Hey Mark,

It's interesting that your new doc doesn't like Paxil for TBI patients. A study released in 2008 by Toronto's Sunnybrook Hospital showed that, for brain injury patients, SSRIs were largely ineffective and sometimes even counterproductive. This was a big study and one of the few not funded by the drug companies themselves.
http://www.sunnybrook.ca/media/item....i=258&page=524

Hockey

I haven't read the report yet, so if this doesn't make sense sorry. Can you direct me to or give me a thought of something other than paxil, that would be a lot like it that might be better. I have someone in mind that had a pretty severe TBI, that its just now being realized that it was never considered one. And paxil is one of the few meds she can take.

She has a problem with being able to take few things. SO this can be quite a problem.

Donna

Kate

First, you are not allowed to say that you are stupid. You were just not considering how it might be if you waited a little longer. Also consider how you eat too. If you take the medication with a full meal it might last longer.
Not sure on this one. this is something I'm learning a lot about right now.

Next you might come up with a small routine for yourself that you follow daily.
Like a few exercises that you do. Then you also might say, do some mediatation about 30 minutes before the kids are supposed to come home.
I used to try and take a little nap just about 30 minutes before my son came home. It seemed to help me, that or I'd nap the first 30 minutes he was
home. Which he was fine with, he liked to play with the dogs so he would
take them and do that then tell me about his day.

Donna

I already knew that Paxil was dangerous. But, for me, I needed the effect it had on repetitive thoughts that overwhelm my mind.

My brain will get stuck repeating the most mundane things, like a license plate number, a stanza from a song, the spelling of a word. The repetition can last for hours or even days. I may be able to stop it momentarily but it will return. It is an exhausting symptom.

The Paxil works at the 60 mg per day dose but it can be brutal with side effects.

An alternative is L-Tryptophan and other precursors to whatever neurotransmitter is out of whack.

There are other SSRI's and SNRI's that can be helpful but I have never found a physician who will work with me to find a better solution. Back when I went on Paxil, my psych wanted to use L-Tryptophan but it had been blocked by the FDA because of a bad batch that caused some deaths.

It is back on the market now, but I want a physician to help me. The withdrawal from Paxil can be very dangerous. It should never be done without the support and supervision of a knowledgeable psychiatrist.

You guys should be careful with L-Tryptophan. The FDA is still not convinced that it is a safe product and as a result, it is still banned by them even though it has crept back into the market. However, despite the FDA's stance on tryptophan, I have read that it is completely safe to use. The story on Tryptophan is that a series of strange incidents happened in 1999, (by the only reliable accounts, a muscle-paralyzing disease that was caused by an impurity in one manufacturers tryptophan when they changed their manufacturing process.) initiating a chain of events that ended up in an FDA action causing tryptophan from being withdrawn from the market in the US. Other reports, although unverified, have said that it also caused liver failure in these patients.

There are two good alternatives to tryptophan that are just as effective and aren't banned by the FDA. These are 5-HTP and SAMe.

Here is a monograph on tryptophan:
http://en.wikipedia.org/wiki/Tryptophan

The general feeling is that much of the hoohaa was due to pressure from Eli Lilly to remove it, as it was a competitor for the newly introduced Prozac. As the article states, tryptophan was never completely removed from sale...only as a stand alone product. It was safe enough for baby formula back then!

I find tryptophan gentle and easy to tolerate. 5-HTP can cause alot of side effects, IMO. I had extreme edginess, and irritability from 100mg a day of 5-HTP.
Tryptophan for me only causes sleepiness in the beginning, hence I take it at bedtime. (there is less competition at the transporter at this time too).

Some doctors use l-tryptophan now, to ease the symptoms of SSRI withdrawal syndrome, when people discontinue drugs like Paxil and its cousins. SSRI's actually lower serotonin synthesis, because the brain cells do not need to manufacture it as much since it is not being cycled, and it remains in the synapse. In fact serotonin byproducts decrease in the CSF during treatment with SSRIs. Tryptophan may be introduced when the levels of SSRI drug are withdrawn, and may help prevent some of the unpleasant patient reported effects of the discontinuance. This should be monitored by the doctor, of course.

I don't think jumping in with high doses is necessary. I am still at 500mg a day, which is really quite low. That is in the range of food sources. Taking tryptophan in the gram ranges, is another issue IMO. It is also expensive at those doses. I always recommend slowly introducing amino acids, since people vary considerably in response to them. (their own genetic situation concerning amino acid ratios can vary tremendously from person to person).

5-HTP is NOT a safe alternative to L-Tryptophan. L-Tryptophan metabolizes into 5-HTP but not without the brain's regulatory system controlling it.

5-HTP bypasses this regulatory system. 5-HTP can easily be overdosed and result in serotonin syndrome.

SAMe may be used by some for depression but it does not effect neurotransmitters like L-Tryptophan.

SAMe also needs to be only be taken with the appropriate Vit B and other supplements. Otherwise, it can cause a dangerous increase in homo-cysteine levels.

The L-Tryptophan controversy has long ago been resolved. It was an isolated incident due to manufacturing contamination.

As you can see, I am choosing to use a physician's assistance before attempting to fiddle with my brain's neurotransmitters.

I suggest others do the same.

I was under the impression that it was banned. It's good to know that it isn't. [

QUOTE=mrsD;568201]Here is a monograph on tryptophan:
http://en.wikipedia.org/wiki/Tryptophan

The general feeling is that much of the hoohaa was due to pressure from Eli Lilly to remove it, as it was a competitor for the newly introduced Prozac. As the article states, tryptophan was never completely removed from sale...only as a stand alone product. It was safe enough for baby formula back then!

I find tryptophan gentle and easy to tolerate. 5-HTP can cause alot of side effects, IMO. I had extreme edginess, and irritability from 100mg a day of 5-HTP.
Tryptophan for me only causes sleepiness in the beginning, hence I take it at bedtime. (there is less competition at the transporter at this time too).

Some doctors use l-tryptophan now, to ease the symptoms of SSRI withdrawal syndrome, when people discontinue drugs like Paxil and its cousins. SSRI's actually lower serotonin synthesis, because the brain cells do not need to manufacture it as much since it is not being cycled, and it remains in the synapse. In fact serotonin byproducts decrease in the CSF during treatment with SSRIs. Tryptophan may be introduced when the levels of SSRI drug are withdrawn, and may help prevent some of the unpleasant patient reported effects of the discontinuance. This should be monitored by the doctor, of course.

I don't think jumping in with high doses is necessary. I am still at 500mg a day, which is really quite low. That is in the range of food sources. Taking tryptophan in the gram ranges, is another issue IMO. It is also expensive at those doses. I always recommend slowly introducing amino acids, since people vary considerably in response to them. (their own genetic situation concerning amino acid ratios can vary tremendously from person to person).[/QUOTE]

SAMe is only a methyl donor. It cannot make any neurotransmitters without the substrate being available to attach the methyl groups to.

Tryptophan requires B6 to be converted to serotonin.
And serotonin requires methylcobalamin (methyl B12) to convert to melatonin.

Tryptophan does not easily cross the BBB, but 5-HTP does.
Other amino acids compete for the transporter across the BBB.
Taking tryptophan spaced away from other protein foods, will allow it to cross the BBB more easily. High insulin levels facilitate this too.
That is why 5-HTP may cause more side effects, as it crosses easily.

Mark,

There have been no published reports of 5 HTP ever causing serotonin syndrome when taken alone. If you have one, please post on here to substantiate your statement. Yes, if you were to take mass quantities of it over a prolonged period of time, it probably would cause this to happen; however, taking mass quantities of anything for a prolonged period of time can cause adverse side effects. You really only run the risk of developing seretonin syndrome if you mix MAO inhibitors, SSRIs, or tricyclic antidepressants with themselves or with 5-HTP or Tryptophan. You can also develop serotonin syndrome by taking mass quantities of tryptophan. *edit*

SAMe, at recommended doses, is very safe to take. It also has been shown to affect serotonin. Therefore, it can be considered a safe alternative to taking tryptophan.

And, of course, everyone should seek medical advice before taking any drug/supplement that is posted on here. I guess that was always assumed when I posted.