Amino Acid Therapy and Trichotillomania

Amino acid therapy can be very effective at restoring proper neurotransmitter function and alleviating the insatiable urge to pull that some many people with trichotillomania experience. There are really two ways in which amino acids are used for people with trichotillomania. The first is to use n-acetyl cysteine, or NAC, which has been shown in clinical trials to reduce the urge to pull in about 56% of people that use NAC (see our post entitled N-acetylcysteine and Treatment of Trichotillomania for more information). NAC is thought to work by increasing the concentration of glutamate (an excitatory neurotransmitter) in a part of the brain that reduces compulsive behavior and hair pulling. Glutamate works in conjunction with GABA (an inhibitory neurotransmitter) to control many functions in the body. Thus, NAC provides a safe and moderately effective strategy to use amino acid therapy to decrease the urge to pull associated with trichotillomania.

However, we have found that a more effective way to implement amino acid therapy in regards to trichotillomania is to address the serotonin/dopamine system.  By providing the brain the proper proportion of the necessary amino acid precursors and cofactors necessary to achieve optimal serotonin and dopamine function we have had an 86% success rate with eliminating the urge to pull, as opposed to just reducing the urge to pull.

This increased success rate is attributed to the fact that dopamine exhibits control over the release of glutamate and GABA in certain parts of the brain. Therefore, the imbalance between glutamate and GABA that leads to trichotillomania in most people is likely to be caused by an imbalance with dopamine and serotonin (as they are farther upstream). By optimizing serotonin and dopamine function, all the systems downstream, including glutamate and GABA normalize as well. When this happens, the urge to pull disappears.

Another key distinction between using NAC or this balanced amino acid approach is the ability to remain symptom free once the amino acid(s) have been discontinued. With NAC, the urge to pull often returns once the supplement is discontinued (this provides further evidence that NAC may not be addressing the root cause of the imbalance). However, with balanced amino acid therapy we have found that once optimized neurotransmitter function is established and maintained for a period of time, most people can reduce or eliminate the amino acids and remain symptom free utilizing dietary and lifestyle factors to maintain optimal neurotransmitter status.  This means that it is very likely you won’t have to take these supplements forever and you can remain trichotillomania-free. This occurs because we are addressing the underlying root imbalance that seems to lead to the urge to pull for most people with trichotillomania. By correctly the underlying neurotransmitter imbalance with balanced amino acid therapy you effectively eliminate the problem, which allows you to stop pulling your hair out.

SAMe and Neurotransmitter Depletion

I recently had a client ask me whether or not she should take S-adenosyl-methionine (SAMe) as a trich treatment. SAMe is a sulfur amino acid that functions as a one carbon methyl donor in chemical reactions. I knew that SAM-e was often recommended for depression but I hadn’t heard of it in regards to trich.

A literature search provided some unexpected results. Several research articles showed that long term use of SAMe causes depletion of serotonin, dopamine and norepinephrine, which can exacerbate symptoms of depression (and presumably other disorders related to neurotransmitter imbalance) over time. One of the studies even found that this depletion led to the development of Parkinson’s-like disease symptoms.

These are very interesting observations, as it appears that although SAMe is often recommended for symptoms of depression and other disorders relating to imbalanced neurotransmitter levels, long term use depletes the very neurotransmitters that are implicated with those diseases.

I obviously told my client that I would not advise that she use SAMe as a trich treatment. However, that if she chose to use it, she would need to take additional amino acid precursors at the same time in order to prevent further depletion of serotonin, dopamine and norepinephrine. This meant more pills and more money; she gratefully declined.

Sources:

1)      Striatal dopamine depletion, tremors, and hypokinesia following the intracranial injection of S-adenosylmethionine: a possible role of hypermethylation in parkinsonism. http://www.ncbi.nlm.nih.gov/pubmed/8748929

2)      Depletion of nigrostriatal and forebrain tyrosine hydroxylase by S-adenosylmethionine: a model that may explain the occurrence of depression in Parkinson’s disease. http://www.ncbi.nlm.nih.gov/pubmed/9247319

3)      Parkinson’s disease-like effects of S-adenosyl-L-methionine: effects of L-dopa. http://www.ncbi.nlm.nih.gov/pubmed/1359575

Other Disorders Associated with Neurotransmitter Imbalance

Many people that come into the office are often amazed to hear that a number of their symptoms can be caused by neurotransmitter imbalance. A recent client came in suffering from trich. During her initial interview, she also told me that she suffered from constant anxiety, intermittent depression, sleep problems and insomnia in addition to restless legs every time she laid down. I told her this all made perfect sense and she just stared at me. “How could this possibly make sense?”  she asked. I went on to tell her how neurotransmitter imbalances in the brain can manifest themselves in all sorts of ways including:

Most of the time, a person exhibits more than just one symptom of neurotransmitter imbalance, they just don’t make the connection that their symptoms are related.

“I wouldn’t have believed it if I wasn’t living it.
This is a miracle.”

As I explained this, I could see a light bulb go off in my clients head as her stare turned to an expectant grin, “Does this mean that I can address all of those problems using amino acid therapy?” To which I answered, “It most certainly does. As we continue to rebalance your neurotransmitter levels and restore optimal functioning, the symptoms associated with imbalance will disappear.”

She left the office with a new-found hope. That hope turned into amazement and disbelief as her symptoms began to disappear one by one. Now, she is living a life without the burden of constant anxiety or sleep problems; she no longer has restless legs and she is no longer pulling. “I wouldn’t have believed it if I wasn’t living it. This is a miracle.”

I replied, “It’s not a miracle – it’s better living through science.” Using a targeted approach incorporating amino acid therapy will help improve the status and function of your neurotransmitter levels. When this happens, the symptoms associated with the imbalances disappear, and you can get on with your life.

The Real Effect of Amino Acid Therapy

I speak a lot about amino acid therapy and how it modifies neurotransmitter levels in the brain which helps people eliminate the urge to pull.  This is a convenient way to think about the problem and the solution: low or imbalanced levels of certain neurotransmitters cause the urge to pull and correctly those underlying imbalances fixes the problem. However, what we are really doing is a little more complicated than that. This blog post is a little bit more ‘heady’ than most, but will provide a more in-depth explanation of the change we elicit for those of you interested in more of the science of amino acid therapy.

The problem – imbalanced neurotransmitter levels

Neurotransmitters are chemical messengers; when neurotransmitter levels are too low or imbalanced, the messages get garbled and symptoms of disease or disorders develop, like trich. We correct this by restoring proper neurotransmitter balance by providing the body with the nutrients it needs to make the necessary neurotransmitters. However, it isn’t quite as simple as giving the body the nutrients and having it ‘make’ the necessary neurotransmitters.

The primary determinant of neurotransmitter levels in the body is the functional status of molecules called transporters. Transporters, which are molecules in the cell walls, facilitate the movement of neurotransmitters in and out of the cells, including the neurons. Neurotransmitters cannot cross the walls of the neurons on their own as they are water-soluble and the cell walls are made of fat. Water and oil (fat) do not mix. The transporters remedy this by escorting the neurotransmitters in and out of the neurons.

When there is damage to the neurons, a signal is sent throughout the body to all the transporters that encodes them to alter the flow or neurotransmitters in a way to try and compensate for the problem. When the damage is minor, the transporters can compensate for neurotransmitter imbalances by utilizing nutrients from a healthy diet. However, when significant damage occurs, properly balanced amino acid therapy needs to be used to correct the problem.

The solution – Organic Cation Transporter Optimization

A special transporter called the ‘organic cation transporter (OCT)’ is primarily responsible for the transport of serotonin and the catecholamines (dopamine, norepinephrine, and epinephrine) as well as their amino acid precursors. These transporters are found throughout the body in many tissues, including the kidneys, gut, liver as well as the brain and function similarly in all tissues throughout the body. This means that if we affect change to the OCTs with amino acids it affects all the OCTs throughout the entire body.

When we run a ‘neurotransmitter test’ what we are really doing is determining the functional status of these OCTs in the kidneys in relation to a given amount of amino acids. By giving the body properly balanced amino acid therapy we can define the exact amounts of neurotransmitters and amino acids needed to restore proper functioning of the OCTs in the kidneys. However, because this also affects the OCTs in all the other tissues, including the brain in exactly the same way, testing the urinary excretion of neurotransmitters while taking an exact amount of balanced amino acids allows us to restore proper functioning within the brain. This restores the flow of electricity in the neurons and leads to the relief of disease symptoms – in this case – eliminating the urge to pull.

So what we are really doing is using amino acid therapy to help optimize the function of the OCTs in the neurons to facilitate proper signaling. This is akin to unscrambling the messages so that the brain gets the proper signals. When the signals are no longer crossed, you get your life back under (your) control.

If this post is too much science for you, don’t worry. Amino acid therapy works whether or not you understand why it works. It’s wonderful that way.

Beyond NAC – Addressing the Cause

In a previous post we discussed the studies that have been done regarding the use of N-acetylcysteine (NAC) in the treatment of trichotillomania (N-acetylcysteine and Treatment of Trichotillomania).  It is known that NAC increases the concentration of glutamate (an excitatory neurotransmitter) concentration in an area of the brain called the nucleus accumbens that can reduce the incidence of compulsive behaviors and hair pulling (1-4). The most prominent study showed that this reduced hair pulling in 56% of people taking 1200-2400 mg/day of NAC (1). However, there may be a more direct way to influence one’s neurotransmitter balance and affect a greater, more lasting change in hair pulling as well as other addictive or compulsive behaviors.

NAC has a direct effect on the glutamate concentrations in the brain (nucleus accumbens). This seem to restore reduce hair pulling in about half the people taking NAC (1). However, one would assume that discontinuation of NAC would also lead to a return in hair pulling because a lasting effect would be expected only if administration of NAC addressed the cause of neurotransmitter imbalance in the brain.

In a previous post, we discussed the priority of neurotransmitter systems in the body (Neurotransmitter Systems Priority). Research has indicated that the serotonin/catecholamine system exhibits primary control over many systems in the body. The catecholamines include dopamine, norepinephrine and epinephrine. This is also true of the nucleus accumbens, where dopamine-powered neurons exhibit control over the release of neurotransmitters from the nucleus accumbens (5). Therefore, the cause of imbalance in this area of the brain is more likely due to an imbalance in the serotonin/catecholamine systems somewhere upstream of the nucleus accumbens. Addressing the cause should restore proper glutamate/GABA balance in the nucleus accumbens and therefore, lead to a reduction in hair pulling. This is in fact, exactly what we have observed in clinical cases.

Once we restore proper serotonin and catecholamine (dopamine, norepinephrine and epinephrine) function using balanced amino acid therapy, people notice a marked decrease and most often elimination of hair pulling. Based on the observations noted above, balancing the primary neurotransmitter system (i.e., serotonin/catecholamine system), the secondary systems (such as glutamate/GABA)) also rebalance. Addressing neurotransmitter imbalances in this manner has the benefit of addressing the cause rather than the end effect of neurotransmitter imbalance, allowing for the possibility of continued relief from symptoms, such as hair pulling, once proper neurotransmitter status has been restored. We have observed this with clinical cases as well, where people suffering from trichotillomania achieve the elimination of the urge to pull with balanced amino acid therapy and are able to reduce and discontinue amino acid therapy over time without the return of symptoms.

In rare cases, we must augment balanced amino acid therapy with NAC to achieve complete relief of symptoms. It is thought in these cases that permanent damage may be present that inhibits proper neurotransmitter function. These people will most likely need continued amino acid therapy, including NAC, to achieve long-term relief; however, they can be free from the urge to pull doing so.

In summary, it has been our experience that properly addressing the primary serotonin/catecholamine neurotransmitter system facilitates changes in secondary and downstream neurotransmitter systems (such as glutamate/GABA) to produce more dramatic and lasting changes in reducing and eliminating the urge to pull in people with trichotillomania.

References

1. http://yale.tsocd.org/wp-content/uploads/2010/03/Trich-and-NAC-PDF.pdf
2. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, Saksa J, Wu-Y-T, Gueorguieva R, Sanacora G, Malison RT, Krystal JH. Riluzole augmentation in treatment-resistant obsessive-copulsive disorder: an open-label trial. Biol Psychiatry. 2005;58(5):424-428.
3. Odlaug BL, Grant JE. N-acetyl cysteine treatment of grooming disorders. J Clin Psychopharmacol. 2007;27(2):227-229.
4. Coric V, Kelmendi B, Pittenger C, Wasylink S, Bloch MH, Green J. Beneficial effects of the antiglutamatergic agent riluzole in a patient diagnosed with trichotillomania. J Clin Psychiatry. 2007;68(1):170-171.
5. http://en.wikipedia.org/wiki/Nucleus_accumbens

Image: dream designs / FreeDigitalPhotos.net

N-acetylcysteine and Treatment of Trichotillomania

I am periodically asked about the use of N-acetylcysteine (NAC) in the treatment of trichotillomania, and have seen this subject come up on numerous occasions on the trich blogs and forums. There is some research to suggest how n-acetylcysteine works as well as how it can be used to lessen compulsive behaviors like hair pulling.

N-acetylcysteine is an amino acid that appears to work by reducing the release of glutamate (an excitatory neurotransmitter) into the synapse of neurons in a part of the brain called the nucleus accumbens. The nucleus accumbens plays a key role in our feelings of reward, pleasure, addiction, aggression and fear.(1-2) By inhibiting the release of glutamate, NAC causes an increase in glutamate concentration in the nucleus accumbens which reduces compulsive behaviors and hair pulling.(3-6)

The most prominent study done on NAC in relation to trichotillomania found that 56% of people were “much or very much improved” with NAC use compared with 16% of those taking placebo.(3) The dosages used in this study were 1200-2400 mg of NAC per day for 12 weeks, with significant improvement initially noted after 9 weeks of treatment with NAC. Thus, NAC appears to be a very promising therapy for those suffering from trich. However, there are a couple things to consider.

NAC should not be used by those with asthma as it may worsen that condition. In addition, because of the way that NAC is processed by the body, it is recommended that you should take supplemental zinc, copper, selenium and other trace minerals along with extra vitamin C when taking NAC for a long period of time. This can easily be done by taking a quality full spectrum multivitamin/multimineral along with supplemental vitamin C.

NAC appears to be a safe and moderately effective way to decrease hair pulling. However, as we will discuss in a future post, it may be more beneficial to address other key neurotransmitters that can rebalance the neurotransmitter status of the nucleus accumbens further upstream.

References

1. Schwienbacher I, Fendt M, Richardson R, Schnitzler HU (2004). “Temporary inactivation of the nucleus accumbens disrupts acquisition and expression of fear-potentiated startle in rats”. Brain Res. 1027 (1–2): 87–93. doi:10.1016/j.brainres.2004.08.037. PMID 15494160.
2. ^ Dopamine Involved In Aggression – Medical News Today
3. http://yale.tsocd.org/wp-content/uploads/2010/03/Trich-and-NAC-PDF.pdf
4. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, Saksa J, Wu-Y-T, Gueorguieva R, Sanacora G, Malison RT, Krystal JH. Riluzole augmentation in treatment-resistant obsessive-copulsive disorder: an open-label trial. Biol Psychiatry. 2005;58(5):424-428.
5. Odlaug BL, Grant JE. N-acetyl cysteine treatment of grooming disorders. J Clin Psychopharmacol. 2007;27(2):227-229.
6. Coric V, Kelmendi B, Pittenger C, Wasylink S, Bloch MH, Green J. Beneficial effects of the antiglutamatergic agent riluzole in a patient diagnosed with trichotillomania. J Clin Psychiatry. 2007;68(1):170-171.

Can Probiotics Improve Your Mental Health

We talk at great length on this site about how neurotransmitter imbalance can greatly impact your urge to pull and that correcting underlying imbalances is the key for many people to stop pulling. I just came across an interesting article that may provide additional insight into the causes of neurotransmitter imbalance and the how probiotics may be useful in correcting the problem.

Probiotics and mental health

Probiotics are the “good” bacteria that normally reside in a health gastrointestinal (GI) tract. Different formulations are available in many health food stores containing one or more strains of different bacteria. Recently, Professor Mark Lyte and associates at Texas Tech University Health Sciences Center have come up with a radical new concept: that you may be able to affect your neurotransmitter levels – and therefore your psychological health – by taking and establishing the right blend of probiotics.

What these researches found was that several neurotransmitters (normally produced in the brain) are also produced by various probiotic strains in the gut. For instance, they found that bacillus and serratia strains of bacteria produce dopamine; streptococcus, Escherichia and Enterococcus strains produce serotonin; Escherichia, Bacillus and Saccharomyces produce norepinephrine; and Lactobacillus and Bifidobacterium strains produce GABA.

The Second Brain

This has potentially startling implications. First, it provides another pathway to help explain why a person’s neurotransmitter levels become imbalanced in the first place. If the microbial environment of the gut is abnormal from birth, let’s say, this research suggests that over time, neurotransmitter imbalances could result. This could help explain why some kids exhibit symptoms of trich from an early age and why others develop it over time. In addition, we have noticed that several people find a dramatic change in their urge to pull after a round of antibiotics; this research could help explain this as any shift in the microbial environment in the gut could lead to alternations in neurotransmitter levels.

In addition, it provides other possible avenues to correct those underlying imbalances. This research suggests that altering the bacteria in the gut could dramatically affect a person’s overall neurotransmitter balance.

More research needs to be done, but if this hypothesis is confirmed, probiotics could prove to be a valuable adjunctive therapy to help those who suffer from trich and other disorders relating to neurotransmitter imbalance.

Addressing Neurotransmitter Imbalances – NeuroReplete

If you have symptoms of trichotillomania you have a neurotransmitter imbalance. This means that serotonin (the main inhibitory neurotransmitter) and dopamine (the main excitatory neurotransmitter) are out of balance with one another, which causes you to experience an urge to pull.

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Trich – Two Kinds of Pulling

We spend a lot of time on this blog talking about the ins and outs of amino acid therapy as an effective solution to the underlying neurotransmitter imbalance(s) that often lead to trich. However, there is also a behavioral component that cannot be overlooked and must also be addressed. Most people experience both the ‘urge’ to pull and develop a ‘habit’ of pulling.

For instance, many people pull at certain times of day or under certain situations, such as while driving, while studying or when watching TV. They may not even notice that they are doing it. The key is what happens when they do notice – can they tell themselves to stop and move on without giving it another thought? Or do they then have to constantly think about it in an internal struggle not to begin pulling again?

When the underlying neurotransmitter imbalances have been addressed, the urge to pull disappears. However, the habit remains. The good news is that once the urge is gone, when a person catches themselves pulling, they can take a look at the situation and make a decision to stop pulling – and then let it go. Because the urge is gone, they no longer need to bother with any thought of pulling. If they catch themselves pulling again out of habit, they simply correct the behavior. This is in stark contrast to someone that has to continually battle with themselves to not pull their hair out.

Once the urge is gone, behavior modification therapies often are an incredible help. These can be as simple as sitting on ones hands or keeping the hands busy to help break those habitual patterns, or involve more in-depth therapy, such as cognitive behavior therapy (CBT). Many of our clients who had tried CBT in the past with little success report outstanding results once their neurotransmitter levels are balanced.

Differentiating between the urge and habit is important. Habits can be changed with time and attention. Urges require that the underlying biochemical imbalance be corrected.

To find a Cognitive Behavioral Therapist, visit the National Association of Cognitive-Behavioral Therapists website or the Trichotillomania Learning Centers Resource page.

Resources For Those With Trichotillomania

I was asked by a recent client about what resources were available for those that wanted to find out more about trichotillomania. The woman sitting across from me was bewildered with all the information on the internet in regards to trich and wanted my help to try and sort through it. Here are some great places to get you started if you need a reference point to learn more about trich, if you or someone you love has the disorder and what you can do about it.

General Information

WebMD: http://www.webmd.com/anxiety-panic/guide/trichotillomania

Trichotillomania Learning Center: http://www.trich.org/

Tests for Trich

http://www.pamguide.com.au/anxiety/ttm_test.php – provides an easy self-test

http://www.ocdla.com/trichotillomania-hair-pulling-test.html – provides a more in-depth questionnaire, but you have to send your information out to get results from them

Treatments/Therapies for Trich

Neurotransmitter Function: http://www.neuroassist.com/trichotillomania-treatments.htm and http://stoppullinghairout.com/blog/

Cognitive Behavioral Therapy: http://www.trich.org/treatment/options-cognitive.html