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

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anxiety case study

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.

Beyond the Pill by Dr. Jolene Brighten – my book review

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I really wish this book – Beyond the Pill A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill by Dr. Jolene Brighten – was available when I was in my 30s and on the pill.

Dr. Jolene mentions a study in the Journal of the American Medical Association which reports the following:

women who began the pill were more likely to be prescribed an antidepressant – which means it contributes to a bit more than moodiness.

This was not a small study and included over one million women.

Symptoms caused by the pill and the damage it does to your body

This book, Beyond the Pill, provides a comprehensive list of symptoms caused by the pill:

  • hormonal confusion: missing or irregular periods, light or heavy periods, short cycles, infertility, headaches
  • digestive problems: leaky gut, gut dysbiosis, inflammatory bowel disease
  • energy reduction: fatigue, adrenal and thyroid dysfunction
  • skin issues: hair loss, dry skin
  • mood disruption: depression, anxiety
  • lady part disturbance: low libido (Oh, hell no!), vaginal dryness, chronic infection, pain with sex
  • vitamin, mineral, and antioxidant depletion (such as folate, B12, and magnesium) (I’ll add vitamin B6 to this list too – it is mentioned elsewhere in the book)

The pill does further damage to your body and also:

  • intensifies the risk of blood clots, which lead to strokes
  • increases the risk of breast, cervical, and liver cancers
  • increases the risk of diabetes
  • raises the risk of heart attacks
  • triggers autoimmune disease

Truth-bombs about how the pill works

She shares plenty of truth-bombs about how the pill works – like these gems:

As long as you’re on the pill, your brain and ovaries aren’t talking, which can seriously affect all your hormones.

When you take that week of placebo pills, you’re not actually getting a period because you never ovulated. Instead, this is what is called a withdrawal bleed (I did not know this!)

Post–birth control syndrome (PBCS)

I first became aware of Dr. Jolene’s brilliance in this area when she started writing about Post–birth control syndrome (PBCS) a few years ago. PBCS is “is a constellation of symptoms women experience when they discontinue hormonal birth control.” She has found the symptoms of PBCS – hormonal irregularities like no period or heavy bleeding, acne, mood swings and anxiety, headaches, infertility, pill-induced PCOS (polycystic ovarian syndrome), hypothyroidism, gut issues and even autoimmune symptoms – typically occur in the first 4-6 months after stopping the pill. To make it easy for you the PBCS symptoms are all laid out in a handy quiz in the book.

She has found these symptoms won’t go away without taking the necessary steps that include detox, gut repair, healing the thyroid and adrenals, addressing metabolic health or blood sugar control, boosting mood, improving libido and addressing nutritional deficiencies that the pill has caused. This is all covered in the book as a 30-day program to balance your hormones, reclaim your body, and reverse the dangerous side effects of the birth control pill.

I really appreciate that Dr. Jolene shares this:

I want you to know I’m not anti-pill. Nope. I’m pro–informed consent, which means doctors giving you all the information you need to consent to taking birth control.

This book will help you understand what those hormonal symptoms mean, how the pill is affecting your body, and what to do if you either need to stay on it or are ready to get off it.

Addressing low vitamin B6, low serotonin and low GABA

Here are a few of the nutritional supporting approaches she covers (all supported by research) that are very applicable for support for anxiety specifically and relevant to what you’ve been learning from me: addressing low vitamin B6, low serotonin and low GABA.

Because the pill depletes vitamin B6, she recommends up to 100mg per day for PMS and mood-related symptoms, and symptoms of PBCS. (I know vitamin B6 is controversial and she does acknowledge this).

Dr Jolene identifies the concerning and far-reaching effects of the pill on serotonin: “studies have shown that women on the pill don’t metabolize tryptophan normally” affecting both serotonin and melatonin production, reducing kynurenic acid and raising high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation and immune system activation, and shifting the “tryptophan pathway… toward quinolinic acid production, which is inflammatory and harmful to the brain.”

I would have loved to see more about tryptophan and 5-HTP and even vitamin B6 (given that it is crucial for the conversion of tryptophan away from quinolinic acid) in this section of the book. Using tryptophan as a supplement is only briefly mentioned and 50-100mg 5-HTP is only recommended for serotonin-related cravings. As you may know from my work using targeted trials of the amino acid tryptophan and/or 5-HTP offers very quick anxiety relief and  support for PMS within 3 cycles. Fortunately, you can fill in the gaps and use what I teach about these amino acids in conjunction with everything else in the book.

I do love that she adds to our knowledge base with other tips, sharing that the botanicals “passionflower and skullcap support healthy serotonin production by reducing quinolinic acid production.” This was new to me and I’m intrigued.

I love what she writes about progesterone inducing “a sense of calm and a deep sense of love and connection by stimulating gamma-aminobutyric acid (GABA) receptors.”  Theanine and taurine (a precursor of GABA) are recommended and taurine is also part of her detox and adrenal protocols which I love.

However, I use GABA itself extensively in my work and find it to be more effective than theanine or taurine for the anxiety symptoms – it’s a firm favorite for the majority of my anxious clients. Again, you can fill in the gaps and check out what I share about GABA for very quick anxiety relief and PMS support.

 

My other favorite sections: libido and orgasms, and liver detox

Some of my other favorite sections include the libido section and her wonderful information about orgasms – she shares the myriad of health benefits of orgasms and recommends once-weekly orgasms but need I say more than this comment from Dr. Jolene:

Women can have four different types of orgasm throughout the month because of the hormonal changes we experience. Dude, this is a serious reason to consider ending that pill pack.

I couldn’t resist including this advice for anxiety and insomnia:

Trouble with anxiety? Have sex. Trouble with insomnia? Have sex. When you have an orgasm and release oxytocin, it relaxes you, calms your mind, and enables you to get a good night’s sleep. Besides oxytocin, your body releases vasopressin during orgasm, a hormone that often accompanies the release of melatonin.

If you do have low libido Dr. Jolene has this covered.

I also love the liver detox chapter and so will you. You’ll learn that the pill can cause benign liver tumors and can contribute to gallstones and gallbladder disease. She also shares this about the synthetic estrogen in birth control pills and the liver/libido connection:

There is some concern that long-term exposure to the synthetic estrogen in birth control pills actually alters your liver genes to make higher levels of SHBG (sex hormone binding globulin) for the rest of your life. Unfortunately, SHBG also binds up your testosterone. The result is a libido that’s nonexistent.

She also has you covered on how to detox as part of this wonderfully comprehensive hormone balancing program.

The official book blurb

Out of the 100 million women – almost 11 million in the United States alone – who are on the pill, roughly 60 percent take it for non-contraceptive reasons like painful periods, endometriosis, PCOS, and acne. While the birth control pill is widely prescribed as a quick-fix solution to a variety of women’s health conditions, taking it can also result in other more serious and dangerous health consequences.

Did you know that women on the pill are more likely to be prescribed an antidepressant? That they are at significantly increased risk for autoimmune disease, heart attack, thyroid and adrenal disorders, and even breast and cervical cancer? That the pill can even cause vaginal dryness, unexplained hair loss, flagging libido, extreme fatigue, and chronic infection.

As if women didn’t have enough to worry about, that little pill we’re taking to manage our symptoms is only making things worse.

This book is perfect for you if

  • You’re a woman in your child-bearing years and are currently on the pill, considering the pill, have been on the pill in the past and had issues, and even did well on the pill in the past
  • You’re a woman like me and past the birth control age and yet are intrigued to get a better understanding of how you may have been affected by the pill in the past and also want a better understanding of your body and hormonal health going forward
  • You have a daughter or grand-daughter or niece or friend you can gift a copy to
  • You are a practitioner who works with women
  • You are a curious male with women in your life and would like to understand them better so you can continue to have the healthiest relationship possible.

I’m already recommending this book and will continue to recommend it going forward!

This much-needed solution-based and heavily referenced book released January 29. It’s ground-breaking information and I’m thrilled to be sharing it with you!

Grab your copy of Beyond the Pill (my Amazon link) and find additional information here.

I now recognize that post–birth control syndrome (PBCS) was part the perfect storm that contributed to my anxiety and panic attacks in my late 30s (and a whole host of other symptoms). Personally, I found the entire book fascinating reading, and wish I’d had access to this material while I was in the midst of trying to figure things out.

Fortunately, GABA and tryptophan helped immensely with my anxiety and PMS (together with everything else I did) and I eventually discovered FAM (Fertility Awareness Method). But wish I’d know about this safer option when I was younger. Dr. Jolene is a big fan of FAM and covers it extensively in the book, sharing what I found to be true: it works even if it seems scary at first AND you get to learn so much about your body.

Please feel free to share your experiences with the birth control pill (both good and bad), why it was prescribed and what you learn from this book that can help others in your situation. Feel free to post questions here too.

How do I taper tryptophan without withdrawal symptoms: a tight band around my head, brain zaps and agitated free-floating anxiety?

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I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. However, I recently had someone ask this question on the blog (and then had someone else ask a similar question) so I’m sharing these questions and my responses in the hope of gleaning some additional information (and educating you if this applies to you). I never say never and am always learning. I’m also very interested to know how common this is and what some of the underlying factors could be.

Here is the question that was asked by Lara (we’ll call her Lara) and slightly paraphrased for clarity:

I’ve been taking 1500 mg of tryptophan for 3 months, and it has helped a lot with sleep and depression. I dropped to 1000 mg about a week ago then 500mg just to see how I’d do without it. I didn’t think it was numbing my feelings, but I am experiencing a return of feeling good.

I’ve been on antidepressants before and I am feeling the same withdrawal effects as when I weaned off meds. This is exactly why I chose to not go back to pharmaceuticals. It was difficult to wean off. How do I taper tryptophan without experiencing withdrawal symptoms? Thank you for your valuable knowledge.

These are the kinds of questions I’d ask a client in this situation:

  • Was the 1500mg helping and which low serotonin symptoms were eased?
  • How did this change when you reduced to 1000mg and then reduced to 500mg? i.e. did the low serotonin symptoms come back?
  • Which antidepressant are you comparing these affects to? And how long ago did you wean off the antidepressant?
  • Which brand of tryptophan you are using? (I find Lidtke is the best quality)

Keep in mind that we always want to be sure it’s not a one-off situation. In order to be sure someone is observing mild adverse effects from a supplement I’ll often have my client stop it and then add it back to make sure. And sometimes more than once.

In this instance repeating the process may be a good idea i.e. going back to 1000mg and then 1500mg and then reducing again, carefully documenting in a food mood supplement log.

It turns out that Lara was using the Lidtke tryptophan and she was seeing wonderful benefits for her low serotonin symptoms with none of the typical SSRI side-effects:

the 1500mg before bed with a small carb helped me get to sleep and stay asleep. It also helped with anxiety and depression during day. I tend to be a worrier, have social anxiety, and get stuck with negative thoughts about myself and others. And have very little interest in life.

I was on Zoloft from 2005 – 2009. Got off of that and did Lexapro for only 6 months in 2012. The Zoloft was life changing for me but I did not like the side effects and being on an antidepressant for the rest of my life.

The tryptophan is superior to these SSRIs [selective serotonin reuptake inhibitors] – no sexual side effects, no weight gain, or anhedonia [inability to feel pleasure in normally pleasurable activities].

She describes how she reduced the tryptophan and how her withdrawal symptoms were similar to those she experienced when tapering off her SSRIs in the past:

The withdrawal effects were felt when dropping from 1500mg to 1000mg, to 500mg, then zero over 2 days and they lasted about 3 days. By the 4th day I was no longer feeling bad.

The symptoms are hard to explain – it felt like a tight band around my head, also brain zaps (this is a common SSRI withdrawal symptom many describe feeling in their head).

The worst of it was a deep agitated free-floating anxiety like you’re walking along the edge of a cliff and there’s a physical pain in your gut. Fortunately, it was only present from waking up till around 2pm.

These are questions I’d ask or wonder about

As I mentioned in the introduction, I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. But if this is an issue some individuals experience I’d like to know about it

I’d also like to know how long the tapering side-effects of tryptophan last and how severe the symptoms are. In Lara’s case the symptoms were pretty severe but fortunately they only lasted 3 days which is very much shorter than SSRI tapers.

There could be confounding factors and here are additional questions I’d ask or wonder about if a client experienced similar adverse tapering effects. These are questions you could ask yourself if you have experienced this when stopping tryptophan abruptly:

  • Could the prior use of SSRI prescriptions be a factor? (but I have worked with many clients with prior use of SSRIs and not have tryptophan tapering issues)
  • What else has changed in terms of stress, diet, hidden gluten exposure, or even the something like a recent introduction of collagen (which may deplete serotonin levels in susceptible folks)?
  • Are there hormonal changes that could affect serotonin levels – like in a woman with PMS or perimenopausal or menopausal symptoms? (again, I’ve worked with many women of all ages and haven’t observed this to be an issue)
  • If you are prone to the winter blues and reduced winter serotonin, could stopping the tryptophan in the winter play a role? (I have had clients have SSRI tapering issues in winter because of being prone to the winter blues and choose to work with their doctors on their SSRI taper in the spring and summer for this reason)
  • Could this also be an issue with summer blues in hot states like Arizona?
  • Could any of these play a role: a recent medical procedure, a course of antibiotics (especially fluoroquinolones) or antifungals, poor gut health, a new infection, decreased immunity or increased inflammation?
  • Could low levels of these nutrients play a role: vitamin B6, ferritin, magnesium and zinc?
  • Would using high doses of vitamin C during the “taper” help reduce some of the symptoms? (this works well as an antidote when you take tryptophan and don’t need it and want to negate some of the negative effects, so may help in this situation)

Stopped tryptophan and felt very angry and down

The other question I had about tryptophan weaning is this one from someone who shared that she had suggested tryptophan for a friend. This friend was

experiencing a lot of ruminating and anxiety. She responded beautifully and felt great. About a year later, she tried to stop taking it, and said she felt very angry and down. Is there a weaning process for the tryptophan?

This could possibly be related to the above and you could pose similar questions but based on on what I see with clients I feel this is more of a matter of stopping the tryptophan too soon while she still had low serotonin – especially if the ruminating and anxiety came back. Feeling angry and down are classic signs of low serotonin.

The questions asked were specifically about tryptophan but they could also possibly apply to some individuals who stop 5-HTP abruptly.

I’d love to hear if you’ve experienced anything like this with either tryptophan or 5-HTP and if yes please share your answers to some of the above questions.

Right now, I’m afraid I don’t have an answer for you on how to taper tryptophan without these withdrawal symptoms: a tight band around the head, brain zaps and agitated free-floating anxiety. Right now, I’m not sure how big an issue this is. If it is common, I’m hoping some of the feedback I receive may provide some answers.

Little evidence for SSRI use in anxiety and compulsions in ASD: my interview on Nourishing Hope for Autism Summit

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One of the reasons I’m so passionate about participating on summits like The Nourishing Hope for Autism Summit and sharing the powerful nutritional interventions is due to the fact that medications such as antidepressants and benzodiazepines are frequently prescribed in ASD – and the research and clinical evidence shows that children and adolescents with ASD (autism spectrum disorder) are more vulnerable to the side effects.

This paper, Psychopharmacological interventions in autism spectrum disorder, makes the following conclusion:

Psychopharmacological treatment of core and associated symptoms in ASD is challenging, in large part because ASD presents in many different ways. Furthermore, children and adolescents with ASD are more vulnerable to the side effects of psychopharmacological intervention than their age-matched, typically developing counterparts.

This paper, Pharmacotherapy of emotional and behavioral symptoms associated with autism spectrum disorder in children and adolescents, supports this, stating there is little evidence to support the use of SSRIs in ASD:

Selective serotonin reuptake inhibitors are often used in clinical practice to target anxiety and compulsions; however, there is little evidence to support its use in this population. There is a great need for further research on the safety and efficacy of existing psychotropic medications in youth with ASD.

And this paper published a few months ago, An update on pharmacotherapy of autism spectrum disorder in children and adolescents, concludes that

Overall, the evidence is limited for pharmacotherapy in children with ASD, and side-effects with long-term use can be burdensome.

Much of this also applies to adults with ASD and in my interview I talk about the psychiatric medicine concerns within the ASD community and the high incidence of anxiety, aggression, irritability and OCD in this population.

We also discuss the following nutritional solutions in my interview (appropriately titled: How to calm anxiety, and eliminate aggression and OCD) –

  • the role low serotonin plays in anxiety, aggression and OCD/obsessions and the use of tryptophan and when to avoid 5-HTP
  • the low GABA type of physical anxiety and how to effectively use GABA for results
  • how to use inositol for OCD and some wonderful success stories
  • lead toxicity and increased anxiety and the protective role of tryptophan and ascorbic acid
  • phenols and oxalates other special diets (and my story with oxalate issues)

Our interviews are always fun, science based and practical – and in this one we even shared some of our personal results (both good and bad) with some of these nutrients.

Here are just a few of the speakers and topics I’m really looking forward to hearing:

  • James Adams, PhD: The Scientific Evidence Linking Nutrition and Autism Improvement
  • Dietrich Klinghardt: Understanding Lyme, Infections, Mold, and Heavy Metals and the Effects on Autism
  • Chef Pete Evans: Food is Medicine, Inspiration from a chef
  • Kaalya Daniel, PhD: How You Can Use the Healing Properties of Camel’s Milk for Autism
  • Dominic D’Agostino, PhD: Is the Ketogenic Diet Right for an Autistic Child?
  • Susan Owens, MS: The Inflammasome, Oxalates, Autoimmunity and Autism
  • And of course, Julie Matthews, CNC: When GFCF Diets Don’t Work – BioIndividual Nutrition for Autism

This summit provides you with information and tools that address the root causes so medications such as the above do not even have to come into the picture!

The Nourishing Hope for Autism Summit runs July 30 to August 3 and is hosted by my dear friend and colleague Julie Matthews, whose work you’re probably very familiar with. In case Julie’s work is new to you, in my eyes, she is THE autism nutrition expert. I’ve had the pleasure of interviewing her a number of times on the Anxiety Summit, I endorse her Bioindividual Nutrition training (special diets) for practitioners, I highly respect the work she does and I adore her!

The focus of this summit is clearly autism and Julie is THE expert so you’ll learn a ton from the experts she has gathered.

But do keep in mind that those with autism or Asperger’s are often considered the canaries in the coalmine and even if you don’t have a loved one with ASD many of the interviews have wider applications for anxiety, ADHD and other developmental and learning disorders.

Register here for The Nourishing Hope for Autism Summit to learn more! It airs online from July 30 to August 3, 2018

Kate Spade: suicide, hormonal imbalance, antidepressants as a trigger and the stigma of mental health

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Photo by Paul Keleher (originally posted to Flickr as kate spade) [CC BY 2.0], via Wikimedia Commons
Kate Spade, a well-known American fashion icon and handbag designer, died by suicide last week at the age of 55. I’m always torn in situations like this…just share the news story with my sympathies in order to respect the family or use this as an opportunity to learn from and prevent others from suffering the same fate. This time I’m doing the latter – with the risk of appearing insensitive – because there are red flags here and I feel so strongly that we all need to learn from this in order to move mental health forward. I’m hoping her husband and family would approve.

In the announcement about Kate Spade’s suicide in the New York Times, Mr. Spade said:

that though his wife had suffered from anxiety at points during their relationship and marriage, her serious bouts of depression only began about six years ago, at the age of 49.

Kate suffered from depression and anxiety for many years. She was actively seeking help and working closely with her doctors to treat her disease, one that takes far too many lives. We were in touch with her the night before and she sounded happy. There was no indication and no warning that she would do this. It was a complete shock. And it clearly wasn’t her. There were personal demons she was battling.

My heart goes out to Kate Spade’s husband, young daughter and loved ones. Her suicide is just so sad but as I said I have a fair bit to say about this….

 

Hormone imbalance triggering anxiety and depression?

According to the reports, Kate’s “serious bouts of depression only began about six years ago, at the age of 49, but she had suffered “from depression and anxiety for many years”.

Perimenopause and menopause is a classic time for women to experience worsening anxiety and depression and can be driven by fluctuating hormones, especially low estrogen. In this study, Depression and the menopause: why antidepressants are not enough? the authors share that

Postmenopausal depression is more severe, has a more insidious course, is more resistant to conventional antidepressants in comparison with premenopausal women and has better outcomes when antidepressants are combined with HT (hormone therapy).

Addressing hormone imbalance as one possible root cause can eliminate the anxiety and depression. Some of my favorite resources for hormone balance are these books: The Hormone Secret and Cooking for Hormone Balance.

 

Low levels of neurotransmitters like serotonin, catecholamines and GABA?

Directly connected to hormonal imbalance is brain chemistry imbalance. Addressing low levels of neurotransmitters like serotonin, the catecholamines and GABA provide results quickly when they are used in a targeted way based on individual needs:

  • Low serotonin is an issue when estrogen levels are declining and the amino acid tryptophan can have profound benefits if low serotonin is one of the root causes, leading to depression, worry, fear, overwhelm and sleep issues.
  • Low catecholamines can cause the “I just want to say in bed” depression and low motivation, together with fatigue and poor focus. The amino acid tyrosine can help to eliminate some of this and also provides thyroid support.  Poor thyroid health can also be a root cause of depression.
  • We see low GABA levels when progesterone is low and if this is one of the root causes, it can result in increased physical anxiety and insomnia. The amino acid GABA, opened on to the tongue, can provide calming results within minutes.

I can totally relate to the hormonal aspect as I suffered from PMS for years and my anxiety issues and panic attacks started in my late 30s and I had a really low spell as I was going through menopause.  Both GABA and tryptophan turned things around very quickly for me as they do for my clients.

 

The role of diet and nutritional psychiatry?

There is so much new science behind the role of a real foods traditional diet for alleviating both depression and anxiety. The SMILES study, published by Prof Felice Jacka early 2017, was the first randomized controlled diet depression study and ONE THIRD of the dietary intervention group saw improvements in their depression symptoms.  This was just diet alone and switching from processed and junk food to real food with no specific dietary restrictions.

There is also much clinical evidence supporting how diet can have an impact. Holly, suffered from with severe depression and anxiety changed her diet and shared this with me:

Over the course of a year and a half, I was given 10 different psychiatric diagnoses and cycled through 10 different medications. I discovered the healing power of diet completely by accident, and it changed my life. I now live with no diagnoses and no symptoms.

I started with the Whole30 (strict paleo), then went paleo, dabbled with a ketogenic approach, and now I eat a modified paleo diet, with some rice and goat dairy.

This has been termed nutritional psychiatry and you can read more diet-depression and diet-anxiety success stories here.

Keep in mind that your prescribing psychiatrist may not yet be on board with this or up to date on the newest research. Just last week someone told me what happened when they discussed nutritional psychiatry with their doctor and showed them my book The Antianxiety Food Solution (my Amazon link). He said: “Good luck with that!”

 

Could the antidepressant medication have triggered her suicide?

The statement from Kate’s husband says “She was actively seeking help for depression and anxiety over the last 5 years, seeing a doctor on a regular basis and taking medication for both depression and anxiety.”  Could the antidepressant medication have triggered her suicide or played some part?

We will never know with Kate but this is always my first thought when I learn of a suicide and when we hear of homicides in the news. One of my colleagues shared this when her suicide was first announced: “I was wondering if she was under psych care and what role meds might have played in this tragedy.”

This paper is one of many papers reporting similar antidepressant suicide and violence risks, and concludes that:

Antidepressants double the occurrence of events in adult healthy volunteers that can lead to suicide and violence

Kelly Brogan MD – Holistic Psychiatrist​ no longer prescribes psychiatric medications because we don’t know who will experience this side-effect. She writes this about a Swedish study and antidepressants and increased suicides

As antidepressant prescriptions increased 270% over 15 years, suicide rates also increased. Strikingly, more than half of the young women who committed suicide (52%) were prescribed antidepressants within a year of committing suicide. And antidepressants were detected in 41% of the women who committed suicide, showing that they were under the influence of antidepressants at the time of death. 

 

What if you are taking an antidepressant and seeing benefits?

When I posted some of this on Facebook earlier in the week someone who is on an antidepressant and benefiting shared her frustration that we are blaming suicide on medications.

There are many who do benefit but there are two issues I have:

  1. Even if someone is doing well on an antidepressant, benzodiazepine or other psychiatric medication I feel we need informed consent about the side-effects and training for the individual and family on what to look out for as things can change. The can occur when meds are changed, doses are increased or decreased, new meds are added, one or more are stopped abruptly or too quickly (called discontinuation syndrome). Many doctors also need to be educated and to acknowledge that suicide and homicide are very real side-effects of these meds.
  2. We don’t know who will be adversely impacted, which is why consent/knowledge about this is so important.

When we rent ski equipment or go bungee jumping we sign an informed consent form, acknowledging the possible risks of death. Why is this not happening with these medications? I just want individuals to be going into this with eyes wide-open so they don’t say “why didn’t anyone tell us this?”

If someone is currently seeing benefits from antidepressants (or benzodiazepines) I make sure they know ALL the risks and encourage them to continue to look for root the causes and address these (never stopping medications abruptly and never without the prescribing doctor’s permission).

There are many possible biological or biomedical or metabolic causes of depression and anxiety and many of these can play a factor in suicide.  Here is a list of just some of them:

My concern is that none of these – the medications or poor diet and nutritional deficiencies – are ever discussed when someone does commit suicide or goes on a violent or homicidal rampage.

 

The stigma of mental health and the fear of seeking help

There are reports that “Kate Spade felt unable to seek help or discuss her mental health because she feared this might damage the brand she created.”  This is a huge issue and if it was true for her or if anyone with a mental health condition feels like this, this has to change!

As Dr. Mark Hyman MD​ said this when I interviewed him last year before the launch of his Broken Brain docu-series

I began to realize that the body was driving a lot of this brain dysfunction, and that if you fix the body, a lot of the brain disorders would get better, that it wasn’t a primarily a mental problem, but it was a physical problem.

Our interview and full transcript is here and we cover the gamut in 12 minutes: the gut and microbiome, nutritional deficiencies, food sensitivities, heavy metals, other environmental toxins and medications.

We don’t hide the fact that we have a broken leg so why do we have to hide it when we have a broken brain? If we can start to acknowledge that mental health issues so often have this physical aspect (and often it’s 100% physical) then hopefully we can end this crazy stigma.

And even if there is also trauma or lifestyle factors that make someone depressed or anxious – so be it. Stop the stigma and shame. Why do we have to put on a brave face and pretend all is well. It has to stop so people can ask for help.

Last but not least, I feel we need to offer practical nutritional psychiatry resources to the family who have been traumatized by the loss of a loved one to suicide.  We know the amino acids and B vitamins help individuals recover from psychological stress after a natural disaster and these same nutrients can help the family in the midst of their sorrow.

I am aware it’s a very delicate subject and I’m sure this will rub some people the wrong way but I believe we all need to be talking about this and not tip-toeing around it.

I really feel this all needed to be said today. I hope this helps you or a loved one.

Rest in peace Kate Spade.

How do I taper from my antidepressant with tryptophan and can I safely use the other amino acids?

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antidepressant-tapering

Today’s article is based on a question I am seeing more and more on the blog: How do I taper from my antidepressant with tryptophan and can I safely use the other amino acids?

I find my clients do better when tapering off an antidepressant (which is often prescribed for anxiety and panic attacks) when their nutritional status is solid. Incorporating diet changes and adding amino acids and other nutrients first can result in a more successful taper with less side-effects. This would mean starting with the basics – eating real whole food, incorporating quality animal protein, eating to balance blood sugar, and removing gluten, caffeine and sugar.

If needed and based on testing results, it’s important to address any other nutritional deficiencies such as low iron, low vitamin D, low stomach acid, low total cholesterol, low B12 (and whatever else is an issue), plus support the adrenals/sex hormones/thyroid if needed and addressing gut health like leaky gut and dysbiosis.

Adding a good copper free multivitamin and often the addition of zinc and vitamin B6, evening primrose oil and possibly fish oil – the latter based on each person’s unique needs.

With antidepressants such as selective serotonin-reuptake inhibitors (SSRIs), I have my clients work with their prescribing doctor and get the approval to add tryptophan (or 5-HTP) 6 hours apart from the SSRI. If they are taking the medication at night they get the approval from their doctor to switch it to the morning, and will take tryptophan (or 5-HTP) at least 6 hours later, mid-afternoon and evening.

If they decide to do both the medication and tryptophan (or 5-HTP), they get a protocol for the SSRI taper for the future. This is important. If you are in too big a rush to start right away, it often causes more issues. It’s also important to make sure you get a very slow taper protocol from your doctor. Some antidepressants are harder to taper (Paxil is notoriously difficult) and they all should be tapered really slowly.

The plan is to start to taper the SSRI once you have been using the tryptophan (or 5-HTP) for at least 4 to 8 weeks and are seeing real benefits by using it. This translates to much much less or none of the following symptoms: anxiety, depression, insomnia, rumination, worry, negative-self-talk, perfectionism, afternoon and evening carbohydrate cravings, PMS, rage or anger.

For some of my clients it’s 3 months before they feel they are ready to taper. This may be because of feedback they have provided based on prior taper attempts and how they are feeling this time. It may also be based on what else is going on in their lives like a stressful work situation. It may also be based on the time of the year: winter is generally not a good time to taper and definitely not if you suffer from increased depression or anxiety in winter.

The tryptophan (or 5-HTP) is adjusted up as needed while continuing to taper the SSRI.

The doctor is always kept informed and monitors for the possibility of serotonin syndrome. I learned about the potential concerns about serotonin syndrome when using tryptophan or 5-HTP with an SSRI from Julia Ross, author of The Mood Cure, and so I continue to caution my clients about this.

When I interviewed Dr. Peter Bongiorno in season 4 of the Anxiety Summit (Serotonin and anxiety: tryptophan, 5-HTP, serotonin syndrome and medication tapers), he shared that he is not concerned about serotonin syndrome being an issue with tryptophan or 5-HTP dosed with an SSRI, even if taken at the same time. He cited research that found the combination of tryptophan and SSRI did not result in serotonin syndrome in any of the participants.

Dr. Bongiorno also uses the same approach to address the basics:

the most important thing is that we really establish all the basics and that they’re in the healthiest place possible.  Because if those aren’t there, if a patient just gets off the medication and we haven’t really done anything to change the underlying reasons why they got to the place where they had the mood issue, in most cases they’re going to go back there again.

Some people need amino acid support in more than just the low serotonin area so we review the amino acid questionnaire and consider trials of GABA and other amino acids too. All this only applies for SSRIs and tryptophan or 5-HTP. The other amino acids can safely be used with SSRIs, and it’s not uncommon to also have low GABA, low endorphins, low catecholamines and low blood sugar and need them all, but it’s still best to discuss them with the prescribing doctor.

We also review all the amino acid precautions.

Some people choose to work with their doctor to taper the SSRI and then add the tryptophan (or 5-HTP) once they have quit the medication. I have found that this makes it much harder to do and more side-effects are seen. With the amino acids you start to get some relief right away and have hope on the first day! They also make it so much easier to quit the sugar, gluten and caffeine without having to use will-power.

In summary, these are my recommendations for doing an SSRI taper with amino acids:

(please don’t simply read one or two blogs and jump in to this)

  • use the amino acids from day one to start addressing low levels of all the brain chemicals
  • use the tryptophan or 5-HTP at least 6 hours away from the SSRI

I would like to add that Dr. Brogan shares that coffee enemas help her patients who are doing medication tapers.

Have you used a similar SSRI taper protocol? And how did it work for you? What would you have done differently? And what advice would you give someone contemplating an SSRI taper?

Have you found that coffee enemas have helped?