May 12, 2014

Is Serotonin-Booster 5-HTP Safe for People with Parkinson’s?

Last Friday, I recounted my positive experience using the OTC serotonin-booster 5-HTP as a therapy for the non-motor symptoms that typically accompany Parkinson’s.

Several readers asked about possible negative side effects. Several had researched the supplement and found cause for concern. I underwent the same process when I started taking it, and I continue to monitor this safety issue.

Here’s what I’ve found.

Safety Issues
As with all pill questions, I start my research with You have to be a member to access their reports. Membership costs $36 a year.

They had a double-header review on 5-HTP and tryptophan. Their encyclopedia includes articles about both, last reviewed in August 2013.

Here are some pertinent quotes from the report:

·       Many antidepressant drugs work at least in part by raising serotonin levels. The supplement 5-hydroxtryptophan (5-HTP) has been tried in cases of depression for a similar reason. The body uses 5-HTP to make serotonin so providing the body with 5-HTP might therefore raise serotonin levels.

·       A typical dosage of 5-HTP is 100 to 300mg 3 times daily [my daily dose is between 50 and 100mg].

·       Several small short-term studies have found that it may be as effective as standard antidepressant drugs. Since standard antidepressants are also used for insomnia and anxiety, 5-HTP has also been suggested as a treatment for those conditions, but there is only very preliminary evidence as yet that it works.

·       No significant adverse effects have been reported in clinical trials. Side effects appear to be generally limited to short-term, mild digestive distress and possible allergic reactions.

·       One potential safety issue with 5-HTP involves an interaction with a medication used for Parkinson’s disease: carbidopa. Several reports suggest that the combination can create skin changes similar to those that occur in the disease scleroderma.

If you research 5-HTP and possible side effects, you’ll find other similar reports. Like the report, they all flag the possible side effect of greatest concern, which is:

The Risk of Serotonin Syndrome
What grabs your attention in these reviews is one particular risk: "possible death.” My research has been pretty thorough, and I'm reassured I’m not gambling with my life when I take the supplement.

The severest cases of serotonin syndrome (those that include talk of “possible death”) are associated with taking irreversible monoamine oxidase inhibitors (MAOIs), a class of antidepressants including isocarboxazid (Marplan) and phenelzine (Nardil). I've never taken any of those. Whew!

I became concerned again when I discovered the Food and Drug Administration had issued a serotonin syndrome warning in 2007 that triptans -- when administered with SSRIs or SNRIs -- might, in rare cases, precipitate serotonin syndrome. But I was relieved when I checked "triptans" in Wikipedia, which indicated "not to be confused with tryptophan" (like 5-HTP).

Also reassuring was a report from NIH that listed these prerequisites for a serotonin syndrome diagnosis: You must (1) be taking a drug that changes the body’s serotonin levels, AND (2) you must have at least three of the following signs or symptoms:
  • Agitation
  • Diarrhea
  • Heavy sweating not due to activity
  • Fever
  • Mental status changes such as confusion or hypomania
  • Muscle spasms (myoclonus)
  • Overactive reflexes (hyperreflexia)
  • Shivering
  • Tremor
  • Uncoordinated movements (ataxia)
I need to check the hypomania box, since it describes the bursts of euphoria and creativity I often experience with 5-HTP. But that’s the only one. I didn’t check the “uncoordinated movement” box, since what's important is some "change from normal" that could be attributed to serotonin intake. Uncoordinated movement is a Parkinson’s symptom that predated my use of 5-HTP.

The Greatest Threat from 5-HTTP: Me
This is a prime example of the conflict I frequently experience these days between my new mantras “less is more” and “easy does it” on the one hand and my history of following the precepts “anything worth doing is worth overdoing” and “too much of a good thing is a good thing” on the other. Those last two principles played out dangerously in my addictions to nicotine and alcohol.

Those last two maxims -- the ones that got me into trouble with booze and cigarettes -- resurfaced with 5-HTP. It wasn't enough that 5-HTP alleviated the typical Parkinson’s non-motor symptoms of depression, insomnia, constipation, and impaired executive function. I conned myself into thinking that -- as Parkinson’s destroyed more and more of my dopamine-generating brain cells -- I needed to offset that loss by increasing my serotonin intake.

That compulsion to "overdo it" took me to Sibley Hospital’s emergency room -- not once, but twice -- after my systolic pressure spiked above 200. I’m doing much better since those warnings, but it’s still not always easy to fight the temptation to take more of the supplement. But after nearly five years of experience, I know I need to stay within the daily range of 50-100mg.

My standard practice has been to take 50mg of 5-HTP at bedtime. Lately, I’ve been experimenting a bit. I'm taking half a pill (25mg) at bedtime, 8am, and 4pm -- to more evenly distribute the serotonin boost through the day. So far, so good: steadier bp numbers, no scary morning spikes.

I'll share some final thoughts about using 5-HTP soon.

1 comment:

Unknown said...

Hypomania is the opposite of mania. It seems like you can uncheck that box as well.