November 3, 2014

My Name Is John and I'm a Recovering 5-HTP Addict...

... and I've been sober for three days.

I began this blog after receiving my Parkinson's diagnosis five years ago. I thought I'd discovered in the serotonin-boosting supplement 5-HTP a treatment for the three major non-motor side effects of Parkinson's disease (PD) -- depression, insomnia, and constipation.

I had successfully used 5-HTP years ago, when I was having lots of trouble with insomnia and depression. So, when I felt those problems returning after my PD diagnosis, I went to my CVS and bought a bottle of 5-HTP pills at the lowest available dose, 50mg. I recalled getting pretty manic when I overdid it years before.

The results amazed me. The depression, insomnia, constipation... gone. In addition, I was also bursting with creative ideas during my early morning "quiet time."

Occasionally I'd feel downright euphoric. But -- what the hell -- that just made the experience more fun. Actually this actually did concern me,  I just told myself to avoid the excess intake. (I seem to recall saying the same thing about martinis.)

Here on the blog, I began a vigorous effort to spread the word about 5-HTP's efficacy in treating those PD symptoms. I was sure others like me would experience similar benefits.

In time, I noticed I was the only person marching in the parade. So I began cautioning blog readers that my own experience with the supplement was apparently fairly unique. But I continued my research, eager to discover other connections between 5-HTP and PD.

5-HTP and Me
As I had years before, I learned again about 5-HTP's "dark side." This time around, I ended up in my neighborhood hospital's emergency room -- twice -- after taking too much. Even though I was using only half of the 50  mg pill at bedtime, I'd sometimes pop the other half during the day. It didn't take long to learn the lesson -- too much 5-HTP caused scary spikes in my blood pressure... the reason for those trips to the ER.

Once when I'd taken an extra pill after lunch,I soon realized I was about to pass out, and I called 911. When the ambulance got me to the hospital, my systolic (upper) pressure was well over 200.

Even after the second incident -- call me crazy -- I kept taking the supplement, chopping up the little pills, figuring I could avoid those frightening pressure spikes. On difficult days especially, Id' convince myself, "Just a little more won't hurt me." Yes, the addict in action.

Eager to avoid more 911 calls -- and probably to persuade myself that I'm a sane, responsible person -- I began monitoring my blood pressure throughout the day, and entering the numbers into my log. Tracking those numbers became a kind of obsession, but I was convinced I could strike a balance between my 5-HTP-enhanced serotonin and my carbidopa/levodopa-enhanced dopamine.

Ah... the addict's ability to justify his own craziness!

A Classic Example of an Addict at Work
Last Thursday at bedtime, I took my usual 5-HTP dose -- half a 50mg pill.

I woke up at 3am, knowing right away that something was seriously wrong. I checked my blood pressure -- 207/114.

I took a nifedipine, the medication my doctor prescribed to lower my pressure when I sensed it was spiking dangerously. In about half an hour, my numbers dropped into normal territory -- below 150/90.

I kept monitoring my pressure, aware that nifedipine can work "too well" and drive my systolic reading below 100. Luckily, there's an easy remedy to halt those dipping numbers -- two glasses of cold water.

Those 200+ systolic readings -- like what I experienced early Friday -- put me in danger of a stroke... or worse. It took a fair amount of research on my part to discover that  carbidopa does for 5-HTP what it also does for levodopa (PD's gold standard medication) -- enhance its ability to cross the blood/brain barrier and increase its bioavailability by a factor of as high of 8. (A 50 mg pill becomes in effect a 400 mg pill!)  I managed to forget that caution when taking my bedtime 5-HTP.

I also forgot the impact my recent hike in carbidopa/levodopa might have. My neurologist added 800mg of the stuff -- a 50 percent increase -- to see if levodopa's "protective shield" might prevent the pressure spikes.

On Friday morning -- as the dust was settling on this last incident -- I fired off a 5-HTP-fueled email to my son and daughter. Concerned  that the email clearly showed I was on a 5-HTP high  -- and about my recent pattern of experimenting with different pills and dosages, and my continuing pressure spikes and drops -- my kids individually came to the house Friday and pleaded with me to stop taking 5-HTP. In AA, this is known as a "family intervention."

Finally, sobriety, sanity, and common sense prevailed. I haven't taken even a sliver of 5-HTP since Thursday night.

The Bottom Line
I have no regrets about taking 5-HTP for the first five years of my travels down the Parkinson's road. It truly enhanced the quality of my life during that time.

What caused most of the problems was the interaction between 5-HTP and carbidopa, which is part of the key Parkinson's med (carbidopa-levodopa). My experience is an example of the dangers we all face when we take a variety of medications. Old folks like me are especially at risk, since we tend to take lots of meds.

Using 5-HTP put me at even greater risk because:
  1. It's a supplement, and therefore not subject to the regulatory requirements of the Food and Drug Administration.
  2. It's not a well-known supplement and hasn't been subjected to much independent study. For the hell of it, I just checked drug.com's page on possible drug interactions with 5-HTP. It lists 83 drugs, but there is no mention of carbidopa.
  3. I'm also a risk factor. I like trying new things. I have a special attraction to things in the medical field that I discover through my own research. 5-HTP as a treatment for Parkinson's major non-motor symptoms was my baby.

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