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Increasing tryptophan or 5-HTP temporarily when a winter dip in serotonin causes more severe anxiety, OCD and/or the winter blues

December 24, 2021 By Trudy Scott 11 Comments

Don’t forget that serotonin takes a dip in winter when the days are shorter and there is less light. If you’re currently using tryptophan or 5-HTP to boost low serotonin and ease low serotonin symptoms – worry-type anxiety, panic attacks, insomnia, ruminations, PMS, irritability, negativity, perfectionism, obsessiveness, lack of confidence, anger/rage, afternoon/evening cravings – you may find you need to increase your dose for a few months.

This will especially be the case if you check off winter blues or more severe winter anxiety (yes it’s a thing and published in the research) on the low serotonin symptoms list.

I shared this on Facebook last week and the feedback ranged from surprised to curious to confirmatory.

In this blog I’m sharing some of the feedback and some of the supporting evidence, as well as other factors to consider.

The addition of 5-HTP in the morning and a light box

Kathy thanked me for the reminder and shared the changes she makes in the winter months:

Thanks for the reminder! I need to increase my dose this time of year… I can feel myself feeling “down”. I take 500 mg Tryptophan before bed and 100 mg 5-HTP in the morning before breakfast. I also use a light box in the morning while eating breakfast, which helps.

This is an increase from her typical dosing in the spring and summer when she only takes tryptophan at night before bed.

She also only uses her light box or SAD (seasonal affective disorder) lamp in winter. You can read more about SAD/full spectrum lamps here. They are also a wonderful way to boost serotonin and mood in the winter.

My daughter’s anxiety and OCD goes through the roof

Mark shared about his daughter’s anxiety and OCD (obsessive compulsive disorder):

Every year from October – March, my daughter’s anxiety and OCD goes through the roof. At first we thought it was the transition from summer to school, then the craziness of the winter holidays and suspected mold allergy. Now, based on this information, a winter/less light induced dip in serotonin may be an additional factor we hadn’t considered. We’ll try adjusting her 5-HTP dose and see if we gain some improvement. Thanks for the tip.

It’s really common for families to attribute the more severe anxiety and OCD to the stress and craziness of the winter holidays. And of course suspected mold issues do need to be looked into and addressed. But even then, the dip in serotonin can compound all these factors.

Planned tryptophan bump for Christmas sugar cravings and holiday family stress

Carol shared this about her plans to temporarily boost serotonin:

I am one of those light weights that was able to do one 500 mg pill a day of tryptophan. But I do think that it would help to bump it up to two a day to get me through the Christmas sugar cravings AND holiday family stressful get togethers! I’m all about taking the minimum effective dose but this is helpful to know that there could be a temporary boost just to get you through this time!

It’s wonderful that 500mg tryptophan is enough for her and I’m all for a minimum effective dose! However the winter dip in serotonin – and increased sugar cravings and family stress – is a common reason many folks bump up the dose for a month or more.

You may also find you made the change intuitively. Linda shared this: “I had made the adjustment. I just did not realize the reason why.”

A question about timing of 5-HTP and what to do in Spring

Suzanne shared that she uses a SAD light (also called a light box) and finds that it helps. She asks:

Can I just take the 5-HTP on days with no sun or is it better to have it build up in my system? When spring rolls around, do I taper off or can I just stop taking it?

This is my feedback: I haven’t had anyone just use 5-HTP on cloudy days but it’s worth a trial. If you are noticing increased anxiety and mood changes only on cloudy days and using the SAD lamp on those days helps, then using 5-HTP on those days may be enough. If not, use 5-HTP consistently/daily through the winter months.

Amino acids do not need to be tapered but I find my clients do better when they are reduced over a few weeks. Some folks also choose to just stop taking them and do fine.

I appreciate all the feedback and the great questions. I’ll report back when I hear how Mark’s daughter does with the adjusted 5-HTP and how Carol does with the bump in tryptophan (and any other feedback I get from these folks).

Some of the research and possible mechanisms

There are many studies that support serotonin changes and seasonal variations in mood. Here are just two of them:

Effect of sunlight and season on serotonin turnover in the brain “Alterations in monoaminergic neurotransmission in the brain are thought to underlie seasonal variations in mood, behaviour, and affective disorders… turnover of serotonin by the brain was lowest in winter. Moreover, the rate of production of serotonin by the brain was directly related to the prevailing duration of bright sunlight… Our findings are further evidence for the notion that changes in release of serotonin by the brain underlie mood seasonality and seasonal affective disorder.”
Sunshine, Serotonin, and Skin: A Partial Explanation for Seasonal Patterns in Psychopathology? “one contributory facet may be the role of sunshine on human skin. Human skin has an inherent serotonergic system that appears capable of generating serotonin.”

Other factors to consider: low vitamin D, sugar, pyroluria and phenols

There are other low-serotonin related factors to consider too:

Low vitamin D is common in the winter and sufficient levels are needed for making serotonin. This paper, Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior describes how“Brain serotonin is synthesized from tryptophan by tryptophan hydroxylase 2, which is transcriptionally activated by vitamin D hormone. Inadequate levels of vitamin D (∼70% of the population) and omega-3 fatty acids are common, suggesting that brain serotonin synthesis is not optimal.”
The increased consumption of sugar at this time can lead to reduced zinc, magnesium and B vitamins (like vitamin B6 and thiamine) and this can further reduce serotonin levels, which relies on these nutrients as cofactors for production. By boosting serotonin with additional tryptophan or 5-HTP you can actually reduce some of the cravings.
If you have the social anxiety condition called pyroluria, the added stress of family and holiday gatherings can also contribute to zinc and vitamin B6 being dumped, and further impacting serotonin production.
Christmas tree phenols can be a trigger for anger, meltdowns, anxiety, hyperactivity, insomnia, aggression, self-injury and autistic symptoms in susceptible individuals

Resources if you are new to using tryptophan and 5-HTP as supplements

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 the low serotonin symptoms here) and a brief overview here, Anxiety and targeted individual amino acid supplements: a summary.

If you suspect low serotonin or 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 so you are knowledgeable. And be sure to share it with the team you or your loved one is working with.

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 acid products that I use with my individual clients and those in my group programs.

Have you noticed this winter dip in serotonin and made adjustments to your 5-HTP or tryptophan? And do you feel less anxious, less obsessive, not as low and with fewer sugar cravings?

Do you find that using a SAD lamp/full spectrum light at this time helps even further?

Were you aware that serotonin dipped in winter and could be playing a role for you? Or did you think it was just the stress and overwhelm of the holidays (and /or some of the emotional upheaval some of us face at this time)?

If you’re a practitioner, have you seen this with clients or patients?

Have you also noticed you need to adjust your GABA and other amino acids at this time too (both GABA and dopamine show seasonality)?

Feel free to ask your questions here too.

Christmas tree phenols as a trigger for anger, meltdowns, anxiety, hyperactivity, insomnia, aggression, self-injury and autistic symptoms?

December 18, 2020 By Trudy Scott 10 Comments

Are you aware that the aromatic oils that give pine trees their wonderful smell are phenols and that these phenols may be a trigger for anger and meltdowns, anxiety, hyperactivity, irritability insomnia, self-injurious behavior, digestive issues and autistic symptoms (such as stimming, swinging and hand-flapping)? All this can be caused by an indoor Christmas tree in susceptible individuals.

My colleague Julie Matthews writes about this here: Avoiding Holiday Havoc: Healthy solutions to avoid meltdowns and keep the holidays happy

“When phenols are not able to be broken-down and detoxified by a process called sulfation, which is low in many children with autism and ADHD”, they can cause these symptoms and also red cheeks and ears. She shares that “phenolic compounds come in many forms including artificial petroleum-based food additives, and salicylates (a type of phenol) found in plants and foods like strawberries and spices, as well as pine trees.”

In the above blog, Julie shares this story about a client with a 10-year old son with autism. He severely regressed during the holidays and it was because of the Christmas tree. This is what the mom shared:

During the Holidays our son regressed severely. He became anxious, aggressive, and self-abusive. He cried and had tantrums regularly throughout the day. He couldn’t sleep anymore and was up for hours at a time, night after night. He was hand-flapping like crazy. We have a swing in the house for him and he now wanted to swing all day long, constantly, and do nothing else. He lost eye contact and he stopped responding to his name.

Once the Christmas tree was removed the improvements were dramatic:

The next day, he was much calmer. He seemed to have “exhaled.” Within 48 hours, our son was completely back to normal.

I shared Julie’s blog on my Facebook page and a father in my community shared a similar experience about his autistic son’s severe reactions to phenols:

Yes! My autistic son who is sensitive to phenols, would completely meltdown during the holidays. We thought it was just the change in routine and his environment, but quite by accident we discovered fragrances seemed to make him worse. We got rid of the fragrances and holiday tree/decor and the improvement in our son was dramatic! We now realize it was the phenols.

My son’s reaction to phenols/fragrances are bright red cheeks/ears, dark under eye circles, headaches, inappropriate manic laughter, aggression/self injurious behavior, marathon meltdowns/screaming, incontinence, insomnia/less than 3 hrs sleep a night, bumpy rashes, GI issues/diarrhea, excessive sensory stimming (hand flapping, lip licking, running around and body slamming into things.) During the holidays, the intensity of these reactions shot through the roof.

They found out by chance that it was the Christmas tree that was causing his son’s issues each year. It started when he was a toddler and they figured it was the stress and changes of the holidays that was the issue. One year they didn’t put up a tree and they could not believe the difference. It was then they made the connection and learned more about phenols and made the necessary changes.

By reducing phenols in his diet and environment, and giving him Epsom Salt baths and enzymes (No-Fenol), most of the above symptoms were significantly reduced.

I suspect there are many families who are seeing similar meltdowns and have no idea it could be the Christmas tree. Keep in mind that the reactions may not be as severe as these two cases I’ve shared here. If you are seeing any increase in anxiety, irritability, sleep problems, digestive issues or other unusual behavior changes in your child, keep an open mind that it may be more than just the holiday changes.

Julie’s advice is this:

Since so many children with autism and ADHD react to salicylates/phenols – in her nutrition practice she finds an overwhelming majority react negatively – she suggests a cautious approach to holiday decorating for all families of a child with autism or ADHD. Simply avoid the pine Christmas tree.
If you are unsure about their sensitivity to salicylates/phenols you might ask yourself if your child is often hyper, irritable, or has red cheeks, and other common salicylate symptoms, or whether they crave salicylate-rich foods such as berries, grapes, apples, and ketchup. If so, explore salicylates further.

I encourage you to read Julie’s blog to gain a better understanding of salicylates and phenols. If you are a practitioner and want to learn more about low salicylates/phenols and other special diets her practitioner training is excellent.

I appreciate this mom and dad for sharing their experiences with their sons so we can all learn and help other families. I also so appreciate Julie’s expertise in this area and really look forward to digging further into the research and picking her brain so I can share more.

Could your holiday anxiety and/or insomnia be phenol issues too?

Julie works with children with autism and ADHD but as someone who works primarily with adults with anxiety, I’m going to be exploring sensitivity to salicylates/phenols further. Julie recently shared this with me: “if you start looking you’ll probably see a lot of your clients with anxiety have phenol issues.”

If you also notice any increase in anxiety, anger, irritability, sleep problems, digestive issues or other unusual behavior changes, keep an open mind that it may be more than just the holiday stress or winter blues/winter anxiety. It may well be phenol issues too.

Serotonin connection to phenol issues

I’ll be blogging more about this and the fascinating serotonin connection to phenol issues. You may have noticed that many of the symptoms these 2 boys experienced sound a lot like either low serotonin or high serotonin (both of which can occur in autism). Serotonin is an endogenous phenol compound and this phenol issue is likely causing high serotonin.

When I asked Julie about this she shared this with me: “Yes, serotonin and dopamine are phenolic. And sulfation is important for the inactivation of dopamine and serotonin. So poor sulfation can lead to neurotransmitter imbalances.”

Using collagen to lower high serotonin?

I’ve blogged about how collagen can lower serotonin in susceptible folks and increase anxiety. It is also used by some folks to lower their high serotonin and make them calm. Misty reports using collagen ‘therapeutically’:

I use it to reduce tryptophan because I have a tendency toward high serotonin. I have suffered my entire life with ADD, tics as a child, grinding teeth, general anxiety, lack of motivation and later, IBS. In my 53 years I’ve never been as calm as I am now.

I don’t know if Misty has a phenol issue but I’m going to be exploring if collagen or gelatin could possibly be used to help lower the high serotonin and ease some of these severe phenol reactions quickly, in conjunction with other approaches like avoiding the foods and environmental exposures, enzymes and other nutrients, and Epsom salt baths.

Christmas tree syndrome, mold issues and toxic plastic trees

I hate to spoil the Christmas fun but here are a few other things to consider:

Christmas tree syndrome is also a real issue for many individuals
My friend and Enviornmental Toxins expert Lara Adler shares how mold from a real tree made her and her cat really sick “Within a few days of getting the tree, I broke out in a full-body rash that required a 10-day run of prednisone. I didn’t think it was the tree at first (it could have been something else), but then my cat, who was already dealing with GI inflammation and a gut issue developed asthma! Out of nowhere! She also ended up on prednisone. I got rid of the tree and both our symptoms never came back.”
She also shares some issues with plastic trees: they are often made from toxic PVC (polyvinyl chloride) with “softeners like lead and/or phthalates”, and often treated with endocrine-disrupting flame retardant chemicals. More about this on Lara’s blog here.

Have you observed a salicylate/phenol reaction with your child or client/patient? What about a less severe reaction with your child or with you personally?

Have the following helped you: avoiding the foods and environmental exposures like a Christmas tree, using enzymes like No-Fenol and other nutrients, and Epsom salt baths? In the midst of a very severe reaction has collagen or gelatin helped reduce symptoms quickly?

What about mold issues or allergies with a Christmas tree?

Feel free to post your questions here on the blog too.

5-HTP can raise salivary cortisol: does this cause a “wired-tired” feeling?

August 14, 2020 By Trudy Scott 37 Comments

Are you aware that 5-HTP – an amino acid supplement that supports serotonin levels – can raise cortisol levels and leave you feeling “wired-tired”? You may be able to relate to this if you’ve ever used 5-HTP to help with anxiety and insomnia and ended up feeling more anxious and more wide-awake despite your exhaustion and need for sleep. You feel “wired-tired” and it’s not pleasant at all.

Both 5-HTP and tryptophan, used as supplements, help to boost serotonin levels so you can feel happy, calm, sleep well and not crave carbs in the afternoon/evening. They also help with panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues, pain/fibromyalgia, TMJ and anger. I typically have my clients with low serotonin symptoms start with a trial of tryptophan because I see such excellent results with this amino acid. That being said, some people simply do better on one versus the other and you may do better with 5-HTP.

However there is one big caveat with 5-HTP. I don’t recommend 5-HTP when a client has elevated cortisol levels because we know that it can raise cortisol levels in certain individuals. This can leave you feeling agitated, cranky, as well as wired and yet tired at the same time.

In this 2002 study, L-5-hydroxytryptophan induced increase in salivary cortisol in panic disorder patients and healthy volunteers

Salivary cortisol levels were measured in 24 panic disorder patients and 24 healthy volunteers, following ingestion of 200 mg L-5-hydroxytryptophan or placebo.

The experiment was carried out in the afternoon, “when basal cortisol secretion is more stable.” The first saliva sample was obtained at 1pm and the subjects ingested the 200mg 5-HTP at 2pm. Additional saliva samples were obtained at 2:30pm, 3:00pm and 3:30pm.

They report the following:

A significant rise in cortisol was observed in both patients and controls following ingestion of L-5-hydroxytryptophan. No such effects were seen in the placebo condition.

Here are a few additional comments and my thoughts:

This study was done to find evidence for “serotonin receptor hypersensitivity in panic disorder” and not specifically to test for the effects of 5-HTP on cortisol levels but it serves this purpose rather nicely (and it’s one of many similar studies, some of which measure plasma cortisol levels)
Keep in mind 200mg of 5-HTP is a large starting dose. It’s typical to start with 50mg so may be a factor to consider
In this study they did not assess cortisol levels beyond the 1.5 hours from ingestion of the 5-HTP. It would have been useful to see when levels started to go down
We would want to consider the ramifications of using 5-HTP for weeks (whether it’s 50 or 200mg). What impact would that have on cortisol and the adrenals? (I am not aware of a study like this having been done)
I’m also not aware of a study being done with 50mg but if you feel worse and feel “wired-tired” with 5-HTP and switch to tryptophan (the equivalent starting dose is 500mg) and your anxiety and other low serotonin symptoms resolve then you have found your solution
You may be wondering: “could I use 5-HTP to raise my low cortisol levels”? Theoretically yes and possibly very short-term. But I would question the timing since 5-HTP and tryptophan are best dosed mid-afternoon and later. This is when we would expect our cortisol levels to be on the downward slope as we end our day. I’d also want to nourish the adrenals with B vitamins and herbal adaptogen and remove the trigger/s that are leading to low cortisol.

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.

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.

Have you used 5-HTP with success? Or have you used it and felt “wired-tired”? Have you correlated the success or failure of your 5-HTP use with your salivary cortisol levels?

If you switched from 5-HTP to tryptophan did you have success with that?

If you’re a practitioner is this something you see with your clients/patients and take into consideration?

Feel free to post your questions here too.

The amino acids GABA and tryptophan can help to relieve anxiety in children: an interview with Dr. Nicole Beurkens

December 14, 2018 By Trudy Scott 14 Comments

Using individual amino acids such as GABA and tryptophan can have an incredible impact on children with anxiety, easing anxiety very quickly. I don’t often write or talk about using amino acids with children and since many of you have asked for more resources for children, today I’m sharing an interview I recently did on this topic on The Better Behavior Show. This is a podcast hosted by my colleague and good friend Dr. Nicole Beurkens.

I share specifics on how Amino acids can help to relieve anxiety in children, together with some case studies.

Dr. Nicole sums up the power of the amino acids beautifully – and this is exactly why my clients love them so much – they take the edge off quickly, provide results and help with overwhelm:

I think that the fact that these [amino acids] can work quickly is really helpful. And as you said, it helps to take the edge off, it helps to reduce the symptoms so then we can more effectively address all of the underlying things. Because often, I’ll have parents say, “Oh, you want me to change the diet and do all these things, I just feel so overwhelmed, my kid is having so many issues, I don’t know how we’re going to do any of that.” And then when you can use things like targeted aminos to help take the edge off the symptoms for the parent and the child, it makes all of that other stuff more doable, I think.

Here are some snippets from one of the stories I share – the wonderful results I had with a 11-year old girl who had been adopted, was diagnosed with reactive attachment disorder and had explosive anger issues. This young girl:

….also had insomnia, so she was not sleeping well at all. She was very fatigued in the day, had really bad anxiety about going to school and loved colored candies and she was a big bread eater.

This family didn’t have much money to spend so I really had to find an affordable solution with the biggest benefits. She was anemic so we addressed that with iron supplements and getting her eating quality grass-fed red meat again and we figured out that gluten was an issue so she went gluten-free and this made a big difference with the outbursts.

The other factor was to figure out if low serotonin was a factor and address this. The big clues were the anger, the insomnia, the anxiety and the sugary cravings:

I was talking to her about the fact that she loved candies and she loved bread, and I said — how would you feel about giving it up? She was fuming with me. She was in a swivel chair and she turned her back to me and she didn’t want to talk about it.

I offered her a 100mg chewable tryptophan to see if it would help with her sugar cravings and the fact that she was furious with me:

“How about trying this amino acid, it’s called tryptophan and it’s chewable and it doesn’t taste bad… and then we’ll talk a little bit later. Don’t worry about what I said earlier.” So I gave her 100mg of chewable tryptophan.

She chewed the tryptophan and within 5 minutes, she turned around, smiled at me and said, “I think I can do it, I’m ready to do it.”

She was calm and smiling, and ready to give up the candies and bread and other gluten-containing products. These 3 interventions – addressing her low iron levels, having her go gluten-free and supplementing with tryptophan – completely turned this little girl’s life around.

Here is the link to the entire transcript of our interview: Amino acids can help to relieve anxiety in children. You can also find the audio interview at this same link or by going directly to iTunes – simply search for “The Better Behavior Show.”

Do listen in and/or read the transcript and learn more about:

how I do a trial of the amino acids (this allows for quick results in 5-10 minutes)
how I’ve worked with non-verbal children
a simple trick for using the unpleasant tasting tryptophan sublingually
what low GABA anxiety looks like in a child
why ADHD symptoms in children may actually be anxiety (I share another success story in this section)
why I use GABA Calm with children and adults (Dr. Nicole uses this GABA product too and loves that it’s sublingual and tastes great)
times you may consider using tyrosine or DPA
and much more

It was a pleasure to be on the show of someone whose work I deeply respect. Dr. Nicole is a unique combination of clinical psychologist, nutritionist, and special education teacher, and shares these resources for help with improving your child’s behavior naturally: her book Life Will Get Better, blog, and the Better Behavior Naturally Parent Program. and tune in to my interview and some of the other excellent interviews.

If you’d like to learn more about these supplements, look at my supplements blog here

There is also a “Liquid and powder options for children” section on this blog – with other products you may find useful for children.

I’d also like offer a caution about the 100mg chewable tryptophan This chewable form is both good and bad. It’s good because it’s a nice 100mg of tryptophan per tablet, is chewable, tastes good and is suitable for children and “pixie dust” individuals who need a very small amount and for when doing the initial trial. The bad aspect is that it does contain sugar and is quite sweet. Because you are continually consuming something sweet you may end up over-consuming them if sugar addiction is your issue. I’ve seen the same with children who want to eat them like candy. So, what I do most of the time is use the chewable tryptophan for the trial and then switch to the 500mg tryptophan after that. We did that with the 11-year old with anger issues, anxiety and candy cravings.

One more thing: Lidtke is the only brand of tryptophan I use and recommend because of its quality. I forgot to mention that in our interview.

Have you benefited from using any of the amino acids and then found they also help your child/children?

Trichotillomania: NAC, GABA, tryptophan, inositol and zinc?

January 5, 2018 By Trudy Scott 35 Comments

This recent paper reports on a case study with NAC – Trichotillomania: a good response to treatment with N-acetylcysteine

Trichotillomania is considered a behavioral disorder and is characterized by the recurring habit of pulling one’s hair, resulting in secondary alopecia. It affects 1% of the adult population, and 2 to 4.4% of psychiatric patients meet the diagnostic criteria. It can occur at any age and is more prevalent in adolescents and females. Its occurrence in childhood is not uncommon and tends to have a more favorable clinical course.

The scalp, eyebrows and eyelashes are the most commonly affected sites. Glutamate modulating agents, such as N-acetylcysteine, have been shown to be a promising treatment. N-acetylcysteine acts by reducing oxidative stress and normalizing glutaminergic transmission. In this paper, we report a case of trichotillomania with an excellent response to N-acetylcysteine.

In this case report an 11 year-old male student had been pulling his hair out for 6 months. He had a relationship problem with this father and also suffered from asthma and dermatitis. He was started on NAC:

Treatment with N-acetylcysteine was initiated (1200 mg/day for three months). The patient’s outlook improved dramatically, but complete remission was not achieved. We chose to increase the dosage to 1800 mg/day, which resulted in almost complete regrowth.

[From: Trichotillomania: a good response to treatment with N-acetylcysteine]

In this paper from 2009, N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study, it is reported that

Fifty individuals with trichotillomania (45 women and 5 men) received 1200-2400 mg/day of N-acetylcysteine or placebo over a 12-week period.
56% percent of patients experienced “much or very much improved” hair-pulling symptoms with N-acetylcysteine use compared with 16% using the placebo, and the improvements were first noted after 9 weeks of supplementation.
Those in the N-acetylcysteine group did not experience any adverse events.

As you can see, the results with NAC are excellent but it can take 9 weeks and more before results are seen. For this reason, I would always also assess for low serotonin and low GABA and do trials of tryptophan or 5-HTP for low serotonin and GABA for low GABA. With any compulsive and obsessive behaviors I always consider inositol too and we may add this once the ideal dose of tryptophan has been found.

What is my rationale for recommending GABA, tryptophan, 5-HTP and/or inositol?

Since NAC works on reducing oxidative stress and normalizing glutaminergic transmission, GABA may help too and will certainly help to ease any physical anxiety that is being experienced
“Recommended first-line therapy for this psychiatric condition is administration of SSRIs” even though their efficacy is not yet proven in children – for this reason I’d recommend tryptophan or 5-HTP
Also “according to the psychiatric definition, these patients pull their hair because the act is gratifying and reduces tension, anger, depression and anxiety” (these are all signs of low serotonin and another reason to consider tryptophan or 5-HTP)
Because they offer relief right away, within 1-5 minutes

A complete nutritional and functional medicine work-up would be part of the plan too – to address the asthma and dermatitis (in the first paper above) and any other symptoms the person is experiencing and may be a contributing factor.

I’d expect the 56% of improved patients (in the second study above) to go to a much higher percent with all of the above approaches.

When I shared these papers on Facebook I was asked this question from someone who pulls out her eyelashes:

I pull my mascara off what is left of my eyelashes every night. I try my hardest not to do it but I find it impossible once I’ve touched my lashes. I’m about to start taking GABA and I was thinking about taking NAC. Would it be a bad idea to take both these amino acids?

This is my feedback: I always like to do one thing at a time and (as mentioned above) I would do the amino acid questionnaire and a trial of tryptophan and GABA first if the scores are high, and then look at adding NAC. If there are still some obsessive tendencies I would consider adding inositol. I am not aware of any issues with using all of these nutrients at once.

Someone else asked this:

Wouldn’t you deal with the psychological cause of it too – at the same time?

My response: Yes absolutely – if there is a psychological cause. But be aware that sometimes it’s purely nutritional or biochemical.

Another person shared that she only exhibits these behaviors when she’s stressed. Of course, the nutrients mentioned above, plus dietary changes, adrenal support, improving gut health and everything that I educate about, are important for reducing stress.

I also received some success stories. Here is one of them:

I’ve struggled with trichotillomania and dermatillomania (skin picking) for years and years. I underwent hypnosis that was extremely effective. When I added in zinc (after reading your book) the urge is almost completely gone. Thank you!

Keep in mind that zinc is a co-factor for making serotonin and GABA, is important for overall adrenal support and stress reduction, is needed for glutathione production and works as an antioxidant. I’d actually love to see these studies repeated with zinc alone.

And then I received this message from someone else:

I’m messaging you my answer about NAC because it’s slightly embarrassing I’ve always had terrible acne and always have picked at it obsessively and could not stop until I was given some supplements for PCOS which happened to contain NAC. To my surprise I lost the compulsion to pick at my skin, something I had never thought possible!

How wonderful for both of them! I always appreciate feedback like this and have to say nothing is too embarrassing to share (especially if it helps someone else).

Have you used NAC with success – with trichotillomania or dermatillomania (skin-picking) or even nail-biting? Or some other compulsive behavior?

What about GABA or inositol or tryptophan or zinc (or something else) for the same purpose and/or for additional emotional and stress-reducing support?