Hello,

This is the first month where my wife will be taking l-tryptophan instead of Prozac, and we have a few concerns with this.

First, my wife's stress level over this is already increasing. She is afraid of how things will go without the prozac. Even though I'd make my scientific wild-a$$ guess and say that in general, she is more relaxed than I have seen her in years, she is very concerned as to how things will go.

So, I'm wondering how the early stages of taking l-tryptophan and leaving the prozac behind go for people. How long has it taken to figure out individual dosages for people? General experiences?

Any insight would be appreciated.

Hi JBB,

First of all, it is normal for your wife to feel a little trepidation about making the change from Prozac to L-Tryptophan. My best advice to ease the stress of worry about what to expect (!) is to arm yourselves with as much knowledge about L-Tryptophan as you can possibly lay your hands on.

Here's a few starters:

http://www.truestarhealth.com/Notes/1385001.html
http://www.emmadavies.net/blog/amino-acid-trips.aspx
http://www.diagnose-me.com/treat/T138573.html
http://chemistry.about.com/library/weekly/aa110402a.htm

Also, it might be a good idea to keep in mind that worrying unduly about something that has not yet happened is more likely to make it happen than not. ;) Our minds are wonderful and powerful at the same time, and with our thoughts we can actually create our own downfall or our own success.

Also, it is extremely important that she not go 'cold-turkey' with the prozac. It is much safer to wean oneself off the prozac under doctor supervision first before attempting a new treatment.

As you have noted, your wife seems calmer on the L-Tryptophan than before, this is a good sign, although I would caution against expecting too much around her PMDD time. It takes about 3-6 months of consistent use (along with diet and regular daily exercise) to see a complete turn-around.

Improvement will be exponential, and your wife should not feel discouraged if she still presents with symptoms in the 6 month window. You should both notice that although she might still have symptoms, they should start abating and becoming more controllable and easier to manage.

It took me 1 whole year of consistent effort and treatment to effect a complete cure, to where I have not had one PMDD episode at all right up until this moment that I am writing here.

Here is a chronology of events that might be helpful:

1st 2 weeks: Maximum allowable dose of L-Tryptophan daily (1500mg), on an empty stomach (or with a SMALL high carb snack) 1 hour before bed time & daily excercise for 1 hr in the form of brisk walking. Some side-effects occur such as excessive sleepiness, upset tummy and occassional headache. All these were temporary and went away when my body adjusted to the L-Tryptophan. Adjust dosage if side-effects are too heavy, and increase again slowly once body has acclimatized itself.

Weeks 2 - 4: Go to half the maximum allowable dosage (750mg), on an empty stomache (or with a SMALL high carb snack) 1 hour before bedtime & daily brisk exercise for 1 hr. Side-effects should have abated completely by now, if not keep adjusting dosage.

Weeks 4 - 6: Go to daily recommended dosage (500mg) per day, follow guidelines as above.

Weeks 6 through to end of 6 months: Continue on daily recommended dosage (500mg). Take it as before, and continue to watch diet, stress situations, and do exercise daily. By now you should have been well on the way to seeing some noticeable and consistent positive changes in mood, appetite, sleep patterns, energy level and overall feeling of wellbeing.

After 6 months: Take recommended daily dosage in two weeks from ovulation until at or after menstruation. Follow recommendations above. Eventually, it is not even necessary to take the L-Tryptophan for these 2 weeks of the month, but only as needed (when there has been a bit of stress, etc.). By listening to one's own body, one learns the cues as to when it would be propitious to take the L-Tryptophan or not.

Even as I write this, I still take L-Tryptophan on the odd occassion, just as a maintenance, about once a month. If I get ill, L-Tryptophan is part of my regimen as the stress illness can produce in the body affects the immune system and serotonin levels. Unlike Prozac which is basically a prescription up to menopause for many women, L-Tryptophan is a healthy supplement recommended for a maximum time of 6 months to 1 year, depending on the severity of symptoms, after which maintenance doses can be taken optionally.

The most important bit of advice that I can give is that each month gets a little easier than the month before, and this is what your wife should be aiming for in terms of expectations.

All the best, and if you have any more questions re. treatment with L-Tryptophan please don't hesitate to ask me.

Anthea

PS: Here's a tip for all the patient and wonderful husbands and partners of PMDD sufferers who read this forum ... even if your spouse is in denial about her PMDD and is at the moment refusing treatment ... you CAN take L-Tryptophan and ease your own stress! L-Tryptophan is a completely natural substance, an essential amino acid which gets depleted in our bodies through inadequate diet or undue stress.

Anthea,

Thanks for the response, that was pretty much what I was looking for.

While I do agree with you that people are very suggestable and undue worry about something can cause the worst to come to pass, I feel that the amounts of worry both my wife and I are experiencing are within the normal range ;) Heck, you lived with this, I'm pretty sure you were worried too! I don't want to go back to the violent outburst thing again! In other words, I think a little caution is certainly called for in dealing with this problem.

What I am trying to avoid is a situation where she gets discouraged, doesn't stick with it and we're back at square one, which has been a pattern with her medical treatments through the years, as well as therapy, things like that. I expect setbacks, I think they are normal and if she knows what may happen, I think that she will be more inclined to see things through.

She has been experiencing most of the side effects that you mention, she has been a little tired, has had an upset stomach at times, and has had a slight headache for the past few days. All that sounds pretty normal, though, so I won't worry about it.

I do have a final question though - you say that you don't take tryptophan anymore regularly. What has happened that you are able to not take it and not have any problems with re-occurance? I understand that there may have been untold numbers of stress-management classes in there, or whatever, but how is it that you no longer take this and feel normal? How is it that to get an initial benefit, you need to spend months taking tryptophan, but it can then be taken only once in a while for "maintainence"? I don't quite get how that is going to work, maybe its just that the medical solution is "maintainence for life" and I have an inate trust of western medicaine, I dunno, I just dont get it.

Thanks for your help in general, and this particularly valuable post.

Hi JBB,

Yes, of course I was anxious, and that is why I did an enormous amount of research. :) It is natural to feel trepidation when embarking on the unknown, and it is wise to err on the side of caution.

As for why it was not necessary for me to remain on daily L-Tryptophan treatment, this answer is a little more complicated and I can't give you an adequate answer without prefacing with some explanations, please bare with me. :)

From what I understand about how the body and the mind functions, I can say that fundamentally it is a matter of "cause and effect."

THE BASICS: My favorite quotation is from Ralph Waldo Emerson "Life is a perpetual instruction in cause and effect." This is nowhere more true than in dealing with PMDD. PMDD is a cycle which feeds upon itself, and if it goes unchecked, gets exponentially worse -- the word "exponential" is the key here as I will be mentioning it later in my more direct answer to your question. It is also important to understand the role of stress as either a cause of, or in exacerbating PMS/PMDD.

The more consistently stressed we are (I am not referring to normal fight and flight response) the more the amino acid L-Tryptophan (amongst other vital elements) is depleted in our vital systems (we would die if we had no L-Tryptophan in our bodies as it maintains a number of very important biological functions).

The more depleted our L-Tryptophan levels, the less serotonin becomes available to the brain, the more stressed we begin to feel and so a veritable and negative spiral of 'cause and effect' is set into montion.

Btw, there is a great misconception that hormonal imbalances cause PMS/PMDD, not true! I explain why in my essay on my main site. All my information comes from well-founded clinical studies and respected authorities in the field of medicine.

HOW IT ALL STARTS: But back to the main point of this discussion -- because over a period of time (years) our bodies become more and more depleted of L-Tryptophan through basically inadequate diet, poor life-style habits, chronic childhood abuse (which 'hard wires' the stress response), chronic illness, chronic stress, etc. etc., our systems slowly break down ... for many women this break down is in the form of very difficult PMS or PMDD(aside from chronic illnesses e.g. IBS and so forth) and so called 'hormonal irregularities.' For men it would translate to heart disease, and so forth. Now please note I said it takes years for this to happen, we don't deplete our entire store of L-Tryptophan and serotonin to critical levels through a single stressful experience, or indiscretion at the local hamburger joint.

WHY THE INITIAL 6 MONTH DOSING: By the time the physical manifestation of "serotonin deficiency" appears, hence the manifestation of PMS/PMDD and a host of other ailments, we are seriously depleted of L-Tryptophan, and patently not getting enough of it through our diet otherwise we would not be showing symptoms of serotonin deficiency and so forth. It took years for our bodies to deplete its reserves to critical level, it will take a good amount of time and consistency to restore the lost reserves! Hence the 'power dosing' in the initial 6-month phase of treatment. It is vital to rebuild the stores of L-Tryptophan in the brain as quickly as it is safe to do, but at at a controlled and even pace at the same time so that the negative cycle of 'cause and effect' PMDD created can be effectively stopped in its tracks and reversed -- much like throwing spikes accross a highway to stop a speeding gettaway car.

Once normal L-Tryptophan levels have been restored, and serotonin production is normalized (which in turn will EFFECT other positive changes in the body's belaboured systems, hormones included) it should not be necessary to remain on a daily dose after 6 months (maybe less, maybe more -- everyone is different). That is, until we start living impossibly rushed and stressed lives again, stop exercising, eat unhealthily and think pessimistically about life, because the 'stress' that is thus created will once again deplete these important reserves.

It is for this very reason that I so emphatically stress that taking a pill (even just L-Tryp on its own) isn't going to cure PMDD. Only dedication, self-discipline and positive change and determined 'will' will accomplish this, i.e. change to a healthier way of eating, supplement with a multi, exercise exercise exercise, de-stress your life, and so on, WHILST taking the L-Tryptophan, and continue with these changes after the daily dosing is no longer necessary. The L-Tryptophan will only do so much good (and not effect a cure) if it is NOT accompanied by the aforementioned.

WHY IT IS POSSIBLE TO STOP DOSING AFTER 6 MONTHS (LESS OR MORE DEPENDING): --> It is time to mention the word "exponential" again ... and this perhaps is the basic answer you are looking for: Unchecked (and incorrectly treated) PMDD creates a NEGATIVE cause and effect downward spiral, which exponentially gets worse because it feeds upon itself. Prozac and similar drugs DO NOT address the underlying causes of PMDD, and this is why it is necessary for women to remain on the drugs until menopause or they commit suicide or worse, i.e. they hobble along with a band-aid trying to heal a broken arm, instead of having it set properly in a cast to heal permanently.

Checked and correctly treated, PMDD symptoms become less and less severe, each month that dedicated persistence and loyalty to the treatment is applied, hence, a POSITIVE upward spiral of 'cause and effect' is created. Your body and its systems become healthy and normalized again, hence eventually there should be no need to remain on a daily dose of L-Tryptophan (but it is important to continue with exercise, eating right and living right -- that doesn't stop). This is why I no longer have PMDD, and this is why I don't have to have L-Tryptophan or prozac every day just to live a semi-normal life. Heck, I haven't even been to the doctor for the last 6 months for any reason, I'm as healthy as a race-horse, I can't even tell you the last time I had a head cold! Why? Because I applied myself to changing my life from negative to positive, and yes it required learning what 'de-stressing' your life really means at its most basic core. ;)

Hope this all helps to answer your most welcome and extremely important questions re. this issue. You are the first to have asked me why I no longer need treatment. Very good questions indeed!

All the best, :)
Anthea

Hmm, well I was going to guess that during that six months, you are supposed to adjust your life to the point where many of the factors leading into this are no longer a problem.

I guess I was half right. Or something like that.

I have to admit to feeling a little suspicious of this, as all I've ever heard from Doctors about it say that you are stuck with this until menopause.

I do need to thank you for your post yesterday. My wife is an internet-phobe and though she is interested and participating in this (in other words, I am not the person/reason/whatever that is forcing this down her throat, it is most definately her decision) most of the information available on PMDD is internet based, its too new for it to have a section at the local bookstore. I've been printing out various pages and yesterday's post is one of them. Feels good to see that the papers are actually being read, and stored in a neat little pile - usually if I print something out it ends up on the floor or in a corner somewhere. So, even if she isn't active on the board, she is taking information from it and evidently finding something of value there. So, thanks, long winded I know but heartfelt.

I can't believe nobody ever asked you that question before.

As for me, well, we are about to head into the first "bad time" without prozac in two years. She's doing great so far, but I can tell that we are both getting more apprehensive as Saturday comes closer, that should be when she ovulates and the mood in the house is generally good, but it has the feeling of a battlefield just before dawn. Hopefully, we are worried about nothing.

Thanks again.

You're welcome JBB

And your concern is well founded. You can only know the success of the treatment by going through several months of the Tryptophan, after which you will have your own evaluation of a successful outcome or not. Again, I wish you the very best. Your wife is very welcome to correspond with me through e-mail (pmdd@mail.com) if she ever has any questions or concerns.

Here are some additional links you and your wife may be interested in, contains some very helpful information:

http://groups.msn.com/PMSandPMDD/treatments.msnw?action=get_message&mview=0&ID_Message=479&LastModified=4675467563471649490#RepliesBookMark... this is from a woman to me in a previous support group I managed -- she had remarkable success with L-Tryptophan too and she provides a link to an excellent resource for treating PMDD naturally.

http://www.moodcure.com/mainpage.html
This doctor has written several books, the one I found to be very relevant to PMS/PMDD is called "The Moodcure." It deals with using L-Tryptophan, diet and exercise to correct mood problems, and gets my highest recommendations. She is easily contacted through her web site (and has responded personally to my e-mail queries).

http://www.mercola.com/2001/apr/18/prozac.htm
... Dr Mercola was one of the first doctors to prescribe Prozac for PMS/PMDD, he has some interesting comments about this method of treatment, well worth the time to read his info. He has also published several books, and is easily contacted through his web site (his manager responded to some of my queries, but it is possible to set up an appointment to see the doc personally).

All the best,
Anthea

Hi
I see that you(and others) and your wives have been dealing directly with this problem for quite some time.
It's quite a process just trying to figure out if pms/pmdd is a possible contributor to your problems. It must be awfully stressful trying to define a course of treatment eapecially when the same treatment doesn't work for all people.
My wife has said to me,(in a fit of rage) "what do you want to do, put me on prozac"?
I thought to myself(before I knew that prozac was used for pms relief)... hey that might not be a bad idea.
Now I find out that it is used among other treatments. Sometimes I wonder if my wife knows more about her PMS problem than she lets on.
I guess I still don't want to accept that she may have to have some form of pharmacological treatment.
You should feel good that she reads the sheets you print off. It would give me hope if my wife would do that.

Later
Steve

Hi Steve,

Well, I might sound like I am sitting in the cat bird's seat because my wife has started to DO SOMETHING about this problem, but...

Its been a long road. She's always had this; I met her when she was 18 years old and I was a dirty old man of 22. I dated her for a year and a half where she was basically living with me, and it was such a living hell at times that we ended up splitting up with no possible hope of reconciliation. I wouldn't even speak to her anymore (after standing in the middle of a busy street while she screamed "F*CK you and F*CK off, forever, and by the way, I slept with THIS GUY, THIS GUY, and THIS GUY last week!!!" I was inclined to take her at her word). The funny thing was, even after doing that she would still call me up for emotional support, which I didn't feel it was my job to give after that. Well, as a result of all of this, she ended up in the suicide ward, went through a long period of depression and did a lot of very, very unhealthy things that resulted in a lot of health issues we still deal with today, not to mention disturb me greatly. After a break of a year and a half, and a time where I hadn't talked to her in many many months, I bumped into her on the street one day and here we are. She (at the time) seemed that she had cleaned up a lot of her issues, which at the time I blamed on lack of maturity, things like that and figured she would grow out of it.

Well, guess what, she never did. Somwhere around 1995 or so, I realized that there was something SERIOUSLY wrong with her. After our daughter was born in 96, it took a turn for the worst, to where I was attacked physically several times and I was afraid to leave her alone with our baby. Things improved at bit for a while, then we had our son and made a move to a different city, and things took such a horrible turn I din't know what was up. I collect classic motorcycles, one day she went after one of them with a baseball bat and I didn't know what to do so I just stood there and let her do it. I just felt totally powerless in all of this. So I stood there and let her attack my pride and joy, I just didn't know what else to do. Bikes are always fixable, right? I'd rather let her have the chance to get it all out of herself. Or worse - target me instead. I'd rather be hit with that bat then listen to some of the verbal abuse she's heaped on over the years.

In '01, she had a series of major episodes, she was also getting hit with the autoimmune portions of this - back pain, got diagnosed with rheumatoid arthritis, investigated IBS, switching birth control methods, skin irritations, diarea (can't spell it) for six months, huge weight loss. After all of this, she finally called me out of a training class at work threatening suicide, which I have to admit, with her, I would always wonder how serious it was. Even her documented attempt seemed a pretty poor try for someone who is serious, but I've since learned my lesson. Point is, suicide threats were a monthly thing, to the point where I felt she was threatening it just to piss me off. This time sounded more urgent though, so I left from work, ran home, came in the house to find a rope over the rafters, her collapsed on the couch sobbing, and my kids in the middle of it.

That was it for me, that was where I stepped in and said that she was getting medical treatment NOW. Since she was in no state, I arranged psychologists, doctors, etc. an as a result, her gyno finally said, "Hey, you've got PMDD. Here's prozac."

Well, the prozac capped a lot of the bad, but prozac has some really bad effects otherwise. The good times were gone, the bad times were lessened, and she developed a loss of social inhibitions that was hurtful and at times horribly embarrassing. Kind of sucks to hear "You are fat, you are bald, you look like crap" all the time, even worse to know she really MEANS it... (For the record, I'm 5'9", 175 lbs with a heavy build and I still have hair, not as much as I used to but I ain't bald either. Can you tell I really hated hearing this stuff all the time? At the time, I was maybe 10 lbs overwieght and my hair had started to thin).

SO, I withdrew. I stopped sleeping in the bed (didn't feel welcome), wouldn't talk much more than grunts. Sex? Maybe once a month, honestly that was the only form of communication we had. She can't apologize, I think its part of her denial actually... so she makes up for it by wanting to have sex, and frankly, after this long, I need the words. Sex wasn't doing it anymore, it wasn't enough for me to know that she acknowledged the pain she had caused and felt bad about it. Communication, if it happened, came in screaming matches.

Late last October, she announced that she had had it with me and was looking for an apartment. Basically, everything was all my fault. Never had she looked at the reasons WHY I might have been acting like I was acting. If you run through the "Abuse Checklist" on this site, I think I fit every single criteria on it, I think that's a pretty good explaination of my behaviour. Most of my reactions are typical of someone in that situation. Looking at myself as an abused man was actually kind of eye-opening, though most men I know would NEVER admit to being "abused" because its so emasculating.

That was what it took to get into couples counseling. Her overcoming her resistance to entertaining the possibility that her disorder was doing a lot of the talking for her didn't start to creep into the picture until April or so, with a lot of gentle suggestion from both me and the counselor that she is STILL very resistant to.

Out of that, well, now I go to counseling because I realized I have to get over my bad habits for things to improve. She went to a psychiatrist yesterday, basically to get a reality check on her tryptophan ingestion, and to see if there was anything else she could be doing, and she got a lot of suggestions. She was referred to a therapist with PMDD experiance so she can begin counseling.

Well, if you are still here, hope you liked my life's story!

My long-winded point is: It took from 1991 to 2004 to get here. It was a brutal ride, the highs were high, but the lows were so f*cking unbelieveable I sometimes can't understand how in the hell we still are together. Most of the time, actually. I guess the realization long ago that she really wasn't in control of herself can take the credit for the fact I'm not single.

However, buck up - you got it easy! PMDD wasn't in a doctor's vocabulary when we started looking at possibilities, and as far as there being stuff on the 'net, well, in a lot those days, there WASN'T an internet. Still today, I find almost nothing in bookstores on this... its ALL on the net. And there's a lot of good information out there. If I knew then what I know now, the last ~5 years would have gone a lot better, I can assure you.

Since you won't have to do as much footwork to figure out what the heck is going on, you should be able to spare yourself a lot of this. Knowing the problem really contributes to solving it, even if she isn't listening, don't give up yet. Your reactions to her bad days will change; you know what's up and it isn't going to affect you so badly if you know the situation. Who knows, maybe changing YOUR behavior will help her see how hard you are trying, how understanding you really are and stuff like that. THEN, maybe, just maybe, she will start to reach out to you for help and support, and THEN your progress will start.

The best thing is, once it starts, it snowballs. Things aren't perfect, but they are LIGHT YEARS better then in April. Now that she's starting with a counselor, the ball ought to really get rolling. I'm finally starting to see the light at the end of the tunnel, and this time, it doesn't appear to have a train attatched to it.

The other thing is that so far, 1 day into the "bad days" this month and the first month with no Prozac, only tryptophan, vitamins and the like, she is more relazed than I have EVER seen her around this time and I'm getting text messages on my phone all day about how wonderful I am. Granted, I got 9 or so more days of this trepidation to go, but you find hope where you can, right? So far, I'm loving this.

SO\o, this isn't to toot my own horn or because I'm an internet psycho who need to blab on and on about my life to make myself feel important... I was trying to show you that yes, this is a very long and difficult road. She's probably going to miss some obvious stuff about herself, and she will fight tooth and nail to avoid responsibility for any of it... you can't imagine how I felt when I was told the motorcycle/baseball bat thing was MY fault ("well I needed to, because YOU DON'T LISTEN TO ME")... but be patient, things can improve. I found it helpful to find something positive every day, no matter how pitifully small it was - "Wow, she hasn't called me a f*cking *sshole for a WHOLE DAY!!!" Hey man, its something.

Hope it made you feel a little better.

There is a great book out there called "The PMDD Phenomenon" that my fiance bought for me awhile back. He found it on Amazon.com and it's one of the best books I've read (there is also a chapter for people who have to suffer through it)