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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Lao Tzu on June 26, 2010, at 10:07:49
Trying a trial of Niacin again. I take 500mg at bedtime only, and it seems to help my depression the following day. I can't take it during the day because it causes me to have mood swings sometimes, especially if I take a large dose. Because it may lower histamine over time, I also take chelated calcium/magnesium at bedtime only to further help lower histamine. I tend to be a high histamine person, and I can't figure out if Niacin lowers histamine over time or raises it. I know folic acid raises it, and I've been taking folic acid lately, but I can't seem to tolerate it on a continuing basis. I have to take days off. It does help depression, but I think I may be sensitive to it.
Posted by Lao Tzu on June 27, 2010, at 20:34:11
In reply to Niacin/folic acid and depression, posted by Lao Tzu on June 26, 2010, at 10:07:49
Correction--I lowered the Niacin dosage to 250mg at bedtime. This is the time-released form. I can still feel it working the following day, and 500mg feels like too much for me. I always say try lower dosages first to see how sensitive you are to a vitamin. Sometimes, more is not always better and can make matters worse. I am also trying to take 400mcg of folic acid each day. Seems to help with depression as long as I keep the dosage low. Folinic acid is supposed to be a better acting form of folate. I read it is used in Autsim Spectrum disorders. Or there is a prescription medicinal food called Deplin that is actually L-methylfolate and works a heck of a lot better than folic acid to correct folate deficiencies in people who have a low or no response to antidepressants.
Posted by janejane on June 28, 2010, at 7:21:42
In reply to Re: Niacin/folic acid and depression, posted by Lao Tzu on June 27, 2010, at 20:34:11
I noticed that iherb sells the methyl type of folate under the category "Metafolin Folate or 5-MTHF ( 5 Methyl Tetrahydrofolate )". Never tried it myself but thought I'd let you know about it.
In past threads, Larry Hoover has said that the niacinamide form of B3 is best for anxiety since it binds to the benzodiazepine receptor (but at a different place than benzos, so it can compliment them). See here, for example (keep reading the subsequent posts for additional info, including info about histamine):
http://www.dr-bob.org/cgi-bin/pb/mget.pl?post=/babble/alter/20050414/msgs/489221.html#489221
Note that if you read down further, he says "As niacinamide readily crosses the blood-brain barrier, it can serve acutely as an anxiolytic. Long-term use would likely lead to down-regulation. Best keep niacinamide as an acute treatment, rather than use it as a maintenance vitamin."
In another thread, he says to make sure to take it in addition to a daily B vitamin complex. For more, try doing an archive search by typing in "niacinamide anxiety poster:Larry Hoover"
Posted by janejane on June 28, 2010, at 9:07:30
In reply to Re: Niacin/folic acid and depression » Lao Tzu, posted by janejane on June 28, 2010, at 7:21:42
Here are a few quotes regarding niacinamide, from Larry Hoover's old posts (note: ">" indicates another poster's query):
A slightly different form of B3 is niacinamide. It binds to the same receptor complex as do benzos, and has some anxiolytic activity. It binds at a different place on the receptor than do benzos, so it doesn't interfere with that activity. Most people find that niacinamide and benzos complement each other's effects. You can take up to 500 mg niacinamide, four times a day.
Both nicotinic acid and niacinamide can be converted to the molecule NADH. It is a key component of the cellular energy production in mitochondria. I have found that using an NADH supplement (Enada NADH) has substantially improved my level of functioning. The dose must be carefully adjusted, as too much can lead to irritability and insomnia.
(Jane's note: this is from a different thread:)
> Some say niacin should be more effective as niacinamide
More effective for what, exactly?
If you're referring back to the original subject you posted about, anxiety and its related disorders of Social Phobia and Personality Disorder?.....there is only one answer that is correct, and that is niacinamide.
Only the amide binds to the benzodiazepine receptor. Think about the arrogance or hubris or whatever it is that brought us to calling a natural receptor complex after a drug that coincidentally affected that receptor. Did we think God or Mother Nature put it there for our drug to use?
Niacinamide and magnesium both (and quite separately) increase the activity of the benzodiazepine receptor. Niacinamide also mildly agonizes the receptor (acts as an activator).
Niacin does other things entirely.
(Jane's note: Later, in the same thread...)
> Lar, how much niacinamide do you recommend? It seems that everything is pooping out for me, and I'm becoming very depressed and so anxious I don't even react when something happens. Fondly, Phillipa
Single dose, 100-500 mg. Maximum total dose, 2000 mg/day. Individual response varies widely.
Just make very sure you're using niacinamide, not one of the other forms of niacin.
(Jane's note: And later...)
> Thanks so much Larry. I think I'll try it. Years ago I remember taking niacin[don't remember why] and it made me red around the face and neck. I later learned that this side effect didn't occur with niacinamide. I don't even know what the niacin was supposed to be good for. I didn't take it long. Fondly, Phillipa
The niacin flush is histaminic activity in dermal tissue....it also occurs internally, to some extent.
Niacinamide actually has a diametrically opposite effect; it inhibits mast cell degranulation, which is the process of histamine release. Therefore, niacinamide makes a good augment for hayfever treatment, and asthma, too. It also encourages joint health, and may be useful in osteoarthritis.
(Jane's note: And later...)
> I would not say niacin does not have any effect on gaba receptors. All depends about the affinity or in some cases avidity (ligands to receptors) but also the dosage of every substance you take.
Niacinamide and NAD both have binding affinity for GABA(A) receptors. Both change the conformation of the receptor itself, making it more sensitive to GABA. Niacinamide is a (mild) partial agonist, and I believe NAD is, as well.
As niacinamide readily crosses the blood-brain barrier, it can serve acutely as an anxiolytic. Long-term use would likely lead to down-regulation. Best keep niacinamide as an acute treatment, rather than use it as a maintenance vitamin.
(Jane's note: A different thread:)
> Hi folks, I hope my query doesn't take this thread too far off-topic ...
>
> Q: Does anyone know of any scientific evidence indicating what is a safe level of niacinamide -- i.e., one that does not present a risk of liver toxicity? I have searched many websites but most of what I've found on the subject is along the lines of "I've heard that X amount is safe" with no citations and with widely varying ideas as to how much X amount is.
>
> Much obliged for whatever info anyone can provide.The issue of the safe use of a supplement is never off-topic, IMHO.
The hepatotoxic effects of high-dose niacin therapy (e.g. for high blood lipids) first emerged with sustained-release niacin. The sustained-release form was sometimes associated with liver problems at doses as low as 3 grams per day. Even those cases seemed to be presented in the literature as case reports, suggesting it was a somewhat uncommon phenomenon, but certainly worth watching for in all treated patients.
Now, one theory of the increased toxicity of the sustained release formulation is that a greater proportion of it gets shunted down the niacinamide pathway, compared to the conjugation pathway (which causes that yucky flushing feeling). That would seem to implicate niacinamide itself for the toxic reaction, yet I cannot find so much as a case report of a single instance of liver problems related to niacinamed intake.
One hypothesis holds that the liver stress is mediated by depletion of the universal methyl donor, S-adenosyl methionine (SAMe). If that is indeed the case, then ensuring intake of SAMe promoting supplements such as betaine (also known as trimethylglycine (TMG)), and B-12 with B-6, would be altogether preventative of toxic effects.
IMHO, anyone attempting to treat anxiety-related stress with niacinamide should commit to taking a B-complex with added B-12, in any case. Any time you supplement with a lone B-vitamin, you risk placing further stress on systems dependent on other B-vitamins. This may simply be an explicit example of such a consequence.
P.S. from Jane: In the above thread, I meant to type "complement" instead of "compliment." Hate it that we can't edit posts since I make a lot of mistakes. ;-)
Posted by Lao Tzu on June 28, 2010, at 9:55:32
In reply to Re: Niacin/folic acid and depression » Lao Tzu, posted by janejane on June 28, 2010, at 7:21:42
Yes, Niacin supposedly binds to GABA receptors among other things. I personally don't like the niacinamide form. I can only tolerate a small dosage of Niacin, about 250mg per day taken at bedtime. This serves to help my depression, along with B1, B2, and B6, and in the winter, B12. Folic acid is strange for me. I don't think I really need it, but it does serve to help depression somewhat. I'm very sensitive to it, and sometimes I don't like how it makes me feel if I take it everyday. I'm going to stick with Niacin, B1, B2, and B6. These four really help my depression.
Posted by Lao Tzu on June 28, 2010, at 10:01:04
In reply to Re: Niacin/folic acid and depression, posted by janejane on June 28, 2010, at 9:07:30
I really don't think niacinamide can effectively substitute for a benzodiazepine. I know. I took Ativan for two years and it worked better than any vitamin could. Niacinamide has only mild anxiolytic activity, nothing like a benzo. In my opinion, Kava kava is better for anxiety. I used to take that herb as well. It did wonders for my anxiety, and I always felt better while taking it. Over time, niacinamide starts to make me feel depressed. I don't like it at all. Niacin (nicotinic acid) is better in my opinion, at least for me.
Posted by Lao Tzu on July 1, 2010, at 12:29:16
In reply to Niacin/folic acid and depression, posted by Lao Tzu on June 26, 2010, at 10:07:49
I think my experimentation with Niacin and folic acid is over. I really can't seem to tolerate either one because of their effects on histamine. Niacin does help my anxiety, but it tends to lower my energy levels at the same time. Don't like that. Folic acid tends to pump me up, but it is a irritating stimulation. Don't like that either. The best supplements that work for me include Vitamins E and C, zinc and manganese, Fish oil and Borage oil, Calcium and Magnesium, Selenium, B1, B2, B6, and vitamin B12 in the Winter. I am also going to try a low dose of Taurine and see if that helps. It seems to be the only amino that does anything for me.
Posted by Lao Tzu on July 2, 2010, at 9:51:31
In reply to Re: Niacin/folic acid and depression, posted by janejane on June 28, 2010, at 9:07:30
I like the fact that niacinamide acts as an anxiolytic. I have found this to be the case as well. Unfortunately for me, I tend to get depressed on high doses of it, so it doesn't do me much good to supplement with it. It in no way compares with a good benzodiazepine like lorazepam, alprazolam, or clonazepam. I have always gotten a good response from these drugs. For two years of my life, lorazepam made life more bearable. Niacinamide doesn't do this for me, and I was disappointed with it after one week of supplementing with it. I respond better to nicotinic acid, although this vitamin also complicates my depression. So I try to avoid Niacin or its derivatives. It just doesn't work well in my vitamin regimen.
Posted by Lao Tzu on July 3, 2010, at 9:42:13
In reply to Re: Niacin/folic acid and depression, posted by Lao Tzu on July 2, 2010, at 9:51:31
Niacinamide may be an excellent vitamin for someone who is low histamine rather than high histamine. I guess that's why I don't do well on it due to high histamine.
Posted by janejane on July 3, 2010, at 10:51:24
In reply to Re: Niacin/folic acid and depression, posted by Lao Tzu on July 3, 2010, at 9:42:13
> Niacinamide may be an excellent vitamin for someone who is low histamine rather than high histamine. I guess that's why I don't do well on it due to high histamine.
I think you made a typo since you have this backwards (see excerpt from Larry above). Niacianamide lowers histamine while niacin raises it. That's where the flush comes from. Niacinamide is recommended as a natural antihistamine for allergy sufferers.
Actually, here is the quote again, for your convenience:
"The niacin flush is histaminic activity in dermal tissue....it also occurs internally, to some extent.
Niacinamide actually has a diametrically opposite effect; it inhibits mast cell degranulation, which is the process of histamine release. Therefore, niacinamide makes a good augment for hayfever treatment, and asthma, too. It also encourages joint health, and may be useful in osteoarthritis."
Posted by Hombre on July 3, 2010, at 19:52:16
In reply to Re: Niacin/folic acid and depression » Lao Tzu, posted by janejane on July 3, 2010, at 10:51:24
Actually, as I understand it niacin reduces overall histamine. It doesn't raise it. It releases histamine and allows it to be cleared away. Taking aspirin and/or 1g vitamin C will reduce the flush. Regular use of niacin will eliminate the flush, since there won't be much histamine left.
Read A. Hoffer and other orthomolecular scientist's experiences with niacin and schizophrenia for more details. Schizophrenics display an atypical response to niacin - they take much more niacin to flush. There have been some related studies on this phenomenon.
janejane - do you take niacinamide?
Posted by Lao Tzu on July 3, 2010, at 20:30:46
In reply to Re: Niacin/folic acid and depression, posted by Hombre on July 3, 2010, at 19:52:16
Yes, I think you're right. Initially, Niacin increases histamine levels as I understand, but over time actually decreases histamine levels. I read that somewhere. I'm sorry for the typo. I didn't realize niacinamide had the opposite effect of Niacin. Why then do I have a negative reaction to high doses of niacinamide but not to comparable doses of Niacin (nicotinic acid)? Could the niacinamide have a different effect on neurotransmitter levels than Niacin does?High doses of niacinamide tend to make me depressed. I had written a post on whether high dose Niacin (nicotinic acid) might not mix well if you're on psychotropic drugs. I don't think there is an interaction per se, but if you are taking antidepressants that increase serotonin, Niacin could effect tryptophan levels. I'm talking about high doses of Niacin, not say 50mg per day. There must be a good reason why I don't do well on Niacin or niacinamide, perhaps having something to do with serotonin levels. Anyway, thanks for correcting me about niacinamide. I wouldn't want anyone to get misinformation about it.
Posted by Lao Tzu on July 3, 2010, at 20:36:53
In reply to Re: Niacin/folic acid and depression, posted by Hombre on July 3, 2010, at 19:52:16
I have a question then. Why is Niacin recommended for people with low histamine but not for people with high histamine? I'm getting confused. According to A. Hoffer, Niacin at high doses will lower histamine levels over time, or at least, normalize them. But then why should a high histamine person avoid Niacin? I haven't seemed to find a straight answer.
Posted by Hombre on July 4, 2010, at 3:53:00
In reply to Re: Niacin/folic acid and depression, posted by Lao Tzu on July 3, 2010, at 20:36:53
I also don't do too well on niacin or high dose folic acid, but I wonder if it would help (in large doses) if I weren't taking meds. I only wish I'd tried them before I went on meds.
I haven't researched niacinamide at all because I was looking for something to help with cholesterol. Niacinamide is also more likely to cause liver problems. I don't know Larry Hoover and I respect his knowledge, but he isn't guaranteeing anyone's safety with his opinions.
While there are certain appealing things about the whole histamine theory, there are conflicting claims and I have symptoms of both high and low histamine.
What's more interesting to me is the connection between season rhinitis/hay fever and depression. But that's in the realm of Chinese medicine and not related to this thread.
Posted by janejane on July 4, 2010, at 9:46:50
In reply to Re: Niacin/folic acid and depression, posted by Hombre on July 4, 2010, at 3:53:00
If you read the excerpt above, you'll see Larry suggested taking B12 to mitigate possible liver problems. (The original post may have gone into more depth than what I quoted.)
I'm really not qualified to speak on the subject of B3 since I have a poor understanding of chemistry and biology. I do respect Larry's knowledge though, which is why I quoted it. He was always impeccable about doing the research, and often provided extensive lists of sources for follow-up. I only provided a few paragraphs that I thought showed the basic ideas. You will no doubt find more thorough analysis if you look at the original material.
As for Hoffer, I don't know how to reconcile that. I know he did his work a long time ago, and newer research may have altered current thinking. I'm sorry I can't be of more help but the chemistry stuff really does make my head spin.
My own experience with B3 has been limited. There's 55 mg niacinamide and 20 mg niacin in my daily multivitamin. I don't take more than that since B vitamins generally seem to make me anxious. I tried a modest amount of supplemental niacinamide (I think 250 mg) two or three times for allergy type symptoms and didn't notice an improvement. Once I thought it made me sleepy, but I wasn't sure it was to blame. I also tried it for anxiety, and didn't notice a difference, but I later found out the anxiety was caused by 5-HTP so I'm guessing that the problem was that it was hitting the wrong receptors (benzo vs. serotonin). (Simply stopping 5-HTP was the answer to that problem.)
Posted by janejane on July 4, 2010, at 9:52:20
In reply to Re: Niacin/folic acid and depression, posted by Hombre on July 4, 2010, at 3:53:00
One more thing about the liver issues... he clearly said it should be used an acute treatment rather than as a maintenance vitamin so I hardly think his recommendations were irresponsible. Maybe I'm missing something, but it doesn't seem likely that liver problems would develop without chronic high use.
Posted by janejane on July 4, 2010, at 9:55:25
In reply to Re: Niacin/folic acid and depression, posted by Hombre on July 4, 2010, at 3:53:00
Correction... he said niacinamide (actually any B vitamin) should be taken only with an additional B complex including B12. Not just B12.
Posted by Hombre on July 5, 2010, at 4:15:47
In reply to Re: Niacin/folic acid and depression » Hombre, posted by janejane on July 4, 2010, at 9:52:20
> One more thing about the liver issues... he clearly said it should be used an acute treatment rather than as a maintenance vitamin so I hardly think his recommendations were irresponsible. Maybe I'm missing something, but it doesn't seem likely that liver problems would develop without chronic high use.
The use of niacin and niacinamide for mental health purposes--at least historically--is always in the realm of chronic, high-dose usage. People stop taking niacin, their symptoms return. That said, elevated liver enzymes do not necessarily indicate damage. I've done enough reading on niacin from the orthomolecular studies and have taken it in relatively high doses (1-2g/day) to know that it has potential, but just not with meds.
People who take antipsychotics, sometimes just to sleep, need to be on the lookout for something that will help with potential elevation of cholesterol and lipids. That's how I got interested in the first place.
If someone comes forward to say that niacinamide is helping with anxiety and other symptoms, that'd be great. But until then I can only speak from my own experience and the hours of reading I've done on my own. No argument here. I'm all for people giving things a try.
Posted by janejane on July 5, 2010, at 5:23:05
In reply to Re: Niacin/folic acid and depression, posted by Hombre on July 5, 2010, at 4:15:47
> If someone comes forward to say that niacinamide is helping with anxiety and other symptoms, that'd be great.
Check the archives for anecdotal evidence. A number of past posters experienced success with niacinamide for anxiety and allergy symptoms. There's some interesting stuff on NAD too.
Posted by janejane on July 5, 2010, at 6:09:22
In reply to Re: Niacin/folic acid and depression, posted by Hombre on July 5, 2010, at 4:15:47
I was curious, so I searched "niacinamide anxiety" and counted 4 people who said it helped them. This was just within the first few threads I looked at. I got tired of reading so I stopped, but I remember at least one other poster who had dramatic success with it, who I didn't come across, so if you dig, you're bound to find more.
In your research, did you have a chance to look at any of the Eastern European studies? My sense is that some of the best work was done there but that access to those reports might be difficult. I'd look into it myself, but I frankly don't have the energy to do it, and it'd probably be way over my head anyway. (The chemistry stuff always is.)
Posted by Hombre on July 5, 2010, at 19:26:41
In reply to Re: Niacin/folic acid and depression » Hombre, posted by janejane on July 5, 2010, at 6:09:22
> I was curious, so I searched "niacinamide anxiety" and counted 4 people who said it helped them. This was just within the first few threads I looked at. I got tired of reading so I stopped, but I remember at least one other poster who had dramatic success with it, who I didn't come across, so if you dig, you're bound to find more.
>
> In your research, did you have a chance to look at any of the Eastern European studies? My sense is that some of the best work was done there but that access to those reports might be difficult. I'd look into it myself, but I frankly don't have the energy to do it, and it'd probably be way over my head anyway. (The chemistry stuff always is.)I'll definitely take note and file that away for future research. But for the time being, I'm mostly reading up on meditation, since as I told you in PM adding Tai Chi and Qigong/Meditation back into the routine has had profound benefits, and herbal medicine. The healthier my body gets the less I depend on the supplements. It doesn't seem to matter as much if I take them or not.
You see, before I was getting a good response from meds and herbs (and now lots of exercise) I would spend all day researching potential treatments. I've read the algorithms and recommendations from STAR D, STEP BD, CANMAT, along with Stahl's Psychopharmacology and Prescriber's Guide. I also spent hours reading up on vitamins and minerals. I ran through all sorts of scenarios and planned out various med combinations.
And then I started to get better, and part of that meant that I didn't feel the pressing (almost obsessive) need to gather information. Of course I love to read up on health related topics and there is nothing wrong with that since I enjoy it, but I'm no longer searching for the "magic bullet", so to speak. If there is something I want to try, I'll read up. But I tell myself that I don't have to keep searching so hard anymore. So to me, unless someone whom I've invested an interest in over the past ~9 or so months that I've been reading p-babble has a success story to share, it doesn't really matter much to me. I hope that explains where I'm coming from a bit better. And I can't wait to hear your success story as it unfolds.
This is the end of the thread.
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