Supplements as alternatives to benzodiazepines

Here’s an update on this topic:

In her 2007 book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition, Dr. Hyla Cass has an interesting section (pp. 139-140) dealing with supplement alternatives to benzodiazepines and other drugs such as Ambien. (These drugs are generally prescribed as anti-anxiety agents and as sleep aids.)

Dr. Cass is a practicing physician and an expert on integrative (“holistic”) health, and one of her main concerns is to present ways to counter prescription medication side effects, or to identify supplement alternatives to prescription drugs.

Of benzodiazepines (the best-known tradenames in this category are Valium, Xanax, Ativan, Klonopin, Librium, Halcion), Dr. Cass writes that a principal problem is that these drugs develop dependence, and so can require steadily increasing dosages as time goes on. (Ideally, she says, they are intended as short-term therapies, but in fact many patients end up being prescribed them for a much longer time.) Withdrawal from these drugs can be quite hazardous, and should be done only under medical surpervision. Moreover, the effect of this class of medications is often a dulling of response, so their use can be associated with accidents.

Since benzodiazepines deplete needed nutrients, Dr. Cass advises supplementing as follows if you take them:

1000-1200mg Calcium/day, plus 400-600mg/Magnesium
400-800mg Folic acid/day
1000 IU Vitamin D/day
30-100mcg Vitamin K/day

She also states that in her own practice she has often successfully substituted supplements for these prescription drugs. Among the calming supplements that she has used:

5-HTP: 100-200mg at bedtime
Melatonin: 0.5-3.0mg at bedtime
L-theanine: 200mg, one to three times daily, as needed

In Dr. Cass’s view, supplements such as these, sometimes used in combinations, can provide a good alternative to the addictive benzodiazepines and their side effects (which, she says, are also characteristic of the newer drug Ambien).

—–

See the following NYBC entries for additional information on the supplements mentioned above:

Melatonin 1mg and Melatonin 3mg

Theanine Serene (includes L-theanine)

NYBC also stocks 5-HTP and the closely related Tryptophan.

Also note that the Jarrow supplement Bone Up very closely matches the set of supplements recommended by Dr. Cass to offset the nutrients depleted by taking benzodiazepines (Calcium, Magnesium, Folic acid, Vitamin D, Vitamin K).

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Supplements for anxiety

A while back, we posted a review of holistic M.D. Hyla Cass’ recommendations for avoiding the dependence-inducing benzodiazepines for anxiety. Her prescription was to use supplements instead, and she had some specific recommendations:

In her 2007 book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition, Dr. Hyla Cass has an interesting section (pp. 139-140) dealing with supplement alternatives to benzodiazepines and other drugs such as Ambien. (These drugs are generally prescribed as anti-anxiety agents and as sleep aids.)

Of benzodiazepines (the best-known tradenames in this category are Valium, Xanax, Ativan, Klonopin, Librium, Halcion), Dr. Cass writes that a principal problem is that these drugs develop dependence, and so can require steadily increasing dosages as time goes on. (Ideally, she says, they are intended as short-term therapies, but in fact many patients end up being prescribed them for a much longer time.) Withdrawal from these drugs can be quite hazardous, and should be done only under medical surpervision. Moreover, the effect of this class of medications is often a dulling of response, so their use can be associated with accidents.
[…]
She states that in her own practice she has often successfully substituted supplements for these prescription drugs. Among the calming supplements that she has used:

5-HTP: 100-200mg at bedtime
Melatonin: 0.5-3.0mg at bedtime
L-theanine: 200mg, one to three times daily, as needed

In Dr. Cass’s view, supplements such as these, sometimes used in combinations, can provide a good alternative to the addictive benzodiazepines and their side effects.

—–

See the following NYBC entries for additional information on the supplements mentioned above:

Melatonin 1mg and Melatonin 3mg

Theanine Serene (includes L-theanine)

NYBC also stocks 5-HTP and the closely related Tryptophan.

If you do decide to take one of the prescription benzodiazepines, Dr. Cass further notes, it is advisable to supplement to offset the key nutrients that these drugs tend to deplete in the body. We note that the Jarrow supplement Bone Up very closely matches the set of depleted supplements listed by Dr. Cass (Calcium, Magnesium, Folic acid, Vitamin D, Vitamin K).

One last note: rather small doses of melatonin may do the trick in terms of helping you to sleep. A 1mg dose may be all that’s necessary.

Drugs versus supplements as sleep aids

One of the reasons people turn to supplements is that drugs often have side-effects which make their use, especially over the long term, more damaging than helpful. That may be the case with long-term use of some common over-the-counter drugs to aid sleep.

A 2010 study published in the journal Neurology, for example, looked at drugs called anticholinergics, which block acetylcholine, a nervous system neurotransmitter. They include such common over-the-counter brands as Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom. They are taken for a variety of common medical conditions including insomnia or allergies. Unfortunately, according to this Indiana University study, over the long term these drugs also produce cognitive impairment. According to the study authors, taking “one anticholinergic significantly increased an individual’s risk of developing mild cognitive impairment and taking two of these drugs doubled this risk.”

Given these risks, it makes sense to consider such alternatives as Melatonin or 5-HTP. While these supplements, like many others, should be taken carefully and according to recommendations, we don’t know of any research suggesting that they produce cognitive impairment over the long run!

GABA Hey! Blood Pressure and Sleep

NYBC carries Pressure Optimizer and GABA Soothe to help manage a range of issues. Among them, the data below suggest a benefit for managing borderline hypertension (high blood pressure). A related item in the NYBC catalog, Theanine Serene, also has a fair amount of GABA along with green tea-extract theanine; this combination was designed especially as an anti-anxiety or anti-stress formula.

The second study below looked at a combo of GABA and 5-HTP and found some benefits for helping to get a restful sleep.

Shimada M, Hasegawa T, Nishimura C, Kan H, Kanno T, Nakamura T, Matsubayashi T. Anti-hypertensive effect of gamma-aminobutyric acid (GABA)-rich Chlorella on high-normal blood pressure and borderline hypertension in placebo-controlled double blind study. Clin Exp Hypertens. 2009 Jun;31(4):342-354.

Abstract
The anti-hypertensive effect of GABA-rich Chlorella was studied after oral administration for 12 weeks in the subjects with high-normal blood pressure and borderline hypertension in the placebo-controlled, double-blind manner in order to investigate if GABA-rich Chlorella, a dietary supplement, is useful in control of blood pressure. Eighty subjects with Systolic blood pressure (SBP) 130-159 mmHg or diastolic blood pressure (DBP) 85-99 mmHg (40 subjects/group) took the blinded substance of GABA-rich Chlorella (20 mg as gamma-aminobutyric acid) or placebo twice daily for 12 weeks, and had follow-up observation for an additional 4 weeks. Systolic blood pressure in the subjects given GABA-rich Chlorella significantly decreased compared with placebo (p < 0.01). Diastolic blood pressure had the tendency to decrease after intake of GABA-rich Chlorella. Neither adverse events nor abnormal laboratory findings were reported throughout the study period. Reduction of SBP in the subjects with borderline hypertension was higher than those in the subjects with high-normal blood pressure. These results suggest that GABA-rich Chlorella significantly decreased high-normal blood pressure and borderline hypertension, and is a beneficial dietary supplement for prevention of the development of hypertension.

PMID: 19811362 [PubMed – indexed for MEDLINE]

***
Shell W, Bullias D, Charuvastra E, May LA, Silver DS. A randomized, placebo-controlled trial of an amino acid preparation on timing and quality of sleep. Am J Ther. 2010 Mar-Apr;17(2):133-139.

Abstract
This study was an outpatient, randomized, double-blind, placebo-controlled trial of a combination amino acid formula (Gabadone) in patients with sleep disorders. Eighteen patients with sleep disorders were randomized to either placebo or active treatment group. Sleep latency and duration of sleep were measured by daily questionnaires. Sleep quality was measured using a visual analog scale. Autonomic nervous system function was measured by heart rate variability analysis using 24-hour electrocardiographic recordings. In the active group, the baseline time to fall asleep was 32.3 minutes, which was reduced to 19.1 after Gabadone administration (P = 0.01, n = 9). In the placebo group, the baseline latency time was 34.8 minutes compared with 33.1 minutes after placebo (P = nonsignificant, n = 9). The difference was statistically significant (P = 0.02). In the active group, the baseline duration of sleep was 5.0 hours (mean), whereas after Gabadone, the duration of sleep increased to 6.83 (P = 0.01, n = 9). In the placebo group, the baseline sleep duration was 7.17 +/- 7.6 compared with 7.11 +/- 3.67 after placebo (P = nonsignificant, n = 9). The difference between the active and placebo groups was significant (P = 0.01). Ease of falling asleep, awakenings, and am grogginess improved. Objective measurement of parasympathetic function as measured by 24-hour heart rate variability improved in the active group compared with placebo. An amino acid preparation containing both GABA and 5-hydroxytryptophan reduced time to fall asleep, decreased sleep latency, increased the duration of sleep, and improved quality of sleep.

PMID: 19417589 [PubMed – indexed for MEDLINE]

Supplements for Depression: Updated Info Sheet from NYBC

We’ve updated our info sheet on Supplements for Depression, reflecting some additional supporting evidence that has accumulated for these applications, plus new references. See www.newyorkbuyersclub.org for detailed product information.

In recent years there’s been a lot of well-designed scientific research about the effectiveness of dietary supplements for depression. The supplements studied have ranged from the herb St. John’s Wort, which has a long tradition of use, to molecules like SAMe, L-Tryptophan, and 5-HTP, which play a role in the body’s production of neurotransmitters (such as serotonin) connected with mood and cognitive function. Other developments in depression research involve the steroid DHEA and fish oil.

DHEA (Dehydroepiandrosterone). In a study sponsored by the National Institute of Mental Health, DHEA was found to be an effective therapy for mild to moderate or severe midlife depression, on a par with some prescription drug treatments. Moreover, the NIMH research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. (On the other hand, inhibition of sexual function remains one of the chief troublesome side effects of prescription anti-depressants). Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate problems or cancer.

SAMe (S-adenosyl-l-methionine). First studied by Italian researchers in the 1950s, SAMe is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and L-dopamine, which are related to mood. Several studies show SAMe having an anti-depressant effect comparable to that of some prescription drugs. A dose of 400-800mg/day has been studied for mild to moderate depression, and 800-1600mg/day for the moderate to severe condition. As of 2007, SAMe was being compared with the prescription drug Lexapro® in a 5-year NIH-funded study. SAMe generally has fewer side effects than prescription anti-depressants. However, it should be avoided in people with bipolar disorder, and should be used cautiously with other anti-depressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build up of homocysteine, which is associated with heart disease. (It’s best to take them separately.) SAMe also supports joint health and liver function, so may have positive effects for overall health if taken over the long term.

St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it my affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections.

L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan): These closely-related supplements are converted in the body to serotonin and to melatonin. (Specifically, L-Tryptophan converts to 5-HTP, which then converts to serotonin or melatonin.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, try taking the supplement an hour before bedtime.) Mild gastrointestinal side effects have been reported with both. For best absorption, take with water or juice, and separately from protein-containing foods and dietary supplements. Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them. Thus, if encountering unwanted side effects or lack of effect from one, it may still be worthwhile to try the other.
The suggested dosage for 5-HTP is wide, ranging from 50 and 500 mg daily. It can be used together with other anti-depressants, in which case an effective dose could be quite low. The best approach is to start at the low end of the range and increase as needed. Like 5-HTP, L-Tryptophan has been used in combination with other anti-depressants, and has also been employed with lithium for bipolar disorder. An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.

Fish Oil. Epidemiological studies have suggested that populations that eat fish regularly have low rates of depression. More recently, research has found fish oil supplements (omega-3 fatty acids being the significant component) of benefit in treating depression and bipolar disorder. It’s also worth noting that fish oil can be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: as has been widely reported, fish oil can have a beneficial impact on cholesterol regulation and in supporting cardiovascular health.

References:
Christian R. Dolder, “Depression,” in Natural Products: A Case-Based Approach for Health Care Professionals, ed. Karen Shapiro, published by the American Pharmacists Association, Washington, DC (2006), pp. 97-114.
Shaheen E Lakhan and Karen F Vieira. “Nutritional therapies for mental disorders” in Nutrition Journal (2008), 7:2doi:10.1186/1475-2891-7-2. Accessed 10/7/2009 at http://www.nutritionj.com/content/7/1/2
Schmidt PJ, et al. “Dehydroepiandrosterone Monotherapy in Midlife-Onset Major and Minor Depression,” Archives of General Psychiatry (February 2005): Vol. 62, No. 2, pp. 154–62.
Hyla Cass, “Prescriptions for Depression,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. Basic Health Publications (2007), pp. 113-128.

Nutritional supplements for depression: recommendations from an expert on integrative/holistic health

NYBC has been following recent developments in the use of dietary supplements for depression for quite some time now, and we’d like to recommend a recent guide to this topic by Hyla Cass, which appears in her book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition.

Dr. Cass, a practicing physician and an expert on integrative (“holistic”) health, devotes a chapter of her 2007 book to depression. The core elements of her recommendations are the B vitamins, Folate, Omega-3 fatty acids, Calcium, and Vitamin D (especially in winter). She also discusses SAMe, a natural mood enhancer essential for the manufacture of neurotransmitters (like serotonin), and two botanicals that have a history of use as anti-depressants, St. Johns Wort and Rhodiola.

Dr. Cass’ account is particularly good at reviewing the role of neurotransmitters in depression, and explaining how supplements and nutrition have an impact on them. For example, tryptophan, eaten together with carbohydrates, will raise levels of serotonin, the neurotransmitter that makes you feel happy and calm and helps you sleep well. The amino acid 5-HTP, meanwhile, can also help the brain produce more serotonin, though unlike tryptophan it does not need the carbs for it to enter the brain.

Anti-depressant prescriptions, as Dr. Cass notes, are among the top sellers among US pharmaceuticals, with 60 million prescriptions written per year at a cost of $10 billion. And while “antidepressants may be enormously helpful, even life-saving for some people,” she continues, “they are often overprescribed, at too high a dose, over too long a time, and often before a good medical evaluation has been done.” (p. 117) Hence her timely guide to using supplements to help maintain the “nutritional balance necessary for good mental health,” or to create “neurotransmitter balance in depression.”

Reference: Hyla Cass, M.D. “Prescriptions for Psychological Health,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. (Basic Health Publications, 2007)

See also the NYBC entries on supplements mentioned above:

Tryptophan

SAMe

5-HTP

Rosavin (Rhodiola)

B Vitamin Complex (B-right)

Fish oil (omega-3 fatty acids)

HIV and Depression: the ACRIA study on HIV and aging, and some recommendations from NYBC

We’ve spoken recently about the study of HIV and aging produced by ACRIA, a non-profit, community-based AIDS medical research and treatment education organization.

A main finding of the 2006 study is the prevalence of depression among older adults with HIV. In its survey of about 1000 older HIV+ adults, ACRIA researchers found that they experienced depression at a rate almost 13 times as higher than the general population. And for people with HIV, the consequences of depression are associated with many physical issues, far beyond just “feeling down”:

“By suppressing the immune system, depression may render people more vulnerable to infectious diseases. Stress and depression have harmful effects on cellular immunity, including those aspects of the immune system affected by HIV. Body cell mass depletion is associated with significant increases in fatigue, global distress and depressive symptomatology, and reduced life satisfaction. Elevated symptoms of depression are associated with a faster progression to AIDS and a higher risk of mortality. Depressive symptoms, especially in the presence of severe stress, are related to decreases in CD4 cell count and declines in several lymphocytes.”

These study findings and other related research motivated NYBC to assemble up-to-date information on dietary supplements and depression. See, for an overview, this information sheet:

Printable version of the info sheet, including a chart for quick comparison of these supplements as used to address depression

More information on the individual supplements is also available on the NYBC website, at  www.newyorkbuyersclub.org, as well as on this Blog, under “Depression.”