It can be scary to take supplements or herbs, especially if you have not had much experience with this type of therapy or if you are sensitive to a particular one. It's hard to trust that these are going to make you better and not worse. To top it all off, there is a lot of conflicting information online and that makes it virtually impossible to know what to believe. I would like to give you a little bit of information on supplements and medications and I hope you find it interesting and clarifying.
Let's start with drug-nutrient interactions. When a medication is used alongside another medication it is important that the physician pay special attention to ensure the combination is safe and effective. Physicians can check these in medical databases. Interactions range from mild to serious in terms of the risk of causing an adverse reaction and it is up to the physician and patient to decide together if it is the most appropriate option and if the benefits outweigh the potential risks. The drug interactions can be unwanted and harmful or they can be helpful.
Types of interactions.
1. Opposition (antagonism)
When two drugs of opposing actions interact, thereby reducing effectiveness of one or both.An example would be if a person was taking a beta blocker to control high blood pressure and also taking albuterol to manage asthma. One drug blocks the beta2 receptor while one stimulates it.
2. Duplication (synergism)
When two drugs with the same effect are taken, their effects can be intensified
An example would be someone taking Xanax for anxiety while also taking Ambien for sleep. They both act on the same GABA receptors potentially increasing side effects such as drowsiness, dizziness or brain fog.
3. Alteration
When one drug alters how the body absorbs, metabolizes or excretes another drug.An example might be someone taking an acid blocking drug like an H2 blocker which raises the pH of the stomach and decreases absorption of another medication they may be taking.
What about tryptophan?
This is one supplement that I get asked about often, so I want to give it special attention. Tryptophan can have antidepressant effects which is why I believe people think it acts similarly to an SSRI which is also an antidepressant. They are both anti-depressants, right? This is not so.
L-tryptophan is an amino acid found in protein rich foods like meat, oats and nuts. It is often used as a supplement to give people a higher amount than could be consumed. The difference between SSRIs and tryptophan are as follows:
SSRIs (selective serotonin reuptake inhibitors) work by antagonizing/blocking serotonin receptors sites which allow for more serotonin to remain in the synapse with the hope that it will improve mood, sleep and appetite. Tryptophan does not block serotonin receptor sites. So, what does it actually do?
1. Can convert to 5-HTP which can convert to serotonin
2. Can convert to melatonin, an antioxidant as well as hormone associated with sleep
3. Is a precursor for NAD+ (nicotinamide adenine dinucleotide) which is a B vitamin associated with reducing inflammation in the brain, deepening sleep and balancing neurotransmitters.
As you can see tryptophan can do a lot to support the body in various ways during a taper. Some people may not respond well to it and there are usually a few reasons as to why.
Dose matters, form matters, brand matters and a person's health history all play a role in if tryptophan is being used appropriately and how it will feel for a person. For example, If the person is already deficient in pyridoxine and magnesium, they may feel bad taking tryptophan. If the gut doesn't contain enough probiotics to break down the amino acid, it can cause some side effects. The most common side effects of tryptophan are drowsiness and nausea. It is important to remember that a side effect is not the same as an adverse effect. A side effect may be unpleasant causing no actual harm while an adverse effect is harmful. Pharmaceutical drugs typically come with a lot of adverse effects while supplements are just the opposite.
Serotonin Syndrome
Serotonin syndrome is a potentially life threatening condition associated with increased serotonergic activity in the central nervous system. Sounds scary I know, but stay with me. It is seen with therapeutic medication use, and inadvertent interactions between drugs. Symptoms typically onset within 24 hours of an increased serotonergic agent or an overdose. In mild cases the symptoms include:
shivering
sweating
myoclonus (involuntary muscle movements)
usually no fever
As the condition increases in severity, symptoms also can include
agitation
fever
tachycardia (racing heart rate) with dramatic pulse swings
diarrhea
hyperreflexia (overactive reflexes)
Treatment is to stop all serotonergic medications and the condition usually resolves in 24 hours. A higher incidence has been reported in patients with end-stage renal disease who are taking SSRIs. The diagnostic criteria is specific and must include hyperreflexia and clonus. The use of supplements causing Serotonin Syndrome is rare and almost entirely theoretical. With that being said, we practice caution and this is why its imperative that anyone tapering off of psych meds using supplement/nutrient therapy do so und er medical supervision so it is done safely and effectively.
Does this means it’s safe to use tryptophan during a taper?
Yes and no. Certain factors play a role in determining if tryptophan would be helpful or potentially harmful. These include:
medications: type, pharmokinetics, pharmodynamics
taper schedule
supplements
other health conditions
How important are supplement brands?
Brands do matter because purity is a real issue. I only suggest pharmaceutical grade supplements by companies that are reputable. No one can guarantee the purity of products from third party sellers such as amazon.com.
Supplements as a whole have a much safer profile than pharmaceuticals, though it is possible a side effect can happen. In my clinical experience, I have seen most side effects resolved by taking them with food. It is important to use them under guidance, at the appropriate doses with right cofactors.
There are many aspects to tapering off psychiatric medications such as timing of dose cuts, detoxing, diet, blood sugar and supplements. Of the thousands of tapers I have done with people, I would say it is exponentially more difficult without supplemental support.
Taking nutrients with medications during a taper has been shown in research to significantly reduce withdrawal symptoms. Most medications deplete the body of nutrients and many of those nutrient deficiencies have symptoms that mimic withdrawal. Here is an excerpt from one of my favorite studies from the Iranian Journal of Public Health, looking at the use of nutrients to support withdrawal.
"Methadone maintenance treatment, itself, is not a favorable approach until it is coupled with a proper diet due to the negative role of vitamins and minerals deficiencies in the withdrawal process. Williams found that high alcohol intake in rats resulted in vitamin B6, vitamin A, thiamine, riboflavin and pantothenic acid deficiencies. Proteins and key vitamins, as well as minerals such as zinc, iron, calcium, chromium, magnesium, potassium and other essential nutrients should be prescribed in detoxification programs to recovering addicts. Zinc can help to improve the immune system and proper brain function. Many opiate and alcohol addicts have shown calcium and magnesium deficiencies due to poor diet and inadequate intake of calcium. Calcium and magnesium deficiencies are the major factors of pain and nervous/muscular disorders among addicts and alcohol consumers during detoxification programs"
I truly hope this helps to give you more information and understanding about your treatment program and why nutrient therapies are safe and effective.
Sources
Boyer EW, Shannon M. “The Serotonin syndrome”. N Engl J Med 2005; 352:1112.
Dunkley EJ, Isbister GK, Sibbritt D, et al. “The Hunter Serotonin Toxcity Criteria: simple and accurate siagnostic decision rules for serotonin toxicity”. QJM 2003; 96635.
Mason PJ, Morris VA, Balcezak TJ. “Serotonin syndrome. Presentation of 2 cases and review of literature.” Medicine (Baltimore) 2000; 79:201.
Nabipour, Sepideh et al. “Burden and nutritional deficiencies in opiate addiction- systematic review article.” Iranian journal of public health vol. 43,8 (2014): 1022-32.