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Q: I am wondering if the following supplements can trigger a manic
episode:
DL-Phenylalanine
L-Glutamine
5HTP
Thank you in advance for your guidance,
Dear Ms. K' --
5HTP, yes: as you know it's a precursor to serotonin production and can work
somewhat like the serotonin-reuptake-inhibitor antidepressants, increasing the
amount of serotonin your neurons see. Thus like any antidepressant, there is a
risk there, just reasoning from the chemistry of it. Searching "5-HTP mania" on
PUB MED did not turn up case reports, but the same search on Google yielded many
links which cite mania as a risk of 5-HTP, though none offered a reference link
(here's one of the better
examples).
Finally, because I can rarely hold back a comment in
cases like this, may I wonder why you would be looking at adding "supplements"
(an interesting term which I think might artificially lower the level of worry
which should accompany adding anything to what one is taking) rather than
approaches for which we have some evidence regarding benefit? Granted that many
"medications" have substantial risk, such as weight gain, but: a) at least we
have evidence that they work, better than a placebo (for those
medications for which we have placebo-controlled trials, e.g. as shown in this
table of
mood
stabilizers); and b) we often have a pretty good idea of just what the risks
are, and it seems that virtually all the medications do indeed carry some risk
of some sort of side effect at least, if not long-term risk.
I can understand the wish to avoid known side effects.
I can understand the wish to use something which appears to be simple. I can
understand the wish to use something more relatively "natural", compared to some
synthetic "chemical". Your question led to some surfing around sites offering
5-HTP, and I can see there how simple the whole process looks, compared to
trying to get an appointment with a doctor, and paying the co-pay and/or dealing
with your insurance, or maybe not having that option at all.
But I worry that these understandable wishes cloud
peoples' judgment about risk and benefit. My strong preference (sorry for the
knee jerking here; I know you weren't asking for this part), to put it mildly,
is to use agents for which we have some evidence of benefit, let alone risk.
Careful not to get lulled into thinking it's safe in any respect (and good on ya'
for considering effect on cycling) because it's a "supplement".
Dr. Phelps
Published September, 2003
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