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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by laima on July 25, 2006, at 11:59:48
Does anyone know anything about this? I saw a bottle of l-tryptophan at the health foood store yesterday, was tempted to buy it to try for sleep and anxiety- but the bottle noted something about "do not use with ssris or maois". That surprised me, and I didn't buy it as a result.Thanks.
Posted by Tomatheus on July 25, 2006, at 12:47:46
In reply to question re mixing l-tryptophan with EMSAM, posted by laima on July 25, 2006, at 11:59:48
Laima,
It is my understanding that l-tryptophan is contraindicated with MAOIs and SSRIs because of its potential to induce "serotonin syndrome" when combined with either of these meds. L-tryptophan increases synaptic serotonin levels by allowing more serotonin to be produced. And when taken at a dose that's high enough to inhibit a significant amount of brain MAO-A (in most people, I think that this would be a dose of 9 mg/24 hr or higher), Emsam also increases synaptic levels of serotonin. However, instead of enhancing the production of serotonin, Emsam reduces serotonin's destruction by inhibiting MAO-A. So, taking l-tryptophan with Emsam would boost your serotonin levels via two different mechanisms, which could potentially cause your serotonin levels to become dangerously high.
I hope this helps some. Let me know if you have any additional questions or if you need me to clarify anything.
Tomatheus
>
> Does anyone know anything about this? I saw a bottle of l-tryptophan at the health foood store yesterday, was tempted to buy it to try for sleep and anxiety- but the bottle noted something about "do not use with ssris or maois". That surprised me, and I didn't buy it as a result.
>
> Thanks.
Posted by Tomatheus on July 25, 2006, at 13:47:44
In reply to Re: question re mixing l-tryptophan with EMSAM » laima, posted by Tomatheus on July 25, 2006, at 12:47:46
I should probably add that combining l-tryptophan *supplements* with an SSRI or an MAOI could potentially induce serotonin syndrome. It's my understanding that l-tryptophan doesn't cross the blood-brain barrier very easily, especially when other amino acids are also crossing the blood-brain barrier. So, for example, eating turkey (a source of l-tryptophan) will not trigger serotonin syndrome in someone taking an MAOI or an SSRI because 1) the amount of l-tryptophan in turkey is relatively low, especially in comparison to the amount that's found in most supplements, and 2) turkey contains other amino acids that compete with l-tryptophan when crossing the blood-brain barrier. As I understand it, most l-tryptophan supplements contain high doses of the amino acid -- enough to allow a significant amount of l-tryptophan to get across the blood-brain barrier.
Just wanted to clarify...
Tomatheus
Posted by laima on July 25, 2006, at 17:01:49
In reply to Re: question re mixing l-tryptophan with EMSAM, posted by Tomatheus on July 25, 2006, at 13:47:44
Dear Tomatheus,
Thank you for so clearly explaining the potential of the sort of danger that can happen as a result of mixing EMSAM with l-tryptophan supplements. I had hoped it could be a substance that could help me wean away from benzodiazapines. Oh well.
Laima
Posted by Tomatheus on July 26, 2006, at 17:34:04
In reply to Re: question re mixing l-tryptophan with EMSAM » Tomatheus, posted by laima on July 25, 2006, at 17:01:49
Laima,
Thank you for your reply.
Have you ever tried taking GABA in its supplement form? Theoretically, it *might* be able to help you wean off of benzodiazepines, considering that these meds stimulate GABA-A receptors. And unlike l-tryptophan, it's not contraindicated with MAOIs.
Just something to think about...
Tomatheus
> Dear Tomatheus,
>
> Thank you for so clearly explaining the potential of the sort of danger that can happen as a result of mixing EMSAM with l-tryptophan supplements. I had hoped it could be a substance that could help me wean away from benzodiazapines. Oh well.
>
> Laima
Posted by laima on July 26, 2006, at 18:45:05
In reply to Re: question re mixing l-tryptophan with EMSAM » laima, posted by Tomatheus on July 26, 2006, at 17:34:04
Thank you for the suggestion of GABA, Tomatheus.
I saw the bottles of it.
But the man at the health food store advised me that GABA "doesn't usually cross into the brain and you'll end up with nothing more than expensive urine". Do you suppose that's true? Have you tried it? I do plan to read up on it despite his comment.Thanks again,
Laima
> Laima,
>
> Thank you for your reply.
>
> Have you ever tried taking GABA in its supplement form? Theoretically, it *might* be able to help you wean off of benzodiazepines, considering that these meds stimulate GABA-A receptors. And unlike l-tryptophan, it's not contraindicated with MAOIs.
>
> Just something to think about...
>
> Tomatheus
>
> > Dear Tomatheus,
> >
> > Thank you for so clearly explaining the potential of the sort of danger that can happen as a result of mixing EMSAM with l-tryptophan supplements. I had hoped it could be a substance that could help me wean away from benzodiazapines. Oh well.
> >
> > Laima
>
>
Posted by Jakeman on July 28, 2006, at 0:27:33
In reply to Re: question re mixing l-tryptophan with EMSAM » Tomatheus, posted by laima on July 26, 2006, at 18:45:05
I's taken 500 mg tryptophan with with 9 mg Emsam with no ill affect. May not work for everybody, but seems to help me some with sleep. Jake
>
> I saw the bottles of it.
> But the man at the health food store advised me that GABA "doesn't usually cross into the brain and you'll end up with nothing more than expensive urine". Do you suppose that's true? Have you tried it? I do plan to read up on it despite his comment.
>
> Thanks again,
>
> Laima
>
>
>
>
>
> > Laima,
> >
> > Thank you for your reply.
> >
> > Have you ever tried taking GABA in its supplement form? Theoretically, it *might* be able to help you wean off of benzodiazepines, considering that these meds stimulate GABA-A receptors. And unlike l-tryptophan, it's not contraindicated with MAOIs.
> >
> > Just something to think about...
> >
> > Tomatheus
> >
> > > Dear Tomatheus,
> > >
> > > Thank you for so clearly explaining the potential of the sort of danger that can happen as a result of mixing EMSAM with l-tryptophan supplements. I had hoped it could be a substance that could help me wean away from benzodiazapines. Oh well.
> > >
> > > Laima
> >
> >
>
>
Posted by dessbee on July 28, 2006, at 5:37:03
In reply to Re: question re mixing l-tryptophan with EMSAM » laima, posted by Jakeman on July 28, 2006, at 0:27:33
Has anyone of you who is on MAO-inhibitors had any problems with photosensitivity and skin redness/rash?
Posted by laima on July 28, 2006, at 11:10:03
In reply to Re: question re mixing l-tryptophan with EMSAM » laima, posted by Jakeman on July 28, 2006, at 0:27:33
> I's taken 500 mg tryptophan with with 9 mg Emsam with no ill affect. May not work for everybody, but seems to help me some with sleep. Jake
Really? Thanks for that news. I guess sometimes the labels have to be super-cautious.
Posted by Tomatheus on July 28, 2006, at 13:07:09
In reply to Re: question re mixing l-tryptophan with EMSAM » Tomatheus, posted by laima on July 26, 2006, at 18:45:05
Laima,
I too have read that GABA does not cross the blood-brain barrier easily, so I do think that there's probably some truth to what the man at your local health food store told you.
I have taken GABA on occasion, and I've noticed different effects depending on how I was feeling and what meds I was taking. The first time I took it, I was taking Wellbutrin and lithium and still experiencing some residual depression, noticeable cognitive difficulties, and a little bit of anxiety (prior to that, I had been diagnosed with dysthymia and then with bipolar disorder after I experienced some "cycling" between severe depression and mild hypomania while taking Paxil at 60 mg). At that point (when I was on the Wellbutrin-lithium combo), taking one 500mg capsule of GABA (Solgar brand) had such a strong tranquilizing effect that it knocked me out cold.
But after staying on my Wellbutrin-lithium combo for several more months and eventually discontinuing the Wellbutrin (after reaching a point where I could no longer afford it), I slowly but surely developed what I now recognize to be symptoms of panic disorder along with my depressive symptoms after a few months of lithium monotherapy. These anxiety/panic symptoms have since subsided to some extent, but have not completely gone away. Anyway, my point with respect to GABA is that I tried taking the GABA supplement once again to try to control the severe states of panic that I was experiencing then, and it did produce a noticeably calming sensation, but did not knock me out like it did the first time that I tried it. Sometimes I needed to take 1,000 mg (2 capsules) at once to get the calming effect that I needed, but it still didn't make me drowsy in any way (which was a good thing; I'm just trying to show how it affected me differently at different times). The only problem with the GABA was that its effect was relatively short-lived (lasting no longer than 2-3 hours), so I had to keep taking it every few hours to get the effect that I was looking for.
So, based on my experience, I would say that GABA supplements do have an effect, albeit a very short-acting one. And of course, not everybody's experience with GABA is going to be exactly the same as mine. It is certainly possible that GABA supplements may not produce much of an effect in some individuals. And because the production of supplements is not regulated, some brands of GABA may be more effective than others. I've never taken a benzodiazepine, so unfortunately, I can't compare the effects of GABA supplements with those of benzos.
I read on the meds board that you just switched from 6 mg/24 hr of EMSAM to 9 mg/24 hr and have noticed some improvement. I certainly hope that you continue to experience EMSAM's benefits. What you might want to do (as far as weaning off of benzodiazepines is concerned) is wait until you've had a decent therapeutic response from EMSAM for at least a few weeks to see if it might be any easier to wean off of the benzos *with* that therapeutic response. Of course, this is just a suggestion. I am by no means saying that you have to follow it. And of course, I wouldn't advise you to make any changes in your meds without getting your doctor's approval. It's just something to think about.
Thanks for your reply, and I'm sorry for my delay in getting back to you. As always, let me know if you have any questions or need me to clarify anything.
Tomatheus
> Thank you for the suggestion of GABA, Tomatheus.
>
> I saw the bottles of it.
> But the man at the health food store advised me that GABA "doesn't usually cross into the brain and you'll end up with nothing more than expensive urine". Do you suppose that's true? Have you tried it? I do plan to read up on it despite his comment.
>
> Thanks again,
>
> Laima
>
Posted by laima on July 28, 2006, at 17:04:35
In reply to Re: question re mixing l-tryptophan with EMSAM » laima, posted by Tomatheus on July 28, 2006, at 13:07:09
Dear Tomatheus,Thank you for explaining. Yes, the up in EMSAM seems to be working! Very happy about that. Be assured, of course I would discuss any changes in medication/supplements with my doctor before experimenting. MAOIS, I understand, can react with all sorts of substances, so I am being ultra-careful.
My post here is short, not from any lack of interest or appreciation, but because I am quite hot and worn out today. Almost 100 degrees outside today...
Thanks again,
Laima
> Laima,
>
> I too have read that GABA does not cross the blood-brain barrier easily, so I do think that there's probably some truth to what the man at your local health food store told you.
>
> I have taken GABA on occasion, and I've noticed different effects depending on how I was feeling and what meds I was taking. The first time I took it, I was taking Wellbutrin and lithium and still experiencing some residual depression, noticeable cognitive difficulties, and a little bit of anxiety (prior to that, I had been diagnosed with dysthymia and then with bipolar disorder after I experienced some "cycling" between severe depression and mild hypomania while taking Paxil at 60 mg). At that point (when I was on the Wellbutrin-lithium combo), taking one 500mg capsule of GABA (Solgar brand) had such a strong tranquilizing effect that it knocked me out cold.
>
> But after staying on my Wellbutrin-lithium combo for several more months and eventually discontinuing the Wellbutrin (after reaching a point where I could no longer afford it), I slowly but surely developed what I now recognize to be symptoms of panic disorder along with my depressive symptoms after a few months of lithium monotherapy. These anxiety/panic symptoms have since subsided to some extent, but have not completely gone away. Anyway, my point with respect to GABA is that I tried taking the GABA supplement once again to try to control the severe states of panic that I was experiencing then, and it did produce a noticeably calming sensation, but did not knock me out like it did the first time that I tried it. Sometimes I needed to take 1,000 mg (2 capsules) at once to get the calming effect that I needed, but it still didn't make me drowsy in any way (which was a good thing; I'm just trying to show how it affected me differently at different times). The only problem with the GABA was that its effect was relatively short-lived (lasting no longer than 2-3 hours), so I had to keep taking it every few hours to get the effect that I was looking for.
>
> So, based on my experience, I would say that GABA supplements do have an effect, albeit a very short-acting one. And of course, not everybody's experience with GABA is going to be exactly the same as mine. It is certainly possible that GABA supplements may not produce much of an effect in some individuals. And because the production of supplements is not regulated, some brands of GABA may be more effective than others. I've never taken a benzodiazepine, so unfortunately, I can't compare the effects of GABA supplements with those of benzos.
>
> I read on the meds board that you just switched from 6 mg/24 hr of EMSAM to 9 mg/24 hr and have noticed some improvement. I certainly hope that you continue to experience EMSAM's benefits. What you might want to do (as far as weaning off of benzodiazepines is concerned) is wait until you've had a decent therapeutic response from EMSAM for at least a few weeks to see if it might be any easier to wean off of the benzos *with* that therapeutic response. Of course, this is just a suggestion. I am by no means saying that you have to follow it. And of course, I wouldn't advise you to make any changes in your meds without getting your doctor's approval. It's just something to think about.
>
> Thanks for your reply, and I'm sorry for my delay in getting back to you. As always, let me know if you have any questions or need me to clarify anything.
>
> Tomatheus
>
> > Thank you for the suggestion of GABA, Tomatheus.
> >
> > I saw the bottles of it.
> > But the man at the health food store advised me that GABA "doesn't usually cross into the brain and you'll end up with nothing more than expensive urine". Do you suppose that's true? Have you tried it? I do plan to read up on it despite his comment.
> >
> > Thanks again,
> >
> > Laima
> >
Posted by pajo on November 10, 2006, at 12:12:12
In reply to Re: question re mixing l-tryptophan with EMSAM » Tomatheus, posted by laima on July 28, 2006, at 17:04:35
The patient education form I received with my prescription for Emsam (6mg./day)listed tryptophan as interacting with this drug. I am taking a protein powder supplement to gain weight which contains tryptophan. Anyone know if this is going to cause a problem? Thanks.
Posted by laima on November 10, 2006, at 12:17:49
In reply to Re: question re mixing l-tryptophan with EMSAM » laima, posted by pajo on November 10, 2006, at 12:12:12
That's interesting- I don't remember the warning as being in the earlier version of the insert- but I'm not sure. As it turns out, I never used tryptophan, as I'd been warned that drug interactions could be much harrier and more serious than eating the wrong foods.
> The patient education form I received with my prescription for Emsam (6mg./day)listed tryptophan as interacting with this drug. I am taking a protein powder supplement to gain weight which contains tryptophan. Anyone know if this is going to cause a problem? Thanks.
This is the end of the thread.
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