Can These Supplements Trigger a Manic Episode?
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Q:  I am wondering if the following supplements can trigger a manic episode:


Thank you in advance for your guidance,


Dear Ms. K' -- 
5HTP, yes:  as you know it's a precursor to serotonin production and can work somewhat like the serotonin-reuptake-inhibitor antidepressants, increasing the amount of serotonin your neurons see.  Thus like any antidepressant, there is a risk there, just reasoning from the chemistry of it.  Searching "5-HTP mania" on PUB MED did not turn up case reports, but the same search on Google yielded many links which cite mania as a risk of 5-HTP, though none offered a reference link (here's one of the better

Finally, because I can rarely hold back a comment in cases like this, may I wonder why you would be looking at adding "supplements" (an interesting term which I think might artificially lower the level of worry which should accompany adding anything to what one is taking) rather than approaches for which we have some evidence regarding benefit?  Granted that many "medications" have substantial risk, such as weight gain, but: a) at least we have evidence that they work, better than a placebo (for those medications for which we have placebo-controlled trials, e.g. as shown in this table of mood stabilizers); and b) we often have a pretty good idea of just what the risks are, and it seems that virtually all the medications do indeed carry some risk of some sort of side effect at least, if not long-term risk.  

I can understand the wish to avoid known side effects.  I can understand the wish to use something which appears to be simple.  I can understand the wish to use something more relatively "natural", compared to some synthetic "chemical".  Your question led to some surfing around sites offering 5-HTP, and I can see there how simple the whole process looks, compared to trying to get an appointment with a doctor, and paying the co-pay and/or dealing with your insurance, or maybe not having that option at all.  

But I worry that these understandable wishes cloud peoples' judgment about risk and benefit.  My strong preference (sorry for the knee jerking here; I know you weren't asking for this part), to put it mildly, is to use agents for which we have some evidence of benefit, let alone risk.  Careful not to get lulled into thinking it's safe in any respect (and good on ya' for considering effect on cycling) because it's a "supplement".  

Dr. Phelps

Published September, 2003 


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