Serotonin Can Calm Our Nerves in Troubled Times5-HTP Inhibits Panic Attacks
Natural serotonin precursor helps alleviate other forms of anxiety as well
By Dr. Edward R. Rosick
e live in a world that to our great-grandparents would surely seem almost magical. We are able to cross the great expanses of the oceans in ships that would hold a hundred Mayflowers; we have mastered the skies, and our spacecraft traverse the heavens and send us pictures of strange worlds millions of miles away; here on earth, vaccines protect us from diseases that only a century ago took countless lives, young and old alike; and now we can even manipulate our own genes in the never-ending quest to improve our lot. By many measures, we are living in a near-utopia.
Yet despite our technological prowess, the world is still a dangerous place that can provoke anxiety, and even full-blown panic, in many people. While many of the deadly infectious diseases of yesteryear (smallpox and polio, e.g.) are but distant memories, new infections, such as mad cow disease and SARS, are shouted from the headlines. Instead of worrying about where our next meal will come from, we worry about the potentially fatal consequences of obesity. Even with all our material wealth, it seems that we just can’t stop worrying about something.
Panic Disorder Affects Millions
Now, being stressed about certain things in life is entirely reasonable, and it helps keep us on our toes. For some people, however (many, actually), every day is clouded by the specter of an attack of unprovoked anxiety, or even panic. Panic disorder is a specific psychiatric condition that affects at least 3 million American adults—more than the number of people who are afflicted annually by stroke, epilepsy, or AIDS.
Panic disorder is a chronic, relapsing condition that can have devastating effects on one’s job, personal relationships, and family life. Since the symptoms are often believed to be “all in your head” or a byproduct of some other medical condition, panic disorder is often overlooked or misdiagnosed. Yet for people who suffer from it, its symptoms and effects on their lives are all too real.*
There Are Physical Symptoms Too
The hallmark symptom of panic disorder is panic attacks—acute surges of fear or almost paralyzing terror that occur spontaneously, often with no apparent trigger. Along with the emotional distress, panic attacks have true physical symptoms, such as:
- Racing or pounding heartbeat
- Chest pains
- Difficulty breathing
- Chills or hot flashes
- Tingling in fingers or toes
On top of all that, patients who present with panic attacks almost always state that they feel like they’re losing their mind. Obviously, this disorder can be devastating, especially when the attacks occur again and again without warning.
What Causes Panic Attacks?
In a perfect world, the causes of debilitating conditions, such as panic attacks, would be known, and appropriate treatments could be offered. Unfortunately, in our imperfect, anxiety-producing twenty-first century, the causes and cures of many diseases are still beyond our reach. However, medical scientists are making great strides in understanding the complex and mysterious workings of the body and mind, including new insights into the origins of panic attacks.
One line of current thought is that people who are prone to panic attacks are hypersensitive to small changes in their bodies’ biochemical milieu. An example of this is the way in which people respond to carbon dioxide (CO2) in their environment. Everyone’s brain monitors CO2 levels (subconsciously) to detect levels that are high enough to indicate the potential for suffocation.* Researchers have shown that in normal people, there must be a sizeable change in CO2 levels to set off this suffocation response; in people with panic disorder, however, even an insignificant rise in CO2 levels can trigger a full-blown panic attack.
Reduced Serotonin Activity May Be to Blame
Another line of thought has to do with serotonin, a vital neurotransmitter that is involved in a wide variety of behaviors, including aggression, sleep, depression, anxiety, and panic. Serotonin, also known as 5-hydroxytryptamine (5-HT), is produced in the brain from the amino acid 5-hydroxytryptophan, or 5-HTP (which is produced from the amino acid tryptophan). The amount of serotonin in the brain depends strongly on the levels and dietary intake of tryptophan and 5-HTP.
In patients with clinical depression
and anxiety, 5-HTP reduced
symptoms equivalently to Prozac,
but with fewer side effects.
In people who suffer from depression, anxiety, or panic attacks, it’s hypothesized that there is reduced serotonin activity in the brain’s neural synapses (where most serotonin is found). In fact, one way in which most physicians treat panic attacks is with a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft. These drugs increase the levels of serotonin in the synapses and have been shown to be beneficial for a variety of psychiatric problems, including obsessive-compulsive disorder, depression, and panic disorder.
5-HTP Increases Serotonin Levels
Although SSRIs can increase serotonin activity and mitigate the symptoms of anxiety and panic, they’re not without some significant drawbacks. SSRIs are available only by prescription, they are quite expensive, and they can have undesirable side effects, such as nausea, headaches, and interference with sexual function. And although they have been shown to decrease panic attacks over the long term, they can take anywhere from 3 to 6 weeks to be effective, and for the first couple of weeks, they can actually increase anxiety and panic.
A safer and less costly way to increase serotonin levels is to supplement with serotonin precursors—and the immediate precursor in the body’s synthesis of serotonin is 5-HTP. It is well absorbed orally, with 70% of the ingested amount ending up in the bloodstream, and it easily crosses the blood-brain barrier. Thus it can effectively increase the amount of serotonin produced in the brain.
5-HTP Can Alleviate Depression and Anxiety
With that fact in mind, researchers have sought to alleviate depression and anxiety with this safe and natural dietary supplement. Early studies in Europe in the 1980s showed that 5-HTP supplementation brought about a 50–60% improvement in depressed patients, with no significant side effects.
A more recent study done in Switzerland compared 5-HTP with Prozac in 60 patients with clinical depression and anxiety. In this double-blind, placebo-controlled, multicenter, 6-week trial, the patients taking 5-HTP experienced a significant reduction in their symptoms that was equal to that seen in the patients taking Prozac. The patients taking 5-HTP, however, reported significantly fewer side effects than those on Prozac.
Tryptophan Alleviates Panic Attacks . . .
Besides being a safe and effective alternative to prescription drugs when it comes to treating depression and anxiety, studies have shown that 5-HTP (and its precursor, tryptophan) can also help ward off panic attacks. In a simple yet elegant double-blind study, researchers gave 20 patients with panic disorder and 19 normal control subjects a drink containing amino acids (including tryptophan) or a tryptophan-free drink that caused an 80% decrease in plasma tryptophan levels. Four hours later, both the patients and the controls were given a CO2 “challenge” when they breathed normal air that was infused with 5% CO2.
“Panic anxiety and symptoms, as
well as the number of panic attacks
following CO2 inhalation, were
significantly reduced by 5-HTP in
panic disorder patients.”
In the patients with panic disorder, the CO2 challenge induced panic attacks, while in the controls there was no evidence of panic. Furthermore, those patients who had consumed the tryptophan-free drink had even more intense panic attacks than those who had consumed the tryptophan-containing drink. The researchers concluded, “Serotonin may directly modulate anxiety in patients with panic disorder. This may underlie the efficacy of serotonergic antidepressants in treating panic disorder.” (The term serotonergic means serotonin-related, so this would include tryptophan, which is converted to 5-HTP, which is converted to serotonin.)
And 5-HTP Alleviates Panic Attacks
A more recent study described how 5-HTP supplementation alleviated panic symptoms in patients with panic disorder. This randomized, placebo-controlled, double-blind study examined 24 patients with panic disorder (13 men and 11 women, average age 40) and 24 normal controls. The patients were given either a 200-mg capsule of 5-HTP or placebo; 90 minutes later, they were subjected to a 35% CO2 challenge. Immediately before and after the challenge, the patients’ levels of anxiety and panic symptoms were measured, using standardized tests.
The results showed a clear benefit from using 5-HTP. In the authors’ words, “Panic anxiety and symptoms, as well as the number of panic attacks following CO2 inhalation, were significantly reduced by 5-HTP in panic disorder patients. No such effect was observed in healthy volunteers.” It is noteworthy that 5-HTP exerted its calming effects in a span of less than 2 hours, in contrast to the 3 to 6 weeks that it takes for prescription drugs such as Prozac to alleviate panic attacks.
5-HTP—The Natural Answer to Anxiety and Panic
Unless you live in a cave somewhere, it’s impossible to avoid hearing and worrying about the latest warnings of terrorism (being plotted by men who do live in caves), predictions about disastrous global warming, or frightening reports about a possible new infectious disease epidemic. With so much to be anxious about these days, it’s reassuring to know that one need not turn to expensive prescription drugs for relief, since the natural supplement 5-HTP can provide it.
- Panic disorder treatment and referral. National Institute of Mental Health, 1994. Publ. No. 94-3642. www.nimh.nih.gov/anxiety/pdtr.cfm.
- Katzman MA et al. Central and peripheral chemoreflexes in panic disorder. Psychiatry Res 2002;113:181-92.
- Bourin M, Baker GB, Bradwejn J. Neurobiology of panic disorder. J Psychosom Res 1998;44(1):163-80.
- Birdsall TC. 5-Hydroxytryptophan: a clinically effective serotonin precursor. Alt Med Rev 1998;3(4):271-80.
- Meyers S. Use of neurotransmitter precursors for treatment of depression. Alt Med Rev 2000;5(1):64-71.
- Miller HEJ, Deakin JFW, Anderson IM. Effect of acute tryptophan depletion on CO2-induced anxiety in patients with panic disorder and normal volunteers. Brit J Psychiatry 2000;176:182-8.
- Schruers K, van Diest R, Overbeek T, Griez E. Acute L-5-hydroxytryptophan administration inhibits carbon dioxide-induced panic in panic disorder patients. Psychiatry Res 2002;113:237-43.
5-HTP Eases the Pain of Fibromyalgia
Chronic fatigue syndrome and fibromyalgia—these two relatively common, debilitating syndromes share similar symptoms, such as muscle pain, insomnia, and depression. Other unfortunate commonalities include disdain and suspicion from many members of the mainstream medical community, along with no accepted or generally efficacious treatment.
At least for fibromyalgia, however, there is preliminary evidence showing that 5-HTP may be helpful in decreasing some of the most common complaints in this mystifying condition. In a double-blind, placebo-controlled study, researchers gave 100 mg of 5-HTP to 50 fibromyalgia patients over a 30-day period. At the end of the study, the patients reported a significant decrease in tender points, pain, insomnia, and anxiety. A more recent study examined 5-HTP supplementation in patients with fibromyalgia over a 90-day period, and again, patients reported significant relief in their anxiety levels, pain intensity, and fatigue.
With some studies showing fibromyalgia patients having lowered levels of serotonin metabolites (byproducts of serotonin metabolism), it should come as no surprise that 5-HTP has been shown to be beneficial in this painful, depressing condition. While further studies are needed, it’s good to know that a safe, natural supplement such as 5-HTP may bring welcome relief from the pain of fibromyalgia.
- Juhl JH. Fibromyalgia and the serotonin pathway. Alt Med Rev 1998;3(5):367-75.
Dr. Rosick is an attending physician and clinical assistant professor of medicine at Pennsylvania State University, where he specializes in preventive and alternative medicine. He also holds a master’s degree in healthcare administration.