Chapter 34: Transcranial Magnetic Stimulation

 

 

 

My psychiatrist at the Amen Clinic believes I would be a good candidate for Transcranial Magnetic Stimulation.  My brain scans showed decreased activity in the left and right inferior orbital prefrontal cortex on both studies (concentration & rest), more severe at rest.  SIDE NOTE:  When there is decreased activity in the inferior orbital prefrontal cortex during a resting state and it improves with concentration, it is often associated with depressive disorders, and may be responsive to antidepressant medication.

Transcranial Magnetic Stimulation reaches the prefrontal cortex areas of the brain very well.  It does not stimulate the deeper areas of the brain.  That is why my doctor believes I would be a good candidate.  I also have problems with activity in deeper parts of my brain.  If you are interested in seeing my brain scans, go to Chapters 11 & 13.

My medical insurance company believes TMS is experimental and will not help pay for the therapy.  The Neuropsychiatric Institute near the city where I live offers TMS treatment and have had the necessary equipment since January 2010.  I know they have a patient assistance program and I would need to get the details to see if I could afford the therapy at this time.  I think doing the research for this blog chapter will help me decide if I could make this treatment happen!

NEUROSTAR TMS DEPRESSION THERAPY SYSTEM 

FIRST TO BE GIVEN FDA APPROVAL

  

Sean Fallon, author of this post, at GIZMODO

"Last year, Neuronetics' NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy system became the first device of its kind to be cleared by the FDA for treating depression. Although, the similarity to a dentist chair was probably not a great idea.

Nonetheless, trials on 164 patients with unipolar, non-psychotic major depressive disorder using the device proved that treatment with short magnetic field pulses to the left prefrontal cortex can be a viable alternative to medication. After 30 40-minute daily sessions, half of the patients in the trial experienced significant improvement, while a third reported complete resolution. Plus, the only statistically significant side effect was mild discomfort in the treatment area. Currently, patients can receive NeuroStar treatments in a psychiatrist's office while remaining completely awake and alert.

Given all of the uncertainty and danger surrounding many psychiatric drugs, NeuroStar seems like it's worth a shot for people suffering from serious bouts of depression. It could also be a sign of things to come. Perhaps technology like this will one day be implanted directly into our brains—making us feel awesome all the time."

http://gizmodo.com/5403423/neurostar-tms-depression-therapy-system-first-to-be-given-fda-approval

Transcranial Magnetic Stimulation requires the following:

1. Prescription by a Psychiatrist
2. 20-30 Outpatient Treatments, Usually Daily
3. Treatment for 4-6 Weeks
4. 37-40 Minute Sessions
5. Patient is Awake, No Anesthesia or Sedation
6. Usually $325.00 or More For Each Session (Depends on the treatment facility) 

This is the link to the NeuroStar TMS Therapy website.  It will give you more detailed information about the treatment:

http://www.neurostartms.com/Patient/Home.aspx

I thought the video on the NeuroStar website was educational and encouraging.  To watch it, go to this link:  (Sorry it was not possible to embed the video)

http://www.neurostartms.com/NeurostarTMSTherapyforDepression/NeurostarTMS-Video.aspx

GOOD BASIC INFORMATION ON TRANSCRANIAL MAGNETIC STIMULATION 

FROM THE MAYO CLINIC

By Mayo Clinic Staff

RISKS
Transcranial magnetic stimulation is the least invasive of the brain-stimulation procedures used for depression. Unlike vagus nerve stimulation or deep brain stimulation, transcranial magnetic stimulation doesn't require surgery or implantation of electrodes. And, unlike electroconvulsive therapy, it doesn't require seizures or complete sedation with anesthesia. However, transcranial magnetic stimulation does have some risks and can cause some side effects.

Common side effects
Transcranial magnetic stimulation often causes minor short-term side effects. These side effects are generally mild and typically improve after the first week or two of treatment. They can include:

• Headache
• Scalp discomfort at the site of stimulation
• Tingling, spasms or twitching of facial muscles
• Lightheadedness
• Discomfort from noise during treatment

Uncommon side effects
Serious side effects are rare. They can include:

• Seizures
• Mania, particularly in people with bipolar disorder
• Hearing loss due to inadequate ear protection during treatment

More study is needed to determine whether transcranial magnetic stimulation may have any long-term side effects.

  

HOW YOU PREPARE

Before having the procedure, you may need a medical examination to make sure it's safe and a good option for you. You may be asked a number of questions about your depression. Tell your doctor or health provider if:

• You're pregnant or thinking of becoming pregnant.
• You have any metal or implanted medical devices in your body. Transcranial magnetic stimulation usually isn't recommended if this is the case.
• You're taking any medications, including over-the-counter medications, herbal supplements or vitamins. Bring a list of what you're taking to your doctor's appointment and include dosages and how often you take them.
• You have a history of seizures or mania. Tell your doctor about any past injuries or surgeries and about any other physical or mental health problems you have.

Little preparation is needed. Transcranial magnetic stimulation isn't invasive, doesn't require anesthesia and can be performed in a doctor's office. You don't need to arrange for someone to drive you home after treatment. Before considering treatment, however, check with your health insurance company to see whether transcranial magnetic stimulation is covered. Your policy may not cover it. 

 

WHAT YOU CAN EXPECT

Transcranial

Your first treatment
Before treatment can begin, your doctor will need to identify the best place to put the magnets on your head and will need to find the best dose of magnetic energy for you.

This is what will most likely occur during your first appointment:

• You'll be taken to a treatment room. You'll be asked to sit in a reclining chair, and you'll be given earplugs to wear during the procedure.
• An electromagnetic coil is placed against your head. The electromagnetic coil is switched off and on repeatedly, up to 10 times a second to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You'll also feel a light tapping sensation on your forehead. This part of the process is called mapping.
• The amount of magnetic energy needed is determined. Your doctor will increase the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed depending on your symptoms and side effects.
• Once the coil placement and dose are identified, you're ready to begin. The treatment itself will last about 40 minutes. The entire appointment typically lasts about one to two hours.

During transcranial magnetic stimulation
Here's what to expect during each treatment:

• You'll sit in a comfortable chair. The magnetic coil is placed against your head.
• The machine is turned on. You'll hear clicking sounds and feel tapping on your forehead.
• Each treatment session lasts about 40 minutes. You'll remain awake and alert.
• After treatment, you can return to your normal daily activities.

There are different ways to perform the procedure. Techniques may change as more is learned about the most effective ways to perform treatments.

  

RESULTS

Some research showed that transcranial magnetic stimulation improved depression symptoms, while in other studies it didn't seem to help. If transcranial magnetic stimulation works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.

Transcranial magnetic stimulation may be less likely to work if:

• Your mental illness causes detachment from reality (psychosis)
• Your depression has lasted for four or more years
• Electroconvulsive therapy (ECT) has not worked to improve depression symptoms

It's not yet known if transcranial magnetic stimulation can be used to treat depression for the long term, or whether you can have periodic maintenance treatments to prevent depression symptoms from returning. The effectiveness of transcranial magnetic stimulation may improve as researchers learn more about techniques, the number of stimulations required and the best sites on the brain to stimulate. 

http://www.mayoclinic.com/health/transcranial-magnetic-stimulation/MY00185

If you are interested in reading a more in depth article on the background, development, practical implementation, and applications of TMS go to:  

http://www.scholarpedia.org/article/Transcranial_magnetic_stimulation

I am also considering going to Newport Beach (Amen Clinic) to have TMS done.  The doctor there does one TMS treatment and an EEG on the brain.  There needs to be a day in between, and then another TMS treatment is performed and another EEG on the brain.  The EEG's results give the doctor information to help him predict if TMS is going to be effective for that particular patient.  I will find out if this procedure is still being used, and if it is used at the Neuropsychiatric Institute near my home.

I think affordable medical treatment should be available to anyone who might benefit from it!

Chapter 33: Endorphins - Natural Morphine

I had my tonsils removed in August of 1977 when I was 24 years old.  I was teaching first grade students at the time, and was getting repeated upper respiratory infections with a painful sore throat.  I was so frustrated with being sick, I told my doctor the surgery would be worth it to me if there was any chance it would end the infections.

I had some people tell me the pain I would feel after surgery might not be as bad as the pain I felt with the sore throats.  Well, for me the pain after surgery was millions of times worse!  I was in the hospital for a few days, a tonsillectomy was not an outpatient surgery 33 years ago.  While I was in the hospital I was given morphine, by injection, which made the pain bearable.  

After I left the hospital I was given a prescription for a pain killer, I don't remember which drug it was, but it was definitely not as effective as morphine!  I slowly recovered from the surgery and fortunately soon after the repeated infections stopped.  After that experience I knew morphine would be by drug of choice if I was in pain, and in the hospital!

Part of my treatment plan from the Amen Clinic is to do aerobic exercise everyday for 30-40 minutes.  The positive effects of endorphins last for 24 hours, so my doctor recommended I replenish them every day.  Some patients are encouraged to workout at least 5 times per week.

These are my exercise instructions from my treatment plan:  "The health benefit from physical exercise is truly amazing.  Solid research has shown that regular exercise helps protect brain cells against toxins, including free radicals and excess glutamate; helps repair damaged DNA; reduces the risk of cognitive impairment, heart disease and stroke; improves cholesterol and fat metabolism, plus improving blood, oxygen and glucose delivery to tissues; reduces risk of diabetes, osteoporosis, depression , colon and breast cancer.  Regular exercise is one of the best natural treatments for ADD and depression.  I recommend you exercise 30 minutes a day 5 times a week.  In order for the exercise to be aerobic you must have a sustained increased heart rate."

I was doing regular aerobic exercise before I went to the Amen Clinic.  I know I feel better when I work out, but it has been hard for me to be consistent in exercising every day!  I decided I would do some research on endorphins, hoping this will help me start on a daily exercise habit.

CTER - Endorphins

http://wik.ed.uiuc.edu/index.php/Endorphins

"According to Rathus and Nevid, the word endorphin comes from the words endogenous morphine. Endogenous means developing from within. Endorphins are similar to the narcotic morphine in their functions, and we produce them in our own bodies. They occur naturally in the brain and bloodstream.

According to the Houghton Mifflin Dictionary, an endorphin is any of a group of peptide hormones that bind to opiate receptors and are found mainly in the brain. Endorphins reduce the sensation of pain and affect emotions.

According to the 2001 Columbia House Encyclopedia, Sixth Edition, endorphins are neurotransmitters found in the brain that have pain-relieving properties similar to morphine. There are three major types of endorphins: beta endorphins, enkephalins, and dynorphin. Beta endorphins are found primarily in the pituitary gland, and enkephalins and dynorphin are both distributed throughout the nervous system. Endorphins interact with opiate receptor neurons to reduce the intensity of pain. Among individuals afflicted with chronic pain disorders, endorphins are often found in high numbers. Many painkilling drugs, such as morphine and codeine, act like endorphins and actually activate opiate receptors. Besides behaving as a pain regulator, endorphins are also thought to be connected to physiological processes including euphoric feelings, appetite modulation, and the release of sex hormones. Prolonged, continuous exercise contributes to an increased production and release of endorphins, resulting in a sense of euphoria that has been popularly labeled "runner's high."

       Types of Endorphins

• Beta-endorphins are produced by the pituitary gland and are believed to produce a greater "high" than the other types of endorphins. The beta-endorphin is generally believed to provide a considerable amount of natural pain relief. Some scientists believe it is due to beta-endorphins that some people who experience a traumatic injury, such as the loss of a limb, experience little or no immediate pain.

• Alpha-endorphins have been studied since the 1970's, but little is known about how they affect the body. Some research suggests that alpha-endorphins may stimulate the brain in ways similar to amphetamines and others claim that they may help treat anaphylactic shock and similar conditions.

• Gamma-endorphins have also been researched since the 1970's, but most of the information on how the substance affects the body is pure speculation. Some studies show that they have antipsychotic effects on patients suffering from disorders such as schizophrenia, while others show that they may help regulate blood pressure.

How Do Endorphins Work?

Endorphins act by locking into receptors in the nervous system for chemicals that transmit pain messages to the brain. Once the endorphin, or the "key", is in the "lock," pain causing chemicals are prevented from transmitting their messages (Rathus and Nevid 2003). Endorphins interact with the opiate receptors in the brain to reduce our perception of pain, similar to the drugs morphine and codeine. The body's release of endorphins, however, does not lead to addiction like morphine and codeine might. 

              RELEASING ENDORPHINS

The release of endorphins is different based on each individual. Certain foods such as chocolate and chili peppers can lead to enhanced production of endorphins. Laughter is thought to release endorphins into the brain. Strenuous exercise, exposure to ultraviolet light, massage therapy, and acupuncture can also activate endorphin production. 

Okay, morphine is still my drug of choice for pain even after trying Oxycodone and Lortab years later after other surgeries. =)  Endorphins are like morphine in their functions and I produce them in my own body.  They occur naturally in my brain and bloodstream.  Yes, this is motivating for me to work out more often even if I don't take advantage of the endorphin "runners high" every day!  I like to do aerobic exercise on an Elliptical Cross Trainer in my basement.  I do not have the excuse that working out is inconvenient.

How endorphins were discovered:

COLIN BLAKEMORE and SHELIA JENNETT. "endorphins." The Oxford Companion to the Body. 2001. Encyclopedia.com. (December 4, 2010). http://www.encyclopedia.com/doc/1O128-endorphins.html

© The Oxford Companion to the Body 2001, originally published by Oxford University Press 2001. 

endorphins During the 1960s and early 1970s, it became apparent that opioid drugs such as morphine and heroin produced their profound actions in the body by interacting with specific receptors on the outer membrane of nerve cells. This raised the intriguing question of why the body goes to the trouble of synthesizing such receptor proteins. Surely it was not just on the off chance that a drug such as morphine might be administered. In 1975 the group in Aberdeen, Scotland led by Hans Kosterlitz and John Hughes, isolated from the pig brain two related molecules, the enkephalins, which bind to and activate opioid receptors. These enkephalins are short peptides, each comprising five amino acids. Although at first glance the enkephalins did not look similar in chemical composition to morphine, they proved to have a crucial component in common. We now know that the brain contains as many as thirteen such endogenous (internally generated) opioid peptides, which have come to be referred to collectively as ‘endorphins’. 

Well, I definitely believe adding more aerobic workouts to my schedule will help my depression symptoms.  The hard part is depression symptoms make me not want to do anything.  This is what I need to push through and workout anyway.

If you are interested in reading more about endorphins, this website is a good one.  It has photos expressing the molecular structure of different kinds of endorphins, called the Endorphin Collection.  It also has good information.

http://microscopy.fsu.edu/micro/gallery/endorphin/endorphins.html

 

Chapter 32: 6,000mg Of Fish Oil A Day

The groundbreaking omega-3 antidepression diet and brain program, The Omega-3 Connection, by Andrew L. Stoll, M.D. 

This is an excellent book.  Reading it has kept me motivated to be consistent in taking fish oil.  Quoted from the front flap of the book:

"In his groundbreaking research, Stoll found that omega-3 fatty acids, already known for their importance in preventing heart disease, Crohn's disease, rheumatoid arthritis, and cancer, play a crucial role in mental health---regulating and enhancing mood, sharpening memory, and even aiding concentration and learning.  And these remarkable substances, so essential to our health, are found abundantly in common fish oils and other sources.

The bad news is that even though omega-3 fatty acids have played a critical role in our evolutionary past, these extraordinary substances have been depleted by our Western diet and lifestyle, and the resulting nutritional imbalance seems to have led to a sharp rise in heart disease and depression.  By contrast, in Japan and other countries where fish consumption is high, both heart disease and depression rates are low."

Andrew L. Stoll, M.D., is Director of the Psychopharmacology Research Laboratory at McLean Hospital in Boston and an Assistant Professor of Psychiatry at Harvard Medical School, as well as the recipient of the 1999 Klerman Award from the National Alliance for Research on Schizophrenia and Depression for the studies described in this book.  He is the author of dozens of academic papers.  This is his first book for the general public.

Part of my depression treatment plan from the Amen Clinic is to take 6,000mg of fish oil every day.  I was taking 2,000mg before I went to the clinic.  This is what I learned about omega-3 fatty acids from the Amen Clinic:

"The brain is 60% fat.  All of our 100 billion nerve cells are lined in essential fatty acids.  Low levels of omega three fatty acids have been found in ADD, depression and dementia.  Omega- 3 fatty acids (found in fish and flax seed oil) taken at a dosage of 2,000 to 6,000mg daily can be a beneficial augmentation for mood stabilization.  High quality fish oil is usually best as it has higher levels than flax seed oil to boost the levels of  omega-3 fatty acids in the brain.  We often recommend NeuroEPA for people who have more ADD type issues, and NeurOmega for people who have more mood or overfocused issues.

Research in the last few years has revealed that diets rich in omega-3 fatty acids may help promote a healthy emotional balance and positive mood, and may help us maintain a healthy mental status in later years.  Researchers speculate that a diet rich in the omega-3 fatty acid DHA, found in fish oil, may help promote a healthy emotional balance and positive mood in part because DHA is a main component of the synaptic membranes in the brain.  Researchers in another study found that people with a healthy emotional balance and positive mental outlook tended to have higher levels of DHA in their red blood cells.  A Danish team of researchers compared the diets of 5,386 healthy older individuals and found that the more fish in a person's diet, the longer the person was able to maintain a healthy mental status.  Here are sources of good and bad dietary fat.

Good fat sources:  anchovies, avocados, Brazil nuts, canola oil, cashews, flax seed oil, green leafy vegetables, herring, lean meats, olive oil, peanut oil, Pistachio nuts, salmon, sardines, soybean oil, trout, tuna, walnuts, whitefish.

Bad fat sources:  bacon, butter, cheese (regular fat) cream sauces, donuts, fried foods, such as potatoes/onion rings, ice cream, lamb chops, margarine, potato chips (fried), processed foods, steak and whole milk."

In the video below, Dr. Mark Hyman talks about getting healthy omega-3 fatty acids without adding mercury poisoning from eating fish.

Can Healthy Omega 3 Fatty Acids Give You Mercury Poisoning

 

Foods Rich in Omega-3 Fatty Acids

Dietary Sources of Essential Fats EPA, DHA, and ALA

Aug 28, 2009 Jennifer Murray

The three most nutritionally beneficial omega-3 fatty acids are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA). Research suggests these omega-3 fatty acids are better absorbed by the body when obtained from food rather than omega-3 supplements. Although fatty fish is known as the best source of omega-3s, there are many other foods that contain these health boosting fatty acids. 

 

Food Sources of EPA and DHA

EPA and DHA omega-3s are mainly found in fish, especially cold-water, high-fat varieties such as:

• Albacore tuna
• Sardines
• Salmon
• Mackerel
• Atlantic herring
• Swordfish
• Lake trout

 

Sources of Alpha-linolenic Acid 

Since the body cannot make ALA, this fatty acid must be consumed in the diet.  Approximately 35 percent of ALA found in food is converted to EPA and DHA.  Good sources of ALA include:

• Flaxseeds and flaxseed oil
• Soybeans and soybean oil
• Walnuts
• Brazil nuts
• Soy nuts
• Olive oil
• Hemp seeds
• Pumpkin seeds

Read more at Suite101: Foods Rich in Omega-3 Fatty Acids: Dietary Sources of Essential Fats EPA, DHA and ALA http://www.suite101.com/content/foods-rich-in-omega3-fatty-acids-a143527#ixzz15xxALUjT


I have been taking 6,000mg of fish oil since I returned from the Amen Clinic on March 14, 2010. This is the fish oil I take; it is recommended by Mark Hyman, M.D.

Metagenics, EPA-DHA Extra Strength Enteric Coated: Serving 2 capsules
2/breakfast  2/lunch  2/dinner
EPA 600 mg, DHA 400 mg sardine, anchovy, herring.

I am hoping the fish oil I have been taking will be part of the puzzle of healing the depression and ADHD symptoms I am experiencing.  After I lowered the dose of Effexor XR to 225mg, the depression symptoms increased.  I am now back on 300mg of Effexor XR, and have raised the dose of Luvox up to 50mg in the morning and 50mg in the afternoon.  

Previously, 300mg of Effexor XR was causing insomnia because of too much norepinephrine; and 50mg of Luvox was not giving me enough calming serotonin to create a balance.  I will see if 100mg of Luvox will give me enough serotonin to equalize the two neurotransmitters.  I am so ready for this to happen! =)

Chapter 31: L-Tryptophan > 5-HTP > Serotonin

This question and comment were written on Chapter 22:  Serotonin, Deep Limbic System.  After reading this comment I wanted to find out more about L-Tryptophan.

 

          Steve said...

Can a person take too much L-Tryptophan? I take 3000 mg but more actually helps me sleep.

November 4, 2010 6:29 PM    

General Information About L-Tryptophan

This information is from WEBMD

 http://www.webmd.com/vitamins-supplements/ingredientmono-326-L-TRYPTOPHAN.aspx?activeIngredientId=326&activeIngredientName=L-TRYPTOPHAN

What is L-Tryptophan and How Does it Work

L-tryptophan is naturally found in animal and plant proteins. L-tryptophan is considered an essential amino acid because our bodies can't make it. It is important for the development and functioning of many organs in the body. After absorbing L-tryptophan from food, our bodies convert it to 5-HTP (5-hyrdoxytryptophan), and then to serotonin. Serotonin is a hormone that transmits signals between nerve cells. It also causes blood vessels to narrow. Changes in the level of serotonin in the brain can alter mood.

L-Tryptophan Uses

L-tryptophan is used for insomnia, sleep apnea, depression, anxiety, facial pain, a severe form of premenstrual syndrome called premenstrual dysphoric disorder (PMDD), smoking cessation, grinding teeth during sleep (bruxism), attention deficit-hyperactivity disorder (ADHD), Tourette's syndrome, and to improve athletic performance. 

Possible Interactions With L-Tryptophan 

Major Interaction Do not take this combination

• Medications for depression (Antidepressant drugs) interacts with L-TRYPTOPHAN
  L-tryptophan increases a brain chemical called serotonin. Some medications for depression also increase the brain chemical serotonin. Taking L-tryptophan along with these medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety. Do not take L-tryptophan if you are taking medications for depression.
  Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.
• Medications for depression (MAOIs) interacts with L-TRYPTOPHAN
  L-tryptophan increases a chemical in the brain. This chemical is called serotonin. Some medications used for depression also increase serotonin. Taking L-tryptophan with these medications used for depression might cause there to be too much serotonin. This could cause serious side effects including heart problems, shivering, and anxiety.
  Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.
• Sedative medications (CNS depressants) interacts with L-TRYPTOPHAN
  L-tryptophan might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking L-tryptophan along with sedative medications might cause too much sleepiness.
  Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.

L-Tryptophan Dosing

The appropriate dose of L-tryptophan depends on several factors such as the user's age, health, and several other conditions. At this time, there is not enough scientific information to determine an appropriate range of doses for L-tryptophan. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other health care professional before using.

This information is from THE SLEEP WELL SITE

http://www.thesleepwellsite.com/Essential.htm

The information from this site talks more specifically about the question and comment above.  Can a person take too much L-Tryptophan?  I take 3,000 mg but more actually helps me sleep.

L-Tryptophan and Dosing

The more Tryptophan there is in our blood, the more Serotonin our bodies can make, and the easier it is for us to feel calm and satisfied.  When we need sleep, having enough Tryptophan in our bodies allows us to fall asleep.

So much for theory; now on to the particulars.  For a 160 lb. person, taking 2 to 8 500mg capsules of Tryptophan before bed time will cause much of it to enter the blood in about 25 to 30 minutes.  This is enough to cause a sense of drowsiness.  It is important that no protein be consumed for 3 to 4 hours before bed time.  Another 2 to 8 capsules can be taken in the middle of the night if needed.  It is wise to begin with a lower dosage and wait an hour to take additional capsules as needed.

The number of capsules taken may be adjusted according to weight.  For example, 3 to 6 capsules may be right for a 120 lb. person. Also, if the Tryptophan deficiency is particularly severe, a somewhat larger dose may be appropriate at first.  Tryptophan is not dangerous!  It cannot hurt you!  It is worth repeating: you need Tryptophan to live.  You will know if you take more than you need because you will feel a little bit groggy the next day.

Eating a light snack consisting of carbohydrates or sugar with the Tryptophan may help some people.  On the one hand, eating will dilute the Tryptophan.  On the other hand, the carbohydrates may help it enter the brain more easily.  Experiment with this.

Most people have a very easy time sleeping the very first time they take Tryptophan capsules.  When the Tryptophan is taken every night, it should gradually become easier to fall asleep over a period of about 3 months, and the sleep will be longer and sounder.  Be patient with this process. The body is rebuilding itself from the ground up.  Some people may also find they are more patient, comfortable and satisfied with life.  But again, this is an almost imperceptibly gradual process.

Can everyone take Tryptophan safely?  Does it have side effects, or other benefits?  Dr. Elson M. Haas, M.D., addresses these questions thoroughly:

“Patients with asthma or systemic lupus erythematosus should not take tryptophan. Generally, side effects are negligible, and tryptophan does not distort sleep patterns until more than 10 grams are taken. Occasionally, some morning sluggishness may occur. Tryptophan also has an antidepressant effect and is particularly effective in manic depression and depression associated with menopause. Many depressed patients have low levels of tryptophan. Tryptophan can be a useful and safe pain reliever. It has been shown most helpful for dental pain, headaches (migraines in particular), and cancer pain, often in conjunction with aspirin or acetaminophen. Tryptophan appears to increase the pain threshold. It may help treat anorexia by increasing the appetite. Since it is the precursor of niacin, tryptophan supplementation may help to lower cholesterol and blood fat levels. Other possible uses for L-tryptophan include parkinsonism, epilepsy, and schizophrenia, and with further research, we may find this important amino acid may provide help in other medical conditions.”

© Elson M. Haas M.D. (Excerpted from Staying Healthy with Nutrition:
The Complete Guide to Diet and Nutritional Medicine, Celestial Arts)

Where can you get Tryptophan?  At this time, there are only a few sources.

It is available from:

http://www.biochemicals.com/productinfo.php3?id=22

http://healthproducts-usa.com/lidtke_tryptophan.htm

http://www.sagesherbalandsuch.com/lidtke.php

http://www.thecompounder.com/LTryptophanReturns.html

http://www.tahoma-clinic.com/shop/default.php/manufacturers_id/265

http://www.supervits.com/catalog/product.asp?categoryID=456&show=p

http://www.coenzyme-a.com/Merchant2/merchant.mv?Screen=PROD&Store_Code=ap9999&Product_Code=LTR001&Category_Code=CA004

http://www.spiritofhealing.com/articles/html/print_html/Tryptophan.htm

This information is from Mark Hyman, M.D.
Book: The UltraMind Solution, page 121 & 122 

This section explains the importance of good nutrition in helping our bodies complete the process of absorbing Tryptophan and building it into serotonin.

The only function of your DNA is to make proteins, as I said earlier (page 95).  Enzymes are one of thousands of proteins created from your DNA.  However, these particular proteins are critically important, because they are the catalysts that help turn one molecule into another---they are the helpers that slow down or speed up all the trillions of chemical reactions that happen every second in your body.

Nutrients, in turn, control the function of these enzymes.  They tell your enzymes what to do.  They turn on or turn off the chemical reactions in your body.  Let's look at how we make serotonin as an example of how this works.  Serotonin is a peptide (which is just a little protein) known as a neurotransmitter, which boosts our mood.  You don't eat serotonin, but your body makes it.  It builds serotonin from the amino-acid tryptophan that comes from the protein in our turkey sandwich.

The enzyme designed to convert tryptophan from turkey into serotonin needs vitamin B-6, or pyridoxine, to help it perform its chemical wizardry.  No B-6, no enzyme reaction , no serotonin, no happy mood.  The result?  Depression---along with a host of other potential problems.

But the real critical element in this equation is you.  You may need more B-6 to get your enzymes to turn tryptophan into serotonin than your next-door neighbor does.  Your genes may not have created an enzyme that is as responsive to B-6 as your neighbor's enzymes are, or just runs a little more slowly.  Hence you need more B-6 to do the job.  Why?

Because you are a genetically unique individual.  As a result your enzymes are constructed differently and respond to nutrients differently than those of your neighbors.  About one-third (or 1 million) of your SNPs (the variations in your genes) are dedicated solely to the job of determining how effectively your enzymes are controlled by the nutrients you consume!

Why is it critical to your health?  If you understand that one-third of the entire variation in your genetic code affects the function of your enzymes, and that nutrients are the control switches for those enzymes, you will want to make sure you have all the right raw materials (nutrients) to make those enzymes function optimally.

Mark Hyman, M.D.:  The UltraMind Solution, page 354

5-HTP, L-Tryptophan, and Melatonin Dosing Guidelines

You can take either 5-HTP or tryptophan to support your serotonin level. Try:

5-HTP (5-hydroxytryptophan), 50 mg twice a day, once in the afternoon and once before bed.  Add an additional 50 mg in the afternoon and at bedtime every three days until you get to a maximum dose of 150 mg once in the afternoon and once before bed.

OR:

Take tryptophan, 500 mg once in the afternoon and once before bed. Take these on an empty stomach, one hour before or two hours after meals.

REMEMBER: use either 5-HTP or tryptophan, not both. If you are taking an SSRI or antidepressant, check with your health-care provider before taking 5-HTP or tryptophan.

To help you sleep, you can also try:

1 to 3 mg of melatonin before bed to help with sleep if needed.

This information is from Daniel G. Amen, M.D.

Book: Healing Anxiety and Depression, page 169

L-trytophan and 5-HTP are amino acid building blocks for serotonin and taking these supplements can increase cerebral serotonin. L-tryptophan is a naturally occurring amino acid found in milk, meat, and eggs. It is helpful for some patients in improving sleep, decreasing aggressiveness, and stabilizing mood. One of the problems with dietary L-tryptophan is that a significant portion of it does not enter the brain, but is used to make proteins and vitamin B-3.  This necessitates taking large amounts of tryptophan.  Recommended dosage is 1,000 to 3,000 mg at bedtime.

Tryptophan is in the following foods.

This information is from the Love to Know Website
http://vitamins.lovetoknow.com/Food_Sources_of_Tryptophan 

The following foods are excellent sources of Tryptophan: 

• Beef tenderloin (broiled)
• Calf liver (broiled)
• Chicken breast
  
  (roasted)
• Chinook Salmon (baked or broiled)
• Cod (baked or broiled)
• Halibut (baked or broiled)
• Lamb loin (roasted)
• Mustard greens
• Raw mushrooms
• Scallops (baked or broiled)
• Shrimp (steamed or boiled)
• Soy sauce
• Soy beans (cooked)
• Snapper (baked or broiled)
• Spinach
• Tofu (raw)
• Tuna (baked or broiled)
• Turkey breast (roasted)

Very Good Dietary Sources of Tryptophan

• Asparagus
• Black beans
• Broccoli
• Brussels Sprouts
• Bulgar wheat
• Cauliflower
• Chard
• Collard greens
• Eggs (boiled)
• Goat milk
• Green beans
• Kale
• Lentils
• Lima beans
• Milk (2 percent)
• Miso
• Mozzarella cheese (part skim)
• Mustard sees
• Navy beans
• Parsley (fresh)
• Peppermint leaves
• Pinto beans
• Red kidney beans
• Split peas
• Turnip greens  

Good Sources of Tryptophan

• Almonds (raw)
• Apricots (raw)
• Baked potato
• Barley
• Beets (boiled)
• Brown rice
• Buckwheat
• Cabbage (boiled)
• Cashews (raw)
• Celery (raw)
• Eggplant (boiled)
• Garbanzo beans
• Garlic
• Green peas
• Low-fat yogurt
• Millet (cooked)
• Oats (whole grain not quick oats)
• Onions (raw)
• Peanuts (raw)
• Pumpkin seeds
• Quinoa
• Red bell peppers (raw)
• Rye (whole grain)
• Sesame seeds
• Summer squash
• Sunflower seeds (dried)
• Tomatoes (raw)
• Walnuts
• Whole grain flour
• Winter squash

My personal experience using L-Tryptophan.

Several years ago I tried using 5-HTP and L-tryptophan supplements to relieve depression symptoms.  I was not on an antidepressant at the time and thought I would try these supplements first.  I read the books, The Diet Cure and The Mood Cure, by Julia Ross, M.A.  I followed the directions in The Mood Cure under the direction of my doctor.  I tried 5-HTP first, these two supplements should not be taken together.

5-HTP Directions:

"Start with one 50 mg capsule in midafternoon.  Go up to two (100 mg) if you don't get much benefit from one in an hour.  Add a third, if needed for maximum effect, in about an hour.  Now you've established your dose.  Take the same dose at nine-thirty at night if you have sleep problems.  If moodiness (or craving for carbs or alcohol) occurs only in the evening before bedtime, move your midafternoon dose up closer to dinnertime or take your bedtime dose earlier (an hour or two after dinner).  You can also take 1 or 2 more capsules if you wake up in the night and don't drop right back to sleep or if you wake up anxious and worried in the morning.  Four to 6 (50 mg) capsules a day is all that our clients typically require.  Larger or more depleted people sometimes need more."

I did not feel any different after taking 5-HTP for a week, so I tried L-tryptophan next.  The directions are:  Stop your 5-HTP and take 500 milligrams of L-tryptophan for every 50 milligrams of 5-HTP you had been taking.  I did not feel any different after taking L-tryptophan for a week either, so I stopped taking it.  I was disappointed, but not really surprised.  It would have been nice to be free of the side effects caused by an antidepressant, but suicide is too big of a risk for me.  I started back on medication.

In the past 29 years of dealing with depression I have tried the following "natural" treatments:  5-HTP, L-tryptophan, acupuncture and herbs, and the amino acid therapy described at www.neuroassist.com.  (PLEASE DO NOT try this amino acid therapy without talking to me first.)  None of these treatments were effective, which helped confirm how severe this disease is for my body!

Chapter 30: Don't Stop Believing

This made me feel good this week!

"Steve Perry and 43,000 Friends NEVER 'Stop Believing' in the Giants - NLCS Game 5" 

You may remember the rock band Journey.  They were playing one of their songs, "Don't Stop Believin'", during the Giants National League Championship Series, Game 5 on 10/21/10.  One of the cameras caught Steve Perry, lead singer, standing up in the crowd singing his own song.  Awesome!

"Gotta love Steve Perry leading a packed house @ AT&T Park, San Francisco"

  


Steve Perry and Journey Performing "Don't Stop Believin'" In Concert
(I'm trying to find out where and when.)

This song, first featured on Journey's Escape album, was written by 

Jonathan Cain, Steve Perry, and Neal Schon; all members of Journey.

Don't Stop Believin'
- Journey
1981

Just a small town girl
Living in a lonely world
She took the midnight train going anywhere
Just a city boy
Born and raised in South Detroit
He took the midnight train going anywhere

A singer in a smoky room
A smell of wine and cheap perfume
For a smile they can share the night
It goes on and on and on and on

{Refrain}
Strangers, waiting, up and down the boulevard
Their shadows searching in the night
Streetlight people, living just to find emotion
Hiding somewhere in the night

Working hard to get my fill
Everybody wants a thrill
Paying anything to roll the dice
Just one more time
Some will win, some will lose
Some were born to sing the blues
Oh the movie never ends
It goes on and on and on and on

{Refrain}

Don't stop believing
Hold on to that feeling
Streetlight people

Popularity:
The song reached #8 on Billboard's Mainstream Rock chart, and #9 on the Billboard Hot 100 chart. It also peaked at #62 on the UK singles chart. The song also has appeared in a number of film and television series, including The Wedding Singer, Monster, Shrek The Halls, The Comebacks and Scrubs.

Journey
Journey live in Minneapolis, Minnesota on September 16, 2008.
Background information
Origin	San Francisco, California
Genres	Rock, hard rock, pop rock, progressive rock, jazz-fusion, AOR
Years active	1973–1987; 1995–present
Labels	Columbia, Frontiers, Sanctuary
Associated acts	Santana, The Babys, Steve Perry, Hardline, Bad English, The Storm, Vital Information, The Zoo
Website	JourneyMusic.com
Members
Neal Schon Ross Valory Jonathan Cain Deen Castronovo Arnel Pineda

http://en.wikipedia.org/wiki/Journey_%28band%29

Update on my treatment plan from the Amen Clinic:

After being on 300 mg of Effexor XR for 5 weeks a new side effect started, insomnia.  In the past, the side effects would start 3-4 days after raising the dose.  After a week of not sleeping well I was exhausted.  There had not been any other changes in my life that would have caused lack of sleep, so I lowered the dose of Effexor XR to 262.5 mg.  

I talked to my psychiatrist here at home and got his guidance on this decision.  This is the plan we decided on.  I stayed on 262.5 mg for 4 days and still could not sleep, so I lowered the dose to 225 mg.  Gradually, I started to sleep again and about 4 days later I was sleeping well.  The depression symptoms have not increased, but they have not decreased as I have been hoping and waiting for.

I have not been able to lower the dose of Luvox below 50 mg per day.  If I did, the depression symptoms became worse.  So I have increased the dose of Luvox to 75 mg a day, 25 mg in the morning, 25 mg in the afternoon, and 25 mg in the evening.  I will increase the dose to 100 mg a day if the depression symptoms do not improve.

So now I am taking 300 mg of Neurontin 4 times a day, 225 mg of Effexor XR once in the morning, 75 mg of Luvox 3 times a day, and the supplements and vitamins/minerals I have been taking for many months.  There are some days I feel good, but it does not stay consistent.  I am hoping all of the things I have been doing to heal are going to come together and work, soon!

DON'T STOP BELIEVING

Chapter 29: Do you know what your Vitamin D level is?

This is funny!  Best_DUI_Ever

Do you know what your Vitamin D, 25-Hydroxy level is?

In November of 2007 I had some blood work done and found out my Vitamin D, 25-Hydroxy level was 20, LOW. The huge normal range is 30-150, and a toxic level for most people is above 150. At the time I was surprised because my diet was pretty healthy. After doing some reading about the subject, I am not surprised because I wasn't spending 15-20 minutes in the sun everyday without sunscreen. (Or with sunscreen either!)

I started taking 2,000 IU of Vitamin D a day and had good intentions of getting more sun. Then, December of 2007 came around and I made the fateful decision to come off my antidepressant, Zoloft, and try an amino acid therapy for depression. Well, the rest is history (a miserable one) and has already been documented in previous blog posts. For the next year my Vitamin D level was not a high priority for me. I felt there was a long list of things I "should" do, and didn't feel well enough to do very many of them.

In March of 2009 I had blood work done again and my Vitamin D level was 26. Yeah, I know it didn't come up much. The amount of Vitamin D I was taking and feeling depressed and sick in the house wasn't very effective. My doctor started me on a 50,000 IU capsule of a prescription Vitamin D, the generic for Drisdol, that I took once per month. In February of 2010 I started taking the supplements Dr. Hyman recommends (See Chapter 12:  I Hate Clonazepam, Supplements) so I was taking 3,200 IU of Vitamin D each day, and 50,000 IU once per month.

In April of 2010 my blood work showed a Vitamin D level of 45. In the gigantic normal range! Maybe I don't absorb it very well. =) My psychiatrist at the Amen Clinic recommended I get my level up to at least 70, because it has a good chance of improving my mood. My doctor here at home is helping me and I am now taking a 50,000 IU capsule every two weeks and 3200 IU every day. I will be tested again in January of 2011; if I am not up to 70 I will begin taking the 50,000 IU capsule every week. I know it would help if I spent some time in the sun, but you know I don't have a good track record for this. I am going to try!

I am hoping a higher Vitamin D level will be one more thing contributing to overcoming the depression symptoms. One more piece of the healing depression puzzle. For me this puzzle has been difficult. I will keep you posted.

I am in the process of reading the book, The Vitamin D Solution, A 3-Step Strategy to Cure Our Most Common Health Problem, by Michael F. Holick, Ph.D., M.D., Foreword by Andrew Weil, M.D. Dr. Holick says having enough Vitamin D can prevent and treat Osteoporosis, Heart Disease, Cancer, Autoimmune Diseases, Depression, Insomnia, Arthritis, Diabetes, Chronic Pain, Psoriasis, Fibromyalgia, and Autism. . .as well as other diseases, chronic conditions, and mild ailments. Wow, it is important. Is the sun out today?

Review of the book, The Vitamin D Solution, A 3-Step Strategy to Cure Our Most Common Health Problem.
http://livinlavidalowcarb.com/blog/review-the-vitamin-d-solution-by-dr-michael-holick/9144%20

Michael F. Holick, Ph.D., M.D., is called the "Pioneer In Vitamin D Research."  This is a video of a speech he gave at a Diagnosis and Treatment of Vitamin D Seminar. This seminar was called, "D-Lightful Vitamin D; Bone and Muscle Health and Prevention of Autoimmune and Chronic Diseases."  It is long, 58 minutes and 52 seconds, but entertaining.

This Vitamin D Quiz is in, The UltraMind Solution, by Mark Hyman, M.D.  It may help you determine if you have a vitamin D deficiency.

VITAMIN D QUIZ

I have seasonal affective disorder.

I experience a loss of mental sharpness or memory.

I have sore or weak muscles.

I have tender bones (press on your shin bone--if it hurts you are vitamin D deficient).

I work indoors.

I avoid the sun.

I wear sunblock most of the time.

I live north of Florida.

I don't eat small fatty fish such as mackerel, herring, or sardines (the main sources of dietary vitamin D).

I have osteoporosis.

I have broken more than two bones or had a hip fracture.

I have autoimmune disease (i.e., multiple sclerosis).

I have osteoarthritis (vitamin D deficiency weakens bones and leads to deterioration).

I have frequent infections.

I have prostate cancer.

I have dark skin (any race other than Caucasian).

I am sixty years old or older.

SCORE:  0-8 Yes Answers---You may have a slightly low level of vitamin D.

                 9 And Above Yes Answers---You may have a severely low level of vitamin D.

I recommend these videos.  They share good information about vitamin D.

Dr. Oz on Good Morning America -- Vitamin D, Swine Flu, Cancer, and the Sun. 

 

 

The Real Story on Vitamin D 

Dr. John Cannell, Vitamin D Council, and Bill Sardi, Knowledge of Health, Inc. 

 

This is an article written by Dr. John Cannell on the history of depression and vitamin D research.  It is called, "Vitamin D and Depression."  Dr. Cannell

http://www.vitamindcouncil.org/depression.shtml