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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 43 to 67 of 84. Go back in thread:
Posted by Larry Hoover on April 25, 2003, at 13:13:37
In reply to Ron, Re: Natural Serotonin enhancers?, posted by McPac on April 25, 2003, at 12:38:27
I'm going to hijack this thread a bit, if you don't mind.
The question of the utility of 5-HTP and/or tryptophan as antidpressant therapies came up, and it would seem that poor quality research has been the norm. If you use the stringent criteria employed in the following meta-analyis, only 2 0f 108 relevant studies provide meaningful outcomes. Nonetheless, it would seem that serotonin precursors are effective, based on limited data.
Cochrane Database Syst Rev 2002;(1):CD003198
Update of:
Cochrane Database Syst Rev. 2001;(3):CD003198.Tryptophan and 5-hydroxytryptophan for depression.
Shaw K, Turner J, Del Mar C.
School of Population Health, University of Queensland, Public Health Building, Herston Rd, Herston, Queensland, Australia, 4006. k.shaw@sph.uq.edu.au
BACKGROUND: 5 Hydroxytryptophan (5-HTP) and tryptophan are so-called natural alternatives to traditional antidepressants, used to treat unipolar depression and dysthymia. OBJECTIVES: To determine whether 5-HTP and tryptophan are more effective than placebo, and whether they are safe to use to treat depressive disorders in adults. SEARCH STRATEGY: Trials were searched in computerized general (Medline, Psychlit, and Embase) and specialized databases (Cochrane Controlled Clinical Trials Register, Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trial Register); by checking reference lists of relevant articles; by handsearching relevant specialist journals; and by contacting relevant authors where appropriate. Publications in all languages were sought. SELECTION CRITERIA: Trials were included if they were randomized, included patients with unipolar depression or dysthymia, compared preparations of 5-HTP or tryptophan with placebo, and included clinical outcomes assessed by scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS: Data was extracted independently by the three reviewers, onto data collection forms. Inclusion criteria were applied to all potential studies independently and a coefficient of agreement (Kappa) was calculated for them. Disagreement was resolved by reaching consensus. Trial quality was scored according to risk of bias. Analysis for 5-HTP and tryptophan were combined due to the small number of included trials. MAIN RESULTS: 108 trials were located using the specified search strategy. Of these, only two trials, involving a total of 64 patients, were of sufficient quality to meet inclusion criteria. The available evidence suggests these substances were better than placebo at alleviating depression (Peto Odds Ratio 4.10; 95% confidence interval 1.28-13.15; RD 0.36; NNT 2.78). However, the evidence was of insufficient quality to be conclusive. REVIEWER'S CONCLUSIONS: A large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present.
Posted by McPac on April 25, 2003, at 13:35:35
In reply to Re: Ron, Re: Natural Serotonin enhancers? » McPac, posted by Larry Hoover on April 25, 2003, at 13:13:37
"I'm going to hijack this thread a bit, if you don't mind".
>>>PLEASE respond whenever you can/wish to---your responses are always appreciated by me!
I thought that Pfeiffer might try trytophan with me (I read about a safety issue w/ regards to 5HTP).....I've got a lot of questions to ask Pfeiffer when I go back to them....Take care!
Posted by Ron Hill on April 25, 2003, at 15:09:40
In reply to Re: Pstims for OCD?? Really? Not!, posted by Larry Hoover on April 25, 2003, at 12:12:38
> So, is your pattern still the same, with respect to the NADH?
Larry,
I've wanted to find time to post to you and give you an update. Some of your writings prompted me to do some reading on TMG (betaine) and several days ago I started taking about 250 mg/day of it. I'll write more at a later date, but the short version is that TMG seems to work in a favorable synergistic way with the Enada NADH. As a result, I am now taking 2.5 mg of Enada NADH only once per week. It’s too early to know how this will all shake out, but so far so (very) good.
As you know, Enada NADH has been very beneficial in the treatment of the atypical depressive side of my BP II. But when I was taking 2.5 mg every four days without the TMG I would get irritable on the day I took it and begin to lose my motivation and become depressed on day four of the dosing schedule. Further, it seemed that as time passed the irritability on the front-end and the depression on the tail-end both were getting worse. The recent addition of the TMG has solved this problem (at least for now).
I also have added a few milligrams of 5-HTP administered sublingually on a PRN basis for treatment of any breakthrough irritability. I don't seem to need the 5-HTP very often, and certainly not every day, but when I do need it, it seems to take the edge off nicely. I have adopted the position that one of the keys to using supplements successfully is to minimize the dose and to take periodic "supplement holidays".
By the way, when I was at the nutritional store purchasing the TMG, I bought a bag full of other supplements that you and others refer to regularly (e.g., Borage oil, R(+)-lipoic acid (kinda spendee stuff), pregnenolone, DMAE, choline, etc). My plan is to add-on one at a time very slowly so that I can determine which one does what to my mood disorder and my general wellbeing.
Thanks for your willingness to share your expertise with so many of us here in pbabbleland. I'm glad to hear that your periodic crash has apparently taken a sabbatical as of late.
-- Ron
Posted by McPac on April 25, 2003, at 15:27:31
In reply to Re: Pstims for OCD?? Really? Not!, posted by Larry Hoover on April 25, 2003, at 12:12:38
"the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder".
>>>>>>What kinds of natural treatments might affect these catecholamines in a way that would be good for someone w/ ocd?
Posted by McPac on April 25, 2003, at 15:38:00
In reply to Re: Serotonin:good for some depressions,bad for others, posted by linkadge on April 23, 2003, at 14:36:46
You mentioned that Remeron made you worse...how so?
thnx
Posted by sapphiredragon on April 25, 2003, at 16:13:42
In reply to sapphiredragon, Re: thinking outside the box, posted by McPac on April 25, 2003, at 13:09:04
The Pfeiffer Center's treatment didn't do much to alleviate my son's very deep depression. He went through a lot of preliminary testing, and they found a few nutritional deficiencies, but nothing dramatic. He tried out their supplements for a month or so, but after noting little effect, decided to stop buying their special vitamins.
As a previous poster said, if nutritional factors are not the primary cause(s) of mental disturbances, nutritional supplementation alone won't solve the problem.
My son was not able to overcome the suicidal thinking of his depressed state until he started on the SSRI and Adderal.
Re your question about digestive enzymes: For general digestion, my son takes betaine HCl and pancreatin. For helping with the assimilation of the fish oil, he has been using an ox bile supplement. Without the ox bile, the fish oil makes him nauseous, he says.
Posted by Larry Hoover on April 25, 2003, at 17:03:54
In reply to Lar, Re: Ron, Re: Natural Serotonin enhancers?, posted by McPac on April 25, 2003, at 13:35:35
> "I'm going to hijack this thread a bit, if you don't mind".
>
> >>>PLEASE respond whenever you can/wish to---your responses are always appreciated by me!
>
> I thought that Pfeiffer might try trytophan with me (I read about a safety issue w/ regards to 5HTP).....I've got a lot of questions to ask Pfeiffer when I go back to them....Take care!Well, if your mare is really skittish, and difficult to breed, you may want to try some supplemental tryptophan to calm her down. Go to:
http://www.buygpdirect.com/gpefeed.htmYou can get fish oil for about $14 a gallon, too.
Lar
>
Posted by McPac on April 25, 2003, at 18:15:31
In reply to Re: thinking outside the box » McPac, posted by sapphiredragon on April 25, 2003, at 16:13:42
Lar, I just found this info. elsewhere:
"High histamine metabolism
High histamine is associated with depression, especially suicidal depression (Walsh, 1992).
What is histamine and why is it so important? Histamine is integral in balancing the electrical activity of the nucleus accumbens, which is an area of the brain responsible for behavioral responses, filtering incoming sensory information, and communicating with the hypothalamus, ventral tegmentum, and amygdala (Shoblock & O'Donnell, 2000; Otake & Nakamura, 2000; Chronister et al, 1982).
It has been reported that people with obsessive compulsive 'tendencies', seasonal depressions, and oppositional defiant behavior (ODD) have high whole blood histamine levels (Walsh, P.T.C.- Ref.B).
The importance of taking detailed patient histories on the first visit is key (Jackson et al, 1998; Edelman, 1996; Jaffe & Kruesi, 1992; Pfeiffer, 1988; Walsh, Ref. B). People with high histamine have been found with typical symptoms of high intelligence, thought blanking, perfectionism, competitiveness, obsessions, compulsions, suicidal and seasonal depression, defiance, and phobia (Jackson et al, 1998; Edelman, 1996; Jaffe & Kruesi, 1992; Pfeiffer, 1988; Walsh, Ref. B).
These patients do well with certain nutrients and herbs but must strictly avoid B-12 and folic acid. These patients need to avoid store-bought multi-vitamins".
***I'm emphasizing THIS: "These patients do well with certain nutrients and herbs but must strictly avoid B-12 and folic acid".
Why the Hell does Pfeiffer have me ON vitamin-B12 then???????? I'm really sick of this baloney. The best anti-depressant is a Smith & Wesson. No need for any response as I know that you don't know why Pfeiffer has me on it....I'm just looking for ANY possible explanation. Take care!
Posted by Larry Hoover on April 25, 2003, at 22:39:52
In reply to Larry..........., posted by McPac on April 25, 2003, at 18:15:31
> Lar, I just found this info. elsewhere:
> ***I'm emphasizing THIS: "These patients do well with certain nutrients and herbs but must strictly avoid B-12 and folic acid".
>
> Why the Hell does Pfeiffer have me ON vitamin-B12 then???????? I'm really sick of this baloney. The best anti-depressant is a Smith & Wesson. No need for any response as I know that you don't know why Pfeiffer has me on it....I'm just looking for ANY possible explanation. Take care!If you look hard at any recommendations, you are bound to find contradictions and inconsistencies, even with those of other theorists who seem to otherwise be in agreement on the main arguments.
I think I best fit the high-histamine protocol, but I've found good reasons for supplementing with B-12, and a B-complex.
Statistically, you're probably most likely to be deficient in magnesium, and then, about equally likely to be deficient in zinc or B-12, followed closely by selenium and the other B-vitamins (my belief, based on evidence I've seen over time).
I think that, overall, Pfeiffer has given you good advice.
Lar
Posted by Ron Hill on April 26, 2003, at 1:17:29
In reply to Re: Lar, Re: Ron, Re: Natural Serotonin enhancers?, posted by Larry Hoover on April 25, 2003, at 17:03:54
> You can get fish oil for about $14 a gallon, too.
Larry, how can I find out the percentage of EPA, DHA, and other omega-3 fatty acids in the Su-Per Fish Oil?
-- Ron
Posted by Simon Sobo, M.D. on April 26, 2003, at 6:51:22
In reply to Re: Larry, Re: about the chemical imbalance concept » McPac, posted by Larry Hoover on April 25, 2003, at 9:56:30
It is interesting that almost all of the posts in reaction to my article have suggested still more medicines and herbs to try to treat "the chemical imbalances" they are dealing with. Actually my article is challenging the automatic assumption that the problem is necessarily chemical. It may be but it may not be. The fact is this. WE DON'T KNOW! I am not against using medications in my practice. They are often very helpful but I am claiming they exert their effect through the more general psychological effects that they have on a person and not through a specific correction of a specific chemical imbalance for a specific diagnosis. Many of you commented on the article that I cited about using amphetamines for OCD. I have never used them for OCD but I am surprised that no one mentioned the other article claiming morphine helps OCD. Actually what I was saying is that intoxicants of all varieties may help OCD symptoms. I am not advocating this as a treatment but many people with OCD lose their OCD when they get drunk (others get worse).
I became interested in the amphetamine article after one of my patients told me cocaine had helped his OCD. Here is the portion of the article that you have reacted to and then I have one further bit of clinical information,"In Obsessive Compulsive Disorder (OCD) similar problems emerge. Originally, the fact that serotonin enhancing drugs were uniquely effective led to a belief that there was a causal connection, but as early as 1991 there was confounding evidence. Thirty mg. of dextroamphetamine was found to ameliorate OCD symptoms (Joffe 1991). Moreover, while I am not advocating this as treatment, I have had patients report to me that intoxicants such as marijuana, alcohol, and cocaine have given them temporary relief from OCD symptoms. Indeed, a recent study has shown that oral morphine is reasonably effective (Franz, 2001). Once again it is possible to speculate that there is a downstream effect on serotonin, but if we use this argument we have come full circle in a tautological trap. The original reason for the serotonin-OCD chemical imbalance model was that serotonergic agents were believed to be unique in their effectiveness"
Here is the other clinical tidbit. The patient who found cocaine helpful for his OCD lost his symptoms completely when he became a Jehovah's Witness. This cure disappeared after about 6 months when he became disillusioned with the cult but it is nevertheless fascinating. OCD has something to do with uncertainty. If you can take that away, give a feeling of completeness or innocence or something like that there will be improvement. I guess morphine, SSRI's, and many intoxicants can do that for certain people, but the primary problem is probably psychological not chemical.
Posted by Larry Hoover on April 26, 2003, at 8:41:17
In reply to Re: On-line Fish Oil Product EPA/DHA Content? » Larry Hoover, posted by Ron Hill on April 26, 2003, at 1:17:29
> > You can get fish oil for about $14 a gallon, too.
>
> Larry, how can I find out the percentage of EPA, DHA, and other omega-3 fatty acids in the Su-Per Fish Oil?
>
> -- Ron
I have no idea, Ron. I doubt they're too concerned. It doesn't mention preservatives, either. How much rancidity might there be? Still, where else can you get fish oil at that price? It might be worth the $14 just to find out.Lar
Posted by Larry Hoover on April 26, 2003, at 8:58:42
In reply to Re: Larry, Re: about the chemical imbalance concept, posted by Simon Sobo, M.D. on April 26, 2003, at 6:51:22
> It is interesting that almost all of the posts in reaction to my article have suggested still more medicines and herbs to try to treat "the chemical imbalances" they are dealing with. Actually my article is challenging the automatic assumption that the problem is necessarily chemical. It may be but it may not be. The fact is this. WE DON'T KNOW! I am not against using medications in my practice. They are often very helpful but I am claiming they exert their effect through the more general psychological effects that they have on a person and not through a specific correction of a specific chemical imbalance for a specific diagnosis.
Dr., I am pleasantly surprised to see your post here. Thank you for coming forward.
If I may ask a couple questions....
Using the state/trait dichotomy, would you say that e.g. antidepressants are capable of inducing states from which a subject may find it easier to cope with their traits?
How have your peers reacted to your article? Was it published in a journal?
Regards,
Lar
Posted by McPac on April 26, 2003, at 13:16:23
In reply to Re: Larry, Re: about the chemical imbalance concept, posted by Simon Sobo, M.D. on April 26, 2003, at 6:51:22
"Here is the other clinical tidbit. The patient who found cocaine helpful for his OCD lost his symptoms completely when he became a Jehovah's Witness. This cure disappeared after about 6 months when he became disillusioned with the cult but it is nevertheless fascinating. OCD has something to do with uncertainty. If you can take that away, give a feeling of completeness or innocence or something like that there will be improvement. I guess morphine, SSRI's, and many intoxicants can do that for certain people,
....but the primary problem is probably psychological not chemical".
>>>>>>> I think it may be that the primary problem for some may be psychological but that for others it is chemical. I don't think OCD, like depression, has a singular etiological cause. Psychological resolutions may very well be the answer to help/(even end) one person's OCD without affecting another sufferer's OCD at all. Still, in other cases, even a head injury can cause/exacerbate ocd, with no psychological help required.
Posted by Caleb462 on April 26, 2003, at 15:28:32
In reply to Re: Larry, Re: about the chemical imbalance concept, posted by McPac on April 26, 2003, at 13:16:23
I have heard about the trial on oral morphine, and it actually makes lots of sense to me - as opiods are the only drug that have ever lessened my OCD symptoms.
Alcohol, pot, stimulants - generally worsen my symptoms.
Posted by McPac on April 27, 2003, at 1:43:44
In reply to Re: Larry, Re: about the chemical imbalance concept, posted by Larry Hoover on April 26, 2003, at 8:58:42
Anybody here know of something I could take during Zoloft withdrawal to ease the withdrawal symptoms...got to be something? (CAN'T do the Prozac idea! terrible reaction to Prozac) Any over-the-counter or natural ideas? I'll bet there's something that could at least help those crazy withdrawal symptoms.
Posted by Dr. Bob on April 27, 2003, at 19:45:56
In reply to Re: Larry, Re: about the chemical imbalance concept, posted by Simon Sobo, M.D. on April 26, 2003, at 6:51:22
> The patient who found cocaine helpful for his OCD lost his symptoms completely when he became a Jehovah's Witness. This cure disappeared after about 6 months when he became disillusioned with the cult...
Thanks for participating, but one goal here is support, so please don't post anything that could lead others to feel accused or put down, thanks.
Bob
PS: Follow-ups regarding posting policies, or complaints about posts, should be redirected to Psycho-Babble Administration.
Posted by Larry Hoover on April 27, 2003, at 20:42:07
In reply to Larry Hoover/Anybody, Re: about the , posted by McPac on April 27, 2003, at 1:43:44
> Anybody here know of something I could take during Zoloft withdrawal to ease the withdrawal symptoms...got to be something? (CAN'T do the Prozac idea! terrible reaction to Prozac) Any over-the-counter or natural ideas? I'll bet there's something that could at least help those crazy withdrawal symptoms.
Dr. Healey, perhaps the world's expert in withdrawal from antidepressants, does recommend liquid Prozac as the best way to proceed, due to fluoxetine's long half-life, but, he also suggest that St. John's wort will work, in the alternative.
Good luck,
Lar
Posted by McPac on April 27, 2003, at 20:56:49
In reply to Re: Zoloft withdrawal » McPac, posted by Larry Hoover on April 27, 2003, at 20:42:07
"but, he also suggest that St. John's wort will work, in the alternative".
So, according to Dr. Healey, it is okay to take St. John's Wort simultaneously with the Zoloft during the Zoloft withdrawal purpose? (I've always heard not to mix the two). Could someone take the FULL, normally recommended dose of SJW or would they need to take a smaller amt. due to the Zoloft? Lastly, Zoloft withdrawal for me could take a LONG time, as I'd like to go SLOWLY...is it safe to take the SJW w/ the Zoloft for an extended withdrawal process? Thanks!
Posted by fayeroe on April 27, 2003, at 22:13:51
In reply to Re: please be civil » Simon Sobo, M.D., posted by Dr. Bob on April 27, 2003, at 19:45:56
> > The patient who found cocaine helpful for his OCD lost his symptoms completely when he became a Jehovah's Witness. This cure disappeared after about 6 months when he became disillusioned with the cult...
>
> Thanks for participating, but one goal here is support, so please don't post anything that could lead others to feel accused or put down, thanks.
>
> Bob
>
> PS: Follow-ups regarding posting policies, or complaints about posts, should be redirected to Psycho-Babble Administration.how was this person uncivil or putting someone down? i'm confused. thanks
Posted by Larry Hoover on April 27, 2003, at 22:43:56
In reply to Lar, Re: Zoloft withdrawal, posted by McPac on April 27, 2003, at 20:56:49
> "but, he also suggest that St. John's wort will work, in the alternative".
>
> So, according to Dr. Healey, it is okay to take St. John's Wort simultaneously with the Zoloft during the Zoloft withdrawal purpose? (I've always heard not to mix the two). Could someone take the FULL, normally recommended dose of SJW or would they need to take a smaller amt. due to the Zoloft? Lastly, Zoloft withdrawal for me could take a LONG time, as I'd like to go SLOWLY...is it safe to take the SJW w/ the Zoloft for an extended withdrawal process? Thanks!The idea is given as almost an afterthought, but it's looks to me like an all-out substitution. An alternative would be to proportionately substitute SJW for the Zoloft, then reduce the dose thereafter.
"There is anecdotal evidence and some theoretical grounds to believe that another option is to substitute St John's Wort for the SSRI. If a dose of 3 tablets of St John's Wort is tolerated instead of the SSRI, this can then be reduced slowly - by one pill per fortnight or even per month."
From:
http://www.benzo.org.uk/healy.htmLar
Posted by Questionmark on April 28, 2003, at 0:49:26
In reply to Re: Larry, Re: about the chemical imbalance concept, posted by Simon Sobo, M.D. on April 26, 2003, at 6:51:22
i just want to mention that i read your article and i think you make some brilliant points in there. i'm glad i had the oppurtunity to read it.
i'm convinced that any strict biochemical explanation for OCD is probably a major oversimplification. This is unfortunate, however, because it means there is no simple cure either. Damn.
Posted by stjames on April 28, 2003, at 17:45:27
In reply to Re: please be civil » Dr. Bob, posted by fayeroe on April 27, 2003, at 22:13:51
> how was this person uncivil or putting someone down? i'm confused. thanks
>Here:
"Jehovah's Witness. .... he became disillusioned with the cult...
~~~~
Posted by McPac on April 28, 2003, at 19:38:57
In reply to Re: Lar, Re: Zoloft withdrawal, posted by Larry Hoover on April 27, 2003, at 22:43:56
I read that link, thanks Lar. Wow, still can't imagine FULLY stopping Zoloft cold turkey while substituting SJW. Those withdrawal symptoms are HELL, just can't see SJW offsetting that.
Posted by Simon Sobo, M.D. on July 20, 2003, at 18:50:16
In reply to Re: Pstims for OCD?? Really? Not!, posted by Larry Hoover on April 25, 2003, at 12:12:38
I have a program that tells me who is reading my article so I have again found discussion of my article on your board. Although I cited the article that found dextroamphetamines helpful for OCD, the real purpose of that citation and the other citation, (which mentions morphine is also helpful) is to make the point that the equation between serotonin and OCD is nonsense. Enhancing sertonin seems to create a psychological state which I describe as "well whatever" This is extremely helpful with OCD and a heck of a lot of other psychiatric difficulties, and I will use it without hesitation, but it does not mean that people with OCD necessarily have a serotonin deficency. OCD is the result of very specific psychological conflicts not a chemical imbalance. That isn't to say that SSRIs morphine, alcohol, (one of my patients told me cocaine) and possibly dextroamphetamine can't help with the symptoms. Anything that gives a feeling of "all is well" may work. I am not suggesting that people try illegal remedies just that this whole way of approaching treatment with chemicals and drugs has a significant downside. The chemical imblance model has turned out to be very flawed
Simon Sobo, MD
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