Dr. Peter Bongiorno, ND, author of Holistic Therapies for Anxiety and Depression, is interviewed on the Anxiety Summit by host of the Anxiety Summit, Trudy Scott, Food Mood Expert and Nutritionist, author of The Antianxiety Food Solution.
Serotonin and anxiety: tryptophan, 5-HTP, serotonin syndrome and medication tapers
- What is the serotonin hypothesis and serotonin syndrome
- Concerns about tryptophan and kynurenine and neurotoxic quinolinic acid
- When to use tryptophan and when to use 5-HTP
- Working with a prescribing doctor to do a SSRI (and benzo) taper
- John’s Wort, saffron and venetron for anxiety and depression
- Hydrotherapy and hugs
Here are some snippets from our interview:
Here are some gems from our interview:
As far as St. John’s Wort I would honestly put that in a different category because St. John’s Wort is not just another type of serotonin enhancer or SSRI. It has many, many other activities. It supports the thyroid. It really helps digestion. It’s a good anti-inflammatory. It calms the nervous system. And it also supports other neurotransmitters too. So to me St. John’s Wort is more like a beautiful food that has these very pleiotropic effects and really helps the whole body kind of cope and gain resilience. Years ago St. John’s Wort was originally used to ward off evil spirits in olden times. And so it has a tremendous history of supporting people with mood and especially people who are very fatigued in the process and they can’t cope and they have no resilience. So I think St. John’s Wort is definitely more than just a serotonin enhancer.
We also cover carnitine:
One of the things I like to check is something called carnitine which is an amino acid which plays a role in how energy is carried in the body. And many women get much depleted in carnitine as they move through pregnancy through the trimesters. And that’s actually quite safe to take during pregnancy and I’ve seen that be very, very helpful in women with mood issues either during pregnancy or postpartum. And there are plenty of studies that show the safety of carnitine. So that’s one of the things I definitely like to look at along with taking some magnesium which is also safe during pregnancy.
We discuss medication tapers of SSRIs:
And the weaning process would have to be different for everyone. Some patients who have been on some of these mood altering medications for many years you can’t just wean off quickly. You have to go exceedingly slow. And depending on how they do then we can support their brain and their body with more nutrients to help that process go as easily as possible and minimize any kind of withdrawal effect. The body will tell us what to do as we go along. But again 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.
Here are two of Dr. Bongiorno’s books:
How Come They’re Happy and I’m Not – The Complete Natural Program for Healing Depression for Good
And his most recent book: Put Anxiety Behind You
Here is his digital gift: 10 Ways to Balance Serotonin Naturally http://www.drpeterbongiorno.com/serotonin/
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Hi Dr Bongornio,
I am in the Uk and wanted to know about the Mood sysem support – are these tablets and do they also contain saffron?
Where can I get hold of them and what would the amount you suggest to take?
Could also just take normal saffron bought from the asian green grocers?
Julie
Yes, I’m also in the UK & interested in the Mood System Support -and the other supplement blend Neurotransmitter Balance? I was hoping there would be info/links on this page re these supplements & how/where to buy them. I had a look on his website, Inner Source but, in their shop, there’s nothing under Mood for either of these.
Also re saffron, he said you could get it much more cheaply if u buy the petals vs the stigmas (I think I was hearing him right) of the plant (the stigmas are what are sold as a spice he said) but where do u buy the petals from?
Thanks, Nisha.
hi Julie and Nisha,
Thank you so much for listening to the Anxiety Summit and for your questions.
Yes, cooking with saffron is helpful – food is wonderful way to get this herb. These are available on my website (check again – you will see them now :)ca ). To order, you can use the code “P167HEALTH” but we would need to add extra postage to mail to the UK, if that is allowable to do so.
As far as the petals, sometimes companies that sell the spice, may also have the petals too.
great health,
dr. peter
I didn’t hear any mention of melatonin as a serotonin precursor to aid in sleep. Is the current opinion that it no longer works? I am not up on the research.
I know the topic of this summit is anxiety, but doctors have often prescribed anti-depressants to me, thinking they would help me sleep, with disastrous results. I’ve tried many different medications over nearly two decades of debilitating insomnia including Elavil, Ambien and Mirtazapine; the side effects of each were far, far worse than the tiny amount of improvement in sleep.
Mary
I love melatonin and typically start with tryptophan and add melatonin if the tryptophan alone doesn’t help with sleep.
I’m sorry to hear about your sleep issues. There can be many underlying factors with insomnia: low serotonin, low GABA, high cortisol, gluten issues, SIBO, low blood sugar so finding the root cause and addressing it is key.
Dr. Bongiornio will hopefully come and comment too
Oh. My. Goodness!
UPDATE: After working with a functional medicine doctor for two years, all my underlying problems have been addressed and now at this point neurotransmitter repletion will be effective for more than a temporary lift. It was a long wait, but it seems that a complete GABA protocol is helping me sleep much more deeply than before. I’ve never been a deep sleeper. This is a new thing for me. Low GABA since childhood has probably been a big part of my lifelong anxiety and my more recent insomnia with racing thoughts in the middle of the night. Just wanted others to know that it is possible to stabilize and balance long term neurotransmitter issues, provided there is adequate preparation.
Hi Mary
So glad to hear! Would love to hear about the underlying problems that were addressed?
that is good news Mary. Like Trudy, I’d be interested in hearing about the underlying factors. Reasons for low GABA are numerous, and are different for each person. At any rate, GABA is such an important calming neurotransmitter, and there are a lot of wonderful choices from the natural world to help encourage it. Sounds like you are doing great work
Hi guys. Thanks for your interest. What my func. med. doc had me do was:
* diet change: remove grain, dairy & sources of free glutamate
* keep blood sugar stable with diet & supplements
* supporting methylation (I’m compound hetero and tested extremely high with whole blood histamine)
* brainwave optimization for sensory overwhelm
* improved sleep hygiene – no screens during evening & night
* copper detox (copper/zinc ratio) <– when I noticed the big change
* iodine repletion (halide detox)
* bio identical progesterone (which didn't work on the first try – we'll get back to that after neurotransmitter repletion)
* currently doing a cocktail of small amounts of various neurotransmitters and supportive supplements, because *all* of mine tested low
* recently started an extensive GABA protocol
Hi Mary,
Sleep issues can certainly be most challenging. Melatonin is actually made from serotonin. In the brain, tryptophan becomes 5HTP, which becomes serotonin, which turns into melatonin. Sometimes, when serotonin is on short supply, taking supplemental melatonin can be very helpful. As Trudy mentioned above, there are many factors that can play a role in poor sleep. I would also add to Trudy’s list above, sometimes female hormones can also be a part as well. Balancing with natural progesterone is helpful in these these cases while working on stress, which is often a reason hormones can get out of balance.
Thank you to both of you for your followup comments, for clarifying that melatonin still is in use when appropriate and also to Dr. Bongornio for explaining the conversion of one chemical to another in the body.
I have had life-limiting insomnia for so long (18 years) that I have tried just about everything, from sleep hygeine to darkening the windowshades and using a sleep mask plus earplugs, to limiting blue light exposure from electronics to magnesium supplements … to mindfulness and developing a proper nighttime winding down for the day routine … and now I will have a sleep study and talk to the sleep disorders clinic for the first time. I really wish I had not allowed this to go on for so long.
Actually, I had no other choice when the pills failed to help, and suffered in silence until I began to demand help from a new doctor, quantifying the extent of my insomnia and fatigue wherever possible by using numbers. I think it is important to give doctors as many objective facts as possible, because they must assume that “everybody goes sleepless once in a while” and you might be talking about something that is of far greater magnitude.
Perhaps I missed Dr. Bongiorno’s clarification of when to use tryptophan and when to use 5-HTP? Would it possible to reiterate?
Thank you!
This is also my question.
And when to use other supplements. How do you know what to start trying first?
I’ll have Dr. Bongiorno come and comment – but will say this – he said it based on the intake and other symptoms. As practitioners we all have our favorite products we use. I typically start with tryptophan (the Lidtke brand)
Thank you. I have heard many stories of tryptophan causing anxiety, and waking with anxiety, after being on it a few days. Any suggestions to avoid this with tryptophan? I’m nervous it will exacerbate my anxiety…though, it’s supposed to help! Thank you so much!
Michele
I agree with all that Dr B says and will add that too much of an amino such as tryptophan (or any of them) can cause anxiety and/or affect sleep. So I like to have my clients start low and build up slowly
Hello, I tried 1 capsule of lidtke tryptophan complete, a few nights ago, and woke relatedly, and have been anxious and nervous all day for the past few days. It seems my system is too sensitive, and anytime I mess with it, things go haywire. Is there anything i can do to counteract this? It’s three days since I’ve taken anything, and I am still waking up with heart racing, anxious, and feel like I’m shaking inside.
Michele
I’m sorry to hear this. Vitamin C 1000mg is a good antidote for the amino acids but they are typically out of the system in about 4 hours. It seems one of the other ingredients in the Tryptophan complete is an issue. It’s likely the folate. This is the reason I prefer to use the 500mg Lidtke Tryptophan with clients first.
I hope you’re doing better now
that is a good question Kim. The answer will certainly depend on the practitioner. I personally like to use supplemental tryptophan for sleep support, and I tend to use 5-HTP more for daytime use. 5-HTP is especially useful when there’s anxiety during thee day, and need for appetite control to support weight loss. Having said that, sometimes, I find if one is not working for a patient, then we might switch to the other to see if results are better. The body has the ultimate wisdom, so I try to follow that.
Dr. Bongiorno,
What if your mental Health issues are biological?
You dont think ssris work??
Awesome interview
Kathleen
Glad you found it awesome! I’m not clear about your question?
Trudy , if someone has a mental health
Its hereditary, / will these nutrients & tapering off still help?
Also do you feel SSRI S are helpful ?
Kathy
For your first question absolutely – if mom has gluten issues, child likely to OR mom low in zinc and so is child OR mom exposed to mercury (and has mood issues) and this affects the child.
I am a nutritionist and encourage food and nutrients. And am very aware of the side-effects and other issues with SSRIs. Dr. Kelly Brogan’s new book “A Mind of Your Own” is an excellent resource. Here is a link to an interview with her https://www.everywomanover29.com/blog/medication-tapering-withdrawal-kelly-brogan/
Please everyone realise that serotonin syndrome is a killer. I was on 1/4 of the prescribed does of two common antidepressants (prescribed dose which was normal dose would have killed me) and had two minutes left to live! My doctors and psychs said it was in my head, an asian pharmacist picked it up immediately, then I had to literally fight in casualty to get to see head of ED who then hit the emergency button (used for cardiac arrest). Note that the effects of excess serotonin often leads to criminality, I have often seen this (I ran a mental health network) it may be transient 24 hrs etc. PLEASE understand the dangers, Also studies now show huge increase in suicidality with excess serotonin. Medics seem to be seriously or wilfully ignorant of this. Nor did the medics ever offer any follow up for the damage this did to my body/mind.
Pip
I’m sorry to hear this and thanks for sharing. Yes, serotonin syndrome is very serious
Great interview! I am a CNC (who specializes in mood disorders) who is also in herbal school. He mentioned an herb near the end of the discussion that I have not heard of. I must be spelling it wrong b/c I cannot find it under the common name or Latin name he stated. Could you spell it for me- it sounded like “venatron” I would like to do some research on it. Thank you!
Here you go: http://maypro.com/products/venetron
Hi Karen
It’s Venetron “a patented, purified, powdered extract of Apocynum venetum” http://maypro.com/products/venetron I have not used it but was intrigued so asked Dr B to share more. Do let us know what you find
I’d love to connect after the summit – a CNC who specializes in mood disorders – fabulous!
Thank you so much Trudy and Dr B !
having sever insomnia; from 23 yrs on Syntroid, over medicated. 🙁 ….no more medz for me ! wanted to find out the Venetron could help.
Thanks so much.
Great presentation. I am curious about supplements and what brands or companies that you feel offer the best quality. At this time I use ortho molecular products for most of my supplements but i have switched to jarrow and a few other brands to try to save money but I wonder if it is adding to my now current episode of anxiety. Is there a place to reference to for quality supplements.
Thank you
Johanna
I’ll ask Dr Bongiorno to hop on and comment. In the meantime I can say that we both use professional grade companies that we have looked into and trust. He mentioned Douglas Labs – I use them too for certain products. I do also find I’ll use one company for one product and another for other products. An example is tryptophan – I find Lidtke tryptophan to be superior to any other and only recommend this one. On Monday you’ll hear my interview with Ron Sturtz from Lidtke and we talk about not cutting corners to save money. This is especially the case with tryptophan but with other products too. Just like food, we want the best. Here is the link to the aminos and related products I use with clients. https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/ You’ll find that each practitioners has their own favorites that have found to give results over the years.
Trudy,
Thank you so much for responding. This summit has come at such a great time for me and I have learned a tremendous amount and have already made a few changes. I do agree that cutting cost on supplements by buying cheaper products was not the best move on my part and I now realize the importance of quality not cost. I do look forward to Dr. Bongiorno comment on supplement companies that he feels are good. I did look into Douglas labs however they do not have the products I take that are egg free. At this time I have to have supplements that are egg, soy, dairy, gluten,corn free. Its harder than it seems to find products free of these things.
Thanks for responding.
Johanna
I have the added complication of requiring a capsule that is not made from gelatin, as the free glutamate is too much for my brain currently. My functional medicine doc is giving me supplements in capsules made from hydroxyproplmethylcellulose – “HPMC.” He said it’s important that I don’t get too much free glutamate at this point in my healing process.
I’d like clarification on the Mood Systems Balance and the Neurotransmitter Balance supplements Dr. Bongiorno mentioned. At what point in time and under what circumstances should they be taken, and how to determine which one to take or can they both be taken at the same time? For example, I have not yet tried l-tryptophan but plan on doing so, so are the Balance supplements a replacement for taking l-tryptophan or GABA, OR are they an adjunct? Thank you!
Donna
There are products that Dr. Bongiorno has formulated and would be instead of tryptophan
Thank you Trudy!
In what situation would 5-HTP be taken instead of tryptophan? What is the difference, and why would one or the other be taken in situations? Thank you!
Sally
Some people do better with one vs the other. I typically start with tryptophan and I generally avoid 5-HTP when someone has high cortisol or has a wired-tired feeling.
Hi Sally,
I often use supplemental tryptophan for sleep support, and I tend to use 5-HTP more for daytime use. 5-HTP is especially useful when there’s anxiety during thee day, and need for appetite control to support weight loss. Having said that, sometimes, I find if one is not working for a patient, then we might switch to the other to see if results are better. The body has the ultimate wisdom, so I try to follow that.
Trudy – You have been doing a GREAT job on this summit. WHile I haven’t listened to all the presentations, I have a question about SAM-e. Has Dr. Bongiorno used this in his supplement regime? If so, what is a suggested dosage?
SAM-e appears to help with more than the serotonin neurotramsmitters. I’d appreciate your thoughts.
Vicki
Vicki
I don’t use SAMe every much at all so can’t comment but Dr Bongionorno covers it in his book “Holistic Solutions for Anxiety and Depression” https://www.everywomanover29.com/blog/holistic-solutions-for-anxiety-depression/
Hi Trudy, Thank you for the note. SAMe is well known and well researched as an antidepressant. In most other countries, it is available by prescription only, although it is a natural substance.
I use it in combination at a lower dosage with a few other neurortransmitter-supportive nutrients in my formula called (http://www.douglaslabs.com/neurotransmitter-balance-dagger.html).
sometimes, I will use it by itself at higher dosages, 200mg to 400mg up to three times a day. I always start with 200mg twice a day, for sometimes the digestive system needs to get used to it first.
great health,
dr. peter
i meant to say “Hi Vicki” – not Trudy 🙂
I seem to get activated by B-12 supplementation. I have major insomnia issues. So many of the supplements that are supposed to be calming and help with sleep have huge amounts of B-12. If I take a b complex at 6:00 am, I have much more difficulty falling and staying asleep that night, even if I take prescription sleep meds. Does anyone else experience this?
Trini, as soon as I started to take methyl donors (precursors for B12) my sleep became less deep but this part of the process is necessary for me. I’m working with a functional medicine clinic. I think B6 and B multi formulations also tend to rev me up, even if I take them at breakfast. I think it’s pretty common.
Hi Trini – many people are sensitive to these. If so, then lower dosages may be best until other aspects of your care are addressed. I would rather see a patients get lower dosages, but sleep better.
yours,
dr. peter
Hi Trudy,
Could you clarify whether or not the B Vitamins that are needed with Tryptophan need to be taken at the same time as taking the Tryptophan or if those can be taken earlier in the day?
Also, when I’ve taken St. John’s Wort in the past, it seemed like over time it may have helped my depression, but really increased my anxiety. I know I’m very sensitive, but have you run into that with your clients? Do you think it was just too high of a dose? A homeopath I worked with said that St. John’s Wort and too much Vitamin D could bring on anxiety. Just wondering if there are studies that show that. The same goes for Curcumin. I keep hearing the great benefits of curcumin and would like to take it, but it seems like when I do or when I eat curry, which I love, my anxiety increases.
Thanks for your thoughts and especially help on knowing when B Vitamins should be taken with Tryptophan. And thanks again, so very much for putting on this Summit. I started my daughter on the Theanine Dr. Zendi recommended and I think it is helping already:)
Dawn
I don’t think it matters if they are not taken at the exact same time. St. John’s Wort is not something I’ve used with clients so I can’t comment on that one.
With curcumin it could be a food intolerance or an oxalate issue – here’s a great article on curry and oxalates http://lowoxalateinfo.com/the-low-oxalate-curry-guide/
Wonderful that the theanine is helping your daughter aleady
Hi dawn, thank you for the note. I use a tryptophan product (called Tryptophan Calmplete) that has both the b vitamins and the tryptophan together for convenience. However, I don’t know of any reason why they need to be taken together. Traditionally, St. John’s wort is used for people who are dealing with both anxiety and depression (especially when there are digestive issues). I do use SJW often, and do not see it increase anxiety. It does affect liver clearance of medications, and may be affecting levels of drugs if you are possibly taking them. As far as too much vitamin D, I do believe excess amounts of anything can be unbalancing. best, dr. p
I have many of the symptoms of pyoluria including one frequently mentioned, thin skin (and was the lighter of 2 kids which is also sometimes mentioned). What can I do to solve the thin skin issue? And are there any practitioners who you know that deal with skin a lot in a natural way as you do?
Chrysan
With pyroluria zinc is the nutrient that helps with skin issues. I love Dr. Trevor Cates http://drtrevorcates.com/ for skin health
Hi Chyrsan,
Yes to the zinc. I also use an activated form of vitamin B6 (called P5P) and I like a little extra vitamin A in the form of cod liver oil or a supplement from fish oil. Do not take vitamin A if pregnant though. Also, with thin skin, consider looking at cortisol levels in the body. Sometimes when these are high, the skin can thin a bit yours, dr. peter
Hello Trudy,
fantastic job with the summit! I just love all the experts you bring together. I believe during Dr. Bongiorno’s talk he mentioned an app that he uses in the morning time to see how well he slept (using the camera on the phone to measure his resting heart rate?) Can you remind me of the name of this app?
Thanks so much!
Hi Sara, Thank you for the note and for listening. I do not believe that was my interview. I do not use an app in the morning myself – I do see many of my patients who use these though, and find they are helpful. I do not have a specific recommendation though. – dr. p
Sara
It was in Mike Mutzel’s interview on leptin resistance and anxiety. It was the Insight Meditation timer (free) and the Muse Meditation Headband. (It’s a mobile quantitative EEG device.)
Let us know what you think of it
Hi Trudy, I wanted to know better about the doses of tryptophan and inositol. When do you take tryptophan and inositol you can take them near or you have to wait time between each other? A 14 year old boy can take 35mg of tryptophan and 2gr of inositol? Are safe doses for a boy of this age? I’m learning many things by reading you, thank you for the valuable information .. Many thanks.
Rafael
The typical starting dose of tryptophan is 500mg and I use 2g of inositol. I use 120lbs as the weight cut off for adults and use less for children under this weight. They can be used together
Hi Trudy/Dr. Peter,
I am going through antidepressant discontinuation syndrome. I took mirtazapine for 11 months. Prior to mirtazapine, I was on Clonazapam for 1 month.
I tested low on serotonin and started the amino acid therapy last Jan 6. I had 100mg of 5HTP on hand. I took 1 capsule and I immediately felt like old self! The effect lasted the whole day. That night, I took another 100mg at bedtime and was able to sleep, although my sleep was still light / disturbed.
The following day, Jan 7, the daytime result was the same on 100mg 5HTP! I decided to add GABA NOW True Calm at bedtime because I read it helped with sleep. I was only able to sleep from 9pm-12mn then I woke up. I decided to take 100mg 5HTP to fall back asleep and that helped.
On Jan 8, I took True Calm again (has 200mg GABA and other ingredients) in the morning and my anxiety was through the roof and it’s all been hit & miss & downhill from there. I removed the GABA and took 5HTP & Tryptophan but sometimes it would work, sometimes it would make my anxiety worse.
I am taking Theanine now and that helps with my physical anxiety symptoms but I find myself feeling flat. I tried to add in 5HTP & Tryptophan for mood lifting but it wasn’t successful. My anxiety was worse. I also tried Taurine but I didn’t have any positive effect.
Do you have any ideas how I can make the therapy work for me? I really don’t want to go back to taking mirtazapine.
Thank you for your time.
Jen
Sorry to hear you’re going though this. Unfortunately prior medication use can lead to hit and miss results. It’s a matter of adjusting up and down as symptoms fluctuate.
Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.
Hi Jen – As do I apologize for the delay in response. I would also think about looking into and supporting the other aspects of your body’s physiology that play a role in serotonin and creating neurotransmitters: adrenal function, mitochondrial function, estrogen balance, nutrient levels (like zinc, B vitamins). Oftentimes, the pathways that help keep serotonin and GABA sustained need support from these more fundamental aspects of the body. While adding amino acid precursors can help in the short term, working on these and others can sustain balance in the long term.
I have been on Paxil for 20 years. I want to get off of it if I can. I have developed gut dysbiosis, gluten sensitivity, low sex drive and other issues. Could you give me a protocol to get off of this drug that I never wanted to be on. Thank you!! 🙂
Mary
I have clients discuss this with the prescribing doctor https://www.everywomanover29.com/blog/taper-from-antidepressant-tryptophan-amino-acids/
We also work on all aspects from my book “The Antianxiety Food Solution” https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/