Nutraceuticals, Supplements, and Mental Health

2009 April 19
tags: , , , ,
by admin


I run the expert forums in addiction and in mental health at MedHelp.org;  tonight I answered a question that has come up from patients of my practice and so I decided to share my answer here as well.

First, the question: 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 addiction, i do believe that many people suffering with addiction have co morbid  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.

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

My answer:

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.  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.

Jeffrey T Junig MD PhD
Fond du Lac Psychiatry

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from → Addiction Treatment, Health scams, Patient Perspectives, Pharmacology

3 Comments leave one →
2009 August 6
Jessica

This is in response to your comment about suboxone doctors being greedy. It took me weeks of trying to find a doctor to see me. I have great health insurance, and yet no one would see me because they all wanted cash, and would not except insurance. Because Of this experience, I can understand why some would suggest there is a problem. I understand the stigma that is attached to heroin addicts and the need for doctors to make money, But I was treated very poorly by certain suboxone doctors when I asked if they would accept my PPo insurance plan. The only way I was able to get on suboxone was when I had only one doctor in my area to call. I called and was crying so hysterically that I was surprised he understood anything at all, luckily for me, he accpected my 400.00 a month, best you can get, insurance plan. I can only wonder what this experience would have been like, if I had an HMO. While I am sure that this doesn’t happen to everyone, it happens to enough people to suggest there is a problem, whether it is with certain doctors or with certain insurance companies. Thanks for listening.

2009 August 6
admin

The problem, from the doctor’s perspective, is that it is very frustrating working with addicts. I say this as a person with my own problems, as I write about elsewhere on the blog. Opiate addicts do not tell the truth when they are in active addiction. That sounds mean, but anyone who thinks otherwise has no understanding of opiate addiction! An addict in withdrawal will do anything for relief of that withdrawal, and sobbing hysterically is no indicator of truthfulness or of the person’s true intentions– because the addict herself has no knowledge of her true intentions. She is only being driven to find more opiates, and will promise to pay next week, will give the clinic her sister or friend’s insurance card and use a false name, will claim to be employed and covered by insurance when the truth is that she is neither…. I cannot imagine treating opiate addiction by any way other than cash up front, followed by reimbursement of any proceeds payed by the insurer. I think there are many other reasons to do it that way; Suboxone is NOT a sure thing, particularly with young addicts; you still need a person who is truly sick and tired of using, or the Suboxone will not be effective long-term. The average addict I see is taking 100-200 mg of OC per day at a cost of $1 per mg; they will save up the $300 consult fee by staying clean for two days! If the person cannot do that, then the person is not yet ready for Suboxone treatment.

There is a reason that many parts of the country have a shortage of Suboxone docs; it is not an easy way to make money. Even at $400, that is a lot of money– but an orthopedist does an ACL reconstruction in 40 minutes and gets paid $15,000. A plastic surgeon who does hand surgery is paid over $10,000 per finger re-attached. An anesthesiologist, my old profession, gets $700 for the 20 minutes it takes to put in a labor epidural. None of those people will work ‘on credit’; they will first verify that the person has insurance, and if not, they will want payment up front. The residential treatments in my area are all paid up front– because the success rate is below 50%, and addicts who relapse are never going to pay the bill!

I do appreciate your comments. My main point is that there is a reason for asking for payment up front, in cash– before I started doing so I collected quite a pile of worthless checks and unpaid invoices!

JJ

2009 September 28
SuboxoneMom

Boy, you took the words right out of my mouth. I went on Suboxone back in 2001. I was at the jumping off place, wishing for the end. I would have paid any amount of money for someone to just give me the hope of being able to quit my addiction to oc’s.

After many, many telephone calls trying to find a doctor who would even see me back then was enough to make me desperate enough to surrender to the requirements, whether it was money, midnight appointments or standing on my head spitting nickels for an hour. I was so truly sick and tired of being sick and tired.

The doctor I finally went to was the one whom I called and left a message for on a Friday nite, around 11pm. I rambled on a bit about my story and left my telephone #. To my surprise, he returned my call that evening and the first thing he said to me was, “Well Suboxone Mom, tell me your story”. And I truly believe that with those words, my healing began to take form.

I stayed on Suboxone for over 4 years. I went to this doctor every month for $275.00 a visit plus the cost of the Subs were over $300 a month. But I thought nothing of spending $600 a week for oc’s. So “giving” that money to my doctor only made me that much more determined to stick with the treatment and therapy and anything else that went along with my recovery.

Since the introduction of bupe to aid in the recovery of addicts was relatively new back in 2001, my doctor was also very new to its treatment, and the progress and eventual outcome of each case. He didn’t have much of his own experience to draw from, so we kind of learned together. The first time he told me he trusted me, just an off-handed comment he made in one session, was like a huge weight being lifted. I mean, I had used so many people, lied, stole, cheated, begged and borrowed from every living sole I knew. So to have someone say they trusted me after only being on Subs for about 4 or 5 months made a huge impact on me.

I was lucky enough that I had a doctor who I trusted, and who trusted me. We worked on my recovery together. He didn’t pressure me to wean down, and always left it up to me. Every session he would ask if I was ready, I was always honest enough to say yes or no.

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