Serotonin OTC: The Latest in Mental Health Nutraceuticals

Jaclyn Engelsher DNP, APRN

Background

Ashwagandha (withania somnifera)

Gamma-Amniobutyric Acid (GABA)Rhodiola rosea

References

The U.S. vitamin and supplement industry grosses nearly $30 billion per year with a growing number of products targeted to the prevention and alleviation of mental health related conditions. Although the industry is regulated by the FDA and products must adhere to Good Manufacturing Practices (GMP), broad claims of efficacy are not subject to scientific validation.

Nutraceuticals include dietary supplements and functional foods that provide health benefits and nutritional value. Nutraceuticals are advertised as natural alternatives or augmenters to standard psycho-pharmacy. Consumer interest, desire to decrease pill burden, and product proliferation in the marketplace have encouraged increased research to substantiate health claims, determine potential medication interactions, and provide a basis for recommendation. Consumers who self-treat with nutraceuticals may experience a measurable benefit, but also put themselves at risk for deleterious outcomes.

This presentation provides an overview of the functions, indications, precautions, and dosages for ten common and novel mental health focused nutraceuticals.

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Amino acid derivative; CNS primary inhibitor; enhances alpha waves; increases human growth hormone production

Promotes relaxation and positive mood, reduces tardive dyskinesia; improves sleep quality; ADHD

Enhanced utilization with cofactor B6Does not fully cross blood brain barrier200-1000mg dailyAdditional sources: Valarian root, Kava Kava,

tomatoes, and black or green tea due to high theanine content

Increases synthesis of serotoninDepression, anxiety, moderate food cravings and appetite, fibromyalgia Derived from the griffonia simplicifolia seed, 5-HTP crosses the blood-brain barrier more efficiently than amino acid precursor tryptophanContraindicated with concurrent use of SSRI and MAOI medications and St. John’s wart50-300mg daily, requires dose tapering to initiate and discontinueAdditional sources: Poultry, red meat, fish, eggs, nuts, seeds, legumes, & other foods high in tryptophan

Antioxidant; hepatoprotectant; dopamine & serotonin agonist; facilitates melatonin synthesis Depression; ADHD; fibromyalgia; improve cognitive function; alcoholic liver injuryImproved efficacy with cofactors B12 and Folate (5MTHF); similar in effect to TCA though better toleratedAvoid concurrent use of SSRIs, TCAs, MAOI, L-Dopa, dextromethorphan, & meperidine. May exacerbate Parkinsonian symptoms and manic/anxious symptoms of bipolar200-1600mg daily; requires dose tapering to initiate and discontinue

Amino acid; antioxidant - reactive oxygen species scavenger (ROS) decreases oxidative stress; modulates dopamine release and glutamate levelsAdjunctive treatment for depressive symptoms of bipolar; slow neurodegeneration in Alzheimer’s dementia; OCD manifestations; antipsychotic-induced tardive dyskinesia No drug interactions or special precautions known2000mg daily

Plant sterol; stimulates HPA-AxisSSRI-induced sexual dysfunction; reduces anxiety; and depression in menopausal women Contraindicated with elevated PSA and hormone-based cancers500-155 mg daily standardized root extract; raw root may also be cooked and eaten or fermented into a drink

Adaptogen; anxiolytic, improves adrenal catecholamine; increases blood-brain barrier permeability to neurotransmitter (NT) precursors Moderate symptoms of stress related to fatigue, memory, concentration; improve recovery, endurance, and coordination; enhance cognitive functionAvoid concurrent use of antiarrhythmic & adrenergic-blocking medication 100 – 400mg daily (standardized extract 3% and rosavins 1% salidrosides)

Amino acid; precursor for thyroxine and catecholamine NTs including l-dopa, dopamine, norepinephrine, & epinephrinePromote cognitive function and memory under stress, and attention in ADHD with NT metabolism impairmentContraindicated with L-dopa; caution with concurrent use of thyroid medication600-2400mg daily – frequently combined with other amino acid formulations

Antioxidant effect in the hippocampus, frontal cortex, & striatum; ROS scavenger, decreases cortisol; anxiolytic; noortopic ADHD; improved retention of new information, memory consolidation, & visual processing, enhance cognitive function, stress reductionCaution with concurrent use of sedatives & T4 stimulating drugs200-600mg daily (standardized extract of 20% bacosides)

Mineral salt; unique form crosses blood-brain barrier to increase synaptic density in hippocampusImprove learning ability and memory; slow cognitive impairment in early Alzheimer’s disease; decrease anxiety; insomnia Take separate from bisphosphonate medications; caution with potassium-sparing diuretics and antibiotics1000-2000mg daily, sold under proprietary name Magtein™

L-Tyrosine

Magnesium-l-threonate

Bacopa monniera

N-Acetyl Cysteine (NAC)

5-hydroxy-L-tryptophan (5-HTP)

S-Adenosyl-Methionine (SAMe)

Maca Root (Lepidium meyenii)

Adaptogenic; maintains adrenal cortisol activity & c-reactive protein levels; stimulates formation of T4Stress-induced illness, promote relaxationContra-indicated with immunosuppressant drugs and nightshade allergy; caution with thyroid & sedative medications500-1500mg daily (2.5% standardized root extract)