Let's be frank, there's a double standard in psychiatry when it comes to taking risks with nutritional supplements vs. prescription medications. This hypocrisy is most evident when the use of a supplement might lead to the loss of a patient, not from death, but from recovery. For, recovery would hurt the doctor's and the pharmaceutical industry's (financial) well-being.
The classic example is the use of 5-HTP when withdrawing from a selective serotonin re-uptake inhibitor (SSRI). Psychiatrists warn against its use because it might lead to serotonin syndrome and possible death. I disagree. Here are my opinions as a holistic psychiatrist.
Have a wonderful week!
A Holistic Psychiatrist's Perspective on Serotonin Syndrome
Risks and Benefits of Using 5-HTP During SSRI Withdrawal
Let's start with a reasonable question:
If using 5-HTP (an activated form of the amino acid L-Tryptophan) is so effective at making serotonin that psychiatrists are afraid it will cause serotonin syndrome when used with an SSRI, then why use an SSRI in the first place?
Either 5-HTP is effective at making serotonin or it's not. It doesn't make sense to ignore its effectiveness for raising serotonin levels in the treatment of depression, while simultaneously prohibiting its use in SSRI withdrawal because of its effectiveness in increasing serotonin.
If the goal is to increase serotonin levels, why not start with 5-HTP and a multivitamin/mineral supplement to help convert the 5-HTP into serotonin?
Wouldn't that get rid of the risk of serotonin syndrome? Don't use the medication and voilà, you've gotten rid of the risk. But no. Unfortunately, that is not how a typical psychiatrist thinks.
A psychiatrist, being a medical doctor, picks the medication over the amino acid. The amino acid, found in food, is viewed with greater fear and trepidation than the prescription medication with its many and unexplored side effects. In the case of SSRIs, the black box warning of "increased suicidal ideation and behavior," which can lead to death, is considered an acceptable risk compared to the use of a natural substance.
Here's another reasonable question:
If a patient uses 5-HTP with an SSRI, and the serotonin level rises above a "normal" level, why can't the patient simply lower the SSRI instead of the 5-HTP?
Isn't that the definition of a viable withdrawal process? The patient is supposed to need less medication. Rather than see it as a problem, I see it as a solution. Perhaps from the psychiatrist's perspective, having patients successfully lower their SSRIs and no longer needing psychiatric care are not the kinds of successes they envision for the patient.
In my article, What to do Before Lowering Medications, I wrote:
"At the 2016 IMMH conference, Dr. Marty Hinz, MD, shared that studies show the use of selective serotonin reuptake inhibitors (SSRI's) depletes the total releasable storage levels of serotonin in the platelets by 80% after 3 weeks of use. The platelets contain 90% of releasable serotonin stores. He wrote, 'reuptake inhibitors deplete the monoamines serotonin, dopamine, norepinephrine, and epinephrine in all subjects not ingesting adequate amounts of balanced nutrients; when depletion is significant enough, the point is reached where the effects of the drug and/or the placebo effect are no longer observed.'1
"After using an SSRI for many years, it is necessary to restore serotonin levels before tapering it. The conventional approach that avoids serotonin building supplements along with the use of SSRIs (due to a fear of serotonin syndrome) undermines the patient's ability to come off these medications during the tapering process. Such an approach creates a dependency on these SSRIs."
Finally, my last reasonable question:
How can we tell if serotonin levels are getting too high (without the benefits of regular energy testing or neurotransmitter testing) so we can avoid this problem?
Serotonin syndrome is a diagnosis of having dangerously high levels of serotonin (though an actual level is not used to give the diagnosis). Before one reaches that high a level, there are signs that you might be ready to lower your SSRI (due to a robust level of serotonin).
Having more vivid dreams. Serotonin gets converted to melatonin, so your sleep will improve when serotonin levels improve. As the levels go up, your melatonin levels will go up and your dreams will become more vivid.
More active GI system. 90% to 95% of the serotonin is found in the GI tract. If your serotonin levels are higher than normal, your GI system may be a little more "gurgly" and your bowel movements a little more frequent.
Lower attention and focus. The serotonin and dopamine systems are somewhat interdependent. When serotonin levels go up, the dopamine levels go down. Dopamine helps with focus, attention, and motivation. Also, when serotonin levels are too high, blood flow to the frontal lobes goes down. Perhaps that contributes to the dimming effect of having a high serotonin level.
Feeling flat and numb. This can feel like depression, but it's actually a sign that it's time to lower, not increase, the SSRI. Some patients who can't metabolize an SSRI very well will have high levels of the medication accumulate in their bodies. They often complain that they feel flat, apathetic, and numb, but when the SSRI is lowered, their symptoms resolve.
Check your blood pressure. Blood pressure dysregulation or high blood pressure are signs of having serotonin syndrome. You can check your blood pressure regularly and make sure that all is well in that area.
Link to a ist of signs and symptoms of having serotonin syndrome. No serotonin level is actually used to define what is too high or toxic a level of serotonin. It is a diagnosis based on a set of symptoms and associated with the use of serotonin inducing medications.
Most patients who seek to taper off their SSRIs have been on them for years and need serotonin support for a week or two before I am able to start lowering their medication. The amount I usually recommend is 50 to 100 mg of 5-HTP at bedtime, along with the helpful vitamins and minerals to help convert the amino acid to serotonin. SeroPlus by Pure Encapsulations is a typical, reliable supplement that can do the job.
In the 18 years that I have used 5-HTP for SSRI withdrawal, no one has ever gotten serotonin syndrome. What they got was the ability to get off their SSRIs and move on with their lives, which is what every psychiatrist should seek for their patients.
1 - See this article for more information: Monoamine depletion by reuptake inhibitors (Marty Hinz, MD, 2011)
Have a great week!