agitation

The marketing of Risperdal and how atypical antipsychotics became a multi-billion-dollar industry – a shockingly eye-opening article!

August 22, 2025 By Trudy Scott 2 Comments

Even though I’m very aware this happens, this shockingly eye-opening article by Lydia Green is the best explanation I’ve heard….

I didn’t set out to shape the field of psychiatry. I was just a copywriter working in pharmaceutical advertising. But over time, I found myself at the center of a campaign that would help transform how mental illness—and its treatment—are understood in the U.S. This is the story of how we marketed one drug, Risperdal, and how that effort helped turn atypical antipsychotics into a multi-billion-dollar industry.

If you’ve ever wondered how this powerful class of drugs ended up being prescribed for everything from adolescent mood swings to agitated nursing home patients, you’re not alone. The rise of atypical antipsychotics was a business and marketing phenomenon—driven in part by a wave of pharmaceutical mergers in the 1990s. First introduced for schizophrenia, atypical antipsychotics were promoted as more effective and safer than older drugs like Haldol or Thorazine.

While journalists and regulators have addressed this issue, I want to share my memories of marketing Risperdal—the first widely prescribed atypical antipsychotic. This is the story of how we promoted Risperdal not just as a medication, but as a revolution in psychiatric care. It’s also the story of how we redefined schizophrenia, rewrote the safety narrative of antipsychotics, and helped drive one of the most successful (and concerning) pharmaceutical launches in history.

It was also my first realization of the immense power marketers have to shape their version of the truth—and how I eventually came to question the very system I helped build.

This is an excerpt from the excellent article recently published on the Mad in America site. We all need to be aware what happened with this medication and is still happening. It’s so wrong and is just heart-breaking to think how individuals and their families were manipulated and impacted. Unfortunately it’s very likely also happening with many other block-buster medications too – like Ozempic (for weight-loss), Evenity (for osteoporosis) and more.

In this blog, I share stories from social workers and psychologists who were working in the field at time, the overprescribing of atypical antipsychotics to children and teens in the mid-1990s and now, and the powerful effects of tryptophan, GABA, other nutrients and diet for anxiety, agitation, rage and sleep issues in autism, dementia and ADHD.

You can read the full article here – Confessions of an Ad Writer: How I Helped Turn Atypical Antipsychotics into a Billion-Dollar Industry.

Be sure to read some of the many comments from individuals and families who bore the brunt of this. It’s heartbreaking.

Stories from individuals who were working in the trenches at the time

I shared this article on Facebook and here is some of the feedback I received from the community. Laura Ann’s response:

Thank you for sharing this article. I can remember when I was fresh out of my grad social work program and was working in child psychiatry at the University of Maryland, our docs were pushing this drug for young children with ADHD and conduct disorder. Unbelievable! These companies and their executives should be criminally prosecuted.

We tend to think of these scandals as something that happened but aren’t currently happening. I think we will be reading similar articles about GLP-1’s.

I appreciate her for sharing what she was seeing as a social worker at the time. This is so sad and so wrong. I agree that these companies should be prosecuted. Instead they pay massive fines which are part of their marketing and just-doing-business budget, and continue as before.

Unfortunately Laura Ann is spot on, as much of this continues with Risperdal and other psychiatric meds and it’s already happening with GLP-1s. I share more on this below.

Elizabeth Mary’s response:

Just reading your post gave me chills and made my stomach turn. I worked with folks with developmental disabilities during this time period, I had for years! I watched as the antipsychotics and various psych meds infiltrated the group homes and joined a team of co-workers to fight it. We lost. It was disgusting. And I had no idea all this was happening in the background

My heart breaks for these individuals and their families. Bravo to her for trying to fight it and I appreciate her for sharing what she saw happening.

And this feedback from someone else in the community:

This drug was pushed on individuals with ASD (autism spectrum disorder)! Probably still is! Very sad!

I am a retired psychologist who worked primarily with individuals with developmental disabilities. I saw it all the time. The “medical model” was used a lot, meaning many saw psychiatrists and/or PCPs (primary care providers) who prescribed these meds. It has a long history.

Overprescribing of atypical antipsychotics and other psychiatric medications to children and teens – then and now

As mentioned above, I’ve been aware for some time that there is overprescribing of psychiatric medications to children and teens. In one of my interviews on an Anxiety Summit, “Psychiatric Medications in Children and Teens” with Dr. Nicole Beurkens, we discuss these results from this 2019 paper, Current Pattern of Psychiatric Comorbidity and Psychotropic Drug Prescription in Child and Adolescent Patients:

Our study indicates that the rate of presentation to child and adolescent psychiatry outpatient clinics is increasing, and rates of diagnosis and initiation of psychiatry drugs are high among the presented children.
The prevalence of ADHD shows an increase in males and females in our country, and psychiatric polypharmacy (multiple medications) has reached significant rates.

Keep in mind that Lydia Green shared her marketing work began in the mid-1990s, about 25 years before the above paper was published.

Unfortunately not much has changed. This 2025 paper from Swedish authors reports that the “number of prescriptions to children aged 5-17 years has increased” and that “most prescribed drugs were risperidone [Risperdal] and aripiprazole.”

This 2025 paper report that in a group of Australian children with intellectual disability, autism spectrum disorder and cerebral palsy, “risperidone was the most prescribed antipsychotic medication” and it was often prescribed off-label.

Similar increases in antipsychotic prescriptions are also reported in children and teens in Israel in 2025. The list of papers goes on and on and there are similar papers for dementia and other conditions.

There are versions of this story about a lot of diseases: osteoporosis is another one

Melissa’s response to the Risperdal article was this: “Makes you wonder about therapies they are pushing today.” It’s creating awareness which is what we need and she is asking a great question. Yes – there are many versions of this story about other medications.

Here is a perfect quote from this 2009 article: How A Bone Disease Grew To Fit The Prescription

There’s a powerful economic incentive for pharmaceutical firms to expand the boundaries of the use of different therapies. So whether you consider treatments for osteoporosis or treatments for depression or treatments for high cholesterol — in all of these settings — pharmaceutical firms stand to benefit if the therapies for these diseases are broadly used, even if they’re used among people who have very mild forms of these diseases.

In this same article, Caleb Alexander, a pharmaco-epidemiologist at the University of Chicago, is writing about the marketing of osteoporosis medications and says “the dynamic is well understood.” But all this applies equally to the marketing of all medications i.e. “There are versions of this story about a lot of diseases.”

Dubious marketing by the makers of Ozempic and Wegovy (GLP-1s for weight loss)

This is happening right now for GLP-1s. There were already reports in 2023 about dubious marketing by Novo Nordisk, the makers of Ozempic and Wegovy:

In Great Britain, the company has paid within three years a total of around 21.7 million pounds (24.7 million euros) to experts and organisations including important opinion leaders who have since touted semaglutide as a “game changer” in obesity in a campaign described as an “orchestrated PR campaign.

Sadly I expect their marketing campaigns to run unchecked and get more and more sophisticated, with unsuspecting consumers being taken advantage of and harmed.

Families are not aware of the powerful effects of tryptophan, GABA, other nutrients and diet

My goal is to try and change this lack of awareness so families and individuals can explore other options when they are faced with decisions about some of these medications.

Instead of using antipsychotics for a family member with dementia or Alzheimer’s who is experiencing agitation, aggression and anxiety, consider tryptophan and melatonin, and GABA:

Instead of using antipsychotics, explore the use of 5-HTP/tryptophan and/or GABA for kids with ADHD:

Instead of antipsychotics and other psychotropic medications in autism, explore tryptophan and GABA:

This is by no means a conclusive approach to addressing these symptoms in dementia/Alzheimer’s, ADHD and autism. We also need to consider and address diet, other nutritional imbalances, infections, gut health, toxins and much more.

Additional resources when you are new to using GABA and tryptophan as supplements

As always, I use the symptoms questionnaire to figure out if low GABA or low serotonin or other neurotransmitter imbalances may be an issue.

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control (this is covered in an entire chapter too), sugar cravings, anxiety and mood issues.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support. You can sign up to be notified when the next live launch is happening.

If you need serotonin support, the Serotonin QuickStart Program is a good place to get help. This is also a paid online/virtual group program where you get my guidance on using tryptophan and 5-HTP safely, and community support during 5 LIVE Q&A calls. You can sign up to be notified when the next live launch of this program is happening.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Wrapping up and your feedback

I appreciate Lydia for sharing this and enlightening us, and Mad in Arica for inviting her to do the article. And I appreciate community members for sharing and allowing me to share on this blog

Have you or a family member been the victim of the overprescribing of atypical antipsychotics ?

Have you seen this overprescribing of atypical antipsychotics happening in the work you do as a social worker, psychologist, doctor or other health professional?

Are you surprised to learn about similar strategies being used for marketing osteoporosis and GLP-1 medications?

Feel free to share and ask your questions below.

GABA lessens anxiety, agitation and defiance in 98 year old mother who has been “sundowning” for a couple of years

March 17, 2023 By Trudy Scott 11 Comments

Marsha shared this feedback on one of the blogs, saying that GABA lessens anxiety in her 98 year old mother:

My mother is 98 and has been “sundowning” for a couple of years. It starts around 3pm, sometimes earlier. Some days it’s no big deal. It is on those other days when she starts and then it goes to anxiety, agitation, then she can get sort of defiant which is so not her. She is a gentle soul, friendly, and kind so this is difficult on her as well as our family.

I just started to use my pestle and mortar to crush up a 125 mg GABA CALM supplement (Source Naturals) and I mix a little into her flavored yogurt when I start to see her having difficulty. I give it to her throughout the day. She only gets the 125 mg amount so I feel safe with that.

I believe that I do notice it lessens her anxiety. I pray that this will be helpful for her because that anxiety can be really draining for her. I will keep you posted. I have not noticed any adverse reactions. Thank you Trudy for all your info.

Anxiety, fear and agitation in sundowning syndrome: circadian dysfunction and low GABA

I responded, saying how wonderful to hear that she is noticing supplemental GABA lessens her mother’s anxiety (and presumably her agitation and defiance too). And I shared that GABA may be involved in sundowning syndrome.

This paper describes “sundowning syndrome,” as “a poorly understood (and even controversial) clinical phenomenon in Alzheimer’s and dementia patients that is characterized by agitation, aggression, and delirium during the late afternoon and early evening hours.”

The authors are focusing on potential pathways for circadian rhythm – physical, mental, and behavioral changes that follow a 24-hour cycle – dysfunction in sundowning. They also mention the presence of fear and anxiety and the fact that there is a circadian aspect of these emotional processes.

What is interesting is that the “master circadian pacemaker” i.e. “the suprachiasmatic nucleus of the hypothalamus” has impacts on both GABA and serotonin, and also dopamine and orexin (involved in sleep-wake processes).

Given the circadian aspect addressed in the above paper, “properly timed light exposure” i.e. early morning sunlight, is also worth exploring.

This paper, Implications of GABAergic Neurotransmission in Alzheimer’s Disease, focuses onGABA and shares that “of the two major types of synapses in the central nervous system (CNS): glutamatergic and GABAergic, which provide excitatory and inhibitory outputs respectively, abundant data implicate an impaired glutamatergic system during disease progression.”

The amino acid GABA helps to ease anxiety symptoms and agitation and restlessness, also helping with disturbed sleep.

GABA Calm dosing in the elderly with sundowning syndrome: my observations

I also expressed how this is a smart way to use the GABA Calm. I’m going to make some assumptions and share my observations:

Marsha uses GABA Calm herself and has a good level of comfort based on personal results. She knows how she feels after using it and is observing her mother’s symptoms. I have guided many family members in doing the same type of thing – mom’s working to help a child and a granddaughter helping a grandparent – and it works well.
Marsha has also started with a low dose of 125 mg. This is a typical starting dose and is a reasonable dose that may suffice for the entire day for someone this age. She may also need more and increasing the dose and observing is the way to go when someone can’t articulate how the amino acid is helping them. For some folks, 125mg may be too much – making them too sleepy or even more agitated/anxious – the dose can be reduced in this case (after using vitamin C as an antidote).
Marsha crushes the GABA Calm chewable/sublingual and mixes it into her mother’s flavored yogurt, since having her suck on the chewable is not an option. This is a great plan but as she continues to help her, she may see better results using a non-protein source to mix it in – like apple sauce or mashed banana.
Finally, she gives it to her mother when she starts to see her having difficulty. Again, it’s wonderful she is observing and helping her at the moment, but this could be a clue that she needs more GABA to provide even better results. We also don’t want to wait for the anxiety and then address it. Instead, we want to get GABA levels up and prevent it.

You can read more about Source Naturals GABA Calm product and why I use it with clients here.

Low serotonin, tryptophan and melatonin in sundowning syndrome

I also told Marsha that when I hear symptoms like agitation and defiance, especially with the 3pm start, I also would also consider low serotonin since it starts to decline afternoon into evening.

Her mother’s anxiety may be a mix of low GABA physical-type anxiety and low serotonin worry-type anxiety. She’ll only really know once she trials the respective amino acids.

I’ve seen low serotonin worry-type anxiety, agitation and defiance symptoms improve with tryptophan and/or melatonin and share more about this in this blog post – Sundowning in Alzheimer’s and dementia: melatonin/tryptophan for the agitation, restlessness, anxiety, disturbed sleep and aggression

Dietary factors and low dose lithium

Marsha says some days it’s no big deal. I would recommend keeping a food-mood log and make sure it’s not something in her diet that may be a trigger: hidden gluten, dietary oxalates or even blood sugar swings.

These are mentioned in the above blog, together with low dose lithium orotate which can help keep moods more even.

Microdose lithium is also capable of halting signs of advanced Alzheimer’s and improving cognition. More on that here.

It’s with much appreciation that Marsha shared this feedback. I’m thrilled for her and her mother. Hopefully, my feedback on this blog means she’ll be able to fine-tune things. And you get to learn and benefit from this feedback too – for your loved one.

A few GABA product options – a sublingual, a powder and a cream

A product I use and recommend is Source Naturals GABA Calm lozenges. This is one Marsha uses for herself and is using with her mother. It’s a good low dose of 125 mg and is convenient and effective because it’s a sublingual lozenge.

Now GABA Powder is another product I use and recommend. It does need to be measured out to provide a 125 mg typical starting dose or less (as needed), and could be mixed in water in a situation like this. I have clients use a handy mini measuring spoon like this one (my Amazon link) and share more about how to measure out GABA powder on this blog).

For Source Naturals GABA Calm lozenges and Now GABA Powder:

You can purchase these from my online store (Fullscript – only available to US customers – use this link to set up an account).
If you’re not in the US, you can purchase these at iherb (use this link to save 5%).

Somnium GABA Cream is another option that could be considered especially for those with Alzheimer’s or dementia who may struggle with using a supplement. It is available in the US and elsewhere with international shipping. Read more about the product and who else may benefit from using a cream, and grab my coupon code to save 15%.

Resources if you are new to using tryptophan or GABA as supplements

If you are new to using tryptophan or GABA as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA and low serotonin).

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues (which include rage/anger/irritability/self-harm).

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store. The above oral lavender products are available in my online store too.

Have you found GABA to help in a situation like this?

If yes, which symptoms have resolved and how much GABA/which product are you using/did you use?

What time did the symptoms start to ramp up?

And has serotonin support with tryptophan and/or melatonin also helped?

If you have questions and other feedback please share it here too.

Sundowning in Alzheimer’s and dementia: melatonin/tryptophan for the agitation, restlessness, anxiety, disturbed sleep and aggression

March 3, 2023 By Trudy Scott 8 Comments

The terms “sundown syndrome” or “sundowning” are used to describe a wide range of neuropsychiatric symptoms occurring in individuals with dementia in the late afternoon, evening, or night. These symptoms include confusion, restlessness, anxiety, agitation, aggression, pacing, wandering, screaming, yelling, and hallucinations. The treatment of sundown syndrome is challenging, and pharmacological therapies are not particularly effective.

This definition is from a very encouraging case study published as a letter to the editor of the Journal of the American Geriatrics Society – Melatonin for Sundown Syndrome and Delirium in Dementia: Is It Effective?

This case study is very typical in terms of symptoms and a pharmacological approach:

An 81-year-old man with Alzheimer’s disease diagnosed 4 years previously was admitted to the elderly department because of behavioral disturbances, sleep disorders, and wandering. His wife said that his cognitive and functional impairments had gradually worsened over the past 4 years and that, in the last 6 months, her husband had become verbally aggressive, agitated, and restless; wandered; and paced. He did not sleep for long and had difficulty falling asleep. The symptoms increased in the late afternoon and at night. He had no hallucinations or delusions. One month before admission, delirium was suspected, and his general practitioner prescribed haloperidol, but it was not effective.

During admission, sundown syndrome was diagnosed, and he received pharmacological and nonpharmacological interventions for behavioral and sleep disturbances, but none was effective, and some aggravated symptoms. The pharmacological interventions consisted of benzodiazepines, antipsychotics, cholinesterase inhibitors, mood stabilizers, and antidepressants, all given in an optimal dosing schedule.

Melatonin led to much improved symptoms within a few hours

None of the medications were effective and some made his symptoms worse. This case study is atypical in that his doctors were open to the use of melatonin. This led to much improved symptoms within a few hours and complete resolution in 2 weeks with a second dose:

After extensive review of his history, the effect of past treatments, and the published literature, melatonin was started at a dose of 2 mg at 8:00 p.m. for sleep disorders. Not only did his sleep quality improve within a week, but there was also significant improvement in his behavior within 2 hours of initiation of melatonin. A therapeutic trial with an additional dose of 2 mg given at 3:00 p.m. was started, and his symptoms gradually improved over the subsequent 2 weeks (NPI score 20). No behavioral changes were observed in the 2-month follow-up.

These results are powerful and mirror what a number of other studies are showing, for sundowning and to also slow “down the progression of cognitive impairment”). We also see melatonin working clinically for this population.

I share this case study so if you are a carer or have a parent or loved one with Alzheimer’s or dementia, you have a resource to share with the medical team. There is growing awareness of this research and some neurologists are prescribing melatonin with success. Typically 0.5 mg to 5 mg melatonin is used once or twice a day.

My hope is that this becomes the standard of care instead of prescribing psychiatric medications which the authors acknowledge are not particularly effective. And they don’t get to the root cause that is triggering these symptoms: low melatonin and low serotonin (more on low serotonin below).

Melatonin and anxiety

Melatonin also improves sleep quality and reduces anxiety after a TBI (traumatic brain injury). I blogged about a study that used timed-release melatonin here. The study participants used 2 mg of timed-release/prolonged-release melatonin for 4 weeks. This improved sleep quality and melatonin was also associated with a small decrease in self-reported anxiety.

As outlined in this paper, Melatonin as a Potential Approach to Anxiety Treatment, “melatonin’s benefit in anxiety may reside in its sympatholytic action, interaction with the renin-angiotensin and glucocorticoid systems, modulation of interneuronal signaling and its extraordinary antioxidant and radical scavenging nature.”

The serotonin connection and using tryptophan or 5-HTP

Keep in mind the strong serotonin connection: these sundowning symptoms start late afternoon and evening (hence the name sundowning) and serotonin is a precursor to melatonin production.

I look forward to seeing research on the use of tryptophan or 5-HTP for sundowning symptoms too. Until then, based on the above, and the fact that many of these symptoms are classic signs of low serotonin, I feel comfortable recommending either of these amino acids.

As always, we start low, use afternoon and evening doses and increase based on symptom resolution. The typical adult dose of tryptophan is 500 mg and 50 mg of 5-HTP. I recommend starting with 100 mg tryptophan and 10mg of 5-HTP. The amino acid precautions are always reviewed. I would not recommend either tryptophan or 5-HTP if the individual is currently prescribed an antidepressant, unless you are working with a knowledgeable practitioner and always with the approval and monitoring of the prescribing doctor. This is because of the possibility of serotonin syndrome.

Dr. Dale Bredesen recommends tryptophan and melatonin

Dr. Dale Bredesen is the author of The End of Alzheimer’s (my Amazon link) and a number of other books on Alzheimer’s. He is an authority on Alzheimer’s and recommends both tryptophan and melatonin. In this paper, Reversal of cognitive decline: A novel therapeutic program, he reports the use of 0.5 mg melatonin and 500 mg tryptophan used (3 x week) for sleep issues.

Interestingly and surprisingly, he doesn’t mention sundowning in his books or papers. However, if you are new to his work, I encourage you to look into his functional medicine approach, which is extensive and offers results and hope for many.

Low GABA in Alzheimer’s disease and dementia

This paper, Implications of GABAergic Neurotransmission in Alzheimer’s Disease, shares that “of the two major types of synapses in the central nervous system (CNS): glutamatergic and GABAergic, which provide excitatory and inhibitory outputs respectively, abundant data implicate an impaired glutamatergic system during disease progression.”

The amino acid GABA may also help anxiety, disturbed sleep and restlessness. And it’s common to have both low serotonin and low GABA.

This case study illustrates how using the amino acid GABA can help ease the anxiety often experienced in those with Alzheimer’s disease.

It’s too entrenched in our thinking that there is nothing to be done

It saddens me that it’s too entrenched in our thinking that there is nothing to be done. Unfortunately, many family members and medical professionals consider sundowning a normal part of the disease progression and question whether it’s worth doing anything.

My feedback is this: please don’t discount the power of the amino acids, melatonin and other nutritional approaches to offer some relief and improved quality of life for the patient. And when they are calmer, less aggressive and sleeping better it’s so much easier for the caregivers too.

Resources if you are new to using tryptophan or GABA as supplements

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.

Have you used melatonin to help with sundowning symptoms with your loved one and if yes how much helps?

Was melatonin prescribed or did you research it and bring the information to the doctor?

Have you used melatonin to help with sundowning symptoms in your clients/patients? What ranges have you seen to help?

Have you also found tryptophan, 5-HTP and/or GABA to help?

If you have questions and other feedback please share it here too.

PharmaGABA vs GABA when you have histamine issues/MCAS: does pharmaGABA ease physical anxiety or make things worse?

April 15, 2022 By Trudy Scott 34 Comments

If you have histamine issues or MCAS (mast cell activation syndrome) and the low GABA type of physical anxiety (with muscle tension, insomnia and stress eating), you may well want to consider which type of GABA product you use. It may be wise to avoid or use caution with the type of GABA that is produced via fermentation and could actually make your symptoms worse and cause a histamine reaction.

PharmaGABA and GABA (gamma-aminobutyric acid) are the two forms of commercially available GABA products. PharmaGABA is produced via industrial fermentation of the amino acid glutamic acid (glutamate) using Lactobacillus hilgardii. This is the same beneficial bacteria that is used to ferment foods like kimchi, the well-known Korean vegetable fermented product.

However, GABA is not fermented and is a manufactured product. It’s the form I typically have clients start with simply because it’s been around longer than pharmaGABA and I’ve had such excellent results with it.

I’ve also had reliable feedback from folks who have used both, that GABA works best for them. That said, some folks do find that pharmaGABA works better for their needs and I recognize that there is no one-size-fits-all.

How probable is it that someone could have a histamine reaction to pharmaGABA?

It was only recently that I became aware of the possibility that someone could have a histamine reaction to pharmaGABA. Someone asked the question in my GABA Quickstart online group program and I posed the question to folks on Facebook. Today I’m sharing some of that feedback and asking you to please contribute to the discussion so we can all learn.

Based on what I’ve learned so far I believe it’s very feasible and also probable for many individuals who have histamine issues to have a bad response to pharmaGABA. Keep in mind, histamine triggers are not the same across the board, and it’s possible that some individuals may not react initially and may only react as more and more is used. Or they may not not react at all.

Today’s blog is to shine light on the matter because it’s not something I’ve heard about or seen documented in the research or company product specifications or warnings.

PharmaGABA wasn’t tolerated by Calina’s daughter: she had increased ADHD, agitation, rages, tics and was argumentative and very emotional

Calina shared this about her daughter’s reaction to pharmaGABA and asked about a GABA product that isn’t fermented:

My daughter has high histamine and did not tolerate the pharmaGABA at all. She has increased ADHD, agitation, rages, constantly starts arguments, tics and is very emotional. She has the same reactions with fermented foods (like sauerkraut).

Calina shared that she is 20 and was diagnosed with MCAS at 2 years old:

It improved some for many years, but she’s always been very short attention span, anxiety, OCD, ODD, and learning differences.

Her daughter has a number of more recent factors that are likely compounding things for her:

In 2017 after a mold exposure, dog bite, mosquito bites that left bullseye rashes, all of those symptoms intensified to the extreme.

She used to eat sauerkraut daily but became intolerant. She’s always had problems with all fermented foods and supplements.

I suspect her daughter does have a histamine reaction to pharmaGABA. The clue for me is that her reactions to pharmaGABA are the same as when she consumes fermented foods.

And the symptoms are more severe and more varied than what we see when too much GABA or too much pharmaGABA is used. With too much of either we see increased anxiety and/or more sleepiness and/or feeling flushed. Flushing is common with histamine issues/MCAS and it can be challenging to figure out cause and effect, but this mom and daughter have been dealing with this for a long time and are more likely able to identify what is causing what.

If her daughter has low GABA anxiety physical type symptoms (with insomnia, spinning/focus issues, intrusive thoughts, panic attacks, stiff and tense muscles) I would recommend a GABA-only product, with manufactured GABA instead of fermented pharmaGABA.

PharmaGABA didn’t work for Bren and caused a migraine the next day

A common sign of histamine intolerance/MCAS is migraines so it’s possible that pharmaGABA could trigger a migraine in someone with histamine issues.

Bren shared this on my Facebook post:

Ah now I think I understand why Jarrow’s GABA Soothe not only didn’t work nearly as well for me as GABA Calm, but I also had a migraine the next day. Thanks so much for that information.

When I asked if she has histamine issues and if a migraine is a typical histamine reaction for her she shared that is really only just learning about histamine issues:

Until recently I would have said no and have only had the vaguest idea of what that might mean. But I have been struggling to get off Seroquel, which is the reason I started taking GABA, and I recently found out that Seroquel is a potent anti-histamine. So when you posted about people having histamine issues with the pharmaGABA, which seemed to have caused my migraine, I put 2 and 2 together. I may have it all wrong, but if so it is quite a coincidence.

In Bren’s case it’s a bit more challenging to tease out since this is new to her, she doesn’t eat sauerkraut because she doesn’t like them, but she feels there may be other foods that are affecting her.

This Jarrow GABA Soothe product also contains theanine and Ashwagandha extract so it’s hard to know if it was the pharmaGABA itself. In this instance confirming her reaction with a pharmaGABA only product would be better.

Quetiapine, sold under the brand name Seroquel, is an atypical antipsychotic medication and Bren started to make the connections when she saw my question and because she had read about Seroquel being a histamine-blocking medication.

I share her example because you may not know if you have histamine issues but you may have had a less than pleasant reaction. This will hopefully give you some things to think about.

Product labeling of pharmaGABA can be confusing

You may have noticed this product, Jarrow GABA Soothe, has GABA on the front of the bottle and strangely has “Gamma-amino butyric acid (GABA) (PharmaGABA)” on the product label.

This label makes no sense at all and is contributing to consumer and practitioner confusion.

Unfortunately this kind of labeling is not unusual and variations of this is common with many products.

GABA is used interchangeably with pharmaGABA all the time. In fact, I do it here on the blog and did it in my book. Maybe we are going to find we need to be specific.

Is the flush reaction from too much GABA or because of a histamine reaction?

The biggest issue I see with GABA and pharmaGABA is using too high a dose to start. This causes a temporary and uncomfortable tingling niacin-like flush sensation (in the brain and body).

One challenging aspect is figuring out if the flush reaction is from too much pharmaGABA, or if it’s due to a histamine reaction.

I’d suggest lowering the pharmaGABA dose and looking at all the adverse symptoms. For example, the symptoms of increased ADHD, agitation, rages, tics, being more argumentative and very emotional experienced by Calina’s daughter would not be attributed to too much pharmaGABA but to a histamine reaction (especially when correlated with her similar reactions to high histamine foods.)

If you’re new to histamine issues and MCAS

If you’re new to histamine issues and MCAS (mast cell activation syndrome), Dr. Jill Carnahan has an excellent overview here – Mast Cell Activation Syndrome: Here’s What You Need to Know When Histamine Goes Haywire.

Mast cell activation syndrome is an immune disorder. It’s just one type of mast cell activation disease.

What sets MCAS apart from other mast cell activation diseases is that it isn’t caused by an abnormally large amount of mast cells, and it isn’t a result of pathogen infection. Instead, when you have MCAS, you have a normal amount of mast cells, but they’re overactive and malfunctioning.

When your body is exposed to what it thinks is a threat, these overactive mast cells start to go haywire and secrete massive amounts of chemical mediators stored in the cytoplasm of your cells—degranulation. What’s meant to be a positive, protective response from your mast cells instead triggers both local and systemic negative effects.

When chemical messengers are released into your body, they set off an alarm that triggers an immune system response. And when this response becomes chronic—the chemical messengers are set off too much, too often—the result is mast cell activation syndrome.

In this instance, because pharmaGABA is fermented (and is likely high in histamine for this reason), it’s perceived to be a threat and causes adverse symptoms.

Over the next few months I’ll be sharing additional information about histamine issues and MCAS because of the symptoms of anxiety, insomnia, brain fog, depression and racing heart. Stress is a big trigger and teasing out the role and interplay of neurotransmitter support with GABA and tryptophan is of value.

Resources if you are new to using GABA or pharmaGABA as supplement

If you are new to using the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the low GABA symptoms).

I actually write about pharmaGABA briefly because it was new at the time and I had some clients who were seeing success with GABA, also trial pharmaGABA. The results were not as good as when they used GABA, so I continued to use GABA.

If you don’t feel comfortable reading my book and figuring things out on your own (doing the symptoms questionnaire and doing respective trials), you can get guidance from me in the GABA Quickstart Program (online/virtual).

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. It’s an opportunity to interact with me and other practitioners who are also using the amino acids.

If you have histamine issues or have been diagnosed with MCAS:

Have you found you can’t tolerate pharmaGABA and do better with GABA for easing physical anxiety, insomnia and/or stress eating?
Are your histamine reactions to pharmaGABA similar to when you eat fermented foods and other high histamine foods?
Please share which pharmaGABA product you used and how much you used
Please share the reactions and the foods that trigger similar reactions so we can build an informal database with the feedback

If you have experienced reactions to pharmaGABA but do well with GABA, do you now have plans to look into the possibility of histamine issues/MCAS? Please share which pharmaGABA product you used and how much you used.

If you’re a practitioner, have you observed these effects with your patients and/or clients and is it something you caution them about?

Feel free to ask your questions here too.

Anxiety case study: a very very slow SSRI taper with tryptophan and other nutritional support

August 28, 2020 By Trudy Scott 14 Comments

Today I’m sharing an update from someone in my community who is tapering from an SSRI (Cipralex/lexapro) in the best way possible – very methodically and doing a very very slow taper, using compounded medication and nutritional support. It is a team approach with a supportive doctor monitoring for serotonin syndrome, her pharmacist compounding her medication and input from me.

She has an excellent diet that contains enough healthy protein and fats, plenty of vegetables, and no sugar or caffeine. She has the basic nutrients covered and is on the pyroluria protocol (these nutrients help make serotonin). She is using the amino acid tryptophan for serotonin support as she tapers. And she is out walking in nature and practicing mindfulness.

All of this sets her up for success and being able to avoid antidepressant discontinuation syndrome.

Here is her story:

I began tapering off 10 mg of Cipralex in November 2017. I have my little “Support Team” that includes a compounding pharmacist and my GP. Feeling very fortunate that I have these people as my taper has not exactly gone as planned (although far better than my last two attempts)

Originally, the plan was to go down by 10% of the dose and stay at that dose for 4 weeks. That didn’t work for me. I was fine when I dropped from 10mg to 9, but after my next 10% drop I experienced that familiar withdrawal hell. I got a little scared, but stuck with it, and decided to stay at that dose for a bit longer. While I leveled out, I did a lot of reading about how SSRIs work. I learned about the 1/2 life of Cipralex (all SSRIs have a different 1/2 life) and what was actually happening physiologically as my body adjusts to the lower dose. It’s a recovery process.

With that new knowledge, I decided to try another approach. I knew I couldn’t handle a drop of 10%. So, I started to taper at a rate of 0.1mg once a week (far less than 10%!). By day three at the new dose, I could feel the withdrawal, but it was far less severe. Small drops=small “withdrawal wave”. I discovered that I am able to manage a 2% drop of the current dose and I have been able to drop that % each week. So, I’m still reducing by 8% a month, which means I am close to the original plan of dropping by 10% a month. At this time I am at 6.24mg.

Yes, it is a very slow process and I have a long way to go, but it’s working. I have read that some people have to reduce by 1% of their current dose and remain at that dose for 4 weeks to allow their body the time to heal and adjust to life on the lower dose. Having the liquid compound has made such a difference! You sure would have difficulty accurately shaving off a pill by 2%!! If anyone is trying to come off of this drug, do your best to find a compounding pharmacist!

I find that I must stick to a very healthy diet. I eat a lot of fresh, raw and cooked vegetables. I mean a LOT of vegetables. I eat good sources of protein and walk for at least 45 min almost every day. I steer clear of sugar and caffeine. Both make my withdrawal much worse.

Every day I take omega 3, vitamin C, vitamin D, vitamin B complex. I take the supplements for pyroluria, vitamin B6, evening primrose oil and zinc. I take magnesium at night. I took Trudy’s amino acids course online and did all of the amino acid trials. I discovered all I really need is tryptophan. It has made a huge difference for me. Yes, I take Lidke tryptophan. For us Canadians, it can be ordered online.

I practice mindfulness. I’ve read a lot about the anxious brain (the reason I took Cipralex in the first place) so I understand what is happening now, what is real and what is just noise in my head.

Antidepressant discontinuation syndrome

This is the best way to taper SSRI medications in order to avoid withdrawal effects, also known as discontinuation syndrome which can be very severe for some folks.

Accordingly to this paper, Antidepressant discontinuation syndrome occurs in about 20% of patients who reduce the dose or abruptly stop an antidepressant that they have been taking for one month. This paper states that “symptoms are usually mild….occur within two to four days after drug cessation and usually last one to two weeks.”

It also states that occasionally symptoms “may persist up to one year…and if the same or a similar drug is started, the symptoms will resolve within one to three days.”

I typically hear from individuals who fall into the category of severe symptoms that are persisting past 2 weeks. It’s not uncommon to see symptoms continue for a year and often longer in some cases.

Also from the above paper, is the mnemonic FINISH which summarizes these symptoms:

Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
Insomnia (with vivid dreams or nightmares)
Nausea (sometimes vomiting)
Imbalance (dizziness, vertigo, light-headedness)
Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations) and
Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).”

How you will feel if your serotonin is low and how to learn more

With low serotonin you will have the worry-in-your-head and ruminating type of anxiety, panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues, insomnia and afternoon/evening cravings.

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 and navigating this with your prescribing physician: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings. You may need to lend him/her a copy of my book too.

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 will find the Lidtke Tryptophan here. You can also read more about why I prefer the Lidtke tryptophan on this blog.

I would like to end off by saying how much I appreciate this woman and others sharing their stories like this so we can all learn!

Please also share your taper story and what you did to make it easier. If you had challenges share those too. Let us know if you can relate to any of the above FINISH symptoms and how long they lasted.

Feel free to post your questions here too.

GABA and tryptophan for pain and anxiety in Parkinson’s disease?

August 25, 2017 By Trudy Scott 12 Comments

Last week I blogged about my recent back injury and how acupuncture boosts GABA to reduce back pain and how oral GABA further reduces the pain. Both these interventions have helped me so much and I’m doing so much better.

I love the feedback I receive in the blog comments and the great questions – which get to help the person asking the question and everyone else reading the blog and comments. So thank you if you comment!

I received this lovely feedback about GABA and anxiety, and a question about Parkinson’s disease (on the above blog) and want to share it and my response here so you and families with a loved one with Parkinson’s disease will also have access to this information:

I have loved reading your articles for a long time and listen to you whenever you are on a summit. I have learned a lot. GABA definitely helps me to relax, reduce my monkey mind and sleep better.

My mom has Parkinson’s disease and is very stiff and tight. She hurts often, especially her back. She also has afternoon anxiety, some call it “sundowners”. Can she take GABA with carbidopa-levidopa and blood pressure meds? She needs some kind of help!

Thank you in advance for any suggestions you might have to give her any quality of life as right now it is not good and the doctors offer no suggestions beyond possibly more prescriptions.

I responded saying how glad I was to hear GABA helps her to relax, reduces her monkey mind and also helps her to sleep better and how sorry I was to hear about her mom’s stiffness, pain and anxiety.

I posted this regarding the stiffness and back pain: share this paper with your doctor and get his/her approval to do a trial of GABA – Parkinson’s Disease and Neurodegeneration: GABA-Collapse Hypothesis:

the original description of Parkinson’s disease (PD) as due to the selective damage of dopaminergic neurons in the mesencephalon should be updated into the concept of a severe multisystemic neurodegenerative disorder of the nervous system, whose clinical symptoms reflect the localization and progression of the most advanced GABA pathology. A future and more complete therapeutic approach to PD should be aimed first at slowing (or stopping) the progression of Ca(2+)/GABA functional decline.

I have worked with a few people with Parkinson’s disease and GABA has been very helpful for the stiffness and pain, the physical anxiety, easing some of their tremors and helping with insomnia. I always do a trial so we know how much the individual will need.

For someone on blood pressure medication I’d start with a GABA-only product or GABA-theanine product rather than GABA Calm which does contain tyrosine.

I posted this regarding the “sundowners” question: I’d share this with your doctor and get the approval to do a trial of tryptophan – Sundown Syndrome in Persons with Dementia: An Update

sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night.

Although this paper refers to dementia, these symptoms also happen to be classic low serotonin symptoms that typically respond really well to tryptophan. The paper mentions melatonin as an intervention but since tryptophan converts to melatonin I’d start with tryptophan (based on doing a trial) and then consider adding melatonin too if needed.

I shared a few more resources on Parkinson’s disease:

Chris Kresser has an excellent blog post called New Research and Treatments for Parkinson’s Disease where he writes about the microbiome, constipation, SIBO, gluten, the HPA axis, low-dose naltrexone (LDN) and the possible autoimmune aspect, iron overload and the benefits of curcumin, a ketogenic diet and glutathione.
The Wahls Protocol for MS (some versions of which are ketogenic diets) shows promise for many neurodegenerative diseases and is also being researched for Parkinson’s disease

I also shared this amazing and inspiring video created by physical therapist Anicea Gunlock, on how using music while gait training can be beneficial for those suffering from Parkinsons’s disease

You read more about this music approach Anicea Gunlock used with her patient here.

The amino acids GABA and tryptophan can often be used in conjunction with all of the above approaches and often provide immediate relief for anxiety, pain, agitation and insomnia while some of the other root causes are being addressed.

I’ve recently updated the Antianxiety Food Solution Amino Acid and Pyroluria Supplements blog with some of my favorite GABA and tryptophan products mentioned above. You’ll also see the amino acid questionnaire and amino acid precautions on this blog.

Instead of only considering the amino acids for someone whose primary issue is anxiety, I’d like you to start thinking about using the amino acids for anyone who has a medical diagnosis – such as autism, cancer, ALS, Parkinson’s disease, MS, Alzheimer’s disease or anything else – and who also happens to suffer from anxiety.

Have you used GABA or tryptophan to ease stiff and tense muscles and pain in your Parksinson’s disease, for a family member or for a patient/client?

And have you used tryptophan for the low serotonin worry-type of anxiety, agitation and insomnia?