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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Tomatheus on February 26, 2014, at 23:06:45
I just came across this recently published study on the role that vitamin D has on serotonin synthesis. I'm only able to access the study's abstract, and the study seems to focus on autism, but I think that the study's findings could be of interest to anyone who either has a vitamin D deficiency or insufficiency or anyone who has a disorder in which disturbances in the serotonin system have been implicated. It seems that the study found, among other things, that vitamin D activates the tryptophan hydroxylase 2 gene in the brain but represses the tryptophan hydroxylase 1 gene outside the blood-brain barrier. So, if my understanding is correct, the more vitamin D we have, the more serotonin gets synthesized in the brain, and the less serotonin gets synthesized outside the blood-brain barrier. Here's a link to the abstract:
http://www.fasebj.org/content/early/2014/02/14/fj.13-246546.abstract
Tomatheus
Posted by Tomatheus on February 27, 2014, at 0:46:32
In reply to Interesting study on vitamin D, serotonin, posted by Tomatheus on February 26, 2014, at 23:06:45
Here's a news article on the study that I linked to in my previous post:
http://www.dailycal.org/2014/02/25/researchers-verify-link-vitamin-d-potential-autism-cure/
It might also be worth mentioning that vitamin D has been found to boost the expression of the tyrosine hydroxylase gene (which helps to synthesize dopamine, norepinephrine, and adrenaline), and it's also been found to boost the activity of the choline acetyltransferase enzyme (which helps to synthesize acetylcholine). So, in addition to helping to synthesize dopamine, norepinephrine, adrenaline, and acetylcholine, it seems that there is now evidence to support the idea that vitamin D helps to synthesize serotonin, at least in the brain. That's assuming that I'm understanding all of this correctly.
Tomatheus
Posted by bleauberry on March 1, 2014, at 12:33:18
In reply to Interesting study on vitamin D, serotonin, posted by Tomatheus on February 26, 2014, at 23:06:45
I find that totally fascinating and here is why.
I used to try 5htp and trytophan supps. The problem was, it was all going to serotonin in my body but not my brain. Even at low doses I got the same side effects you would get from high dose SSRI. There were no brain effects at all.
Well, I did not know it at the time, but due to ongoing undiagnosed Lyme disease my vitamin was very low. Anyone with low D, it's low for a reason and it's probably an infection you aren't aware of.
Hmm. Well, labs last week showed that for the first time in years my Vit D is back in the normal range, after intense antibiotics and high dose D for many months.
Does that mean I am going to run out and try an SSRI or 5htp to see if things are different now? More brain serotonin?
Answer: NOOOO!!!!!!!!!
:-)
Posted by Tomatheus on March 1, 2014, at 14:28:21
In reply to Re: Interesting study on vitamin D, serotonin, posted by bleauberry on March 1, 2014, at 12:33:18
Bleauberry,
Thanks for responding. Yeah, with no offense meant to anybody, I think it would be kind of silly to go get a prescription for an SSRI or to get some 5-HTP for more brain serotonin when you quite possibly could have already gotten to the root of why serotonin might have been low in the brain (and that's *if* it was low) by taking vitamin D. Of course, if your vitamin D level is back to normal, and you're doing well, it would make no sense to go messing with something that no longer needs to be messed with.
And of course, even though the study that I posted found that vitamin D modulates enzymes involved in serotonin synthesis, there's a lot more than just serotonin that vitamin D affects. I mentioned the vitamin's (or hormone's) effects on the synthesis of dopamine, norepinephrine, adrenaline, and acetylcholine in another post -- and these neurotransmitters are all relevant to mental health and illness -- but in actuality, vitamin D has been found to influence more than 200 genes in the body. So, yeah, I suppose that if a person has a vitamin D deficiency or insufficiency, the person could just address the possible "imbalances" in serotonin, but it does of course make more sense if a person has a vitamin D deficiency or insufficiency to address the vitamin D problem instead of just treating one of its many effects.
As far as why vitamin D is low is concerned, I wouldn't rule out the possibility that an infection might be causing it, but I think that there's a good chance that many individuals with low vitamin D levels became that way because they largely cut themselves off from the main source of vitamin D, namely the sun. I've been found to have a vitamin D insufficiency, and I've usually attributed the onset of my psychiatric symptoms to the fact that I deprived myself of sleep over an extended period of time during my third year of college. I would also say that my symptoms seemed to intensify when I had a job that involved working the overnight shift. I didn't sleep at night when I worked that job, which of course meant that I slept during the day, when I could have otherwise been spending at least some time outside absorbing the vitamin D-producing UVB rays of the sun. After that point, I started sleeping excessively, sometimes during at least some of the peak vitamin D hours of 10 a.m. to 3 p.m. That probably caused my vitamin D level to drop further, worsening my symptoms and creating a vicious cycle.
At any rate, although we may have differing opinions as to what causes vitamin D levels to drop in individuals with deficiencies or insufficiencies of the vitamin-hormone, we seem to be in agreement that if someone is low in vitamin D that something needs to be done to bring that person's vitamin D level back up into the healthy, normal range. I don't think that vitamin D is benign with respect to its effects on mental health, and even though studies on the effect of vitamin D supplementation in clinically depressed patients have yielded mixed results (possibly because some of the studies were too short), I do think that vitamin D is turning out to be a big piece of the mental illness puzzle.
Anyway, I hope I didn't carry on for too long. Take care, Bleauberry. I wish you continued good health, mental and otherwise.
Tomatheus
Posted by herpills on March 1, 2014, at 18:29:37
In reply to Interesting study on vitamin D, serotonin, posted by Tomatheus on February 26, 2014, at 23:06:45
Thanks for posting this.
Are you still supplementing with vitamin D? My new primary care physician tested mine not too long ago, and it was low, 28 (I'm not sure what the number means, but was told it should be at least 50)
So I've been instructed to take 4000IU which I have been doing for about 6 weeks. I was told it will take several months to get it back to normal range.
Last summer I was very depressed and stayed indoors most of the time. I'm hoping to get out more this summer and soak up all that vitamin D!
Posted by Tomatheus on March 1, 2014, at 20:18:18
In reply to Re: Interesting study on vitamin D, serotonin, posted by herpills on March 1, 2014, at 18:29:37
Herpills,
Thank you for your message. I am still (or perhaps I should say "once again") supplementing with vitamin D3. I've started and stopped supplementing with the vitamin a few times now, with my longest stint on vitamin D3 lasting 3.5 months and my current trial lasting about a month. I'll probably write an update on my vitamin D thread further up on this board soon, but I will say here that since the last time I posted to my vitamin D thread, I've increased my dose twice: first from 1,200 IU to 1,600 IU, and then from 1,600 IU to 2,000 IU. My symptoms haven't been perfectly consistent since I've started taking vitamin D3 again most recently, but my energy, concentration, overall cognition, and time spent asleep (less being better for me because I experience hypersomnia) have all been better than how they are when I'm just taking Abilify (or just Abilify with niacin). So, I seem to be responding positively at this point. I do intend on staying on vitamin D3 for at least six months (maybe even a year or longer) even if I don't continue to respond positively, just in case it might take a really long time to see a full response to supplementation.
Do you happen to know which unit of measurement was used when your vitamin D level was measured? According to Michael F. Holick, Ph.D., M.D. (2010), a vitamin D level of 28 ng/mL would be considered to be insufficient -- assuming that your lab used ng/mL as the units of measurement. Mine was 21.9 ng/mL when I had it tested about a year ago, which also falls into Dr. Holick's insufficient range. Basically, levels below 20 ng/mL are considered to indicate a deficiency, levels between 20 and 30 ng/mL are considered to indicate an insufficiency, levels between 30 and 100 ng/mL are considered to be in the "reference range" (with 40 to 60 ng/mL being "ideal," at least according to Dr. Holick), levels between 100 ng/mL and 150 are considered to be high, and levels above 150 ng/mL are considered to indicate vitamin D toxicity (Holick, 2010). However, considering that you were told that your vitamin D level should be at at least 50, I think that there's a good chance that your lab might have used a unit of measurement other than ng/mL. Using ng/mL, a vitamin D level of 50 would be right in the middle of Dr. Holick's "ideal" range, which is what I'm aiming for myself.
So, have you noticed any improvements that you might be able to attribute to vitamin D supplementation so far? I too have read that it can take several months (at least six, maybe up to a year) to get vitamin D levels into the normal range, and a lot of what I've read suggests that improvements in well being don't typically occur until the same amount of time has passed. That's not to say that nobody could experience a therapeutic response sooner, but I do think that generally it takes some time to get true results from vitamin D supplementation (both as far as getting up to an ideal level is concerned and as far as getting therapeutic benefits is concerned). And that makes me hope that I (and you) will respond in the long run, because if I don't, I can't help but think that I might be left with this feeling that I've wasted too much time chasing a response that I couldn't get. Still, though, supplementing with vitamin D is thought to have a range of potential health benefits, so even if supplementation doesn't help with my mental illness symptoms, maybe I'll be able to say that I've improved my overall health.
At any rate, this message is getting kind of long, so I'm going to wrap things up for now. I wish you luck with your vitamin D trial, and I'd of course like to encourage you to let us Psycho-Babble members know how you do with the vitamin as you go further into your trial.
Take care,
Tomatheus==
REFERENCE
Holick, M.F. (2010). "The Vitamin D Solution" . New York: Hudson Street Press.
Posted by bleauberry on March 2, 2014, at 15:42:45
In reply to Re: Interesting study on vitamin D, serotonin » herpills, posted by Tomatheus on March 1, 2014, at 20:18:18
My vit d has been measured several times throughout the last few years. It was very low the whole time. Modest attempts to raise it didn't do much. It's sort of like trying to turn the titanic. Slow. Anyway, at 6 months of doing 5000iu per day, I am now in normal range.
Well, disclaimer, I do not trust that word normal or the word range, because both are subjective and based on general population trends not based on individual patients.
I do not believe vit d by itself or as a primary weapon is going to be all that helpful. It will be for some, everything is, but for the most part probably not. It is however a crucial link in the chain. If that link is broken, a whole bunch of other links break too.
I heard that merely 10 to 20 minutes of sun on the skin is all it takes to get the vit d we need? Yes? No? Anyone know? I think the only way to really know is to measure it. It's an easy test.
Infection is the primary cause. imo I learned that from my docs but didn't believe them. I learned in on patient blogs. I didn't believe them. I read it in magazines. I didn't believe them.
Ho hum. Learned the hard way I did.
Posted by Tomatheus on March 2, 2014, at 16:06:53
In reply to Re: Interesting study on vitamin D, serotonin, posted by bleauberry on March 2, 2014, at 15:42:45
Bleauberry,
You could be right in what you say. I think that the most important thing is that what you're doing seems to be working for you. Again, I wish you continued good health.
Tomatheus
Posted by Tomatheus on March 2, 2014, at 16:31:55
In reply to Re: Interesting study on vitamin D, serotonin, posted by bleauberry on March 2, 2014, at 15:42:45
As far as the amount of vitamin D that we need is concerned, my understanding is that what you said is generally correct, but that factors such as latitude, age, and skin type can influence how efficiently we make vitamin D from the sun. It's also my understanding that we make vitamin D much more efficiently during the peak vitamin D hours of 10 a.m. to 3 p.m. than we do outside of those hours and that those of us who live at higher latitudes get practically no vitamin D from the sun during the winter. So, I do think that staying up during late-night hours and consequently sleeping during peak vitamin D hours can seriously hamper a person's ability to get his or her needed vitamin D. At least that's my understanding.
Tomatheus
Posted by herpills on March 4, 2014, at 19:35:01
In reply to Re: Interesting study on vitamin D, serotonin » herpills, posted by Tomatheus on March 1, 2014, at 20:18:18
Well I think we are talking about the same measurement, as the 30-100 reference range is something I recall seeing on the lab results. As to why my doctor felt that it should be at least 50, he did not go into further detail.
As far as how I'm feeling...I think its too early to tell how it will impact my treatment. I do think that since it is so low, and I have tolerated the 4000IU without problems, I'm certainly going to continue with it for the time being. I do feel slightly better than I did 6 weeks ago, but this could be due to multiple factors. I doubled my dose of omega 3 from 2g to 4g the same time I started the vitamin D. I aslo discontinued a medication, Lyrica, which turns out was making my mood worse. It was subtle at first and I didn't realize the negative effect it was having on me.
I am taking Lamictal for depression but I really feel that it has "pooped out" on me. At one time in my life it was one of the best meds I've ever been on, I went a good two years or so without any symptoms. I'm probably going to go back on an antidepressant because the symptoms right now are really affecting my quality of life.
I'd love to be able to fight this with all "natural" treatments but I've come to the conclusion that I think an integrative approach combining alternative and traditional psychiatric treatments is going to give me the best chance at remission. And I'm glad I've finally found a primary care physician who is willing to help me in that area and not just hand me a psych script and send me on my way. It gives me hope.
I agree with bleauberry that vitamin D probably isn't going to make a huge difference on its own, but for me it is part of a plan to get my body in an optimal state so that my brain starts to feel better! I do believe that psych meds have the potential to work better when nutrition and other such factors are optimized.
Posted by Tomatheus on March 4, 2014, at 20:41:34
In reply to Re: Interesting study on vitamin D, serotonin » Tomatheus, posted by herpills on March 4, 2014, at 19:35:01
Herpills,
Thank you for your reply. It's good to hear that you seem to be feeling at least a little bit better than how you were feeling before you started supplementing with vitamin D, and I also think that what you wrote about the slight improvement that you've noticed being due to multiple factors makes total sense. And I think that what you wrote about it being too early to tell how vitamin D might affect your treatment also makes sense, especially given the fact that the vitamin seems to have a long half-life in the body and that there seems to be some information indicating that a good response to vitamin D can take some time. I do, of course, hope that the vitamin will end up having a clear, positive effect on your mood, along with the other treatments that you're utilizing.
==
> I'd love to be able to fight this with all "natural" treatments but I've come to the conclusion that I think an integrative approach combining alternative and traditional psychiatric treatments is going to give me the best chance at remission. And I'm glad I've finally found a primary care physician who is willing to help me in that area and not just hand me a psych script and send me on my way. It gives me hope.
I like what you wrote here about combining alternative treatments with traditional ones. I too take a psychiatric medication in Abilify, and although I would love to eventually be able to discontinue it (mostly because of side effects), I think that I'd likely be a wreck without it at this point, and the same may continue to be true six months down the line, a year down the line, or even longer. I don't know how well vitamin D3 is going to help me in the long run, and even though I have some reason to think that vitamin D plays a role in the development of mental disorders (especially schizophrenia and clinical depression), the evidence that the vitamin can work as a treatment isn't so strong at present. So, even though I think it's smart to use vitamin D as a treatment for cases of mental illness that involve vitamin D deficiency or insufficiency, I think that combining vitamin D supplementation with traditional mental health treatments is even smarter.
Here's to hoping that your treatment regimen will serve you well.
Tomatheus
Posted by SLS on March 5, 2014, at 8:02:14
In reply to Re: Interesting study on vitamin D, serotonin » Tomatheus, posted by herpills on March 4, 2014, at 19:35:01
Sorry for the temporary deviation from alternative treatments.
You could try adding Wellbutrin to the Lamictal if you want to avoid a serotonin reuptake inhibitor at this time. My doctor likes this combination. The two drugs might act together to boost dopamine.
No antidepressants: I know someone who does well when she combines Lamictal, Abilify, and minocycline. Her depression resolved completely within a few days of adding the minocycline.
Everyone is so different.
Anyway, good luck with the D3.
Just as an aside, I react instantly to large doses of calcium by becoming more severely depressed. Magnesium for me is a better choice. The two ions oppose each other at the synapse. I really haven't thought about which neurotransmitters are likely to be involved. I would guess that glutamate is one.
- Scott
Posted by herpills on March 11, 2014, at 10:19:20
In reply to Re: Interesting study on vitamin D, serotonin » herpills, posted by SLS on March 5, 2014, at 8:02:14
Thanks, Scott. I have an appointment with a new provider on Friday. I think I'm done with antipsychotics for now. Abilify didn't really help me, and I was on Lamictal at the time. I'll keep Wellbutrin in mind.
What is your opinion of mirtazapine?
Posted by SLS on March 12, 2014, at 15:06:00
In reply to Re: Interesting study on vitamin D, serotonin » SLS, posted by herpills on March 11, 2014, at 10:19:20
> Thanks, Scott. I have an appointment with a new provider on Friday. I think I'm done with antipsychotics for now. Abilify didn't really help me, and I was on Lamictal at the time. I'll keep Wellbutrin in mind.
>
> What is your opinion of mirtazapine?
NE = norepinephrine
5-HT = serotonin
DA = dopamineFor some people, it is a miracle.
Mirtazapine (Remeron) is very different from SSRIs, SNRIs, and TCAs. It is different enough that it might be worth trying. It is the only antidepressant in the USA to act as an antagonist (blocker) at the NE alpha-2 presynaptic autoreceptor (Mianserin is still available in Europe). When blocked, the neuron is told to manufacture and release more NE. NE is usually considered to be a excitatory neurotransmitter. It can be activating. Remeron also blocks 5-HT2a, 5-HT2c, and 5-HT3 receptors. Blocking the 5-HT2a/c receptors increases NE activity. 5-HT2a blockade also increases DA activity.
The problem with the way many doctors use mirtazapine for depression is that they don't prescribe a dosage high enough to block sufficiently the activating NE receptors. Lower dosages are soporific and sedating because mirtazapine is a potent antihistamine. People sleep and eat too much on low dosages of mirtazapine (15-30 mg/day) because of this. For many, mirtazapine at low dosages makes for a good sleeping-pill, but not an effective antidepressant. At higher dosages (45-90 mg/day), antidepressant effects emerge and the sleepiness and increased appetite often mitigate.
Mirtazapine can be a great adjunct to SRIs (SSRIs and SNRIs) because of its ability to block the 5-HT2 receptors. Without this blockade, 5-HT can flood these receptors and suppress NE and DA activity downstream in areas thought to be involved in depression (prefrontal cortex, nucleus accumbens, and hippocampus). This probably explains the amotivation and apathy that can occur with SRI drugs. Does mirtazapine reverse these unwanted behavioral effects? I don't know. It may not if the apathy is an effect of 5-HT2b activation.
In a very few people, mirtazapine exacerbates their depression. It does mine. I attribute this to its antagonism of NE alpha-2 autoreceptors. Latuda and Saphris are both antipsychotics that block these receptors. I did not react well to these drugs at all. I had a difficult time rejecting suicidal ideations while taking Latuda.
It is reasonable to try mirtazapine if you have not responded well to other classes of medication. If you are already taking a SRI, you could even add mirtazapine rather than switch. I would just make sure that your doctor is willing to go up to at least 60 mg/day of mirtazapine before beginning treatment.
- Scott
This is the end of the thread.
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