23 replies to this topic

[sk8rmama24]

I really don't take supplements often, I had generally been pretty healthy before, but now I am getting older and having more issues with my health.  As for tapering of duloxetine, it has left me with a rather undesirable symptom...neuropathy.  So, in an effort to ease some of the symptoms associated with neuropathy, I did some research, found a few recommended vitamins, minerals, supplements, etc, so I thought I would share some of what I have found.

 

Omega 3 Supplements

I have taken these before, and researched the optimal doses and formulations for Omega 3s as they related to being used to augment treatment for depression or ADHD.  This supplement also seems to help with brain zaps from what I have read on other forums.  The ratio of EPA/DHA has been examined and found to be pretty important in the overall efficacy of the supplement.  These are the two Omega 3 supplements I have selected for 1) most cost effective, 2) most potency in smallest possible dosage, 3) optimal EPA/DHA ratio and 4) least fishy smell and burpless.  I prefer the Bioscience Nutrition brand.  I am sure there are other good formulations available, but these are ones I use.

• Bioscience Nutrition (now Arazo Nutrition) Triple Strength Omega 3 Fish Oil: 2250mg omega 3s (1200mg EPA/900mg DHA) - 3 softgels
• Bronson Omega 3 Fish Oil Triple Strength: 2720mg (1250mg EPA/ 488mg DHA) - 2 softgels

Neurovascular Support/Nerve Health/Brain Health Supplements

There are a variety of supplements out there formulated for nerve health and to ease neuropathy.  I did a search for recommended and effective supplements and looked up information regarding each component of a neuro-health supplement.  The top most recommended components include:

• alpha lipoic acid (generally safe evaluated dose for neuropathy-600mg)
• benfotiamine (B1 vitamin) (generally safe evaluated dose- 300-600mg)
• acetyl L-carnitine (generally safe evaluated dose - 500mg)
• N-acetyl Cysteine (1200mg 1-2 times a day, start lower and increase)
• resveratrol (dose clinically evaluated from 500-1000mg, side effects at higher doses)
• evening primrose oil (recommended dose-500mg)
• curcumin (recommended dose- 500-1000mg, start lower and increase, do not take within 4 hours of medications, multiple precautions)

The different formulations also contain B vitamin, calcium, magnesium, chromium, glucosamine, etc.  Dosages and ingredients really vary by manufacturer, and I am still researching the most cost effective formulation in this category, I will post my findings later.  Before taking any formulated supplement, ALWAYS READ THE INGREDIENTS AND DOSES!  There is such a broad array of formulations, some contain subtherapeutic doses, some contain an excess in doses, and if you take multiple supplements or vitamins, double check the total dose you are consuming with all supplements because many formulations contain B, D, C, calcium, magnesium.  Some excess vitamin or mineral may be excreted as unused waste, but some become toxic at higher doses or require blood concentration monitoring.

 

https://www.salubrainous.com  has a good and easy to read explanation, scientific references, and precautions for various supplements. I found it useful.

 

Vitamins and Minerals

There are also some recommended vitamins and minerals for neuro, immune and metabolism/mithochondrial health.

• B vitamins
  • ​​B1, B2, B3, B5, B6, B7, B9, B12 (may interact with certain medications, verify interactions)
  • Combination (B1, B6, B12) helps relieve neuropathic pain (B6 is toxic at 1000mg per day, must use less than 100-200mg per day)
  • B12 can reverse neuropathy and support clinical recovery (dose range 20-1840mcg cyanocobalamin or 4-1500mg methylcobalamin)
• D Vitamins (D2, D3)
  • supplementation is only beneficial for deficiency. do not supplement long-term as it may cause toxicity
  • maintain calcium and magnesium levels
  • 1000-2000IU per day, more than 2000IU and blood levels should be monitored
  • D3 is preferred over D2
• Magnesium
  • combination with B, C, E and Zinc (also omega 3s) help alleviate neuropathy
  • dose range 250-500mg start lower and increase
  • dose differs based on type (magnesium oxide, magnesium citrate, magnesium gluconate, etc.)
  • magnesium oxide has less absorption and bioavailability
  • magnesium citrate also used as a laxative
  • most common side effect is laxative due to nonabsorption, choose type that works for you
  • interacts with many medications, verify interactions

I am still selecting vitamin and mineral brands.  Vitamin C + Zinc is an available formulation as well as a Calcium+Magnesium+Zinc+D3 formulation.  I need to check formulation concentrations and compare the costs of buying a formulated mix to the cost of buying each supplement as a stand-alone.

 

I am also stopping my usual multivitamin to prevent possible overdose on any of the above listed supplements.  I am creating a supplement regimen specifically to alleviate the neuropathy and withdrawal symptoms I am experiencing with the duloxetine taper.  Once I have completely stopped duloxetine and my neuropathy has improved, I will return to my previous supplement regimen of a multivitamin and Omega 3.  I use the Twice-Per-Day multivitamin by LifeExtension, it is the most potent and broad spectrum multivitamin I found containing recommended doses for the majority of vitamins and minerals, plus some super-food extract combinations.

 

When verifying potential drug interactions when using supplements, also check to see if there are any physiological interactions.  Some supplements will decrease blood sugar which is a concern for diabetics, or decrease blood pressure, or have an anti-coagulant effect and increase the possibility of bleeding.  Make sure to inform your doctor, and when having surgery, it is recommended to stop using most supplements for at least 2 weeks prior to the surgery.  Also check supplements for compatibility, as some are powerful antioxidants, and if used with other antioxidants, the doses should be reduced.

[fishinghat]

A good deal of work there Sk8.
 
Some notes.
 
Omega 3 - Good info. There is also enteric coated Omega 3 to help avoid stomach upset.
 
Neurovascular -
B1 - Note - Use of thiamine supplements may increase gaba concentrations in the brain but it may also increase acetylcholine. This may account for the variety of responses by members.

B1 (thiamine) is the most active form is thiamine pyrophosphate (TPP), a coenzyme in the breakdown of sugars and amino acids. Synthetically thiamine is usually marketed as thiamin hydrochloride or thiamin mononitrate and is a made from Grewe diamine (a coal tar derivative) processed with ammonia and other chemicals.

Vitamin B1 toxicity is very rare but supplements can lower other vitamins.

B3 - The FDA does not recommend the taking of vitamin B3 supplements due to its toxic effects on the liver if taken over the RDA.

Taking niacin also might worsen allergies, gallbladder disease and symptoms of certain thyroid disorders. If you have diabetes, niacin can interfere with blood glucose control. Use niacin with caution if you have the complex form of arthritis gout. Niacin can cause an excess of uric acid in the blood (hyperuricemia), putting you at risk of gout. (Mayo Clinic)

B5 -Extremely high doses have been found to produce panic attacks. Synthetic pantothenic acid is processed with formaldehyde (a strong cancer causing agent. It exists in 2 other forms; pantotheno and calcium pantothenate.
 
B6 -The RDA is 1 – 3 mg/day. Doses of pyridoxine in excess of the RDA over long periods of time result in painful and ultimately irreversible neurological problems. There are 7 forms; Pyridoxine (most common), Pyridoxine 5'-phosphate, Pyridoxal, Pyridoxa 5'-phosphate, the metabolically active form (sold as 'P-5-P' vitamin supplement) Pyridoxamine (PM), Pyridoxamine 5'-phosphate (PMP) and 4-Pyridoxic acid (PA). Due to its half life of up to 25 days it is easy to buildup toxic amounts in the blood stream. Vitamin B6 toxicity is on the rise in the USA. The FDA recommends that supplementation does not exceed 3 mg per day with blood tests every 6 months.

Vitamin B6 Toxicity
 
Note - A search of vitamin B6 supplements on Amazon shows that many supplements currently on the market are well above the recommended dietary allowances. The long half life (see below) allows for toxic levels to build rapidly.

Cin - a good mult-vitamin, but don't overdo it on the B vitamins (even though they are water soluble, I actually got vit. B6 toxicity and that caused some nerve issues that I'm not sure will ever completely reverese),

FH - My wife developed Vitamin B6 toxicity by taking a stress tab with 5 mg dose once a day for several years. The dr said it would take her 6 months to recover and that recovery may not be complete.

https://www.ncbi.nlm.../pubmed/6308447
We describe seven adults who had ataxia and severe sensory-nervous-system dysfunction after daily high-level pyridoxine (vitamin B6) consumption. Four were severely disabled; all improved after withdrawal. Weakness was not a feature of this condition, and the central nervous system was clinically spared. Although consumption of large doses of pyridoxine has gained wide public acceptance, this report indicates that it can cause sensory neuropathy or neuronopathy syndromes and that safe guidelines should be established for the use of this widely abused vitamin.

https://www.ncbi.nlm...ooks/NBK114313/
Half-Life is 15 to 24 days.

https://www.ncbi.nlm.../pubmed/3041185
Pyridoxine neuropathy.
A case of sensory neuropathy in a young woman due to long-term ingestion of pyridoxine, with subsequent recovery, is described. Pyridoxine neuropathy may occur after the long-term ingestion of doses as low as 200 mg a day. Because of its widespread use in the community, both the general public and the medical community need to be aware of this recently described complication of megavitamin therapy.

https://www.ncbi.nlm.../pubmed/3630649
A newly recognized neurotoxic syndrome due to pyridoxine (B6) overdose is described. It is the largest series of B6 intoxication hitherto reported. A raised serum B6 level was present in 172 women of whom 60% had neurological symptoms, which disappeared when B6 was withdrawn and reappeared in 4 cases when B6 was restarted. The mean dose of B6 in the 103 women with neurological symptoms was 117 +/- 92 mgs, compared with 116.2 +/- 66 mgs in the control group. There was a significant difference (P less than 0.01) in the average duration of ingestion of B6 in the neurotoxic group of 2.9 +/- 1.9 years compared with 1.6 +/- 2.1 years in controls. The symptoms were paraesthesia, hyperaesthesia, bone pains, muscle weakness, numbness and fasciculation, most marked on the extremities and predominantly bilateral unless there was a history of previous trauma to the limb. These women were taking a lower dose of B6 than previously described (1,2), which may account for the complete recovery within 6 months of stopping B6.

 

https://www.ncbi.nlm...pubmed/25056196

Vitamin B9 (folate) - Alcohol interferes with folate absorption. It also increases folate excretion through the urine.

D3 - May cause constipation, nausea and vomiting as these are symptoms of an allergic reaction that require immediate medical attention. If taking vit d3 you should have your calcium and D3 levels checked each 6 months. Long term use can cause hypercalcemia (too high calcium levels and low magnesium levels (hypomagnesaemia).

Vitamin C - Sensitivity to Vitamin C is fairly common with doses of 200 or more mg per day causing heart pounding, cardiac arrhythmias and flushing. Two of our members have experienced that condition.
 
Vitamin E - Supplementation may lower Vitamin K levels in the body which should be routinely monitored.

Magnesium - Supplementation can cause a decrease in calcium leading to hypocalcemia. Calcium and magnesium levels should be checked every 12 months if using supplements.

The most readily absorbed for is amino acid chelate magnesium. It is also very easy on the stomach and the risk of diarrhea is low.
 
Zinc -
Excess zinc...
⦁ Zinc may accumulate and cause acute kidney injury.
⦁ Those with haemochromatosis may absorb larger amounts of zinc.
⦁ Various pesticides contain zinc salts.
⦁ Compounds used to make paints, rubber and dyes may also contain zinc.
⦁ Zinc absorption from dandruff shampoos and denture creams. (numerous lawsuits pending)
⦁ Supplements
Increasing in occurrence.

⦁ People taking large amounts of iron supplementation (iron can interfere with zinc absorption).
Competition of minerals and vitamins in the body.

If you take a large dose of a mineral, it will compete with other minerals to reduce their absorption.

Doses of magnesium can also be relatively large and should, ideally, be taken apart from other minerals.

 

Magnesium competes with calcium for absorption.

If you take high doses of zinc long-term (50 mg or more per day for 10 weeks or longer ), be aware that it can cause copper deficiency, so you may need to supplement with copper as well.

Iron, copper and zinc are competitive for absorption.

The use of prescription drugs also helps in the deficiency of minerals. Antibiotics, Tylenol, Advil, Motrin, and aspirin all inhibit the absorption of minerals especially zinc, chromium and calcium.

Research has shown the best bioavailable minerals are amino acid chelated minerals.

Fiber which contains phytates, tea which contains tannins and rhubarb and spinach which contains oxalates are known as bad chelates. This is because phytates, tannins and oxalates bind the minerals in the body to themselves in the same way that amino acids do, this results in the minerals not being absorbed by the body but excreted instead.

Methionine effects the concentration of vitamin B6, B12, choline, folic acid and magnesium.

Vitamin C can enhance iron absorption from supplements and plant foods.

The fat-soluble vitamins (A, D, E and K) are likely to be better absorbed if taken with a meal that contains fats. In fact, one study found that taking vitamin D with dinner rather than breakfast increased blood levels of vitamin D by about 50%.

Moderate to large doses of fat-soluble vitamins reduce absorption of other fat-soluble vitamins - by about 10 to 50% - due to competition.

Absorption of vitamin K appears to be particularly reduced by taking other fat-soluble vitamins.

Vitamin A absorption is least affected and may actually be better absorbed when taken with vitamin E.

Taking vitamins D, E, or K several hours before or after other fat-soluble vitamins would seem to maximize their absorption.

Vitamin C can inhibit copper absorption, and too much copper can lead to vitamin C deficiency.

Zinc inhibits both copper and iron; magnesium, copper, iron and calcium all compete for absorption, so too much of one can lead to low blood levels of the others.

Taking antibiotics for a long time can also deplete the body's levels of several B vitamins. On the other hand, taking vitamin B-12 with the antibiotic tetracycline may interfere with the medication's absorption and effectiveness.

Weight loss medication that prevents your body from absorbing fat also prevents your body from absorbing fat-soluble vitamins.

Taking Magnesium with food can reduce the occurrence of diarrhea.

Taking iron with food can reduce the chance of stomach upset.

Be aware that vitamins and minerals can also affect the absorption and effectiveness of medications.

l-leucine was inhibited by l-valine, l-isoleucine and l-methionine

l-lysine was inhibited by l-arginine, l-phenylalanine and l-histidine.

Little or no competition was observed for the glycine uptake site

Many other amino acids compete with each other for absorption.

https://www.consumer...-take-vitamins/
https://www.livestro...other-vitamins/
http://www.foodminer...human-body.html
https://www.scienced...300962977903528

 

[fishinghat]

Oh yea, if you read the thread "and the answer to your question is....) in the Medical Support Section you will find this and 100s of other things dealing with supplements, OTC drugs, therapy, drugs, etc.

[fishinghat]

Sk8

 

If you don't mind I would like to incorporate some of your information in that thread. Is that OK?

[sk8rmama24]

Hi FH,

 

Sure, please feel free to use anything you find of value here in the other thread.  I did look at some of the other threads you suggested, and found some good information that I kept note of for my personal supplement regimen research.  I have picked through the website a little bit, but if anything was more than a year or two old with no current responses, I didn't spend a lot of time digging for information.  I've just been super busy since I posted the initial topic, so I hadn't had a chance to respond or update much.  I have narrowed down which supplements I am going to hone in on from the original list, and looked up suppliers and formulations, and am nearly close to determining the most cost effective approach to create a supplement regimen to help with my neuropathy symptoms.  I will update my progress as soon as I can, plus I will also include a recommendation that any supplement regimen that is being changed or started should be done so conservatively.  I am not going to begin all supplements at once, that is never recommended, usually the approach is take 1 type of new supplement (no more than 2) at a time for a week or two, to determine potential side effects or issues that could arise.  Plus many of the supplement doses I researched come with the recommendation to start with a low dose and increase over time, so this will be an involved process.  My initial plan is to restart Omega 3, add B12, then add the other vitamins or minerals one at a time, keeping the supplements with the most likely to cause unpleasant side effects based on dose or mixed formulations until towards the end.  I will only be on the regimen as long as necessary, up to 6 months maximum.  I've already made a calendar to chart out my daily duloxetine doses (yes, I have a spreadsheet as well, I entered all the info and it calculates my doses and bead counts automatically...I am a geek) and the duration it will take me to taper completely.  There is still room to adjust to 5% if 10% is too much for me when I hit 30mg, but I believe I can still accomplish coming off duloxetine completely within 6 months.

 

But I already cross checked all the ingredients and verified the total dose of each item that will be consumed daily.  B6 was a tricky one, many formulations tend to list it at a higher dose, so in order to keep the total daily dose well under 100mg, I opted to go with supplements that had the least amount of B6, even if the supplement didn't contain the desired dose for another ingredient I was looking at.  But less is generally better in most cases, and I am pretty methodical in my approaches.

Sk8

 

If you don't mind I would like to incorporate some of your information in that thread. Is that OK?

[fishinghat]

"I will also include a recommendation that any supplement regimen that is being changed or started should be done so conservatively. I am not going to begin all supplements at once, that is never recommended, usually the approach is take 1 type of new supplement (no more than 2) at a time for a week or two, to determine potential side effects or issues that could arise. Plus many of the supplement doses I researched come with the recommendation to start with a low dose and increase over time, so this will be an involved process."

Brilliant idea. I follow what the old time drs called the "tea cup/teaspoon" method. Yes, I am that old. Basically it goes....If the dr prescribes that you take a teacup full just start with a teaspoon full and slowly work your way up. And as an scientist we were always taught in college never change two things at once. If something goes bad, or even improves, you won't know which one was responsible.

 

You got it together girl. Keep us posted.

[sk8rmama24]

I am finally getting a chance to update my post.  There is currently a sale on a couple different brands of supplements in our local stores, they have a Buy One Get One deal, plus there were manufacturer coupons in the mail this week for the same brands.  So, I veered a bit off my original list and picked up a few supplements so I could start my regimen ASAP.  So, this is what the current regimen will consist of, until I get a little more income to spare.  The brands are Nature's Bounty, Nature Made, Sundown Naturals and Citracal.  The green tea extract (ECGC) is from BulkSupplements.  They gave me a free item in return for a review on Amazon, so I have about a 3 month supply of the green tea extract capsules since I only take 1 per day and the smallest product size was 100 capsules.  You can take up to 2 per day, but I don't want to overdo the caffeine and polyphenols because they can be bad for the liver.  The supplement is only supposed to be used for a maximum of 3 months as well to prevent liver damage.

 

I also take all my supplements with meals, even if not specifically recommended, because it is easier on my stomach.  I separated them out to take some in the morning with breakfast, and the rest in the evening with dinner.  I take my prescription medications in the morning first thing, and then make breakfast, then take the morning supplements.  The B12 I selected is actually a sublingual tablet, so it dissolves under the tongue.

 

 

1400mg Fish Oil softgel Omega 3 (900mg)

1 x AM /

1 x PM

500mg tablet Vitamin C 2 x AM 500IU Citracal-combined D3 and Calcium tablet Vitamin D3

1 x AM / 

1 x PM

630mg Citracal-combined D3 and Calcium tablet Calcium

1 x AM /

1 x PM

500mcg

tablet/

sublingual

B12 3 x AM 250mg tablet Magnesium 2 x PM 400IU Softgel capsule Vitamin E 1 X PM 400mg Combined ALA & ALC Capsule Alpha Lipoic Acid 1 x PM 800mg Combined ALA & ALC Capsule Acetyl-L Carnitine 1 x PM 500mg Green Tea Extract Capsule ECGC 1 x AM Dose/Serving Supplement form

Vitamin/Mineral/Antioxidant/

Herbal

# servings/dose and

Time of Day

 

So this is where I am at currently, the concentration of the supplements I take and how many servings of the supplement I take to get the desired target dose.  I'm currently on the lower end of recommended doses for neuropathy, so I will see how I am feeling in a few weeks and maybe increase some doses, or include the other supplements I have omitted from this regimen (e.g. resveratrol, evening primrose oil, N-acetyl cysteine, etc.)

 

On a positive note, I followed up with my primary doctor about my cholesterol levels and told her I was concerned my blood sugar was out of whack so I had started monitoring it at home, even though I am not diabetic.  They were pretty high at my physical 6 months ago, but she gave me time to bring it down through diet changes I had been implementing (but didn't stick with for more than a month).  I was pretty sure my numbers weren't great since I hadn't been able to lose any weight either, but surprisingly, my numbers went down.  My blood pressure was even a bit lower.  My doctor and I are pretty confident the numbers are due to my reductions in psychotropic medications since that is all I really changed.  So we are going to keep watching and see if the numbers improve further as I reduce medications even more.  The thing is, in 2012-2013, my routine physicals were great.  Sure, I had 20-30 extra pounds on me, but my blood-work was great, perfect health I was jogging 3 miles a few times a week, textbook blood-pressure and low resting heart rate, all was well.  But in 2014, when I was having extreme changes in my psychotropic meds, my body went haywire.  I gained a ton of weight, (20lbs in a month thanks to Seroquel alone), my blood sugar started creeping up, my cholesterol was insane, my blood pressure was pretty much in hypertension land and my heart rate was irregular, usually on the higher side with a resting rate of 100bpm most of the time with random tachycardia that usually landed me in observation in the hospital with a continuous ECG monitor and cardiac ultrasound, but they never could find out why my heart rate would spike, then come down eventually.  Tonight, my heart rate was 74bpm, which I swear is the lowest it's been in a long time.  So yeah, 4 years of messing around with these medications has really taken a toll on my metabolism and circulatory systems, so I am hoping to improve them again by getting off this crap (that didn't even work anyway).

[fishinghat]

"My doctor and I are pretty confident the numbers are due to my reductions in psychotropic medications since that is all I really changed."

Definitely possible. Some of the ADs will elevate blood glucose. (including Cymbalta)

It sounds like you are on the right track. It is such a shame all the nasty effects that the psych meds can have on us. Don't rush too much though. Slow but steady.

[brzghoff]

I started taking ashwagandha. As an adaptogen there’s evidence it helps level off/reduce levels of cortisol. A couple double blind studies to support that, not a lot of research, however. it seems that it wont eliminate low level anxiety but it does seem to impact the strong “spike” that i get when something triggers my anger. Takes a couple months for it to really kick in.

It doesnt seem to have any negative side effects, except for those with thyroid or other hormone disorders, not recommended, it can put levels out of wack. Also some evidence that those with auto immune disorders should avoid. Evidence suggests that ashwagandha actually strengthens the immune system - which would put those with auto-disorders out of wack.

[sk8rmama24]

Yeah, I had looked into ashwagandha, it seems to be an ingredient in many formulations for mood support.  I did have a supplement that was for adrenal support/stress reduction that I started to take, but I read that people that are allergic to ragweed should not take ashwagandha since they are from a similar family.  I stopped taking it because I do have a ragweed allergy, and have had reactions to supplements in the past, as well as some prescription medications.  I was able to take St. John's Wort for awhile, but then I started having symptoms of an allergic reaction, so I had to stop taking it before it became full blown anaphylaxis.  I am really sensitive when it comes to medicines or herbals (I am even allergic to marijuana) and tend to have the more adverse reactions and side effects, including the less common ones.  Keeps things interesting for my doctor I am sure.  Even mineral supplements can be challenging to incorporate, which is why I generally didn't take many before.  I learned the hard way that calcium can impact the efficacy of antidepressants.  I had been on Nexium for awhile because I was developing an ulcer, and that leaches calcium from your bones.  When I started getting pain in my hip bone/joint because of the calcium depletion, I stopped Nexium and added calcium, which caused an increase in my depressive symptoms.  But I digressed.  I end up getting the individual herbals instead of a formulated supplement because ashwagandha is very commonly used now.  My parents tease me about my make-shift pharmacy set-up for tapering the duloxetine capsule doses, and making supplement combinations.  I have the capsule holder, funnel, weighing boats, scoopula/spatula, empty gelatin capsules.  I don't have a micro-scale yet, but might get one eventually since it would be far easier and more efficient than bead counting.

I started taking ashwagandha. As an adaptogen there’s evidence it helps level off/reduce levels of cortisol. A couple double blind studies to support that, not a lot of research, however. it seems that it wont eliminate low level anxiety but it does seem to impact the strong “spike” that i get when something triggers my anger. Takes a couple months for it to really kick in.

It doesnt seem to have any negative side effects, except for those with thyroid or other hormone disorders, not recommended, it can put levels out of wack. Also some evidence that those with auto immune disorders should avoid. Evidence suggests that ashwagandha actually strengthens the immune system - which would put those with auto-disorders out of wack.

[fishinghat]

For those who are curious...

Ashwagandha (Withania somnifera )

https://www.webmd.co...ngredientid=953
https://www.ncbi.nlm.../?term=24458838
https://www.ncbi.nlm.../?term=24431513
https://www.ncbi.nlm...les/PMC3573577/

https://www.ncbi.nlm...pubmed/25405876
All five studies concluded that WS intervention resulted in greater score improvements (significantly in most cases) than placebo in outcomes on anxiety or stress scales.

https://www.ncbi.nlm...pubmed/26068424
Our results provide evidence indicating that key constituents in WS may have an important role in the development of pharmacological treatments for neurological disorders associated with GABAergic signaling dysfunction such as general anxiety disorders, sleep disturbances, muscle spasms, and seizures.

https://www.ncbi.nlm...pubmed/19718255
300 mg twice a day.
Final BAI scores (anxiety test) decreased by 56.5% in the Ashwagandha group. Significant differences between groups were also observed in mental health, concentration, fatigue, social functioning, vitality, and overall quality of life with the Ashwagandha group exhibiting greater clinical benefit. No serious adverse reactions were observed in either group.

http://www.ncbi.nlm....pubmed/24497737
250 mg 2x/day


http://www.ncbi.nlm....pubmed/24330893
500 mg/day for bipolar, effective.

http://www.ncbi.nlm....pubmed/23439798
Each capsule contained 300 mg of high-concentration full-spectrum extract from the root of the Ashwagandha plant. Each person took 2 capsules a day. The treatment group that was given the high-concentration full-spectrum Ashwagandha root extract exhibited a significant reduction in scores on all the stress-assessment scales on Day 60, relative to the placebo group. The serum cortisol levels were substantially reduced in the Ashwagandha group, relative to the placebo group. No serious adverse events were reported.

http://www.ncbi.nlm....pubmed/22546655
W. somnifera extract is effective in treating obsessive compulsive disorder

https://www.ncbi.nlm...pubmed/18697607
The results suggest the protective effect of WS in the management of ethanol (alcohol)withdrawal reactions.

https://www.ncbi.nlm...pubmed/17585686
Preliminary results suggest that Withania root extract can be used in the management sleep loss and associated oxidative stress.

http://www.ncbi.nlm....pubmed/19363747
Effective for anxiety

http://www.ncbi.nlm....pubmed/11194174
WSG also exhibited an antidepressant effect, comparable with that induced by imipramine in the 'behavioural despair' and 'learned helplessness' tests. The investigations support the use of WS as a mood stabilizer in clinical conditions of anxiety and depression

http://www.ncbi.nlm....les/PMC3252722/
It has a Cognition Promoting Effect and was useful in children with memory deficit and in old age people loss of memory. It was also found useful in neurodegenerative diseases such as Parkinson's, Huntington's and Alzeimer's diseases. It has GABA mimetic effect and was shown to promote formation of dendrites. It has anxiolytic effect and improves energy levels and mitochondrial health. It is an anti-inflammatory and anti-arthritic agent and was found useful in clinical cases of Rheumatoid and Osteoarthritis.

http://www.ncbi.nlm....les/PMC3487234/
1,250 mg/day × 10 days
All volunteers tolerated WS without any adverse event.
Safety and side effects


https://www.ncbi.nlm...les/PMC2958355/
250 mg twice a day.
At 6 weeks, significantly more patients met a priori response criteria in the drug group (88.2%) as compared with the placebo group (50%). The drug was well-tolerated and did not occasion more adverse effects than did placebo. It is concluded that this ethanolic extract of Withania somnifera has useful anxiolytic potential and merits further investigation.

https://www.ncbi.nlm...pubmed/28004351
This study provides scientific validation to the anxiolytic, anti-inflammatory and anti-apoptotic properties of ASH-WEX, which may serve as an effective dietary supplement for management of SD induced stress and associated functional impairments.

Members Comments
One member reported taking it during withdrawal and said it was very beneficial.
Brz - I started taking ashwagandha. As an adaptogen there’s evidence it helps level off/reduce levels of cortisol. A couple double blind studies to support that, not a lot of research, however. it seems that it wont eliminate low level anxiety but it does seem to impact the strong “spike” that i get when something triggers my anger. Takes a couple months for it to really kick in.
 

[fishinghat]

Sk8rmama brings up an interesting point on how one supplement can effect other supplements and conditions leading to a circular event. In the thread "and the answer to the question is..." there is a whole section about which supplements effect other supplements. It is interesting reading and explains why it is so hard to control supplement levels sometimes. She also brings up an issue of Nexium. The PPI (proton pump inhibitors, also known as acid reducers) effect the CPY systems in the stomach which are responsible for absorption of nutrients and medicines. You need to be very careful taking any PPI with medication. Please look carefully at your meds before taking a PPI. PPIs have been known to allow antidepressants to build in the body to toxic levels.

[brzghoff]

update on the ashwagandha... i was getting mildly noticeable results for anxiety/stress tolerance even though i was only on it for a week - i understand it takes a couple months to reach maximum effect. however, i developed a tight chest, scratchy throat, sneezing, congestion and watery eyes. sounds like allergies which sk8ermama24 indicated above. at the same time a respiratory virus has been circulating my workplace - i am the only one on my team of 10 people (we all sit and work closely together) who hasn't had to take sick days so far. i have a great immune system anyway so that is not too unusual. but i had been feeling like i was fighting something - but winning - even before starting with the ashwagandha.

 

i also do suffer from allergies and am usually able to tell the difference between a cold or allergies because with me, a cold causes itchy ear canals and allergies don't.  respiratory infections can create a tight/heavy chest but allergies don't either. after starting the "ash" the symptoms that started included the itchy ears and heavy chest. i also felt tired - don't get that with allergies - but then one of the side effects of the "ash" is mild fatigue. i've read some people do get a "tight" feeling in their chest with the "ash". 

 

so as you can see it could be one or the other <sigh> i stopped taking the "ash" now for seven days. the heavy chest cleared up after the 3rd day and so did the itchy ears, but my throat is still sore, i still sneeze a lot, have post nasal drip (source of the sore throat) all my normal allergies. i am waiting for all symptoms to clear up to re-start to see what evolves next. i have read that a tight chest is a side effect for those with an "ash" allergy - but its also a symptom of a respiratory infection. at this point i don't know if the symptoms cleared up as i "recovered" from a virus, or from an allergic reaction to the "ash". here in florida we're in the thick of allergy season - pollen has been really high for the past several months -  so its really hard to tell what's up. i did notice that after a few days off the "ash" i started feeling a bit of the jitters and the propensity for frustration/anger returning 

 

i'll keep ya'll posted because ashwagandha could really show promise for some. i've also been reading up on rhodiola rosea - a similar acting adaptogen. no experience with it yet.

[fishinghat]

I appreciate the update Brz. I know some others trying it and am anxious to pass on your results as you post. They have just started theirs as well and have not had any side effects so far.

[sk8rmama24]

I know I have been absent from posting for awhile, things have been INSANELY busy lately with some of my schedule changes, but here is my update:

 

I started my supplement regimen towards the end of March after consulting with my primary care doctor, so it has been a little less than a month.  This is what I take:

Omega-3 Fish Oil, 1400mg (900mg O3s), 1 softgel twice daily for 2800mg (1800mg O3s) daily total

Vitamin C, 500mg, 2 tablets once daily for 1000mg daily total

Vitamin D3/Calcium, 500IU/630mg, twice daily for 1000IU/1260mg daily total

Vitamin B12, 500mcg, 3 tablets once daily for 1500mcg daily total

Magnesium, 250mg, 2 tablets once daily for 500mg daily total

Vitamin E, 400 IU, once daily total

Alpha-Lipoic-Acid/Acetyl L-Carnitine, 400mg/800mg once daily total

Green Tea Extract, 500mg once daily total

 

I had not noticed any adverse effects since starting, however have had some other recent health issues appear in the last 1-2 weeks which may or may not be directly related.  I went to the ER this past Tuesday evening because I had swelling in my arms/hands, legs/ankles/feet, chest pain, shortness of breath which is potentially symptomatic of a pulmonary embolism or congestive heart failure, both of which I have strong family history for.  I still have the numbness/tingling/pain in my arms and hands that began when I started tapering the duloxetine, but now had added pain in my legs and large joints (e.g. shoulders) and weakness in my arms and hands.  I also experienced nightly nosebleeds prior to going to the ER.  ER ruled out anything life-threatening, no clot in lungs, EKG and troponin levels were ok and ruled out cardiac issue, no sign of systemic infection in my blood, I was not anemic, electrolyte/fluid levels were ok, and my magnesium level was ok.  So obviously the ER didn't find out the cause of my swelling, pain and breathing issues, but since nothing appeared life threatening, I was released to follow-up with my doctor, which I have the appointment scheduled and am just waiting in misery until then.

 

However, I now have something to bring up with my primary doctor, and I am going to ask for a referral to an endocrinologist.  I was particularly concerned about my magnesium levels being OK because I started taking the magnesium supplement about a month ago.  The recommended daily allowance/dose for women is 310-320mg magnesium supplementation, however I am taking 500mg which is above the daily recommended amount.  I also want to ask the endocrinologist about the bioavailability and time it takes the magnesium level in your blood to reach maximum concentration after taking the supplement, because I take my 500mg dose in the evenings with dinner.  So I took 500mg of magnesium within 3 hours of having my blood/serum magnesium levels tested, and I am wondering if I actually have an underlying magnesium deficiency. Extreme magnesium deficiency can cause numbness, tingling, muscle cramps, seizures, personality changes, and an abnormal heart rhythm.  With the exception of seizures, I have had the other symptoms occur over the last few years, and depending on which symptom it is, it is treated by a different physician (psychiatrist for mood/personality, pain management for muscular pain/spasms, etc.).  Every time I am evaluated because I have transient tachycardia, physicians write it off as a side effect of being on a stimulant medication (methylphenidate).  I tried to have a Vitamin D level test, but nutritional screenings are not covered by insurance unless you can support they are medically necessary.  But now I have a probable cause for magnesium issues and I want to pursue getting my nutrient levels checked.

To further complicate things, I also want to have my hormone levels checked, not just thyroid.  Again, I was never able to get my estrogen, FSH, or other levels checked because I had no medical reason to support these evaluations.  There is a distinct possibility that I have actually experienced premature menopause, beginning in my early 30s, which they could diagnose menopause by checking my hormone levels.  I had an ablation in my early 30s when I began having debilitating menstrual problems, so in the absence of getting a period every month, I have no indicator that I would be experiencing premature ovarian failure and having a hormonal imbalance.  Considering that no woman in my family lineage has actually managed to reach menopause naturally and have hysterectomies at ages ranging from 27-42, it is reasonable to believe that this could be a possibility since I am 37.  Coincidence being, symptoms of premature menopause could explain my health issues that were becoming problematic in my early 30s... the onset of the depressive symptoms, mood changes, fatigue and exhaustion.  I also started having night sweats and hot flashes, and weight gain, but these began later after I had already started taking antidepressant medications.  But these are also possible side effects of... you guessed it, antidepressant medications.

But that is my update.  Sort of makes me want to smack someone that my health problems might actually be caused by something else, and what I was getting treated for could be masking the symptoms of the actual problem.  I have to blame the way the healthcare system is designed, because of my age I am not actually able to get covered for tests without having an appropriate diagnosis (symptoms aren't enough justification), but I need the tests to get the diagnosis.

[fishinghat]

Edema is not unusual during Cymbalta withdrawal. Many have had a problem with that.

That is quite a background and I am sorry about what you have been through. I think your medical perception of the problems is quite logical. I am surprised that your insurance won't cover some of that testing. I have had several different insurances over the years and they all cover all types of screening at 100%. That really sucks that you can't get your tests run. I wish I could help.

God bless

[sk8rmama24]

Yeah, insurance can be a nightmare sometimes.  The tests I am seeking to get are not typically routine for someone my age, which is where I run into some issues with getting authorizations.  I happen to also be finishing up school to begin a career (hopefully) in medical coding and billing.  I am getting to see more in depth the requirements for medical necessity, how insurance companies determine coverages, and all that fun stuff.  The insurance companies are actually rather nit-picky about what they pay for and there are guidance documents for the national coverage determinations and local coverage determinations, and payment for your procedures is dependent on having an approved diagnosis as well.  But diagnoses can be very specific and without the exact one required, you are not covered for a procedure.  A lot of this isn't obvious to a patient because they don't usually see how their medical records are coded and claims submitted for payment.  Claims are actually flagged for review automatically before submission if there is a conflict in the diagnosis and procedure that could potentially make it not payable, or if there is a question about medical necessity being met based on the codes submitted on the claim and the medical records are reviewed and documentation provided if there is support for medical necessity.  The system is updated annually with current edits and payer requirements to catch claim issues during the billing process.  Sometimes, listing the codes on the claims in the wrong order would get your claim denied.  But if caught before your claim is submitted, the patient never even knows because that happens when the provider does the billing.

Edema is not unusual during Cymbalta withdrawal. Many have had a problem with that.

That is quite a background and I am sorry about what you have been through. I think your medical perception of the problems is quite logical. I am surprised that your insurance won't cover some of that testing. I have had several different insurances over the years and they all cover all types of screening at 100%. That really sucks that you can't get your tests run. I wish I could help.

God bless

[brzghoff]

sk8r: i hear ya about the need for accurate coding - which can mean the the difference of thousands of dollars. this is nowhere more apparent than with the new ACA guidelines for colonoscopies. for those over 50 years old, there is no additional charge if you are getting a SCREENING (other than for the anesthesiologist) insurance is supposed to eat it if you are in-network. but if its DIAGNOSTIC you pay everything up to deductible, which can be thousands. its amazing how often doctors and their billing offices don't pay attention to the little details. even with an annual wellness exam that should be at no additional charge, my husband's was coded as a regular dr's office visit. we got it fixed but its a hassle! 

 

as for you not being able to get the vitamin D and other nutrient screening, I am very surprised - i guess as you suggest its age related? i am 58 and my Dr always gets that profile during my annual blood work along with the CBC. however, it may not have been until i was over 50 that it started. i just started seeing it in my labs. thats how we found out I was vitamin D deficient (in florida go figure!). i take a supplement also. 

 

also, you said... "Sort of makes me want to smack someone that my health problems might actually be caused by something else, and what I was getting treated for could be masking the symptoms of the actual problem."  its my belief that's why so many westerners are put on antidepressants in the first place. big pharma has eliminated a physician's need to get creative in finding the root of a problem. they just want to cover it up.  

 

i sure hope you get answers - you've sure done your homework! 

[sk8rmama24]

Yeah, I am almost positive age had a big part in denial for the Vitamin D check.  It is probably associated with menopause because that is when bone loss generally begins, which would explain why it would be included and covered after the age 50.  All my routine labs for my age and suspected medical conditions always come back with me being normal and healthy.  The coding for preventative exams is actually age specific, which is just for the actual office visit excluding the ordered labs.  Everything performed has it's own code, right down getting a routine immunization.  There are two codes for that, the code for the injection and the code for the vaccine.  But when it comes to the actual billing, only certain codes are important or covered.  It is mind boggling at best.

sk8r: i hear ya about the need for accurate coding - which can mean the the difference of thousands of dollars. this is nowhere more apparent than with the new ACA guidelines for colonoscopies. for those over 50 years old, there is no additional charge if you are getting a SCREENING (other than for the anesthesiologist) insurance is supposed to eat it if you are in-network. but if its DIAGNOSTIC you pay everything up to deductible, which can be thousands. its amazing how often doctors and their billing offices don't pay attention to the little details. even with an annual wellness exam that should be at no additional charge, my husband's was coded as a regular dr's office visit. we got it fixed but its a hassle! 

 

as for you not being able to get the vitamin D and other nutrient screening, I am very surprised - i guess as you suggest its age related? i am 58 and my Dr always gets that profile during my annual blood work along with the CBC. however, it may not have been until i was over 50 that it started. i just started seeing it in my labs. thats how we found out I was vitamin D deficient (in florida go figure!). i take a supplement also. 

 

also, you said... "Sort of makes me want to smack someone that my health problems might actually be caused by something else, and what I was getting treated for could be masking the symptoms of the actual problem."  its my belief that's why so many westerners are put on antidepressants in the first place. big pharma has eliminated a physician's need to get creative in finding the root of a problem. they just want to cover it up.  

 

i sure hope you get answers - you've sure done your homework! 

[brzghoff]

ashwagandha update:

 

had to stop - bummer.

 

definitely allergic. just like sk8ermama. i couldn't figure out why my allergies hadn't gone away even after the pollen count dropped way down. stopped the ashwagandha and my congestion and headaches subsided. not to mention i had a very tight chest feeling. very uncomfortable. my side effects are not uncommon from what i've learned. i may try again way down the road but now that i'm battling reflux, i don't want to complicate things. i've heard rhodiola is a similar adaptogen, but don't want to introduce anything new into my system right now. 

[gail]

Keep us posted Brz, supplements are such a mystery. What's not?

[sk8rmama24]

That is a bummer.

 

I ended up stopping everything that was non-essential and holding my duloxetine reduction plan because of some of the issues I was having.  Still haven't figured out the cause of any of it though.  Been to the urgent care and ER more times than I would like, and still nothing.  I call the cardiologist tomorrow to get the results from the heart monitor I wore for a weekend.  Now I have a referral to a neurologist though, last time I was in the ER they called it an atypical migraine that didn't respond to anything.  Never knew a migraine could make your neck so stiff it wouldn't move, I was worried I had meningitis.  The only abnormal test I have had though in all of is was a urine culture a little over a week ago.  No foreign bacteria, but an elevated level of the natural bacteria.  I didn't have symptoms of a urinary tract infection, except when the doctor felt my organs and lymph nodes he said my kidneys and bladder were tender (they were, it HURT to have them touched) so they gave me some mega antibiotics for 10 days to see if that helped.  Heck, I thought I had the flu when I went to the urgent care.  Feverish, nausea, achy.  Guess it was a kidney infection, which I follow up with my primary doctor this week.  

 

Just frustrated though.  I am tired all the time because of the heart rate drops, yesterday I slept all day.  Can't exercise because I can't breathe.  I just wish I knew what was wrong.

 

ashwagandha update:

 

had to stop - bummer.

 

definitely allergic. just like sk8ermama. i couldn't figure out why my allergies hadn't gone away even after the pollen count dropped way down. stopped the ashwagandha and my congestion and headaches subsided. not to mention i had a very tight chest feeling. very uncomfortable. my side effects are not uncommon from what i've learned. i may try again way down the road but now that i'm battling reflux, i don't want to complicate things. i've heard rhodiola is a similar adaptogen, but don't want to introduce anything new into my system right now. 

[fishinghat]

Hang in there Sk8rmama

 

Some sounds a little like withdrawal but not most of it. Lets hope it gets better soon.

[sk8rmama24]

Thanks FH.  It has been an ordeal, spend more time at the doctor or in the ER than should be possible and I have no answers at all.  This last ER visit they called a migraine, I didn't think a migraine could last for weeks or not respond to anything.  Even my blood oxygen level was lower than usual for me, but still within normal limits so no one has seemed worried about it except me.  Sure felt like a flu or other illness, because of the fevers.  But I am supposed to see a neurologist now, maybe that will be a good thing.  I spent most of today in bed with pain in my limb muscles and back and my internal organs still feel tender.  Everything just hurts.  I need to call the cardiologist for results tomorrow, the office left a voicemail before the long weekend.

Hang in there Sk8rmama

 

Some sounds a little like withdrawal but not most of it. Lets hope it gets better soon.