neurotransmitter question

[dave42a]

Dear Dr. Junig:
I previously sent this directly to your email. I apologize for that. I had forgotten that you are on this forum and its more appropriate to address here. Although its not specifically related to addiciton, i do believe that many people suffering with addicition have comorbid  psych issues so perhaps it will be of general interest.  I was hoping that you would be so kind to comment on an article that I read written by a group or neurologists.   I know that your primary interests are in general psychiatry and addiction but I recall that you have a strong background in neurochemistry.

I have been on a program to try to eliminate chronic headaches. The program consists of various supplements (DHEA, 7-Keto, 5-HTP, pregnenolone, phosphatidylserine, saw palmetto,melatonin, testosterone gel and progesterone gel) along with some vitamins and fish oils.  The doses were based on blood levels of my hormones so it wasnt shooting blindly.  


The article that I am inquiring about stated that taking 5-HTP without taking tyrosine, dopa, and cysteine will lead to eventual depletion of dopamine and norepinephrine.  The article seems to make some sense to me with my limited medical knowledge------but could be a load of ****.  Have you heard anything along those lines.  

l
Thanks so much . I hope you will be able to comment when you get the opportunity.
    

[BOK2Bjan]

I've been researching this topic due to having low levels of serotonin.  Since it is also in the intestines, having an effect on motility, and platelets, effecting vessel contraction, as well as the bronchial tubes, (I have lung involvement with the Sys. Sclerosis) and on to the pinial gland, where some becomes melatonin, I'm trying to determine how my low levels may be effecting my body as a whole.  I have the two vaso-spastic disorders, Raynauds, and Erythromelalgia, as well as poor to no motility in my GI tract, and mood disorders, currently treated with SSRIs.  I've heard that SSRIs can over time, actually lower the amt. of serotonin available in the brain.  I also am low in vit D (very low), and am on 50K units/mo for that.  My question is, under these circumstances, do you feel some attempt to raise serotonin levels would be worth a try?  I've looked at the precursor, tryptophan, as well as 5HTP.  I have always been of the opinion that our bodies were made to turn almost any fuel its given into the basic nutrients it needs, and that most supplementation is a marketing ploy.  But by the same token, when you're suffering from diseases that are terminal and progressive, it's important to keep looking for help.  Plus, antibiotic use and toxins have also altered the equation.  I try to get my info from those not just selling a product, but rather researchers. (harder, but important)

So far, the only supplements I take are D and probiotics (due to my GI issues from Scleroderma)  And since I have MS, vit D is of interest.  I value your opinion on these issues and was glad to run across this thread.  Any further comment about the serotonin issue - from more than just the brain neurotransmitter role - would be appreciated.

Thanks, Jan

[dave42a]

I am the one who posted the message to Dr. junig. I think he is a very bright physician and also quite humble. I have had several extended communications with him via email.  However, by his own admission, he states that these are his opinions and recognizes that not everyone will agree and that doesnt make them wrong and him right nor vice versa.  

[codean]

I'd be interested to see the article - could you post a link? And if there is a more detailed response from Dr Tunig, it'd be good to see that too. There's certainly an awful lot of people on the substance abuse forum who are under the impression that taking these supplements is a very god idea during both wds and afterwards to help 'rebuild' the brain's balance after it has become depleted in various substances, Reading Dr Tunig's reply here, it seems that he is pretty clearly saying that this won't work, but on the other forum, it seems to be more or less accepted as truth.
So now I'm wondering whether this big pile of supplements I'm taking every day is at best pointless and at worst possibly even harmful...
I appreciate that a varied and balance diet can provide all that is required but I'm also aware that in the early stages of recovery, appetite is pretty poor and as such diet is poor, therefore it seemed to make sense to me that I wouldn't be getting these substances from food.

[J T Junig, MD PhD]

There was a time in my life when I would go to bed each night with all of those metabolic pathways in my head...  now I have to look things up!  I would be interested in seeing the article-- if you want to send it to my e-mail address go ahead, and I will give you my thoughts.  I actually already have an opinion that isn't real favorable-- but admittedly I haven't seen it, so I am basing my opinion on things that might not be entirely fair.

It is easy for a person with a medical degree to 'scam' patients;  medicine enjoys a certain amount of trust from the general population;  trust in the doctors, and trust in the bodies that regulate them.  Yet there have always been doctors who 'take advantage'...  they are easily recognizable by the medical community though, and so that tends to keep it to a minimum.  But when the desire for money overcomes the fear of embarrassment, the abuse occurs.  

In general it is seen by medical professionals as a conflict of interest to sell things that the same person prescribes.  The Federal Government has very strict rules against that type of thing for any medicare patient;  doctors cannot own labs or pharmacies, for example, that do tests or sell meds that the doctors ordered.  

The 'anti-Suboxone' crowd often says things like 'doctors are getting rich off Suboxone', but it just isn't the case;  if there was a great profit in treating patients with Suboxone there wouldn't be such a shortage of physicians prescribing it.  But if I could SELL Suboxone, I could probably do very well-- but I would feel uncomfortable about the clarity of my decisions.  I get paid if I prescribe Suboxone, if I recommend residential treatment, or if I prescribe naltrexone-- or if I see the person for psychotherapy and don't recommend anything else.  And while there is this impression that Suboxone is 'chaining' people to their doctor, in reality that isn't the case;  it is their illness, opiate dependence, that requires medical attention.  I spent 14 years seeing the same addictionologist because of the relapsing nature of addiction-- not because of Suboxone (which I didn't use).  Yes, a tangent... but something that comes up frequently and that deserved to be addressed.

A very large study was published two months ago-- I wish I could remember the reference-- that showed no benefit from vitamins except in unusual and rare circumstances.  The products that you mentioned benefit from a 'loophole' in regulations that allow some products to be sold as 'nutrients' rather than as 'medications';  nutrients avoid having to go to the FDA and show effectiveness in treating a condition.  Some other products present themselves as 'homeopathic', a fancy word for 'equal to placebo', as a homeopathic product is a substance in such minute quantities that it cannot be harmful (or helpful-- unless you accept that some healing 'essence' of the original substance is left behind in the otherwise-empty capsules).  I will never change the mind of those who believe in nutraceuticals though, so I generally don't try.  I'll just say that in MY opinion, humans have survived for centuries without adding saw palmetto to the diet.  And while foods are much more processed these days, we probably have access to much greater variety than many other healthy cultures throughout history.  How many green leafy vegetables did the eskimo population eat over the last several hundred years?

Most hormones exist in a huge range in the body;  look at the 'normal' levels for testosterone in middle-aged men and you will see numbers that vary over a range of 100-fold.  Why is 5 normal for one person, and 500 normal for another person? We have no idea!  And we are NOWHERE near the place where we 'know' the effects of adding some of this and some of that.  Yes, I could come up with a great story--  one that would sound very intelligent-- but it would be BS.  And there are no docs out there that have some 'secret knowledge';  again, medicine doesn't work that way.  When you see an infomercial with some guy with a foreign accent who talks about his 'research', I wish the fake-host would ask him, how did you collect the 5000 people necessary to show an effect, randomize them into separate groups, and follow them for ten years while controlling for all of their confounding behavior--- and keep it a secret?

I think the comments you described refer to the fact that in the brain, there are a number of neurotransmitters that produced from a common pathway;  one transmitter converted to the next, etc.  Each step in the metabolism has a 'balance' between the precursor side and the product side;  if there is a large amount of the terminal product around, it feeds back and reduces production of the entire line of chemicals.  So adding 5HT (which is serotonin) feeds back and reduces the production of catecholamine transmitters like dopamine and norepi.  You can overcome this effect by adding more of the precursors-- like tyrosine and dopa.

The problem with all of this, though, is that there is a huge difference between swallowing a substance and getting it into neurons.  It has to cross the wall of the gut, survive passage through the portal vein and liver, cross the blood-brain barrier, and avoid being broken down by the many enzymes in the blood and on 'neuroglia' that metabolize the substance.  I don't know for sure, but I strongly doubt that you can change the level of 5HT in the brain by taking it orally-- or even intravenously.  Yes, we can get dopa into the brain when the person takes enough of it orally, but dopa is used because the desired substance-- dopamine-- does NOT get into the brain.  So to finally wrap up.... I would say that I am skeptical about the whole affair, and I think most other docs would be as well.  I recommend being wary about anyone who claims to have some sort of 'special knowledge'-- I would suspect that what they REALLY have is a 'special' marketing campaign.