Archives for July 2020

Hydroxychloroquine and chloroquine (antimalarial drugs): quinism and the risk of sudden and lasting neuropsychiatric effects

July 31, 2020 By Trudy Scott 69 Comments

The Quinism Foundation, a nonprofit charitable organization “promotes and supports education and research on quinism, the family of medical disorders caused by poisoning by mefloquine, tafenoquine, chloroquine, and related quinoline drugs.”

Executive Director of the foundation, Dr. Remington Nevin, MD, MPH, DrPH, is a Johns-Hopkins trained psychiatric epidemiologist and drug safety expert and former U.S. Army public health physician. He has published extensively on the subject.

The foundation share the symptoms of chronic quinoline encephalopathy, also known as neuropsychiatric quinism:

The term “quinism” may seem new, but the symptoms of poisoning by mefloquine (previously marketed as Lariam®), tafenoquine (marketed as Krintafel® and Arakoda™), chloroquine (marketed as Aralen®), and related quinoline drugs are all too familiar: Tinnitus. Dizziness. Vertigo. Paresthesias. Visual disturbances. Gastroesophageal and intestinal problems. Nightmares. Insomnia. Sleep apnea. Anxiety. Agoraphobia. Paranoia. Cognitive dysfunction. Depression. Personality change. Suicidal thoughts.

These symptoms are not “side effects,” they are symptoms of poisoning by a class of drug that is neurotoxic and that injures the brain and brainstem. This poisoning causes a disease, and this disease has a name: Chronic quinoline encephalopathy — also known as quinism.

In March they published this press release: The Quinism Foundation Warns of Dangers from Use of Antimalarial Quinolines Against COVID‑19. Here are some highlights:

A risk of sudden and lasting neuropsychiatric effects from the use of antimalarial quinolines against COVID‑19, the disease caused by the novel coronavirus
In susceptible individuals, these drugs act as idiosyncratic neurotoxicants, potentially causing irreversible brain and brainstem dysfunction, even when used at relatively low doses

What is concerning is lasting neuropsychiatric effects and the fact that even low doses can cause irreversible effects. The Foundation “has urged policy makers, physicians, and members of the public to be alert to such effects.”

Dr. Nevin states that “these are not safe drugs” and “While it may be tempting to attribute anxiety, depression, paranoia, or other mental health symptoms to the psychological effects of the COVID‑19 pandemic, these symptoms may be an early warning sign of idiosyncratic neurotoxicity, and must be taken seriously.”

You can read the entire March 2020 press release here. It contains a link to U.S. Food and Drug Administration’s MedWatch program for reporting adverse effects.

Another press release published late July also cautions the use of tafenoquine against COVID-19 which The Qunism Foundation states “is a neurotoxic quinoline antimalarial drug with a similar adverse effect profile to mefloquine.”

New COVID-19 research on chloroquine and hydroxychloroquine

It’s encouraging to see that new research published on COVID-19 and these medications also highlights the possibility of neuropsychiatric side effects (even through the authors state it’s considered uncommon): Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake of COVID-19: Psychopharmacological Interactions and Neuropsychiatric Sequelae

…neuropsychiatric side effects are very uncommon but possible, and include a potentially prolonged phenomenon of “psychosis following chloroquine.” Hydroxychloroquine has less information available about its neuropsychiatric side effects than chloroquine, with psychosis literature limited to several case reports

Case reports on psychiatric symptoms induced by hydroxychloroquine

Here is one of these case reports: Psychiatric symptoms induced by hydroxychloroquine. A 36-year-old woman was diagnosed with Systemic Lupus Erythematosus (SLE) and antiphospholipid syndrome, and was treated with prednisone 10 mg and hydroxychloroquine 200 mg every 24 hours. Her arthritis improved but

One month after initiation of treatment, the patient began with generalized anxiety, suicidal ideation and the appearance of auditory and kinaesthetic [tactile] hallucinations.

She had similar adverse effects 5 years later when hydroxychloroquine (without prednisone) was prescribed following an outbreak of cutaneous SLE

A week later, the patient was admitted to the Department of Psychiatry because of suicidal ideation, self-harm and kinaesthetic and auditory hallucinations, which improved after withdrawal of hydroxychloroquine and treatment in a psychiatric setting.

Since then, the patient has not been taking hydroxychloroquine and has had no further episodes of kinaesthetic [tactile] or auditory hallucinations.

Here are two other case reports: Hydroxychloroquine-induced acute psychosis in a systemic lupus erythematosus female and Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report.

Risk factors for susceptibility

This review article from 2018, Neuropsychiatric clinical manifestations in elderly patients treated with hydroxychloroquine: A review article mentions that these adverse events can range from less severe nervousness to “actual psychosis and suicidal tendencies.”

It also lists possible risk factors that may make certain individuals more susceptible:

co-exposure to interacting drugs, alcohol intake, familial history of psychiatric diseases, female gender, and the concomitant use of low-dose glucocorticoids [such as prednisone].

Malaria drug causes brain damage that mimics PTSD

I first learned of this neuropsychiatric connection a number of years ago when I read about the “case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug.” You can read about this here – Malaria drug causes brain damage that mimics PTSD: case study.

A few years ago I also blogged about the anti-malaria medication mefloquine and how it was known to contribute to neuropsychiatric symptoms in susceptible individuals: PTSD from 3 tours in Afghanistan: Can GABA help with the anxiety?

My concerns about long-term prophylactic use and lack of awareness

My concerns are long-term prophylactic use. There are a number of clinical trials planned or in progress for long-term use in healthcare workers. If they are stressed, anxious, depressed and exhausted because of the COVID-19 work they have been doing, they may incorrectly attribute some of their symptoms to all that rather than the medication side-effects. And if they do get COVID-19, they may confuse the neurological and psychiatric effects of COVID-19 with those of chloroquine or hydroxychloroquine.

What also concerns me is the lack of awareness. None of the advocates of this class of medications mentions quinism, the possible neuropsychiatric side-effects and long-term risks, or who may be susceptible.

I would be very happy if chloroquine or hydroxychloroquine is found to be a solution (or part of a solution) for COVID-19 – alone or in combination with zinc – for certain individuals.

But I believe we do need to be very aware about side-effects as serious as these. I’d also like to see education for healthcare providers and the consumer, as well as informed consent for the consumer.

Similar concerns with other medications

In the past I’ve written about similar concerns with other medications such as benzodiazepines, SSRIs and fluoroquinolone antibiotics:

Your feedback and questions so we can all learn

I encourage you to keep all this in mind as you navigate what you hear in the news, read on social media and/or read in the research on hydroxychloroquine.

Keep all this in mind too if you have future plans to travel to a malaria area for a vacation in the future (wouldn’t we love that – a trip!?).

Have you used chloroquine or hydroxychloroquine for COVID-19 and experienced psychiatric side-effects? Or know someone who has?

Have you used antimalarial medications in the past and experienced psychiatric side-effects? Was this a short-course or long-term prophylactic use?

Have you used these medications for lupus or rheumatoid arthritis with success and without psychiatric side-effects? Or have you experienced adverse effects and had to stop?

If you have had adverse psychiatric effects please share which medication, dosage and frequency? Also do you have any of the predisposing risk factors: alcohol intake at the time, history of psychiatric diseases (you or family members), are female, and were also prescribed low-dose glucocorticoids such as prednisone, and/or other medications (and which ones)?

Feel free to post your questions here too.

I am an emotional eater and eat sugar as a reward and find myself craving it when I am fatigued. Do you have clients on more than one amino acid?!

July 24, 2020 By Trudy Scott 22 Comments

This is a question I received from a stressed out mom in my community. She has identified when she craves sugar and the emotion connected to her cravings. Now she has questions about how to trial and use amino acids to stop her cravings, get her energy back and feel emotionally stable:

I know I am an emotional eater, I know I eat sugar as a reward and I do find myself craving it when I am fatigued. I also seem to crave it after a very savory meal; especially one with garlic. What is THAT about?! Do you have clients on more than one amino acid?!

I have been a caregiver for my son (multiple disabilities) for 30 years; he has uncontrolled seizures and my husband has PTSD. It is a stressful household.

This is what I shared with her about the brain chemical imbalances and amino acids:

Many of my clients need more than one amino acid but it’s best to trial one at a time. When I hear my client say they eat sugar as a reward we immediately consider a trial of DPA (d-phenylalanine) especially if they are also overly emotional/weepy and also have physical pain.
When I hear my client say “I do find myself craving sugar when I am fatigued” we consider low catecholamines and a trial of tyrosine especially if they also have poor focus, low motivation and a flat mood. If the fatigue is caused by low blood sugar this can cause fatigue, irritability/crankiness and anxiety and a trial of glutamine may be a better option. If the DPA helps the emotional-reward-eating after a week or two, then we may do a trial of tyrosine and/or glutamine (one at a time) and use them in addition to the DPA.
When I hear “sugar cravings after a savory meal” we consider low serotonin and a trial of tryptophan if it’s after lunch or dinner. Serotonin dips in the afternoon and evening triggering this type of craving. With low serotonin we also see worry, anxiety, depression, anger, PMS, insomnia and irritability. Let’s assume the DPA helps and the tyrosine helps with the fatigue, then we’d consider a trial of tryptophan and add that.

So yes I do have many clients needing more than one amino acid! But we always trial one at a time and find a good baseline before adding the next one or doing a new trial if the first one didn’t give expected results.

With regards to which amino acid trial to do first, I always ask my client which area is causing the most problem or distress in your life and we start there. Since she mentioned emotional eating and then fatigue and then cravings after a savory meal, this sequence may be best for her. But addressing the fatigue with tyrosine first may be a better approach for someone else.

With regards to cravings after a savory meal we also look into how much protein and healthy fats the client has in that meal. I don’t know why garlic would be a trigger other than it’s possibly stirring up candida. Candida is also a big factor when it comes to sugar cravings, fatigue and feeling sad/emotional so we would also possibly need to address this too.

Adrenal and sleep support is also key and I recommend this resource for additional caregiver support for her – The psychological trauma of coronavirus – nutritional support for doctors, nurses and their loved ones.

For her husband’s PTSD I recommend this resource – PTSD from 3 tours in Afghanistan: Can GABA help with the anxiety?

For her son’s seizures I recommend this paper, Ketogenic Diet and Epilepsy: What We Know So Far, and working with a practitioner who could offer consultation and guidance on a ketogenic diet. Another useful resource is this one – Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials.

If you suspect low levels of any any of the neurotransmitters and are new to using the amino acids and do not have my book I highly recommend getting it and reading it before jumping in to taking supplements: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings.

There is a complete chapter on the amino acids and one for pyroluria, plus information on real whole food, sugar and blood sugar, gluten, digestion and much more. If you’re not a reader there is now also an audible version.

Here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary

Please also read and follow these Amino Acid Precautions.

This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs. You’ll find DPA, tyrosine and tryptophan listed here.

Please share your emotional eating and sugar craving success story if you have one using DPA.

And let us know if tyrosine helps with your fatigue and low-energy driven sugar cravings?

And does tryptophan help your afternoon and evening sugar cravings?

Feel free to post your questions here too.

Tryptophan ends TMJ pain, headaches and worry, and improves mood and sleep: a success story

July 17, 2020 By Trudy Scott 22 Comments

Today I’m sharing a success story on how the amino acid tryptophan, taken as a supplement, ends TMJ (temporomandibular joint) pain and headaches in a woman in my community. She had the added benefits of an improved mood and less worrying and her sleep improved too.

There is evidence to support the low serotonin connection to TMJ and pain like fibromyalgia and I share that research below.

Before I share the success story, in case you’re new to neurotransmitter imbalances, the other symptoms we see with low serotonin are the worrying-type of anxiety, panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues, insomnia and afternoon/evening cravings. Tryptophan can be used to boost serotonin levels and improve these symptoms as you’ll see below.

Right after speaking on the recent Trauma and Mind-Body Super Conference, Renee shared her wonderful success story on Facebook:

Out of all the interviews I felt yours gave the most actionable steps. I was taking amitriptyline for TMJ and didn’t like the side effects, however what other options did I have? Not many according to my GP [general practitioner]. Luckily I found your suggestion of tryptophan. And I can’t explain how much of a change it made! I weaned off the medicine and took tryptophan instead and not only did it help the TMJ but also helped me feel more even emotionally.

I am being referred for trauma therapy and I am optimistic that I will be discomfort free soon.

So huge thanks for sharing your knowledge. It helped me at a time when I was really starting to think there were no ‘natural’ options and conventional meds were all I could take.

I checked in with her, thanking her and acknowledging her wonderful feedback. I also asked how much tryptophan made this difference and how quickly she saw an improvement. And what side-effects she was seeing with the medication. She shared this:

I am a week into taking tryptophan, and I’m taking 500mg. I saw improvements with the TMJ within an hour of taking it. My jaw felt loose and I had no headaches, I also felt more ‘even’ mood wise. Like an underlying worry had gone. [worry is a classic symptom of low serotonin – more on that here]

I also had some stress yesterday that usually would have made me crumble, but instead I was able to stand up for myself and see subjectively the extent of the issue and resolve it. I am amazed!

My original medication (amitriptyline) had given me extreme dry mouth, which I found hard to manage, the headaches were also not relieved as much as I had hoped, plus I was having sessions of palpitations.

I haven’t had any palpitations from the day I started tryptophan whereas the dry mouth took some time to subside.

These really are wonderful results and typical that we’d see results this quickly with tryptophan if the root cause of the TMJ and headaches is low serotonin. It can sometimes take a few weeks to find the ideal dose but Renee found it with the initial trial amount of 500mg.

The tryptophan also improved her sleep (and the palpitations and dry mouth side-effects from the medication stopped):

I was struggling to get to sleep and stay asleep, suffering bouts of insomnia, prior to any medication. I still am sleeping well taking tryptophan which I am pleased about.

She did however share that the timing of the tryptophan was making her too sleepy too early in the evening and she was planning to shift the timing:

I am finding tryptophan is making me feel drowsy in the evening, so I am trying different times during the day to take it. Hopefully I can push back the tiredness to perhaps 8/9 at night to coincide with bedtime.

My advice to her was that I have my clients use tryptophan MA (mid-afternoon) and evening and if MA makes them too sleepy they just do an evening dose. That can be enough for TMJ the next day. Sometimes more than 1 x 500mg in the evening is needed for easing TMJ and headache pain that night and the next day too.

I did check with her about weaning off the medication as cold-turkey quitting of psychiatric medications are dangerous and not advised. She shared this:

I weaned off over 1 week, but I was only in it for 8 weeks in total before I found tryptophan.

A slow taper under the guidance of the prescribing doctor is always recommended (more on this for amitriptyline/Elavil withdrawal here).

Here is some research supporting this serotonin/TMJ connection:

Plasma tryptophan and kynurenine in females with temporomandibular disorders and fibromyalgia – An exploratory pilot study

…both temporomandibular disorders myalgia (TMDM) and fibromyalgia (FM) have been linked to central and peripheral changes in serotonin availability.” (tryptophan is not used in this study which also makes the serotonin/anxiety connection)

The effects of dietary tryptophan on chronic maxillofacial pain and experimental pain tolerance

Over the 4 weeks of the study, there was a greater reduction in reported clinical pain and a greater increase in pain tolerance threshold in the tryptophan group than in the placebo group. The tryptophan group was given “three grams of tryptophan in conjunction with a high carbohydrate, low fat, low protein diet.”

If you suspect low serotonin symptoms and are new to using the amino acids and do not have my book I highly recommend getting it and reading it before jumping in to taking supplements: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings.

Here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary

Please also read and follow these Amino Acid Precautions.

This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs.

We appreciate Renee sharing her success story. Please share your TMJ/headache tryptophan success story if you have one. And feel free to post your questions here too.

Mercury & gadolinium toxicity, iron overload, COVID-19: NBMI research update and potential applications

July 10, 2020 By Trudy Scott 9 Comments

Professor Boyd Haley set out to find a safe and non-toxic heavy metal chelator that would cross the blood-brain barrier, get inside the cells and bind mercury. The compound was initially sold as an antioxidant called OSR and is now called NBMI. In 2018 I wrote a blog about this – Mercury detox: NBMI as a safe and non-toxic heavy metal chelator. At the time NBMI was in phase 2 clinical trials. The blog was a popular one then and still gets many comments and requests for updates. Today I’m sharing some updates on progress, new studies and proposed new applications. I still find NBMI intriguing and look forward to it being readily available once the studies are completed.

The recent newsletter from EmeraMed, reports that their projects are all running according to plan (despite coronavirus setbacks) and “producing the anticipated positive results necessary to bring our drug to market. When we complete the studies requested last year by the FDA, EmeraMed will file a new drug application (NDA), which then starts the FDA approval process.”

Studies on metal binding have shown that NBMI is strongly attracted to mercury, arsenic, lead, cadmium, uranium, gadolinium [used as a contrast agent in MRIs] and free iron and copper.

EmeraMed are expanding the clinical trials to look at other disorders that NBMI can potentially improve. These updates were shared in the newsletter:

The Colombian drug regulatory agency INVIMA approved a trial for mercury intoxication in May 2020:

…mercury intoxication and kidney disease are a serious life-threatening intractable condition and prominent in Colombia

…mercury from fish in the Santa Margareta river is one potential source for kidney injury leading to dialysis treatment. It will be a double-blind placebo controlled pivotal study, the participants health and results will be carefully monitored.

The treatment will be much longer than our earlier trials with gold miners and will look at numerous physiological parameters.

There are two pilot studies on iron overload in Europe:

Excess iron causes many devastating disorders, some lethal. Atypical Parkinson, an always fatal disease, is partially finished.

We expect to receive an interim report by July 2020 on a Thalassemia study that shows a highly significant benefit from NBMI. 8 out of 8 improved without any reported drug induce toxic side effects. “Impressive” in the words of one reviewer.

A potential use for COVID-19 based on NBMI increasing glutathione levels:

The mechanism of action is based on the ability of Emeramide to: 1; enter cells and cross the blood brain barrier, 2; scavenge and remove existing hydroxyl free radicals lowering oxidative stress and 3; chelate into non-reactive and non-toxic complexes several toxic metals and most importantly Fe2+ a redox metal that has been proposed to be displaced from hemoglobin by the COVID-19 infection.

We know NBMI would help because viruses need to release free iron to be able to reproduce. That iron causes oxidative stress possibly leading to a cytokine storm.

Another potential application is environmental clean-up of rivers, lakes and streams:

Arsenic (As) in drinking water is a well-recognized problem but since it is very difficult to remove, EPA maximum drinking water standard allows drinking water to have arsenic levels that cause significant amounts of bladder and lung cancers.

And one more potential application is the improved “treatment of waste-water sewer sludge to remove mercury or other toxic metals before it is spread on farms.”

Here is the mercury feasibility trial mentioned in the newsletter: Efficacy of N,N’bis-(2-mercaptoethyl) Isophthalamide on Mercury Intoxication: A Randomized Controlled Trial, where NBMI was given to 36 gold miners with high levels of mercury in their urine:

Although this study was designed with a small sample size to test for feasibility, the gained results with 300 mg NBMI already showed an effect on physical fatigue with statistical significance and there were indications to positive effects on other symptoms, like sleeping problems.

The newsletter link above has information about which countries are allowing early access. Please contact the company directly rather than ask me about how to obtain the product as I am simply sharing what they have shared with me. I also encourage you to sign up for EmeraMed’s newsletter so you can keep up to date with progress and access information.

I find it intriguing and look forward to it being readily available once the studies are completed.

Please share if you used the original OSR product with any success or if you have managed to obtain NBMI and trial it?

And feel free to post your questions for Professor Boyd Haley. I’m hoping to have him speak on Anxiety Summit 6: Toxins/Meds/Infections.

Anxiety and globus pharyngeus (lump in the throat): GABA to the rescue?

July 3, 2020 By Trudy Scott 41 Comments

Low levels of GABA, a calming neurotransmitter can lead to anxiety, fears and panic attacks. With low GABA, the anxiety is a physical kind of anxiety with muscle tension or muscle spasms. Today you’ll read how low GABA may be one possible root cause of globus pharyngeus, which you may have experienced as a rather scary golf-ball-like lump or constriction in the throat.

Let me describe globus pharyngeus and then I’ll share my story with globus pharyngeus, why low GABA may be a factor (and supplemental sublingual GABA to the rescue) and other possible root causes that should be considered.

This 2015 paper, Globus pharyngeus: an update for general practice, defines it as follows:

Globus pharyngeus or globus sensation is the painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling.

Globus means globe or sphere and it can actually feel like you have a golf-ball sized object in your throat.

You may have experienced it without even knowing the medical name. Only a few of my clients and those in my community have ever heard the term. I also only learned about the name many years after my episode.

What is very surprising is that, according to the above paper, up to 45% of the population have experienced it.

My story with globus pharyngeus

I’m one of the 45% and for me it was a terrifying experience. As you may know, I experienced anxiety, PMS, fears and panic attacks in my late 30s and early 40s (it’s why I do this work).

Fortunately I only had one episode. It truly felt like I had a golf-ball in my throat and was horrifying. I knew I needed to swallow so I could get rid of this obstruction but at the same time I was terrified to swallow in case it got stuck and choked and killed me.

I remember going to the mirror to try and see this golf-ball sized object in my throat. I was so surprised that I couldn’t see anything.

Looking back, I suspect the addition of GABA Calm to my protocol prevented further episodes. I was also using progesterone cream at the time and this promotes GABA production too.

I’ve had many clients report that looking back they also realized their episodes stopped once they addressed their low GABA levels.

I was also under a great deal of stress at the time: work stress (long hours and my adrenals were a mess) and physical stress (due to amalgam removal, gluten issues, perimenopausal changes and much more).

Globus pharyngeus and GABA

The fact that the throat or pharynx “is a muscular tube that runs from the back of your nose down into your neck” is one reason for considering a muscle spasm and low GABA as a root cause.

The amino acid GABA, when used sublingually, eases muscle spasms within 15 seconds to 2 minutes. Some examples where we see this:

If you’re in the midst of an episode it’s impossible to open a capsule of GABA into your mouth. Until a client knows how much they can tolerate we start with 100-125 mg and increased based on the trial. Taking the powder and dabbing it with a wet finger and putting the finger to the inside cheek a few times is the best way for quick relief.

A product that is GABA-only in a capsule such as Enzymatic Therapy GABA or ProThera 500mg GABA are my choices for in-the moment relief (more on these in my supplement store here).

Source Naturals GABA Calm is my most popular GABA product and is my choice for everyday use.

Of course, I recommend this approach to doing nothing. The authors state: “simple reassurance may be all that is required” or “Advise patients to resist the urge to dry swallow.” We can do better.

Once your GABA levels are sufficient, it’s less likely to happen unless you’re under a great deal of stress and/or there are psychological factors at play:

There is increased reporting of stressful life events prior to development of symptoms and research suggests that as many as 96% of patients with globus sensation report an exacerbation of symptoms during times of emotional intensity.

During times of added stress, folks may experience other “physical symptoms such as palpitations, poor sleep, and feelings of panic.”