Doctors Report
How Their Patients are Doing on 5-HTP

By David Jay Brown

David Jay Brown interviewed several physicians and other health practitioners about their patients' experiences with 5-hydroxytryptophan (5-HTP). Various problems discussed included: sleep disorders, depression, anxiety, migraines, fibromyalgia, and weight management.

MY PERSONAL PERILS WITH SEROTONIN DEFICIENCY
have suffered from Serotonin Deficiency Syndrome (SDS) for many years. From 1988 until 1996 I needed to drink - virtually every night - a half-quart of cow's milk (which has relatively high levels of the amino acid tryptophan) to help me sleep, enhance my mood, and reduce anxiety. Drinking milk was necessary for me because the FDA banned the sale of tryptophan in 1988. I had previously used tryptophan with great success to treat my SDS. My brain simply craved serotonin. Large quantities of milk helped, although I got awfully sick of drinking milk. But the tryptophan supplements had provided exquisite relief.

During two periods of significant depression I tried the pharmaceutical compounds Prozac® and Zoloft®. Like tryptophan, these drugs increase the activity of serotonin in the brain, but I found the side effects intolerable. With both drugs I found it incredibly difficult, if not impossible, to reach orgasm during sex. Both drugs dampened my creativity, which being a writer, is my life-blood. And, while the drugs raised the floor on my emotional lows, they also lowered the ceiling on my emotional highs. I felt as though my emotions were trapped in a box. I never had any of these side effects with tryptophan. This made sense to me since tryptophan is natural to the body and is simply the metabolic precursor to serotonin.

David Jay Brown earned his master's degree in psychobiology at NYU, and researched learning and memory while in USC's doctoral program in Behavioral Neuroscience. He is the author of Brainchild, and coauthor of Mavericks of the Mind and Voices from the Edge. His new science fiction novel, Virus, will be published this Fall by New Falcon, and he is currently working on a book with British biologist, Rupert Sheldrake, about the unexplained abilities of animals. His interview work is available online at: www.levity.com/mavericks

The FDA prohibition resulted from a single contaminated batch of tryptophan. It was synthesized by a Japanese manufacturer who used a new and untested raw-material source and skimped on filtering. Several people suffered serious adverse reactions due to the contaminated batch. For the FDA to universally and permanently ban all tryptophan - which is found naturally in mother's milk - seems extremely questionable to me. Aside from two exceptions, infant formulas and parenteral care IVs, the moratorium on the use of tryptophan continues to this day to the extent that it can only be obtained by prescription. The ban is not based on FDA ignorance, since the Center for Disease Control's reports acknowledge the adverse effects were due to a contamination by one manufacturer. This simply gave the FDA their perfect excuse to exile the natural tryptophan for their vested interest in pharmaceutical companies, who are unable to patent naturally-occurring substances such as tryptophan. The FDA/prescription company alliances don't want tryptophan competing, however effective and safe, with their highly profitable drugs, such as Prozac, Zoloft, and Paxil®.

So you can imagine, I was more than delighted in 1996 when 5-hydroxytryptophan became available as a nutritional supplement. 5-HTP is the metabolite of tryptophan and the precursor to serotonin. So 5-HTP is one step closer to serotonin. I was even more thrilled when I discovered that it improved my sleep and reduced my anxiety even better than tryptophan, especially with a small amount of St. John's wort (hypericin). Since I've had positive experiences with 5-HTP, I have become very familiar with the considerable amount of scientific literature reporting 5-HTP's impressive results treating not only sleep disorders and anxiety, but also depression, PMS, seasonal affective disorder, and migraine headaches. 5-HTP has also been found to be helpful with reducing weight and improving cognitive performance.

Although many health practitioners are not familiar with the studies done on 5-HTP, a growing number have been using it in their practice, often with great success. For this article, I interviewed several health practitioners with various backgrounds and specialties from around the country to find out why they are giving 5-HTP to their patients and what kind of success they're having. Most of the doctors I interviewed are prescribing 5-HTP for a variety of ailments and are experiencing considerable success with it.

WHAT DOCTORS ARE SAYING
When interviewing Dr. Alexander Cadoux, a physician in Tucson, Arizona, he was excited to report,
"I find 5-HTP very successful. What I mostly use it for in my practice is for people who have difficulty falling asleep, but I also use it for chronic anxiety states. It's orthomolecular. It's important to get it from a quality manufacturer so you can be assured of the purity of the material. I have used it for several years and I haven't had any complications with it - although I've heard of others who have. I find it to be basically equivalent to tryptophan.

"I find 5-HTP highly successful in helping people induce sleep, but it has a relatively short half-life. [It gets used up relatively fast.] So if someone's sleep disturbance pattern is such that they're awakening at three or four in the morning, yet they have no trouble falling asleep, then taking it at bedtime typically will not keep them asleep, because it doesn't have a very long half-life in the body. But if they do awaken at two or three in the morning, and can't go back to sleep, I've had some good success having those individuals just take it again at three in the morning.

"I've used 5-HTP a lot for sleep in conjunction with melatonin, and I find this works pretty well. With some people, taking oral minerals at night also helps. I try to stay with orthomolecular sleep aids as much as possible. I also use valerian, which isn't orthomolecular, but does have a nice sedative effect for a lot of people. Sometimes combinations of these things can work pretty well. I think 5-HTP works very well to help induce sleep in my experience.

"In terms of chronic anxiety states, 5-HTP may be helpful as an adjunct to other treatment modalities. Sometimes I have people take it two or three times a day, usually in addition with other things. But I do find it very valuable. I use 5-HTP now instead of tryptophan. The only time I prescribe tryptophan is if somebody has an extremely good pharmaceutical insurance plan, where they'll get reimbursed for it. But that's pretty rare. Otherwise I prescribe the 5-HTP."


Speaking at length with Dr. Tim Tupper, a chiropractor in Santa Barbara, California, I learned he uses 5-HTP for a variety of problems with his patients. He states,
"I use 5-HTP for a number of things, but the most common thing is for sleep, for people who have insomnia. I would say that for at least 80% of them it works really well. It's only occasionally that it doesn't work. The other thing I use it for is appetite control - especially for people who crave refined carbohydrates, such as sugars and chocolate. It's great for chocoholics. It really, really helps curb those cravings. And the success I've had with that is almost 100%. It's quite amazing how effective it is for that.

"I also use 5-HTP for depression. That was probably the first thing that I used it for, and it has worked well. For a long time I had been using tryptophan, when it was available, for depression - especially [for] women who get depression from PMS. It's just very, very amazing. When they took it off the market I had so many women that were just going crazy. They would have gotten it from anywhere then. I also use it for general depression as well, which it works really well for. The success rate for that is probably 75%.

"I've also used 5-HTP for anxiety. Not manic-depression - just when people have anxiety, like from taking a test, or something like that. Again, it works really well. I've used it with a couple [of] cases as a migraine preventative, especially women who get migraines related to their menstrual cycle - when they can predict by looking at a calendar that they're going to get a migraine on the 28th day of the month. If I have them start taking the 5-HTP, maybe two or three days before they expect to get a migraine, they usually don't get a migraine. I've used it on a few people like that, and it's worked every time. But I couldn't say that it's a 100% success rate, because I haven't had enough people using it to determine that. But those are the main things that I use it for. It's a great product."


Oz Garcia, a nutritional consultant with a private practice at Personal Best, a nutritional consulting firm in New York City, recommends that 5-HTP be used for people who have difficulty sleeping. Oz shared with me,
"I think sleep improvement has been the most effective way that we found people use 5-HTP. I think our success rate, from what we're able to see, is about 60%. That's for people that use it and have actually stopped using other compounds."


I enjoyed speaking with Dr. Paul Wehrum, Sr., a physician in Cleveland Heights, Ohio, who has a clinical focus in weight management. His comments about 5-HTP and weight loss were,
"I do a lot of work with weight reduction. In fact, my practice is limited to weight control. We had a lot of patients on fen-phen, and they all did very well, but it was taken off the market. I continue to use phentermine or Adipex®, and that works. It's been on the market for probably 30 years, and it's probably the safest, but unfortunately, it's only mildly effective. So in order to enhance its effectiveness I use 5-HTP in an effort to raise serotonin levels. And, I would say, I've had modest improvements. All of the patients who take it, like it."


Dr. Dennis Sievers, a chiropractor in Fairfax, Virginia, recommends 5-HTP for his patients for a myriad of problems and has exceptional success for patients suffering from fibromyalgia. He relates,
"Basically we use 5-HTP with people who complain about insomnia, sleep disorders, and depression. We think in terms of the precursor nutrients that help with the body's serotonin levels. One supplement is tryptophan, which you can't get anymore. So we use the 5-HTP to supplement serotonin. Usually we have people take 50 mg at bedtime. What happens is they sleep through the night. The majority of people who I have using it are fibromyalgia patients. We're finding that fibromyalgia patients have high cortisol, low DHEA, and low serotonin.

"We put them on a food supplement, plus 5-HTP. And it does remarkable things. Between the food supplement and the 5-HTP they're getting stage-4 deep sleep. The food supplement helps by improving mitochondrial function. And within six weeks, I'm getting a lot of fibromyalgia patients going into remission. The myriad of symptoms that go along with fibromyalgia are eliminated: such as, numbness, tingling sensations, and cognitive disorders. So using 5-HTP and the food supplement together has made a remarkable difference for my fibromyalgia patients. We've had about a 90% success rate."


Dr. Thomas Brod, M.D., a psychiatrist in Los Angeles, California and Assistant Clinical Professor of Psychiatry at UCLA, related that he hadn't found 5-HTP to work as well as other people had, but he did have one really successful case using it.

"I often recommend 5-HTP," he said, "to patients with mild depression, sleep problems, and patients with restlessness on antidepressants. Most of the time it hasn't been more than marginally helpful. However, for various reasons, including medical-legal considerations, I have been cautious and made a point of not being enthusiastic in these recommendations. Obviously, these patients do not get a strong placebo response - which I understand as a harnessing of the patient's inborn healing responses to and through their unconscious therapeutic alliance with the physician. Perhaps that is why my clinical experience doesn't dovetail with some of the reported benefits I've read about.

"The most successful use has been in a patient with obsessive-compulsive disorder, and some concurrent depression. She finds that 5-HTP augments her Prozac. The pressures of her obsessions and compulsions seem to diminish. In addition to Prozac, she also uses Xanax®; as you would expect, 5-HTP seems to act differently from either of them. This is the one patient who has come back really enthusiastically about it.

"Incidentally, I do strongly recommend Acetyl L-carnitine (ALC) for almost all of my seriously depressed patients, particularly if they have a severe major depressive episode. I'm drawing on the published literature demonstrating ALC's neuroprotective benefits, hoping to diminish the long-term memory effects, the flood of corticosteroids that accompany severe depressive episodes."


Dr. Arthur LaBruce, a physician in Charleston, South Carolina, shared with me that he hadn't been using 5-HTP for very long, but has been getting favorable results so far. He comments,
"I've been using 5-HTP for just a couple of things," he told me," some depression, but for insomnia mainly. I've got some people doing trials on it now. I think it has benefits and I plan to conduct some more trials. It hasn't been available very long and I haven't collected a lot of data yet, so it's too early for me to tell. But I've been taking notes on the people who have been taking it, and I haven't had any unfavorable reports back to me yet. It's just that I think it is non-toxic, and the results have been favorable so far."


Dr. Dale Guyer, M.D., a physician in Indianapolis, Indiana, recommends 5-HTP for his patients for assorted problems, stating,
"I've used 5-HTP for a variety of things. When it first became available we used it a lot in the place of tryptophan, which is a little more difficult to come by, at least until it became available at compounding pharmacies. I've used 5-HTP for sleep problems and a lot for depression. I've also used it a lot for fibromyalgia. I've had some select individuals for whom it's been helpful for weight loss, generally in a little bit higher doses. But I wouldn't say that's a real high percentage, maybe 20%. Chronic pain disorders sometimes are helped by 5-HTP.

"But very rarely in my practice do I use just one therapy. I usually combine things to get a synergistic effect. So it's a little bit difficult to tell you how much is related just to the 5-HTP. For example, on some of the sleep cases I've had really good luck in combining (through the compounding pharmacies) 5-HTP and tryptophan together. But by itself  5-HTP clearly works very well. It's not necessarily a panacea for everything, where it works 100% of the time. But what really does? But for the primary things I've mentioned 5-HTP usually is pretty consistent. I've had some really good results with it.

"With fibromyalgia I've had really good luck with somewhat higher doses - higher to me means like 100 to 200 mg per day. This is an estimate on my part, but I think 65% of people often will tell me that a lot of their pain improves very dramatically. If I include a percentage of all people who improve even subtly, the percentage would be even higher. But that's what I would consider in the range of good improvement. For appetite control - 5-HTP seems to get a lot of press for this - I've not really noticed it to be as helpful. But I would say in total I've only had a dozen patients who have selectively tried 5-HTP by itself for appetite control, and for them maybe it works for 20% of the time. Then with sleep it is a lot more consistent. I'd say at least 80% do pretty well by improving their sleep."


Concluding my interviews, Dr. Randy Baker, M.D., a physician in Soquel, California, also recommends 5-HTP for various disorders. He thinks it is helpful for some but it's not a panacea. He concludes,
"I use 5-HTP primarily for treating insomnia and depression. I have occasionally recommended it for weight loss as well. Estimating my success rate is really difficult to assess with any certitude, since I don't keep statistics. What I can say is, it definitely works for a significant portion of patients. I can also say there's a very significant portion for which I'm not impressed. But it's something I'm very comfortable recommending trying for patients with both insomnia and depression.

"With regard to my success rate, I'd say that 55% would be my guess. It's not as good as the statistics that I see in the research studies. So it's a bit disappointing sometimes. People with mild insomnia often have good results with it, but I've had some patients with insomnia where it doesn't seem to really have a huge impact. And the same thing with depression. For people with mild depression it's often very helpful, but I've had quite a few patients with depression where it didn't seem to have a large impact. I still feel it's very worth trying, but nothing in medicine is a sure thing. I don't know of any medicine, any herb, any supplement that works on everyone. It works well enough for me to recommend it fairly often, and I have a significant number of people who are helped by 5-HTP. But it's not a panacea."


ART AND INTELLIGENT EXPERIMENTATION
While interviewing all these health practitioners, I wondered why different people have varying responses to 5-HTP, including myself. Why have I had such dramatic improvement with my sleep and moods and others have experienced only mild or moderate success. It seems plausible an individual's difficulty may not be limited to serotonin deficiency or to serotonin deficiency alone. They may have other undetected medical problems requiring other not-yet implemented solutions; or they may have undiscerned causes of the presenting problem, explaining why many clinicians use multiple modalities or substances to treat a problem. Also, everybody's body chemistry varies to some extent and that could contribute to different results among different people. Additionally, some clinicians did not seem to have enough of a patient-selection sample to make confident conclusions about 5-HTP's effectiveness. However dramatically or mildly effective 5-HTP was - whether used for sleep disorder, depression, anxiety, weight management, migraines, or fibromyalgia - the doctors all had at least one thing in common: they felt 5-HTP was safe so there was no harm in giving it a try.

After interviewing all of these health practitioners I saw another commonality, a message that they were indirectly giving to me: There is no one single antidote to any particular health problem, and without experimentation, no known antidote for any particular individual. And so achieving new or better health does not end with simply the beneficial findings of a scientific study. But the real discoveries begin where the scientific research leaves off. Health restoration additionally is an art and requires implementation of intelligent experimentation, sometimes requiring the guidance of one's nutritionally-educated health care practitioner.

However, not all physicians are familiar with the relevant research available on 5-HTP. Dr. Gail Valentine and Will Block were the first to write about the major research that has been done with 5-HTP and recommend guidelines for using it to treat the various ailments discussed in this article. The best source for finding out more about 5-HTP is in their book, The 5-HTP Archives.

References

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  2. De Beneditts G, Massei R. 5-HT precursors in migraine prophylaxis:A double-blind crossover study with L-5-hydroxy-tryptophan versus placebo. Clin J Pain 1986;3:123-129.
  3. Jacobsen FM, Sack DA, Wehr TA, Rogers S, Rosenthal NE. Neuroendocrine response to 5-hydroxytryptophan in seasonal affective disorder. Arch Gen Psychiatry 1987;44:1086-1091.
  4. Kahn RS, Westenberg HGM. L-5-Hydroxytryptophan in the treatment of anxiety disorders. J Affect Disord 1985;8:197-200.
  5. Poldinger W, Calanchini B, Schwartz W. A functional-dimensional approach to depression: serotonin deficiency as a target syndrome in a comparison of 5-hydroxytryptophan and fluvoxamine. Psychopathology 1991;24:53-81.
  6. Richter-Levin G, Segal M. Serotonin, aging, and cognitive functions of the hippocampus. Rev Neurosciences 1996;7:103-113.
  7. Sayegh R, Schiff I, Wurtman J, Spiers P, McDermott J, Wurtman R. The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstet Gynecol 1995;86:520-528.
  8. Soulairac A, Lambinet H. Action du 5-hydroxytryptophane, precursor de la serotonine, sur les troubles du sommeil. Ann Med-Psychol. 1977;135:792-798.

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