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Nightmares

Tryptophan and DPA (d-phenylalanine) for cravings and sleep issues (and a concern about 5-HTP and nightmares)

By Trudy Scott 19 Comments

tryptophan dpa craving sleep issues

Thank you for all your work! I saw your talk in the Super Trauma conference and immediately went and read your book. I suspect I am low in all 3 neurotransmitters, and have noticed the biggest difference in supplementing with DPA (d-phenylalanine). I started taking all 3 supplements by swallowing and switched to taking them sublingually after I got used to the idea.

My question is about tryptophan in particular. I struggle with nightmares already so I am a bit wary of trying 5-HTP. I tried taking mid afternoon and before bed but it made me way too tired in the afternoon. Is it okay to just double the dose right before bed? How safe are these amino acids in higher doses? I was also wanting to add an evening dose of DPA to help with cravings. Thanks again!

I get many questions like this on the blog about using either 5-HTP with DPA or tryptophan with DPA together, for helping to improve sleep and ease sugar cravings. So today I’m sharing one of these questions and my insights in case you have a similar question. This will also give you the opportunity to ask questions you may have related to using these amino acids together and gain an understanding on how to tweak the amino acids for optimal results.

Read on for my response to the above question from Amanda. I also share more about 5-HTP and nightmares (and why she may also decide to use this amino acid too), vitamin B6 and nightmares, pyroluria, and how to figure out if your cravings are due to low endorphins or low serotonin (or a combination).

Should she add an evening dose of DPA?

It’s wonderful to hear that DPA is helping with Amanda’s comfort cravings/emotional eating and other low endorphin symptoms. As a reminder these include:

  • Heightened sensitivity to emotional pain
  • Heightened sensitivity to physical pain
  • Crying or tearing up easily
  • Eating to soothe your mood, or comfort eating
  • Really, really loving certain foods, behaviors, drugs, or alcohol
  • Craving a reward or numbing treat
  • PMS (premenstrual syndrome) or PMDD (premenstrual dysphoric disorder) *

(bookmark this symptoms questionnaire because it’s updated as new research is published and has more symptoms listed that what is included in my book)

And in case you’re new to DPA (d-phenylalanine), it is an amino acid that prevents the breakdowns of endorphins so we have more of these feel-good neurotransmitters.

I’m really glad she figured out it’s more effective when opened and used on the tongue rather than swallowing it. I share more about this here – How best to use the amino acid DPA for easing heart-ache, weepiness, comfort eating and a compulsive desire for food. It really can mean the difference between no results and great results.

Amanda asks about adding an evening dose of DPA to help with endorphin-related cravings too and also using tryptophan only at night. Keep in mind that afternoon and evening cravings are typically related to low serotonin and it’s best to trial one amino acid at a time so you know which is working for which symptom. If we were working together, I’d recommend figuring out her serotonin support first and then layering in an extra DPA (or possibly two) at night if it’s still needed.

In case you’re curious, I discussed low serotonin, low endorphins and low GABA in my interview at the Trauma Super Conference so she is also using GABA. Using this one sublingually is key and it helps with easing physical tension and stress eating.

What could her serotonin support look like?

Since tryptophan used mid afternoon and before bed made her way too tired in the afternoon she could consider a lower dose of tryptophan (midafternoon and evening) or could just trial one tryptophan after dinner to help with sleep and reduce after dinner cravings.

For some folks this is enough. If not, after a few days of tracking symptoms, she could increase to one tryptophan after dinner and another at bedtime or two tryptophan at bedtime if her symptoms are not down 2/10 or 3/10.

Her concern about 5-HTP and nightmares

Some folks do better on 5-HTP and some on tryptophan and she is getting results with tryptophan so doesn’t really have to worry about 5-HTP at this stage. However, I do want to address Amanda’s concern about 5-HTP and nightmares, because in the future she may want to consider 5-HTP.

She may find she does in fact need some serotonin support earlier in the day and 5-HTP in the afternoon may be the answer for her i.e. 5-HTP midafternoon and tryptophan in the early evening and/or at bedtime.  It’s not unusual that we mix and match these two amino acids.

I’ve not had any clients report nightmares with 5-HTP, so I was surprised to hear this feedback on a Facebook thread, where a number of folks stopped using it for this reason. However, most folks on the same Facebook thread shared that 5-HTP works very well for them and does not cause nightmares. There is also research that supports the use of 5-HTP for night terrors. I suspect it may have to do with low vitamin B6 which we know contributes to poor dream recall and/or nightmares.

I share more about 5-HTP and nightmares here. And vitamin B6 and dream recall here.

I posed this question in the 5-HTP/nightmares blog: “Could it be that folks who get nightmares with 5-HTP, happen to also have pyroluria? Or perhaps they simply have low vitamin B6?” I have all my anxious clients supplement with vitamin B6 and/or P5P and this may be why nightmares with 5-HTP was news to me.

Vitamin B6 for neurotransmitter production and pyroluria

Since she does already struggle with nightmares, I’m not surprised she is concerned. However nightmares are a clue that someone may have low vitamin B6. This is typically picked up when I have clients do the pyroluria questionnaire on the intake form. Addressing low vitamin B6 is also important because it’s a cofactor for making the neurotransmitters and helps with hormone balancing.

I reminded her to read the pyroluria chapter in my book too. It includes the above questionnaire and detailed information on vitamin B6, zinc and evening primrose oil (all needed to address this condition that leads to feelings of being socially anxious).

How safe are these amino acids in higher amounts?

I share the top of the range for dosing all the amino acids in my book. This is typically 1500 mg tryptophan twice a day, 150 mg 5-HTP twice a day and 1500 mg DPA three times a day. Occasionally I have had clients need higher doses. The clue is symptom relief. We start low, monitor symptoms and adjust up as needed, and then down if no additional benefits are observed.

Using extra DPA at night for cravings?

As I mentioned above, I’d recommend figuring out serotonin support first (tryptophan only or a combination of 5-HTP and tryptophan) and then layering in an extra DPA (or possibly two) in the evening if it’s still needed for comfort cravings.

For some folks it’s very easy to identify comfort cravings (low endorphins) from worry/low mood cravings (low serotonin):

  • If you eat sugar or carbs to feel happy (and especially from late afternoon into the evening) then your sugar cravings are likely due to low serotonin, and tryptophan (or 5-HTP) stops the cravings and boosts mood and reduces anxious feelings
  • If you are a comfort-eater then it’s likely due to low endorphins and DPA will stop that feeling of “I deserve-it” kind of reward-eating or comfort-eating and also give you a hug-like mood boost

If it’s not easy to figure out the only way to know for sure is to do a trial of tryptophan and then do a trial of DPA and observe before and after feelings and the need to self-medicate with whatever the sugary treat is. Amanda may need one or the other at various times and she may even need both at certain times.

DPA and tryptophan product options

lidke endorphigen
lidtke l-tryptophan

I recommend Lidtke EndorphiGen (which is DPA) and Lidtke Tryptophan 500mg. You can purchase these from my online store (Fullscript – only available to US customers – use this link to set up an account).

nature's best l-tryptophan
life extension l-tryptophan

If you’re not in the US, these products are available via iherb: Doctor’s Best D-Phenylalanine (or DPA) and Life Extension Tryptophan 500mg (use this link to save 5%).

Additional resources when you are new to using amino acids as supplements

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

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

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

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), if you need serotonin support, the Serotonin QuickStart Program is a good place to start. This is a paid online/virtual group program where you get my guidance on using tryptophan and 5-HTP safely, and community support during 5 LIVE Q&A calls. You can sign up to be notified when the next live launch of this program is happening. We take a deep dive into product options including Lidtke products and others if you’re not able to access Lidtke.

Low GABA can also affect sleep and cause stress eating. If you also have low GABA symptoms, the next step to get help is the GABA QuickStart Program. This is also a paid online/virtual group program where you get my guidance and community support. Another option is the budget-friendly GABA QuickStart Homestudy program.

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

Wrapping up and your feedback

I’m thrilled Amanda is seeing these benefits with DPA, tryptophan and GABA and is fine-tuning her results even further. I appreciate her asking her questions on the blog so I can share and we all can learn.

Now I’d love to hear from you – does any of this resonate with you? If yes, which combination has worked best for you for emotional eating and sleep issues?

Is 5-HTP or tryptophan better for you and is vitamin B6 part of your supplement list.

If you’re a practitioner have you seen this combination work well with clients/patients?

Feel free to share and ask your questions below.

A case of enterobiasis presenting as post-traumatic-stress-disorder / PTSD (i.e. a common and parasitic pinworm infection)

By Trudy Scott 11 Comments

case of enterobiasis

Enterobiasis (oxyuriasis) is a common infection in humans caused by Enterobius vermicularis (E. vermicularis), a human intestinal helminth. Because of the easy way of its transmission among people, it has an extremely high prevalence in overcrowded conditions, such as nurseries and primary schools. Oxyuriasis’s symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis.

Here we report a curious case of oxyuriasis in the settings of a refugee camp in Greece. The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis.

This infection is the first documented case of enterobiasis in the settings of a refugee camp and can highlight the unsanitary living conditions that refugees have to endure in those camps.

The above is the abstract from a 2017 paper: A case of enterobiasis presenting as post-traumatic-stress-disorder (PTSD): a curious case of the infection with predominant mental health symptoms, presenting for the first time in the settings of a refugee camp

In addition to her symptoms of insomnia and irritability, she had a decreased appetite and mild abdominal (tummy) pain. She was also experiencing nausea and vomiting and had a slightly raised body temperature (subfebrile). She was severely malnourished and had lost 3kg/6.6lbs in 5 days.

Because of the violent nature of her situation she was initially seen by a psychologist but her symptoms worsened in a few days. When this young girl complained about itching in the perianal area (around her anus), the clinic reassessed her and scars around the anal area from the scratches.

They then confirmed enterobiasis/pinworm after using a piece of clear adhesive tape “to collect a specimen from the perianal surface of the girl, for three consecutive mornings … A microscopic examination showed the presence of oval shaped eggs, which is typical for the specific helminth [parasitic worm].”

She was treated with “two doses of albendazole, with each dose two weeks apart, in order to avoid reinfection …. And after a 3 month follow-up period, the patient remains asymptomatic without any signs of recurrence.”

An overview of pinworm infections, symptoms, tape test and treatment approaches

This WebMD article offers an overview of pinworm infections, the symptoms, the tape test and treatment approaches.

As you’ll read it’s not only a problem in refugee camps – it’s “very common in elementary school-aged children” and it’s the most common kind of worm infection in the United States. “Most of the time, pinworm infections don’t cause serious problems.” However, when one child (or adult) gets a pinworm infection it can easily be spread to the entire family.  The Syrian refugee paper mentions the whole family was tested.

Systemic infection: female health issues and gut health

The WebMD authors also state, “in rare cases, and especially if you have a lot of them, the pinworms can travel from the anal area up the vagina to the uterus, fallopian tubes, and around the pelvic organs. This can cause inflammation of the vagina (vulvovaginitis).”

I first learned about these serious systemic issues in women from naturopathic doctor Rachel Arthur at a conference in Australia. Contrary to the WedMD article, she believes this is not rare and more common than you’d expect, contributing to hormonal imbalances and even infertility.

The research confirms the impacts of pinworm on the gut, with reports of pinworm associated with appendicitis, pinworm in the liver, pinworms contributing to dysbiosis and pinworm being a factor in inflammatory bowel disease.

The WebMD article doesn’t mention the mental health symptoms and mechanisms but you can read more about that (and my interview with Dr. Jay Davidson) below.

Annual deworming and concerns about drug resistance?

I’m not going to get into anti-parasitic medications and herbal alternatives in this blog post – Dr. Jay talks about mimosa pudica seeds and Dr. Rachel recommends chondroitin sulfate – but do I want to mention that there are many public policy papers calling for annual deworming procedures for everyone. It’s also mentioned in the above Syrian refugee paper, as is hand-washing for prevention.

And many folks recall annual deworming concoctions as a child and did/do the same with their children.

There is, however, the concern about antiparasitic drug resistance similar to what is being seen with antibiotics and antiviral drugs.

If you are new to parasites and their impacts on mood issues, anxiety and insomnia and more

If you are new to parasites, here are some insights from an interview I did with Dr. Jay Davidson on The Anxiety Summit 5: Gut Brain Axis. The topic of our interview is – Parasites, Anxiety and TUDCA for Your Liver. He shares this:

The Greek meaning of parasite is one that sits at another’s table. So essentially think of a parasite as it’s taking things from you. It’s taking nutrients, it’s taking key things that your body needs and literally off of you, not to the point that it’s killing you because then you’re not a good host to give a good environment. So it’s basically just kind of sucking you dry.

We discussed symptoms individuals may experience: mood issues, anxiety and insomnia (especially around full moon). He shared that with insomnia “the big issue that I see is restless sleep where you toss, you turn, you wake often. You can’t just be relaxed when you sleep. Parasites get active when you go to bed. The more active they are within your body and the more you’re trying to calm down, the more your body is getting stressed out. This is where teeth grinding happens when you sleep.

This is very typical and likely the kinds of insomnia symptoms this young refugee girl experienced too. Pinworm is more active at night so the itching around her anus and the need to scratch would have affected her sleep too. This is a classic sign of pinworm.

With regards to anxiety and mood issues and possible mechanisms, Dr. Jay shares how parasites contribute to neurotransmitter imbalances:

Parasites will eat the protein you eat and not allow your body to break down that protein into amino acids. That’s why amino acid therapy can be so beneficial symptomatically and change people’s lives, because they’re getting these amino acids that they’re not getting when they have parasites.

When we digest protein, the amino acids are needed to help us make neurotransmitters. With his amino acid comments, he is making reference to my work with the amino acid tryptophan to support your low serotonin worry-type of anxiety symptoms and the amino acid GABA to support your low GABA physical-anxiety type symptoms. They are wonderful for quick relief of anxiety and mood symptoms, and even help sleep problems too. But as he says “you always want to make sure to go to the underlying cause to remove the parasitic infection.”

Other symptoms of parasitic infection that we discuss at length: restless legs and calf cramping, diarrhea, bowel urgency, SIBO (small intestinal bacterial overgrowth), vertical wrinkles above your mouth, nail-biting, food sensitivities, bed-wetting and night sweats. These are all symptoms that we need to look for and then consider stool testing and/or the sticky tape test/clear adhesive tape test for pinworm (as mentioned in the Syrian refugee paper and WebMD article above).

If you missed this interview and/or summit, you can find the purchase link on the above blog and here.

Tryptophan is not working (possibly because of parasites) and toxoplasma gondii (and GABA/anxiety)

Here is some additional reading on parasites on my site and in the literature:

Resources if you are new to using tryptophan, GABA and other amino acids as supplements

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

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

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

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

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

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

If you or a family member have had a pinworm infection, what symptoms did you experience and was the entire family affected?

Have you had hormonal and/or pelvic issues and/or gut issues as a result of systemic infection with pinworm?

How have other parasitic infections impacted your health?

How familiar are you with the fact that pinworm and other parasites can affect your mood, anxiety and sleep, as well as cause gut issues?

If you’re interested in learning more about testing and herbal protocols please let me know. If you’d like to share what has worked for you please do share too.

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

5-HTP with Paxil, when nursing, for men, with insomnia in Parkinson’s and when it gives you nightmares: questions and answers

By Trudy Scott 8 Comments

5-htp q and a

5-HTP is an amino acid, made from the seeds of an African plant, Griffonia simplicifolia, and used as a supplement to ease low serotonin symptoms of worry-type anxiety, often with ruminations, obsessing and panic attacks. When you have insomnia caused by low serotonin you may lie awake worrying. This type of anxiety is different from the low GABA physical/tension type anxiety. Other low serotonin symptoms include low mood/depression, late afternoon and evening carbohydrate cravings, pain, digestive/IBS symptoms, PMS, irritability, rage and anger, TMJ, low confidence, imposter syndrome and perfectionism.

I’ve blogged about 5-HTP extensively and I receive many great questions about this supplement. Today I’m going to share some of these questions and my answers so you can get the benefits too: using it with Paxil, insomnia when you have Parkinson’s disease, if 5-HTP works for men, timing of 5-HTP with nightmares and if 5-HTP can be used in pregnancy and when nursing.

Haley shared how 5-HTP helps with insomnia and asks about taking it with Paxil:

I was taking 5-HTP and it definitely helped me sleep at night. I recently started Paxil for my panic attacks after a recent trauma and I’m no longer sure if I can take Paxil with 5-HTP or not?

I’m so glad to hear 5-HTP helped with sleep. I’m sorry to hear about your recent trauma but keep in mind the other benefits of 5-HTP – helping with panic attacks is just one. When I’m working with someone who has experienced something like this and is already seeing benefits with 5-HTP, we increase their 5-HTP to help with the panic attacks too.

If they have already started Paxil and would prefer to stop using it I have them read this tapering blog and work/discuss with their prescribing doctor. There is the risk of serotonin syndrome with SSRIs (such as Paxil) and 5-HTP (and tryptophan).

There are many nutritional solutions for trauma and psychological stress (a natural disaster or anything else) and we’d address all this too.

Lynn has Parkinson’s disease and sleep problems:

I have Parkinson’s and sleep is starting to be an issue. I usually fall asleep but after about 4 hours I’m wide awake. I’m afraid this sleeplessness will negatively affect my brain if I can’t remedy this. I take carbidopa/levodopa. I’ve seen a sleep neurologist and she wants to prescribe drugs which again I’m afraid will have a negative effect on my brain. Your suggestions around 5-HTP would be very much appreciated.

We always start with the low serotonin symptoms and do a trial of either 5-HTP or tryptophan if it looks like low serotonin is the root cause of the sleep issues (there are many other root causes of insomnia).

If you score high on many of the low serotonin symptoms I suggest sharing this 5-HTP/Parkinson’s disease blog post and research with your sleep neurologist and Parkinson’s doctor: “Research shows that the amino acid 5-HTP (5-hydroxytryptophan), the intermediate metabolite of tryptophan in the production of serotonin, offers benefits for Parkinson’s disease patients. It has been reported to ease depression and to reduce levodopa-induced motor complications. This was reported in two separate studies by the same research team at the University of Cagliari, Cagliari, Italy. They were small studies and considered preliminary.”

Meleah asks about using 5-HTP with men:

Hi Trudy, did you recommend the same protocol for men? Most of the examples are about women and I have a male friend who needs help

Generally speaking the amino acids work the same for men but I have found that the impact they have on the sex hormone estrogen when using 5-HTP or tryptophan (and progesterone when using GABA) means they tend to work exceptionally well for women.

I also have much more experience working with women so I have more to share on these outcomes. With the few men I have worked with I find they tend to under-report when looking at their low serotonin symptoms so this needs to be taken into account when doing the trial of 5-HTP or tryptophan.

Scott shared how he uses 5-HTP for insomnia and his solution for preventing nightmares when using it:

In regards to nightmares with 5-HTP, I definitely seem to experience disturbing dreams when I take it within 4 hours of bedtime. Therefore, I normally don’t take any after 7pm but do take it periodically throughout the day.

I also suggested it to a friend who tried and likes it very much, however, he experienced excessive dreaming which interferes with him sleeping soundly, so I suggested the same protocol to him.

When I was in college, I am now a senior, I tried taking regular tryptophan and soon started having nightmares and hallucinations as I began seeing faces on the wall when I was trying to fall asleep.

I only take 5-HTP now, in extended release 200mg tablets from the Natrol company. Thank you, Trudy, for bringing this subject up.

I thanked him for sharing this interesting nuance of nightmares with 5-HTP and using it in the day instead. (which I blogged about here i.e. some folks do get nightmares when using 5-HTP)

I’m glad he figured this out and it helps since tryptophan does cause him nightmares. We are all so different and have to find what works best for our unique needs.

Carly asks about using 5-HTP when nursing:

Can someone take 5-HTP while nursing?

5-HTP has not been studied during pregnancy or nursing but a free form amino acid blend that does contain tryptophan is often very helpful. You have to really look for these because many companies choose to leave out tryptophan. I have a few listed on the supplements blog.

Other approaches to improve mood, reduce anxiety and help with sleep while nursing include exercise, yoga, diet and bright light therapy/full spectrum light. Dr. Aviva Romm writes about herbs for anxiety and specifies which are safe while nursing.

If you are new to other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, and pyroluria my book “The Antianxiety Food Solution” is a great place to start for the foundations. Much of this helps with low mood, cravings and insomnia too. More here.

5-HTP is often successfully used in conjunction with other amino acids

Here are some useful blogs related to low serotonin and 5-HTP. As you can see, it’s often successfully used in conjunction with other amino acid supplementation:

As always, it’s not only the low serotonin we need to address. 5-HTP offers quick relief but we must always do a full functional workup looking at diet, nutritional deficiencies, digestion, all hormones, toxins and infections (and so on) so we can address all possible root causes – and why serotonin is low in the first place.

I also want to add that I typically start with tryptophan for low serotonin support simply because I have such good results with it and because 5-HTP can raise cortisol in some folks. If we already have salivary cortisol results and none of the four collections are high then 5-HTP is an option to consider.

Resources if you are new to using 5-HTP and other amino acids as supplements

If you are new to using 5-HTP or any of the other amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA and low serotonin).

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

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

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

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

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

Thanks to these folks for asking good questions and for allowing me to share here.

What questions do you have about 5-HTP?

Which low serotonin symptoms can you relate to and has 5-HTP or tryptophan helped? Or have you found success with a combination?

Feel free to post your questions and feedback in the comments below.

Does 5-HTP (an amino acid) cause nightmares or does it help prevent nightmares (and also support low serotonin symptoms)?

By Trudy Scott 24 Comments

5-htp and nightmares

How do you do with using the amino acid 5-HTP for supporting your low serotonin symptoms of anxiety, worry, ruminating, fears, depression and insomnia?  Does it help or does it cause nightmares? On a recent Facebook thread someone shared that 5-HTP causes really bad nightmares, so she had to stop using it. A few others posted saying 5-HTP also caused them nightmares. I’ve not had any clients report nightmares, so I was surprised to hear this feedback.  However, most folks on the same Facebook thread shared that 5-HTP works very well for them and does not cause nightmares. There is also research that supports the use of 5-HTP for night terrors. I suspect it may have to do with low vitamin B6 and share more on that below.

Here is her experience with 5-HTP and nightmares and some of my feedback:

I don’t know how anyone takes 5-HTP. The horrific nightmares I got from taking it made me stop 50 mg. I tried 3 times thinking it was a fluke and it happened every time. Too scary for me.

My first try was suggested from my Naturopath, Metagenics SeroSyn. 200 mg. First morning waking up I had a nightmare so bad I can’t even share it. I also woke up feeling unable to wake up, drugged almost. So I waited, did more research and googled 5-HTP and nightmares just to see if there was a connection. I found it. I read to lower the dosage. So I went to Pure Encapsulations 50 mg. Same thing happened. I tried 2 more times, same thing happened. When I researched, I found so many people talking about “vivid dreams” and after my last attempt the dream was so real I thought my son was in my home when I woke up and had to process reality from my dream. That did it for me. Now I’m terrified of it. Just my own experience. I did get help from depression though! But I cannot go through one evil for another. Now I’m stuck looking for help and answers.

I thanked her for sharing and agreed it does help to do a few experiments to be sure it was the 5-HTP. I also shared that I would not consider the Metagenics SeroSyn a good 5-HTP to test because of all the other ingredients. But it also happened with Pure Encapsulations 50 mg 5-HTP – that was a good test to confirm.

I also shared that some folks do better on 5-HTP and some on tryptophan so if 5-HTP did help with low serotonin symptoms then I’d consider a trial of tryptophan especially since she did say using the 5-HTP helped with her depression.

We would also look for other ways to support serotonin – saffron, turmeric, St. John’s Wort, theanine (it supports GABA, serotonin and dopamine) and of course diet (real whole food, quality animal protein, no gluten/sugar/caffeine, fermented foods, organic vegetables and fruit, healthy fats etc), gut health and more.

I’d also look into and address low zinc and low vitamin B6 as both are needed to make serotonin and the other neurotransmitters. More on low vitamin B6, pyroluria and nightmares below.

Here is some of the feedback from other folks who also had issues with 5-HTP:

  • 5-HTP didn’t mix well with my body either. Taken at night, horrible dreams, and 50mg Pure Encapsulations formula in the morning made me feel so dark, spaced out and terrible nausea.
  • I appreciate this post. I had nightmares from a magnesium supplement that included 5-HTP! Now I know I’m not alone.

And here is some of the feedback from folks who do well with 5-HTP (the majority of those who responded):

  • I take 100 mg of 5-HTP in the morning (Natural Factors) and about 350 mg of tryptophan before bed (Lidtke). It works well for me. No nightmares although I do dream a lot. Mostly noticed improvement in mood and ruminating thoughts. Also taking Sam-e which also helps.
  • I take chewable natural factors Tranquil Sleep. It contains other ingredients (like theanine) as well but it’s really easy to dose. If I take 2 it’s too much. I get weird dreams and a headache. So 1 1/2 it is.
  • 5-htp helped me so much! But I had to take it in the morning. 250mg was perfect for me. I was using this for my debilitating anxiety which would keep me in flight or fight all day and I would ruminate. Really helped me along with therapy. I no longer need it.
  • I’ve just started taking 50mg 5-HTP at night. It’s a micronized version I buy from a compounding chemist in Australia. No negative side effects so far.
  • Grateful for the reminder … I did great on 5-htp myself. Have had all dose amounts, given at different times too. I deal with chronic pain and trauma/stress.
  • My sister gets anxiety on 5-HTP but it helps me so much! I have not tracked regular consumption compared to my sleep (I get too much REM without it and wake up exhausted). I also no longer need it as a daily and can take it as needed. I take 200mg, forget the brand but it’s a single ingredient.
  • I take 50 mg of 5-HTP from Seeking Health and do very well on it. It has helped me with depression, worry, fear, more energy and motivation and no nightmares.
  • I take the Now brand, 100mg at bedtime along with the same brand of L theanine. No nightmares and I’ve been doing this for about 5 years.
  • I use 50mg Seeking Health 5-HTP and I love it. It gives me energy and motivation, helps with intrusive thoughts and anxiety. I’ve used the Jarrow brand in the past without results. No nightmares. P5P, on the other hand, I cannot take. It gives me such clear, vivid nightmares I would wake up crying. Never again.

We are all unique and there is clearly no one-size fits all.

Low vitamin B6 can cause nightmares or poor dream recall

It’s well recognized that low vitamin B6 can cause nightmares or poor dream recall. In this study, Effects of Vitamin B6 (Pyridoxine) and a B Complex Preparation on Dreaming and Sleep (which was randomized, double-blind and placebo-controlled), 100 participants from across Australia were given 240 mg vitamin B6 (pyridoxine hydrochloride) before bed for five consecutive days. Other study participants were given a B complex. This is the outcome of the study:

  • vitamin B6 significantly increased the amount of dream content participants recalled but did not significantly affect dream vividness, bizarreness, or color, nor did it significantly affect other sleep-related variables
  • participants in the B complex group showed significantly lower self-rated sleep quality and significantly higher tiredness on waking

This vitamin B6/dream recall research is of particular interest to me because of my work with pyroluria, a social anxiety condition which responds really well to supplementation with zinc, vitamin B6 or P5P (pyridoxal-5-phosphate) or a combination of both, and a few other key nutrients.  Here is the pyroluria questionnaire.

One of the classic signs of pyroluria is poor dream recall, stressful or bizarre dreams, or nightmares, signs which the late Carl Pfeiffer, MD attributed to low vitamin B6 status. He suggested that your dreams and dream recall serve as a good indicator of your need for vitamin B6. You should dream every night and you should remember your dreams. They should be pleasant – the kind of dreams where you wake up and want to close your eyes and continue dreaming.

Could it be that folks who get nightmares with 5-HTP, happen to also have pyroluria? Or perhaps they simply have low vitamin B6 status? I have all my anxious clients supplement with vitamin B6 and/or P5P and this may be why nightmares with 5-HTP was news to me.

5-HTP can increase cortisol – does this affect nightmares?

There is research and clinical evidence supporting that, for some individuals, 5-HTP can raise cortisol. I’ve blogged about this here:

This is not always the case. Someone in the same Facebook thread shared this: “My cortisol measured above the reference range, but 5-HTP is the only thing I’ve found that’s helping me sleep recently.”

I’m not aware of a high cortisol-nightmare connection but it’s possible. In one study, nightmares triggered high cortisol the next morning, but I donut this has relevance in this situation.

5-HTP induces long-term improvement of sleep terrors in children

There clearly is a subset of folks who don’t do well with 5-HTP and yet there is evidence that it can actually improve sleep terrors. In a small open label clinical trial of 45 children, it was found that 5-HTP was able to “modulate the arousal level in children and to induce a long-term improvement of sleep terrors” (in the majority of children in the trial). There were 34 male and 11 female children ranging in age from 3.2-10.6 years.

After the first visit, L -5-HTP was administered (2 mg/kg per day) at bedtime to 31 randomly selected patients for a single period of 20 consecutive days. After 1 month of treatment, 29/31 (93.5%) of patients showed a positive response. In the comparison group without drug therapy, after 1 month, the episodes disappeared only in four children (28.6%) while ten children (71.4%) showed the persistence of episodes with the same frequency as before. After 6 months, 26/31 (83.9%) of children treated with L -5HTP were sleep terror-free, while in five children (16.1%) sleep terror episodes persisted. Of the children in the comparison group, ten (71.4%) continued to show sleep terrors at 6-month follow-up.

If we assume a 10-year-old weighs, 70lb or close to 32kg, they would have been given 60mg 5-HTP (i.e. 2 mg/kg).

Typical adult dosing of 5-HTP is 50mg twice a day, mid-afternoon and evening. For a 10-year-old we may start with a quarter of this dose i.e. 12.5mg or 25mg 5-HTP twice a day, for a total of 25mg or 50mg a day – which is close to what was used in this study.

You can read more about this in the paper here: L -5-Hydroxytryptophan treatment of sleep terrors in children

Resources if you are new to using 5-HTP and other amino acids as supplements

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

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

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

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

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

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

How do you do with 5-HTP for low mood, worry-type of low serotonin anxiety, cravings, PMS, negative self-talk, anger/rage/irritability, insomnia, ruminating thoughts, winter blues etc? Does it help?

Or does it give you nightmares that are bad enough that you have had to stop?

Please share how much you used? And if tryptophan or other serotonin support helped instead?

Did the addition of vitamin B6 or P5P help prevent the nightmares when using 5-HTP?

And do you have pyroluria or suspect you may have it? Do you have high cortisol?

If you’re a practitioner I’d love to hear your experiences with 5-HTP and nightmares.

If you have questions please share them here too.

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

By Trudy Scott 14 Comments

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.

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

By Trudy Scott 80 Comments

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.