SSRI

Night eating syndrome: is low serotonin a root cause and is tryptophan a solution?

April 9, 2021 By Trudy Scott 17 Comments

According to this paper, Circadian Rhythm Profiles in Women with Night Eating Syndrome, “Patients with night eating syndrome (NES) – first described in 1955 – demonstrate a phase delay in the circadian pattern of food intake, manifested by evening hyperphagia, nocturnal awakenings with food intake, and morning anorexia.”

I would start by asking this question: is low serotonin a root cause and is tryptophan a possible solution? I’ll share why below and where to start in order to find a solution.

Before I do that let me explain the terminology used in the above quote: Circadian means it happens every 24 hours, hyperphagia is obsessive food-seeking behavior, nocturnal awakenings are waking in the night and anorexia refers to restricted eating in the morning.

There is no research supporting the use of serotonin support with either tryptophan or 5-HTP for night eating syndrome but I would still start here for the following reasons:

this behavior happens in the evening and at night and it’s well recognized that serotonin levels are lower later in the day and at night
carbohydrate cravings and addictions occur with low serotonin and cravings are most intense later in the day (typically afternoon and evening)
obsessive behaviors are common with low serotonin
insomnia or night-time waking is a common symptom with low serotonin
doing a trial with either of these amino acids will very quickly confirm if low serotonin is a contributing factor or will rule it out

I would also have my client look at other low serotonin symptoms which would help confirm that low serotonin may be a factor for them: worry-type of anxiety, ruminations, PMS, irritability, rage or anger, TMJ, panic attacks, perfectionism, depression, low self-esteem and so on. You can see all the low serotonin symptoms here.

We typically start with a trial of tryptophan simply because so many of my clients do so well with it. The other reason is that 5-HTP can raise cortisol and cause a wired-tired feeling. That being said, some folks do better on one vs the other so if tryptophan doesn’t help then we trial 5-HTP. You can see the products I use with my clients here on the supplements blog.

I would love to see tryptophan or 5-HTP being more extensively – because it works so effectively and quickly, and is addressing the root cause – but also because there is research that does support the serotonin connection to night eating syndrome:

Night eating syndome has been associated with “depression, emotional eating, sleep problems, and food addiction as well as with being overweight or with having obesity (especially as people age)” – all low serotonin symptoms.
Night eating patients are “responsive to selective serotonin reuptake inhibitor treatment” (antidepressant/SSRI treatment)
Bright light therapy may help with night eating because of it’s “serotonergic antidepressant mechanisms of action.” Night eating syndrome also shares features with seasonal affective disorder (SAD) and it’s not uncommon to experience both. The winter blues or SAD is common with low serotonin. I write more about SAD and bright light here.

I’d also consider low blood sugar as a contributing factor. We would need to rule out the use of the sleep medication Ambien/Zolpidem which has been shown to cause amnesia and sleep related eating disorders which resolves when the medication is stopped.

As always, it’s not only the low serotonin we need to address. Tryptophan or 5-HTP offer 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 share some possible reasons for low serotonin on this blog on imposter syndrome. Imposter syndrome is another common sign of low serotonin.

Have you been diagnosed with night eating syndrome or do you feel you possibly fit the profile? Does it happen every night and what foods are you drawn to? Which low serotonin symptoms can you relate to and has tryptophan or 5-HTP helped? What about light therapy? And was an antidepressant prescribed?

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

GABA for easing physical anxiety and tension: some questions and answers

April 2, 2021 By Trudy Scott 67 Comments

GABA is an amino acid used as a supplement to ease low GABA levels. With low GABA you’ll experience physical-tension and stiff-and-tense-muscles type of anxiety, panic attacks and insomnia. You may feel the need to self-medicate to calm down, often with alcohol but sometimes with carbs and sugary foods. GABA also helps with muscle spasms and provides pain relief when muscles are tight.

When I share my GABA blogs on Facebook I receive so many great questions (some basic questions and some more complex). Today I’m going to share some of these and my answers so you can get the benefits too.

Let’s start with the basic questions about using GABA.

Amanda asks:

What time of the day is best to take GABA?

The best time is 1 to 4 x a day, depending on your symptoms, between meals and always away from protein so it doesn’t compete for absorption with the other amino acids.

Brian asks:

What dose do you recommend starting at?

I have clients start with 125mg and go up from there based on how they respond i.e. are they getting symptom resolution.

Based on the above 2 questions it’s clear that Amanda and Brian are new to using the amino acid GABA. If you are new to using GAB and the other amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc.) my book “The Antianxiety Food Solution” is a great place to start.

I don’t cover specific brands in my book because brand formulations change and come and go so this is a great question from Olivia who asks:

Which brand would you recommend? thank you

My favorite is Source Naturals GABA Calm but since it’s been in short supply during the pandemic I list many other GABA options here. I’ve updated the main supplements blog with these additional GABA options too.

Now for some of the more advanced questions:

Salome asks:

I’m super sensitive to supplements (Histamine Intolerance / MCAS / Multiple chemical sensitivity). Are there any potential reactions from taking GABA that you know of?

As far as I know there are none (clinically or in the research) but, as always, the best is to do a trial. For clients who are very sensitive we start super low and may use 1/8 to 1/4 of the starting dose of 125mg GABA, and increase from there if there are no adverse effects.

Dena asks:

Does GABA help the same way Xanax does? I only take 0.5mg Xanax a few times a week when I really need it but if GABA works I’d like to try it but worry it won’t help like Xanax does. It calms me down and makes me feel normal

Many of my clients report back that GABA works just like Xanax used to work for them. But do keep in mind it’s important to work with your prescribing doctor and that the benzodiazepine taper should be very very slow. And it’s important to be aware that for some folks tapering can be very challenging (more on that here).

Boyd asks:

In New Zealand GABA is classed as a prohibited Class B drug so what can be used as an alternative for anxiety?

Taurine or theanine are good options if GABA is not available and mail order is not an option. Glutamine can be calming for some folks who are able to convert some of it to GABA. For others it can be too stimulating if it converts to glutamate. Addressing gut health and using precursors like magnesium, zinc and vitamin B6 are also key but this takes longer to see results.

Debbie asks:

Can u take GABA if taking a very low dose SSRI (sertraline). I’ve had to start it because I couldn’t find a GABA product when I needed it.

GABA is safe to take with an SSRI (antidepressant) but this should always be discussed with the prescribing doctor. Also, keep in mind that Sertraline works on serotonin so GABA may not be the best solution and tryptophan or 5-HTP may be. Looking at the low GABA and low serotonin symptoms and doing a trial is the best way to figure this out.

Cornina asks:

What could be used instead of Ativan for travel anxiety?

I would trial GABA if the anxiety is more physical with neck tension and butterflies in the stomach or tummy pain. I would trial tryptophan or 5-HTP if it’s mental like imagining-the- worst or if you have a phobia about flying or you are worrying and obsessing. Ideally you would want to build up levels before travelling and also use the amino acids as needed while traveling. Keep in mind that both GABA and serotonin support may be needed.

Kelly asks:

Is 4,000 mg of Now GABA too much for a person to take a day. This person is 86 years old.

This dose of 4,000mg GABA is high so I’d want to know if she is seeing benefits (and what benefits) and having any adverse reactions. I’d also want to know what product and how it’s being used (swallowed or opened on to the tongue).

I asked the above and Kelly shared this additional information:

Yes, it lessens the anxiety but also makes her very sleepy. She doesn’t take that many mg every day. She just swallows it.

When the GABA capsules are opened less can be used. Also, taking it at night helps improve sleep and avoids the sleepiness in the day and the anxiety-relief benefits often carry over to the next day too. We commonly experiment with different timings and dosing to find what works best for the client as there is no one-size fits all.

Rhonda asks:

Which would be best for a truck driver that drives all night – GABA or 5-HTP?

For someone who drives all night and wants to sleep in the day I would want to know why he or she can’t sleep (assuming it’s related to disrupted circadian rhythm). If it’s physical tension then I’d trial GABA, and if it’s worry and over-thinking then I’d trial 5-HTP or tryptophan for serotonin support. Often a combination is helpful, Research shows the sleep promoting effects of combined GABA and 5-HTP for some folks.

We appreciate these folks for asking questions and allowing me to share here on the blog.

As always, it’s not only the low GABA we need to address. GABA 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.

Have these GABA questions and answers been helpful? Have you seen benefits from using GABA and do you have questions?

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

And join us on Facebook – TrudyScottAntianxietyFoodSolution – to read and ask questions there too.

ADHD: 5-HTP melts have been a miracle for one of my adopted kids

January 15, 2021 By Trudy Scott 48 Comments

A mom in my community responded to an ADHD blog sharing how 5-HTP melts have been a miracle for one of her adopted children – after one week! 5-HTP is not where I typically start with ADHD so I quizzed her to get more details and then went looking for the research to understand the mechanisms. This blog shares her rationale for using 5-HTP, the truly wonderful results her son experienced, some of the research and some possible serotonin/dopamine mechanisms. This is what she posted:

5-HTP melts have been a miracle for one of my adopted kids. He had lots of trauma and off the charts ADHD. 5-HTP is better than methylphenidate (Ritalin) and we are now weaning off the non-stimulants.

Just 80mg 5-HTP in the morning is all he needs. He was super ADHD, he had a para (teacher’s aide) in public school for years to keep him on track and this year at a school for ADHD the teachers were complaining that he was never on task.

Now after a week it has changed his life. I am so thankful for the anxiety summit. Thank you Trudy

This is truly wonderful to hear! I responded saying how thrilled I was to hear the impact it was having and asked why this mom decided to try 5-HTP? This amino acid, which is a serotonin precursor, is not typically my first choice for alleviating ADHD symptoms. I consider low GABA (and using GABA) or low catecholamines (and using tyrosine), together with dietary changes, blood sugar control, and assessing for low zinc, low iron and low omega-3s – as a starting point.

I wanted to know if he had low serotonin symptoms such as the worry, ruminating, and obsessive type of anxiety which could have possibly been driving the ADHD symptoms? Were there any other symptoms that were a clue that low serotonin may be a factor: insomnia (with fatigue the next day impacting focus) or sugar cravings in the afternoon/evening (causing blood sugar swings affecting focus and mood)?

Why she used 5-HTP and which low serotonin symptoms he had

This was her response about why she used 5-HTP and which low serotonin symptoms he had:

We have tried all the amino acids over the years. I tried 5-HTP this time because SSRIs were the only class of medication he has not tried. I thought maybe it was worth a try and I also found this study: Comparative study of efficacy of 1-5-hydroxytryptophan and fluoxetine in patients presenting with first depressive episode (where the therapeutic efficacy of 5-HTP was considered as equal to that of the SSRI fluoxetine).

As for cravings or insomnia: he is a kid who loves sugar so I’m not sure if it’s a craving or typical. He takes 0.3mg of melatonin each night because guanfacine, the non-stimulant, prevents the production of melatonin.

She also mentioned that she has followed me for years and that DPA, an endorphin-boosting amino acid, works for her. She is a dietitian and shares my handouts and blog posts with her clients, so she clearly felt comfortable experimenting with the amino acids with her son.

5-HTP products and dosing

I also asked which product they were using and how she landed at 80mg. She wanted a fast-acting supplement that would dissolve in his mouth and purchased Natrol 5-HTP:

They are 100mg but we are breaking off a little because he was falling asleep in class.

I reminded her that 5-HTP (or tryptophan) is typically best used late afternoon and evening so if someone is falling asleep in the day I’d switch to bedtime dosing. If he needs it during the day for the ADHD symptoms then reducing the dose is the smart thing to do.

I love the sublingual/melt aspect of this product for quick results and because children do so well with a product that tastes pleasant.

However, I do not recommend this particular product because of very mixed ingredients information online. I have not seen the bottle of the actual product used but some of the online information states the product is gluten-free and soy-free and yet other information states it does contains gluten and soy. In some places they state it contains sucralose and an artificial flavor and in other places you see xylitol and natural flavor. This is all rather concerning. I’ll update this section as soon as I can confirm.

What does this mean for this mom? Now that she has figured out that 5-HTP helps her son, it’s best to find a better quality product so as not to cause other problems.

There are two chewable products in my online supplement store that come close to this product:

Serotrex Chewable: Two chewables contain 200mg theanine and 60mg 5-HTP. This could be used in the day or at night.
Designs for Health Insomnitol Chewables: Two chewables contain 10mg vitamin B6, 500mg inositol, 200mg theanine, 100mg 5-HTP and 3mg melatonin. This would need to be used at night instead.

Both of these contain theanine. Research shows that theanine reduces anxiety and improves cognition via “improvements in verbal fluency (especially letter fluency) and improvements in executive function (planning, multi-tasking etc).”

The research on 5-HTP and tryptophan for ADHD

This paper, The effects of 5-hydroxytryptophan on attention and central serotonin neurochemistry in the rhesus macaque, shares that

Individuals with depression and anxiety typically experience impaired executive function and emotional cognition, symptoms that are generally studied by examining disruptions in attention.

This study used 5-HTP as an intramuscular injection, rather than using it orally but the authors did report the following:

Our findings provide unique causal and mechanistic evidence suggesting that enhancing central serotonergic function results in categorically distinct changes in fundamental cognitive operations such as attention.

This paper, Does serotonin deficit mediate susceptibility to ADHD? summarizes the role of serotonin in ADHD, the interplay with dopamine and the use of oral tryptophan (a serotonin precursor similar to 5-HTP):

A chronic deficit of serotonin at the synapse may trigger symptoms of childhood ADHD (developmentally inappropriate levels of hyperactivity, impulsivity and inattention).
Studies from animal models of ADHD indicate intimate interplay between serotonin and dopaminergic neurotransmission.
Selective serotonin re-uptake inhibitors (SSRIs)…as non-stimulant drugs acting on the serotonin system are … clinically effective.
Oral administration of l-tryptophan, the amino acid precursor of serotonin, significantly alleviates ADHD symptoms.
Serotoninergic gene variants are associated with increased risk of ADHD.

I appreciate this mom for giving me permission to share here on the blog so we can inspire hope (and I wish for more and more improvements for this young boy):

My son is a 10-year old RAD (reactive attachment disorder) kid that was meth exposed and adopted at 3 years old. 5-HTP has worked so well. He has not thrown a fit in a month. Before fits were a daily occurrence. This might give hope to other parents.

Have you found that 5-HTP (or tryptophan) helps/helped you or your child with ADHD symptoms? If yes, do you feel the ADHD was caused in part because of anxiety and/or fear and/or feeling inadequate and/or perfectionism and/or poor sleep (all signs of low serotonin)? Or were the main symptoms poor focus, low energy, low motivation and depression caused by low catecholamines/low dopamine? Or a mixture of both?

If you’re a practitioner working with children or adults with ADHD, have you had good results with 5-HTP or tryptophan?

Please do share in the comments below.

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

October 7, 2020 By Trudy Scott Leave a Comment

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

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

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.

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!

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

August 28, 2020 By Trudy Scott 8 Comments

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

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

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

Here is her story:

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

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

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

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

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

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

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

Antidepressant discontinuation syndrome

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

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

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

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

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

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

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

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

If you suspect low serotonin symptoms and are new to using the amino acids and do not have my book I highly recommend getting it and reading it before jumping in to taking supplements and navigating this with your prescribing physician: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings. You may need to lend him/her a copy of my book too.

There is a complete chapter on the amino acids and one for pyroluria, plus information on real whole food, sugar and blood sugar, gluten, digestion and much more. If you’re not a reader there is now also an audible version.

Here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary

Please also read and follow these Amino Acid Precautions.

This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs – you will find the Lidtke Tryptophan here. You can also read more about why I prefer the Lidtke tryptophan on this blog.

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

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

Feel free to post your questions here too.

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

July 31, 2020 By Trudy Scott 73 Comments

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)?