posted by Franz on September 25, 2005, at 17:24:24
why do you say so franz??? personal experience - am curious - i DEF. dont need any more anxiety!
i took my first 5htp yest. and thought it was calming
Posted by Declan on September 26, 2005, at 14:58:30
In reply to Re: 5HTP, SAMe can cause anxiety, posted by maddy4 on September 26, 2005, at 8:09:54
My experience is that 5htp is calming (and no more) and SAMe has an AD effect but may interfere with sleep and cause irritability.
Declan
Posted by clint878 on September 6, 2006, at 12:00:27
In reply to 5 htp vs. sam-e, posted by spiritgirlhere on September 21, 2005, at 21:26:08
While the withdrawal may be difficult from SSRI's, Sam-E caused akathisia for me. It's been four weeks and it's still not yet fully gone.
If one of the SSRI's had caused akathisia, then doctors would recognize it and treat it. But nobody knows what Sam-E is because it's a herbal remedy that is untested.
Stick with the prescription drugs. They have been well-researched and their effects are known.
> Which one is better for anxiety and mild depression? I was on Lexapro for one year, and withdrew in July. On Monday, I had a panic atack while weight-lifting at the gym. Since then, I have been tense and afraid of back-sliding into my anxious place. I really can't stomach the thought of going on an SSRI - the withdrawal was so difficult. Any advice?
Posted by Javelina on December 22, 2006, at 2:01:05
In reply to Re: 5 htp vs. sam-e, posted by Ktemene on September 22, 2005, at 19:14:30
Ktemene,
You mentioned about a year ago, late 2005, that you found the butanedisulfonate formulation of SAM-e at Young Again (http://www.youngagain.com/same.html). Seems like they are now selling one of the tosylate formulations instead. Do you have a current source for the butanedisulfonate formulation? I haven't been able to find a source for it, seems like all the manufacturers have switched to some form of tosylate formulation. If you don't have a current source for the butanedisulfonate formulation, what are you currently using?
Thanks!
Posted by Jimmyboy on December 24, 2006, at 12:31:15
In reply to Re: 5 htp vs. sam-e - Sam-E formulation, posted by Javelina on December 22, 2006, at 2:01:05
The European prescription version, which you can order, but is very expensive is called "Samyr", it contains the butanedisulfonate form. they have pills and ampoules ( injections) , I saw them for sale on a site called "biogenesis" or something .. or just look up "Samyr" and something should come up.
Good luck, I am looking for the same.
JB
Posted by Javelina on January 11, 2007, at 19:05:08
In reply to Re: 5 htp vs. sam-e - Sam-E formulation, posted by Jimmyboy on December 24, 2006, at 12:31:15
Thanks, that's helpful. Yes, the cheapest place I found Samyr is on the Biogenesis Anti-aging (or something like that) site. It is more expensive than the various tosylate formuations, but if it really is 5x more bioavailable (5% instead of 1%) then it would be cost effective, because it isn't 5x more expensive, more like 2.5x. I'll give it a try, as an experiment. I wish I could measure it's effectiveness in some objective way.
I wonder why the butanedisulfonate formulation is no longer readily available? Many vendors formerly offered it, then discontinued their products or changed to the tosylate form. Is there a patent? Are there advantages to the tosylate form?
> The European prescription version, which you can order, but is very expensive is called "Samyr", it contains the butanedisulfonate form. they have pills and ampoules ( injections) , I saw them for sale on a site called "biogenesis" or something .. or just look up "Samyr" and something should come up.
>
> Good luck, I am looking for the same.
>
> JB
Posted by Javelina on January 11, 2007, at 19:08:27
In reply to Re: 5HTP, SAMe can cause anxiety, posted by Declan on September 26, 2005, at 14:58:30
> My experience is that 5htp is calming (and no more) and SAMe has an AD effect but may interfere with sleep and cause irritability.
> DeclanThat experience is corroborated by this article, which may be a biased marketing piece, but nevertheless, here it is
http://www.smart-drugs.com/ias-5htp.htm
This is the end of the thread.
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