Today’s article is based on a question I am seeing more and more on the blog: How do I taper from my antidepressant with tryptophan and can I safely use the other amino acids?
I find my clients do better when tapering off an antidepressant (which is often prescribed for anxiety and panic attacks) when their nutritional status is solid. Incorporating diet changes and adding amino acids and other nutrients first can result in a more successful taper with less side-effects. This would mean starting with the basics – eating real whole food, incorporating quality animal protein, eating to balance blood sugar, and removing gluten, caffeine and sugar.
If needed and based on testing results, it’s important to address any other nutritional deficiencies such as low iron, low vitamin D, low stomach acid, low total cholesterol, low B12 (and whatever else is an issue), plus support the adrenals/sex hormones/thyroid if needed and addressing gut health like leaky gut and dysbiosis.
Adding a good copper free multivitamin and often the addition of zinc and vitamin B6, evening primrose oil and possibly fish oil – the latter based on each person’s unique needs.
With antidepressants such as selective serotonin-reuptake inhibitors (SSRIs), I have my clients work with their prescribing doctor and get the approval to add tryptophan (or 5-HTP) 6 hours apart from the SSRI. If they are taking the medication at night they get the approval from their doctor to switch it to the morning, and will take tryptophan (or 5-HTP) at least 6 hours later, mid-afternoon and evening.
If they decide to do both the medication and tryptophan (or 5-HTP), they get a protocol for the SSRI taper for the future. This is important. If you are in too big a rush to start right away, it often causes more issues. It’s also important to make sure you get a very slow taper protocol from your doctor. Some antidepressants are harder to taper (Paxil is notoriously difficult) and they all should be tapered really slowly.
The plan is to start to taper the SSRI once you have been using the tryptophan (or 5-HTP) for at least 4 to 8 weeks and are seeing real benefits by using it. This translates to much much less or none of the following symptoms: anxiety, depression, insomnia, rumination, worry, negative-self-talk, perfectionism, afternoon and evening carbohydrate cravings, PMS, rage or anger.
For some of my clients it’s 3 months before they feel they are ready to taper. This may be because of feedback they have provided based on prior taper attempts and how they are feeling this time. It may also be based on what else is going on in their lives like a stressful work situation. It may also be based on the time of the year: winter is generally not a good time to taper and definitely not if you suffer from increased depression or anxiety in winter.
The tryptophan (or 5-HTP) is adjusted up as needed while continuing to taper the SSRI.
The doctor is always kept informed and monitors for the possibility of serotonin syndrome. I learned about the potential concerns about serotonin syndrome when using tryptophan or 5-HTP with an SSRI from Julia Ross, author of The Mood Cure, and so I continue to caution my clients about this.
When I interviewed Dr. Peter Bongiorno in season 4 of the Anxiety Summit (Serotonin and anxiety: tryptophan, 5-HTP, serotonin syndrome and medication tapers), he shared that he is not concerned about serotonin syndrome being an issue with tryptophan or 5-HTP dosed with an SSRI, even if taken at the same time. He cited research that found the combination of tryptophan and SSRI did not result in serotonin syndrome in any of the participants.
Dr. Bongiorno also uses the same approach to address the basics:
the most important thing is that we really establish all the basics and that they’re in the healthiest place possible. Because if those aren’t there, if a patient just gets off the medication and we haven’t really done anything to change the underlying reasons why they got to the place where they had the mood issue, in most cases they’re going to go back there again.
Some people need amino acid support in more than just the low serotonin area so we review the amino acid questionnaire and consider trials of GABA and other amino acids too. All this only applies for SSRIs and tryptophan or 5-HTP. The other amino acids can safely be used with SSRIs, and it’s not uncommon to also have low GABA, low endorphins, low catecholamines and low blood sugar and need them all, but it’s still best to discuss them with the prescribing doctor.
We also review all the amino acid precautions.
Some people choose to work with their doctor to taper the SSRI and then add the tryptophan (or 5-HTP) once they have quit the medication. I have found that this makes it much harder to do and more side-effects are seen. With the amino acids you start to get some relief right away and have hope on the first day! They also make it so much easier to quit the sugar, gluten and caffeine without having to use will-power.
In summary, these are my recommendations for doing an SSRI taper with amino acids:
- doctor’s approval to taper the SSRI and use amino acids
- address diet and nutritional deficiencies first – before starting to taper
- work with someone knowledgeable in amino acid use
- OR educate yourself by
(please don’t simply read one or two blogs and jump in to this)
- use the amino acids from day one to start addressing low levels of all the brain chemicals
- use the tryptophan or 5-HTP at least 6 hours away from the SSRI
I would like to add that Dr. Brogan shares that coffee enemas help her patients who are doing medication tapers and this is something I plan to start implementing going forward.
Have you used a similar SSRI taper protocol? And how did it work for you? What would you have done differently? And what advice would you give someone contemplating an SSRI taper?
Have you found that coffee enemas have helped?