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ADHD and psychiatric meds in children/teens on the rise, and benzodiazepine use increases mortality in adults (including suicide)

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meds teens children

Registration for my Anxiety Summit 6: Toxins/Meds/Infections is now open and in the spirit of continuing to share valuable snippets leading up to the summit, here goes for today.

(If you’ve already registered I do hope you find these snippets of value and they help you figure out more about which interviews to tune into first. If you’re only hearing about the summit for the first time, you can register here)

Today I want to highlight some aspects from two of the interviews on psychiatric medications.

In the interview Psychiatric Medications in Children and Teens with Dr. Nicole Beurkens, we discuss these results from a 2019 paper:

  • 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 has reached significant rates.

Polypharmacy means concurrent use of multiple medications by a patient. The fact that psychiatric polypharmacy is increasing in children and adolescents is most concerning. There are safer solutions that address the root causes of ADHD, anxiety and depression.

Here is what we cover in this interview:

  • Increasing ADHD, anti-anxiety, SSRI and antipsychotic meds and discontinuation syndrome
  • Disparities in BIPOC communities;
  • Psychiatric side effects of acne, constipation and asthma medications
  • Nutritional psychiatry/targeted nutrients/gut, sleep, movement, screen time and play

nicole beurkens interview

In the interview SSRIs, Benzodiazepines, Alcohol and Amino acids with Dr. Hyla Cass, she shares how benzodiazepines (a class of antianxiety medications that include Xanax, Ativan, Valium and others) are:

  • strongly associated with all cause mortality, including suicide (even when used for short durations of treatment
  • the cause of many accidents even if taken the previous day

Here is what we cover in this interview:

  • SSRI and benzodiazepine side-effects
  • Discontinuation syndrome, pre-taper protocols and tapering
  • The harmful effects of alcohol and the impacts on sleep
  • The dangers of combining alcohol with benzodiazepines, and the risks of antabuse (commonly used in alcohol addiction treatment plans)
  • GABA, tryptophan, 5-HTP, glutamine, DPA, CBD and key nutrient co-factors for medication taper, alcohol addiction, carb cravings and anxiety

hyla cass interview

Dr. Nicole Beurkens’ interview is focused on children and adolescents, and Dr. Hyla Cass’ interview is focused on adults but both are invaluable resources if you want to learn more about psychiatric medications, discontinuation syndrome, tapering and addressing the root-causes with nutritional other non-medication solutions.

Other related medication interviews of interest would be:

  • GABA and Tryptophan vs Meds for Hormone Balance – one of my 3 interviews (I also cover the birth control pill and more about using the amino acids)
  • Benzodiazepines: Short-Term Benefits, Long-Term Harms – Catherine M. Pittman, PhD, HSPP
  • 5-HTP: Anxiety, Depression, Insomnia and Liver Protection – Michael Murray, ND (he shares studies comparing 5-HTP to SSRIs)
  • Neuropsychiatric Toxicity from Fluoroquinolone Antibiotics – Lisa Bloomquist
  • Your Brain on Food: Anxiety, OCD and PTSD – Uma Naidoo, MD, PCP (she also shares studies comparing psychiatric meds to NAC and inositol)

In case you missed the first few emails about the summit … as you know, anxiety can be related to your daily life experiences BUT it can also be triggered by:

  • foods you eat and what you drink (like wheat, oxalates, alcohol and more)
  • environmental toxins (like lead, plastics, fragrances, insecticides, fluoride and more)
  • many types of medications (like the benzos/SSRIs, birth control pill, acne medication, fluoroquinolone antibiotics and more) and/or
  • chronic infections (like Lyme disease, PANDAS, parasites, candida and more).

Once you identify the root causes and understand anxiety’s mechanisms you can support the liver/gallbladder, detox, address infections, implement targeted and supportive solutions, and get relief!

This is my 6th Anxiety Summit, featuring all new topics and the latest research related to anxiety and toxins, medications and infections.

anxiety summit 6

Over the course of the next 6 weeks you’ll be seeing frequent emails from me with snippets and highlights from various interviews – like this one. I do hope you continue to enjoy them and get excited about the summit! Please do share if you know someone who has anxiety!

You’ve heard me say the Anxiety Summit has been called “a bouquet of hope!”  My wish for you is that this summit is your bouquet of hope!

I hope you’ll join me and these incredible speakers, be enlightened and find YOUR solutions!

Here’s to no more anxiety and you feeling on top of the world again!

Register here

 

If you’re already familiar with some of this information and practice some of this already please share how it’s helped you. That way we can all learn.

If you’d like to ask a question, please post in the comments below.

I’d also love to hear from you once you’ve listened to this interview. Please do come back and comment about some of the highlights of this interview and what changes you plan to make.

Even if you already receive my newsletters and signed up some time ago to be notified about the upcoming Anxiety Summit 6, you will still need to register at the new link here, because Health Talks Online is doing the production and backend work for me.

If you don’t register you won’t get access to the daily summit emails with all the interviews.

You will however, continue to get these emails from me.

This is my 6th Anxiety Summit and it is all new content!

The content is research-based and practical, and is geared to anxious individuals who are health-savvy and to practitioners who work with anxious individuals.

If you are totally new to functional medicine and nutritional solutions for anxiety, you will still learn so much so just take in what you can and know you’ll get all this eventually.

Anxiety, depression and ADHD: air pollution and polycyclic aromatic hydrocarbons (PAHS) on The Anxiety Summit 6

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anxiety depression adhd anxiety summit 6

Dr. Carolyn Ledowsky is one of my guest experts on The Anxiety Summit 6: Toxins/Meds/Infections
and our topic is Anxiety and Genetic Susceptibility to Environmental Toxins. Here is some of what we cover in our interview:  

  • Polycyclic aromatic hydrocarbons/PAHs (air pollution/smoke) and organophosphates
  • Moth balls, candles, xenobiotics, coffee, make-up, perfume and cosmetics
  • Role of CYP1A1, CYP2B, CYP1B1, SOD, GSTM and PON1 polymorphisms

carolyn ledowsky as6

We discuss very common sources of pollution – polycyclic aromatic hydrocarbons (PAHs) – and how certain gene polymorphisms can make us more susceptible leading to increased anxiety, depression and cognitive issues.

If you’re new to the term polycyclic aromatic hydrocarbons (PAHs), according to the EPA they “are a class of chemicals that occur naturally in coal, crude oil, and gasoline. They also are produced when coal, oil, gas, wood, garbage, and tobacco are burned.”

This essentially means that PAHs are all around us: traffic pollution, forest fires, wood burning in your home, coal burning power plants, cigarette smoke, second hand smoke, dust and more!

We discuss one study that reports how prenatal exposure to pollution can impact the ability of children when it comes to learning and make them more anxious and depressed:

  • Children of nonsmoking African-American and Dominican women in New York City were followed from in utero to 6–7 years.
  • The paper mentions urban air pollutants from fossil fuel burning and other combustion sources stating the results suggest an adverse impact of prenatal PAH exposure on child behavior that could impact cognitive development and ability to learn.
  • Anxiety, depression, and attention problems, which were associated with PAH exposure have been shown to affect subsequent academic performance.
  • The authors conclude that prenatal exposure to environmental PAH at levels encountered in the air of New York City may influence child behavior.

There are other similar studies reporting these issues in other age groups and other communities too, supporting the fact that PAHs/air pollution is more than a respiratory issue.

It contributes directly to mental health problems – anxiety, depression and ADHD – and needs to be considered as part of the solution.

—>> Find your anxiety solutions when you attend this complimentary, online event!!

We go deep into other sources of toxins and pollutants. And then look at the CYP enzymes (needed to process PAHs), and PON1 (needed to process organophosphates/pesticides) and what it means when we have polymorphisms i.e. a genetic susceptibility and what to do.

This interview is one of the registration gifts so you can listen to it right away as soon as you register (there will also be a complimentary transcript made available as soon as it’s completed.)

carolyn-ledowsky-as6-interview

Here is a little about the summit… as you know, anxiety can be related to your daily life experiences BUT it can also be triggered by:

  • foods you eat and what you drink (like wheat, oxalates, alcohol and more)
  • environmental toxins (like lead, plastics, fragrances, insecticides, fluoride and more)
  • many types of medications (like the birth control pill, acne medication, fluoroquinolone antibiotics and more) and/or
  • chronic infections (like Lyme disease, PANDAS, parasites, candida and more).

Once you identify the root causes and understand anxiety’s mechanisms you can support the liver/gallbladder, detox, address infections, implement targeted and supportive solutions, and get relief!

WHY ATTEND?

This is my 6th Anxiety Summit, featuring all new topics and the latest research related to anxiety and toxins, medications and infections.

I’ve also experienced many of these health challenges myself – lead and mercury toxicity, gluten issues and candida – and I’m currently dealing with chronic Lyme disease and dietary oxalate issues. You’ll hear some of my healing journey and my solutions in a few interviews too.

anxiety summit 6

WHAT SETS THIS ONLINE EVENT APART?

What sets this apart from other events on toxins and infections is being able to make the many connections to GABA (the main calming neurotransmitter) and serotonin (a happy and calming neurotransmitter) AND how to use  the amino acids GABA and tryptophan to ease your anxiety right away while you are dealing with the other underlying root causes – which take longer to address.

You will see this woven into each of the expert interviews (just like this one with Dr. Schaffner) and also addressed in detail in my 3 interviews where I do a deep dive into specific applications.

For example, in my toxins interview, I share how GABA reverses fluoride-induced anxiety and hypothyroidism, and how tryptophan and vitamin C ease anxiety symptoms associated with lead toxicity  (I’ll be sharing more about this in the future so stay tuned….)

Over the course of the next 6 weeks you’ll be seeing frequent emails from me with snippets and highlights from various interviews – like this one. I do hope you continue to enjoy them and get excited about the summit! Please do share if you know someone who has anxiety!

You’ve heard me say the Anxiety Summit has been called “a bouquet of hope!”  My wish for you is that this summit is your bouquet of hope!

I hope you’ll join me and these incredible speakers, be enlightened and find YOUR solutions!

Here’s to no more anxiety and you feeling on top of the world again!

Register here

 

If you’re already familiar with some of this information and practice some of this already please share how it’s helped you. That way we can all learn.

If you’d like to ask a question, please post in the comments below.

I’d also love to hear from you once you’ve listened to this interview. Please do come back and comment about some of the highlights of this interview and what changes you plan to make.

Even if you already receive my newsletters and signed up some time ago to be notified about the upcoming Anxiety Summit 6, you will still need to register at the new link here, because Health Talks Online is doing the production and backend work for me.

If you don’t register you won’t get access to the daily summit emails with all the interviews.

You will however, continue to get these emails from me.

This is my 6th Anxiety Summit and it is all new content!

The content is research-based and practical, and is geared to anxious individuals who are health-savvy and to practitioners who work with anxious individuals.

If you are totally new to functional medicine and nutritional solutions for anxiety, you will still learn so much so just take in what you can and know you’ll get all this eventually.

Vitamin C causes oxalate formation resulting in pain, anxiety, and insomnia (when there is a defect in ascorbic acid or oxalate metabolism)?

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vitamin c and oxalate

Supplemental vitamin C has many exceptional health benefits and causes no issues for a large majority of individuals. However if you have dietary oxalate issues, doses of vitamin C above 100mg to 250mg per day may be problematic and trigger pain, anxiety, insomnia, bladder issues and more. This blog, Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?, is part 1 of the series  which sets the scene and is a fact-finding article. Part 2, Oxalate crystal disease, dietary oxalates and pain: the research & questions (part 2), covers the research behind oxalate crystal disease.

Today we look at some of the research on vitamin C/ascorbic acid being a possible trigger for the formation of oxalates in certain instances. This paper, No contribution of ascorbic acid to renal calcium oxalate stones, has a good summary:

Even though a certain part of oxalate in the urine derives from metabolized ascorbic acid, the intake of high doses of vitamin C does not increase the risk of calcium oxalate kidney stones due to physiological regulatory factor: gastrointestinal absorption as well as renal tubular reabsorption of ascorbic acid are saturable processes, and the metabolic transformation of ascorbic acid to oxalate is limited as well.

But in the large-scale Harvard Prospective Health Professional Follow-Up Study, those groups in the highest quintile of vitamin C intake (> 1,500 mg/day) had a lower risk of kidney stones than the groups in the lowest quintiles.

This paper does however have this precaution:

Recurrent stone formers and patients with renal failure who have a defect in ascorbic acid or oxalate metabolism should restrict daily vitamin C intakes to approximately 100 mg.

My proposed interpretation of this

I’d like to propose an interpretation of this, based on what we know about oxalates. These are the individuals who should restrict daily vitamin C intakes to approximately 100 mg per day (or up to around 250mg per day – more on the range below):

1) If you are someone who is a recurrent stone former or is in renal failure with a defect in ascorbic acid or oxalate metabolism

2) If you are someone with dietary oxalate issues i.e. you have similar symptoms when consuming vitamin C as you do when consuming high oxalate foods. Could we consider that you be classified as having “a defect in ascorbic acid or oxalate metabolism?” I would say yes.

I’ve added #2 above because we need to keep in mind that many individuals who have issues with dietary oxalates are not necessarily stone formers and nor do they have renal failure.

Research is also lacking in this area as you can read in Oxalate crystal disease, dietary oxalates and pain: the research & questions (part 2).

An omission of the 100mg per day restriction

I would like to point out that the study mentioned above was referred to in an article on Dr. Andrew Saul’s site but for some reason the section about the 100mg daily restriction was omitted from the article. It may have something to do with the fact that the author firmly believes that no-one has oxalate issues with any dose of vitamin C. In fact, he even jokingly makes this comment in the article:

Is some clown still trying to tell you that vitamin C is somehow dangerous? Or that you shouldn’t take more than 200 mg/day?

If you are someone who does experience pain when consuming vitamin C (like I do), I’m pretty sure you don’t find this comment amusing.

Vitamin C intake leading to pain, anxiety, insomnia, low mood and bladder issues

Here is some additional feedback from a question I posted on Facebook. This is the question I posted:

I’ve been sharing here about vitamin C being an issue for some folks who have oxalate issues and seeing an increase in pain. I’d love to hear if you upped your vitamin C intake for immune support and saw your mood take a dive or your anxiety increase or your sleep get worse? Vitamin C typically helps because it’s a cofactor for making neurotransmitters like serotonin and GABA and tyrosine but too much of a good thing is not good! Did you also have increased or new pain (as well as anxiety, low mood and insomnia)?

Here are some of the responses from folks who shared about pain, anxiety, insomnia, low mood and bladder issues:

  • Fay shared this: “Yes increased pain, insomnia and anxiety with increased C and mouth sores to boot. Taking liposomal C and Ester C to boost antioxidants for health reasons and pain in elbows and knees. Not sleeping well at all either.”
  • Lica shared this: “Yes increased anxiety…never thought of it before…felt a bug coming on and took c for a few days…yup anxiety.”
  • Nicola shared this: “Increase in body pain, burning bladder, sleep affected and low mood ( not something I usually suffer with). I was taking liposomal C then increased the dose and also added Ester C as I had symptoms of covid. I was taking 1-2g a day of liposomal previously as a preventative and increased to 4g plus 4g of Ester. Only did it for a couple of days. Stopped three days ago and pain is starting to subside but no sleep last night. So I will continue with a break for now and add a very low dose again perhaps of Ester C and see how I go.”

I really appreciate these women sharing their experiences so we can all learn!

What is the upper limit of vitamin C for individuals with dietary oxalate issues?

I’m sure you’re wondering about the various dosages mentioned: the study mentions 100mg per day,  Dr. Andrew Saul’s clown comment says 200mg per day and Susan Owen’s TLO Facebook group recommends no more than 250mg per day. You’ll need to figure out what the upper dose of vitamin C you can tolerate – by trial and error.

The big disconnect is always the mention of kidney stones

This is one of many similar studies on the topic of ascorbic acid/vitamin C and oxalates. There are also many studies and articles stating that vitamin C does NOT play a role in the formation of oxalates and cause kidney stones. The big disconnect is always the mention of kidney stones. The missing piece – in the research and in many articles – is that you can have issues with dietary oxalates AND vitamin C when there is no kidney disease/no kidney stones.

I have a number of additional oxalate blog posts planned so please let me know what else you want to hear about.

Here are the 2 previous blog posts on this topic of oxalates, vitamin C and pain:

Please also share your vitamin C oxalate story and how you figured it out (and if you react in a similar way to dietary oxalates).

Let us know what your ideal dose is (and which dose caused issues) and what form of vitamin C and product name you use/used. Feel free to share if you also have a history of kidney stones.

Feel free to post your questions here too.

This Is Your Brain on Food by Uma Naidoo, MD (video interview and review)

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brain on food

Dr. Uma Naidoo has a wonderful new book called This Is Your Brain on Food: An Indispensable Guide to the Surprising Foods that Fight Depression, Anxiety, PTSD, OCD, ADHD, and More (my Amazon link)

Her big bold message is this “Until we solve nutritional problems, no amount of medication and psychotherapy is going to be able to stem the tide of mental issues in our society.”  This is something I wholeheartedly agree with!

I had the wonderful opportunity to interview Dr. Naidoo and we talked about the benefits of fermented foods and social anxiety, vitamin D and anxiety, dietary sources of polyphenols for ADHD and much more:

51 women with type 2 diabetes and vitamin D deficiency were randomly allocated to receive one oral pearl of 50,000 IU vitamin D3 (26 women) or a placebo (25 women) fortnightly for 16 weeks

Anxiety score changes were significantly lower in vitamin D group than the controls

Dietary polyphenols… have antioxidant capacities as well as immunoregulatory effects and, therefore, appear appropriate in ADHD therapy.

  • Dr. Naidoo recommends these sources of polyphenols: berries and other fruit, vegetables, extra virgin olive oil.
  • I’m fascinated by the fact that polyphenols “act as a low-dose toxin that trains the body to mount an immune response in a process called hormesis” (there are many geeky gems like this in the book)
  • Dr. Naidoo shares the story of her 36 year old patient with severe anxiety. He was a binge eater and also had a history of alcohol abuse. Vitamin B1 (250mg) was every effective for him…“In animal studies, thiamine appears to reduce stress-like responses because it protects the hippocampus”
  • We talk about chamomile tea and how it helps with sleep. There are some cautions if you’re on a blood thinner prescription or going to have surgery. Pregnant women should also avoid it.
  • Dr. Naidoo shares a delicious Golden Milk recipe with tips on how to use turmeric (one her favorite spices and inspired by her grandmother’s cooking) with black pepper. You’ll find this in the recipes section.
  • Dr Naidoo also shares one of her favorite comfort foods – a yummy lentil soup recipe called dal in south Indian cuisines. It’s a great source of fiber, plant-based protein and is very affordable. And really healthy when cooked with vegetables and spices like mustard seeds, ginger, garlic and turmeric. She shares a tip to improve the flavors – making tadka (listen to the interview below, enjoy and be inspired!)

 

It’s a wonderful book that I highly recommend if:

  • you are new to nutritional psychiatry and the power of food
  • you are a seasoned foodie and want to geek out on mechanisms and the science
  • you want to learn about foods and nutrients (all science-based) specifically for depression, anxiety, PTSD, OCD, ADHD and insomnia
  • you are a practitioner and want to learn and share a wonderful book with your patients or clients

I read it cover to cover and picked up so many gems. I also loved reading about her memories of cooking with her Pinetown granny (Pinetown is just outside Durban where we both happened to grow up)!

We do have a few professional differences of opinion that I feel I should mention:

  • I am not in favor of canola oil and I’d switch out the recipes that call for canola oil with olive oil
  • I have a difficult time extrapolating high-fat diets in rat studies to concerns about saturated fat consumption in humans (given the nature of the rat chow in many of these studies)
  • I’m more concerned with portion-size of carbs than I am with portion-size of healthy fats (and typically recommend full-fat coconut milk, and chicken and turkey with skin-on)
  • I find grass-red meat to be beneficial for my clients with anxiety and mood issues
  • Many of my anxious clients cannot tolerate any caffeine and I consider 14 alcoholic drinks a week for men and 7 alcoholic drinks a week for women to be excessive
  • I prefer stove-top and oven cooking to using a microwave.

This is the official book blurb:

Did you know that blueberries can help you cope with the aftereffects of trauma? That salami can cause depression, or that boosting Vitamin D intake can help treat anxiety?

When it comes to diet, most people’s concerns involve weight loss, fitness, cardiac health, and longevity. But what we eat affects more than our bodies; it also affects our brains. And recent studies have shown that diet can have a profound impact on mental health conditions ranging from ADHD to depression, anxiety, sleep disorders, OCD, dementia and beyond.

A triple threat in the food space, Dr. Uma Naidoo is a board-certified psychiatrist, nutrition specialist, and professionally trained chef. In This Is Your Brain on Food, she draws on cutting-edge research to explain the many ways in which food contributes to our mental health, and shows how a sound diet can help treat and prevent a wide range of psychological and cognitive health issues.

Packed with fascinating science, actionable nutritional recommendations, and delicious, brain-healthy recipes, This Is Your Brain on Food is the go-to guide to optimizing your mental health with food.

Uma Naidoo, MD is board-certified psychiatrist (Harvard Medical School), professional chef (Cambridge School of Culinary Arts), and nutrition specialist (Cornell University). She is currently the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH), where she consults on nutritional interventions for the psychiatrically and medically ill; Director of Nutritional Psychiatry at the Massachusetts General Hospital Academy; and has a private practice in Newton, MA. She also teaches at The Cambridge School of Culinary Arts.

Dr. Naidoo speaks frequently at conferences at Harvard, for Goop audiences, the New York City Jewish Community Center (JCC), and Ivy Boston. She blogs for Harvard Health and Psychology Today and completed a unique video cooking series for the MGH Academy which teaches Nutritional Psychiatry using culinary techniques in the kitchen.

You can get your copy of This Is Your Brain on Food here (my Amazon link) and find additional information about Dr. Naidoo here and the book here.

Let us know what you think in the comments below and be sure to leave Dr. Naidoo a review once you read your copy!

Feel free to post your questions here too.

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

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5-htp salivary

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.

Hydroxychloroquine and chloroquine (antimalarial drugs): quinism and the risk of sudden and lasting neuropsychiatric effects

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Hydroxychloroquine

The Quinism Foundation, a nonprofit charitable organization “promotes and supports education and research on quinism, the family of medical disorders caused by poisoning by mefloquine, tafenoquine, chloroquine, and related quinoline drugs.”

Executive Director of the foundation, Dr. Remington Nevin, MD, MPH, DrPH, is a Johns-Hopkins trained psychiatric epidemiologist and drug safety expert and former U.S. Army public health physician. He has published extensively on the subject.

The foundation share the symptoms of chronic quinoline encephalopathy, also known as neuropsychiatric quinism:

The term “quinism” may seem new, but the symptoms of poisoning by mefloquine (previously marketed as Lariam®), tafenoquine (marketed as Krintafel® and Arakoda™), chloroquine (marketed as Aralen®), and related quinoline drugs are all too familiar: Tinnitus. Dizziness. Vertigo. Paresthesias. Visual disturbances. Gastroesophageal and intestinal problems. Nightmares. Insomnia. Sleep apnea. Anxiety. Agoraphobia. Paranoia. Cognitive dysfunction. Depression. Personality change. Suicidal thoughts.

These symptoms are not “side effects,” they are symptoms of poisoning by a class of drug that is neurotoxic and that injures the brain and brainstem. This poisoning causes a disease, and this disease has a name: Chronic quinoline encephalopathy — also known as quinism.

In March they published this press release: The Quinism Foundation Warns of Dangers from Use of Antimalarial Quinolines Against COVID‑19. Here are some highlights:

  • A risk of sudden and lasting neuropsychiatric effects from the use of antimalarial quinolines against COVID‑19, the disease caused by the novel coronavirus
  • In susceptible individuals, these drugs act as idiosyncratic neurotoxicants, potentially causing irreversible brain and brainstem dysfunction, even when used at relatively low doses

What is concerning is lasting neuropsychiatric effects and the fact that even low doses can cause irreversible effects. The Foundation “has urged policy makers, physicians, and members of the public to be alert to such effects.”

Dr. Nevin states that “these are not safe drugs” and “While it may be tempting to attribute anxiety, depression, paranoia, or other mental health symptoms to the psychological effects of the COVID‑19 pandemic, these symptoms may be an early warning sign of idiosyncratic neurotoxicity, and must be taken seriously.” 

You can read the entire March 2020 press release here. It contains a link to U.S. Food and Drug Administration’s MedWatch program for reporting adverse effects.

Another press release published late July also cautions the use of tafenoquine against COVID-19 which The Qunism Foundation states “is a neurotoxic quinoline antimalarial drug with a similar adverse effect profile to mefloquine.”

New COVID-19 research on chloroquine and hydroxychloroquine

It’s encouraging to see that new research published on COVID-19 and these medications also highlights the possibility of neuropsychiatric side effects (even through the authors state it’s considered uncommon): Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake of COVID-19: Psychopharmacological Interactions and Neuropsychiatric Sequelae

…neuropsychiatric side effects are very uncommon but possible, and include a potentially prolonged phenomenon of “psychosis following chloroquine.” Hydroxychloroquine has less information available about its neuropsychiatric side effects than chloroquine, with psychosis literature limited to several case reports

Case reports on psychiatric symptoms induced by hydroxychloroquine

Here is one of these case reports: Psychiatric symptoms induced by hydroxychloroquine.  A 36-year-old woman was diagnosed with Systemic Lupus Erythematosus (SLE) and antiphospholipid syndrome, and was treated with prednisone 10 mg and hydroxychloroquine 200 mg every 24 hours. Her arthritis improved but

One month after initiation of treatment, the patient began with generalized anxiety, suicidal ideation and the appearance of auditory and kinaesthetic [tactile] hallucinations.

She had similar adverse effects 5 years later  when hydroxychloroquine (without prednisone) was prescribed following an outbreak of cutaneous SLE

A week later, the patient was admitted to the Department of Psychiatry because of suicidal ideation, self-harm and kinaesthetic and auditory hallucinations, which improved after withdrawal of hydroxychloroquine and treatment in a psychiatric setting. 

Since then, the patient has not been taking hydroxychloroquine and has had no further episodes of kinaesthetic [tactile] or auditory hallucinations.

Here are two other case reports: Hydroxychloroquine-induced acute psychosis in a systemic lupus erythematosus female and Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report.

Risk factors for susceptibility

This review article from 2018, Neuropsychiatric clinical manifestations in elderly patients treated with hydroxychloroquine: A review article mentions that these adverse events can range from less severe nervousness to “actual psychosis and suicidal tendencies.” 

It also lists possible risk factors that may make certain individuals more susceptible:

co-exposure to interacting drugs, alcohol intake, familial history of psychiatric diseases, female gender, and the concomitant use of low-dose glucocorticoids [such as prednisone]. 

Malaria drug causes brain damage that mimics PTSD

I first learned of this neuropsychiatric connection a number of years ago when I read about the “case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug.” You can read about this here – Malaria drug causes brain damage that mimics PTSD: case study.

A few years ago I also blogged about the anti-malaria medication mefloquine and how it was known to contribute to neuropsychiatric symptoms in susceptible individuals: PTSD from 3 tours in Afghanistan: Can GABA help with the anxiety?

My concerns about long-term prophylactic use and lack of awareness

My concerns are long-term prophylactic use. There are a number of clinical trials planned or in progress for long-term use in healthcare workers. If they are stressed, anxious, depressed and exhausted because of the COVID-19 work they have been doing, they may incorrectly attribute some of their symptoms to all that rather than the medication side-effects. And if they do get COVID-19, they may confuse the neurological and psychiatric effects of COVID-19 with those of chloroquine or hydroxychloroquine.

What also concerns me is the lack of awareness. None of the advocates of this class of medications mentions quinism, the possible neuropsychiatric side-effects and long-term risks, or who may be susceptible.

I would be very happy if chloroquine or hydroxychloroquine is found to be a solution (or part of a solution) for COVID-19 – alone or in combination with zinc – for certain individuals.

But I believe we do need to be very aware about side-effects as serious as these. I’d also like to see education for healthcare providers and the consumer, as well as informed consent for the consumer.

Similar concerns with other medications

In the past I’ve written about similar concerns with other medications such as benzodiazepines, SSRIs and fluoroquinolone antibiotics:

Your feedback and questions so we can all learn

I encourage you to keep all this in mind as you navigate what you hear in the news, read on social media and/or read in the research on hydroxychloroquine.

Keep all this in mind too if you have future plans to travel to a malaria area for a vacation in the future (wouldn’t we love that – a trip!?).

Have you used chloroquine or hydroxychloroquine for COVID-19 and experienced psychiatric side-effects? Or know someone who has?

Have you used antimalarial medications in the past and experienced psychiatric side-effects? Was this a short-course or long-term prophylactic use?

Have you used these medications for lupus or rheumatoid arthritis with success and without psychiatric side-effects? Or have you experienced adverse effects and had to stop?

If you have had adverse psychiatric effects please share which medication, dosage and frequency? Also do you have any of the predisposing risk factors: alcohol intake at the time, history of psychiatric diseases (you or family members), are female, and were also prescribed low-dose glucocorticoids such as prednisone, and/or other medications (and which ones)?

Feel free to post your questions here too.