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抑郁症天然疗法之羟色氨酸(5-HTP)解决方案  

2015-01-09 15:26:46|  分类: 健康保健 |  标签: |举报 |字号 订阅

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1.血清素

Before discussing natural products to use for stress, anxiety, and insomnia, it is important to mention that often people suffering from these conditions also suffer from depression, and vice-versa. This often reflects low levels of brain serotonin, an important neurotransmitter (a chemical messenger responsible for transmitting information from one nerve cell to another). Serotonin has been referred to as the brain’s own mood-elevating and tranquilizing drug. There is a lot of support for this sentiment. Because the manufacture of serotonin in the brain is dependent upon how much tryptophan is delivered to the brain, in experimental studies researchers can remove tryptophan from the subject’s diet and observe the effect it has. The results from these sorts of studies have contributed greatly to our understanding of just how vital proper levels of serotonin are to a positive human experience. Table 7.1 contrasts the different effects of optimal vs. low serotonin levels.

在讨论天然产品用于处理压力、焦虑、失眠之前,重要的是要提到人们在经常遭受这些状态的同时还患有抑郁症,反之亦然。这通常反映了在大脑血清素水平较低的情况,血清素是一种重要的神经递质,它是一种负责传输信息从一个神经细胞到另一个的化学信使。血清素被称为大脑的情绪提升和镇静性药物。有很多事实支持这个观点。因为大脑中的血清素的生产取决于有多少色氨酸送到大脑,在实验研究中研究人员可以从主题饮食中去除色氨酸并观察它具有的作用。从这些分类研究结果对我们理解适当的水平的血清素对一个积极的人的体验是多么重要作出很大的贡献。

The lower the level of serotonin, the more severe the consequences. For example, low levels of serotonin are linked to depression with the lowest levels being observed in people who have committed or attempted suicide.

血清素的水平越低,后果更严重。例如,低水平的血清素与抑郁有关,在犯下或试图自杀的人当中观察到最低的水平。


2. Antidepressant drugs

抗抑郁症药药物

In the treatment of depression conventional medicine primarily focuses on increasing the effects of serotonin. Once serotonin is manufactured in the brain it is stored in nerve cells waiting for release. Once released, the serotonin carries a chemical message by binding to receptor sites on the neighboring nerve cell. Almost as soon as the serotonin is released enzymes are at work that will either break down the serotonin or work to uptake the serotonin back into the brain cells. Either event terminates the serotonin effect. It is at this point that various drugs typically work, either inhibiting the reuptake of serotonin or preventing its breakdown. Most popular drugs of this type are referred to as SSRIs, short for Selective Serotonin Reuptake Inhibitors (see chart below). As a result of inhibiting serotonin reuptake, there is more serotonin hanging around capable of binding to receptor sites and transmitting the serotonin effect.

在治疗抑郁症中,传统医学主要集中在增加血清素的影响方面。一旦大脑中血清素生产,它存储在神经细胞等待释放。一旦释放,血清素传递绑定到相邻的神经细胞受体部位的化学信息。几乎只要血清素被释放,酶就在工作,它要么分解血清素或操作血清素返回脑细胞。或者事件终止血清素的作用。在这一点上,各种药物通常起作用,抑制血清素的再摄取或防止其分解。最流行的这类药物被称为SSRIs,简称为选择性5 -羟色胺再摄取抑制剂(见下图)。由于抑制5 -羟色胺再摄取,有更多的血清素悬挂在能够绑定到受体部位的周围并和传输5 -羟色胺的效果。

The effectiveness of antidepressant drugs has been the subject of several reviews. The results indicate that they have not been shown to work any better than placebo in cases of mild to moderate depression (the most common reason for prescription medication), and claims that antidepressants are more effective in more severe conditions have little evidence to support them. In fact, the research indicates that SSRIs and other antidepressant drugs might actually increase the likelihood of suicides in adults and children.

抗抑郁药物的有效性已成为一些评论的话题。结果表明,在轻度到中度抑郁(处方药物最常见原因)情形,它们的效果没有显示出好于安慰剂,并声称抗抑郁药物在更严重的状态更有效地几乎没有证据来支持他们。事实上,研究表明SSRI和其他抗抑郁药在成人和儿童中实际上可能会增加自杀的可能性。

An additional alarming finding is that 25% of patients taking antidepressants do not even have depression or a diagnosable psychiatric problem.  So the bottom line is that millions of people are using antidepressants for a problem they do not have, and for the people who have a diagnosable condition, these medications do not work in most cases anyway and may cause significant side effects. As one group of researcher concluded, “Given doubt about their benefits and concern about their risks, current recommendations for prescribing antidepressants should be reconsidered.” This statement is a clear mandate to consider using natural medicine as a way to deal with the causes of these mood disorders.

另外一个令人震惊的发现是,有25%的患者服用抗抑郁药物甚至没有抑郁或可诊断的精神问题。 所以底线是,对于没有这方面问题的人,数以百万计的正在使用抗抑郁药的人;而对于那些有可诊断状态的人,这些药物在大多数情况下不起作用,并可能会导致重大的副作用。作为一组研究者总结道,鉴于怀疑他们的好处和风险的担忧,目前建议对于处方抗抑郁药应该重新考虑。这句话是一个明确的授权考虑使用天然药物来处理这些情绪障碍的原因。

 

While antidepressant drugs are at best only marginally successful in alleviating depression, they do produce many side effects. Approximately 20% of patients experience nausea; 20% headaches; 15% anxiety and nervousness; 14% insomnia; 12% drowsiness; 12% diarrhea; 9.5% dry mouth; 9% loss of appetite; 8% sweating and tremors; and 3% rashes. SSRIs also definitely inhibit sexual function. In studies where sexual side effects were thoroughly evaluated, 43% of men and women taking SSRIs reported loss of libido or diminished sexual response. There is also a significant risk for weight gain and the development of type 2 diabetes.

虽然抗抑郁药物是在最好的情况下仅略微成功缓解抑郁,它们产生许多副作用。大约有20%的患者恶心;20%的头痛;15%的焦虑和紧张, 14%的失眠;12%的嗜睡; 12%的腹泻;9.5%的口干; 9%的食欲不振;8%的出汗和震动;3%的皮疹。SSRI也肯定会抑制性功能。在性副作用的研究中做了彻底的评估,服用SSRI43%的男性和女性报告无性欲或性反应减弱。还有一个重要的风险是体重增加和2型糖尿病的发展。


3. Alternatives to SSRIs

SSRI的替代品

There are effective alternatives to antidepressant drugs. For example, there are a number of lifestyle and dietary factors that lead to reduced serotonin levels. Chief among these factors are cigarette smoking, alcohol abuse, a high sugar intake, too much protein, blood sugar disturbances (hypoglycemia and diabetes), and various nutrient deficiencies. All of these factors have one thing in common – they lower serotonin levels by impairing the conversion of tryptophan to serotonin. A health-promoting lifestyle and diet go a long way towards restoring optimal serotonin levels and relieving depression. But, in the interim, natural agents like 5-HTP, S-adenosylmethionine (SAMe), or lavender extract can provide the boost in mood needed to help make important changes in diet and lifestyle easier to accomplish. Both natural agents are discussed below and a program for weaning off of SSRIs is given on page 84.

现在有有效的抗抑郁药物的替代品。例如,有许多导致血清素水平降低的生活方式和饮食因素。其中最主要的因素是吸烟、酗酒、高糖摄入、过多的蛋白质、血糖紊乱(低血糖和糖尿病)和各种营养素缺乏症。所有这些因素都有一个共同点 他们通过削弱色氨酸转化为5-羟色胺降低了5-羟色胺水平。一个促进健康的生活方式和饮食对恢复最佳的血清素水平和缓解抑郁症大有帮助。但是,在此期间,天然药剂像5-HTP、山姆医(SAMe)或者薰衣草提取物可以提供所需的提振情绪以帮助做出重要改变饮食和生活方式更容易实现。以下讨论天然药剂和替代SSRI的计划。

4. 5-hyDroxytryPtoPhan (5-htP)

羟色氨酸

5-HTP is the direct building block for serotonin. It exerts significant advantages over L-tryptophan. While only 3% of an oral dose of L-tryptophan is converted to serotonin, more than 70% of an oral dose of 5-HTP is converted to serotonin. In addition to increasing serotonin levels, 5-HTP causes an increase in endorphin levels. Numerous double-blind studies have shown that 5-HTP is equal to SSRIs and tricyclic antidepressants in terms of effectiveness, but is less expensive, better tolerated, and associated with fewer and much milder side effects.

5-HTP5-羟色胺的直接构建块。它和左旋色氨酸相比有显著的优势。在只有3%的口服剂量的左旋色氨酸转化为5 -羟色胺的同时,超过70%的口服剂量的5-HTP转化为5-羟色胺。除了增加5-羟色胺的水平,5- HTP也是导致内啡肽水平增加的原因。无数双盲研究表明,在5-HTP等效于SSRIs和三环类抗抑郁药物的有效性,但更便宜,更好的耐受性,并和较少的和更温和的副作用有关。

In many studies of depression, researchers use a rating scale called the Hamilton Depression Scale (HDS). The HDS score is determined by having

the test subject complete a series of questions in which he or she rates the severity of symptoms on a numerical basis, as follows:

在抑郁症的许多研究中,研究人员使用一个叫做汉密顿抑郁量表(HDS)的评定量表。HDS评分是在数值计算的基础上,由测试课题完成的给他(或她)评估症状的严重程度的一系列问题确定的,如下:

1 – present but mild 存在,但轻微

2 – moderate 中等程度的

3 – severe 严重的

4 – very severe 非常严重

 

Symptoms assessed by the HDS include depression, feelings of guilt, insomnia, gastrointestinal symptoms, and other bodily symptoms of depression (e.g., headaches, muscle aches, heart palpitations), and anxiety. The HDS is popular in research because it provides a good assessment of the overall symptoms of depression. Table 7.3 shows the results of a study comparing 5-HTP to tryptophan and a placebo.

通过HDS评估的症状包括抑郁、有罪感、失眠、胃肠道症状和其他身体抑郁症的症状(如头痛、肌肉疼痛、心悸)和焦虑。在研究中HDS是很流行的,因为它提供了一个良好的整体评估抑郁症的症状。表7.3中给出了一个5-HTP、色氨酸和安慰剂比较的研究结果。

 

Table 1. – Hamilton Depression Scale from a comparative study of 5-HTP, Tryptophan, and Placebo

表1.   5-HTP、色氨酸和安慰剂的汉密尔顿抑郁量表的比较研究

Result

结果

5-HTP

羟色胺酸

Tryptophan

色氨酸

Placebo

安慰剂

Beginning of the study研究开始

26

25

23

End of the study (30 days) 研究结束(30天)

9

15

19

 

In another study, 5-HTP was compared with the SSRI fluvoxamine (Luvox). Fluvoxamine is used primarily in the United States as a treatment for obsessive compulsive disorder (OCD), an anxiety disorder characterized by obsessions and compulsions affecting an estimated 5 million Americans. Fluvoxamine exerts antidepressant activity comparable to (if not better than) other SSRIs like Prozac, Zoloft, and Paxil. In the study, subjects received either 5-HTP (100 mg) or fluvoxamine (50 mg) three times daily for six weeks. The assessment methods used to judge effectiveness included the HSD, the self-assessment depression scale (SADS), and physicians’ assessments (Clinical Global Impression). As indicated in Table 7.4, the percentage decrease in depression was slightly better in the 5-HTP group (60.7% vs. 56.1%). The 5-HTP was quicker-acting than the fluvoxamine, and a higher percentage of patients responded to 5-HTP than to fluvoxamine.

在另一项研究中,将5-HTPSSRI氟伏沙明(Luvox)进行比较。在美国,氟伏沙明主要用于治疗强迫症(OCD),这是一种影响估计有500万美国人的以痴迷和被迫做某事为特征的焦虑症候群。与其他SSRI(在不好于的情形)如百忧解、左洛复和帕罗西汀相比,氟伏沙明发挥抗抑郁活性。在这项研究中,受试者接受5-HTP(100毫克)或氟伏沙明(50毫克),每天3次,持续6个星期。用于判断有效性评估方法包括HSD、自评抑郁量表(SADS)和医生的评估(临床疗效总评量表)。如表7.4所述,在5-HTP组中减少抑郁的比例略胜一筹(60.7%56.1%)5-HTP比氟伏沙明起作用更快,并且相对于氟伏沙明有更高比例的患者对5-HTP有反应。

 

Table 2 – Improvement in Specific Depression Symptoms

表 2.  特定的抑郁症状的改善

Symptom

症状

5-HTP

羟色胺酸

Fluvoxamine

氟伏沙明

Depressed mood

抑郁情绪

67.5%

61.8%

Anxiety

焦虑

58.2%

48.3%

Physical Symptoms

身体症状

47.6%

37.8%

 

The advantages of 5-HTP over fluvoxamine were really evident when looking at the subcategories of the HDS: depressed mood, anxiety, physical symptoms, and insomnia, as shown in Table 7.4. However, perhaps more important than simply relieving insomnia is 5-HTP’s ability to improve the quality of sleep. By contrast, antidepressant drugs greatly disrupt sleep processes.

当从HDS的子分类(抑郁情绪、焦虑、身体症状、失眠,如表7.4所示)看时,5-HTP相对在氟伏沙明的优势很明显。然而,或许比简单缓解失眠更重要的是 5-HTP提高睡眠质量的能力。相比之下,抗抑郁药物大大干扰睡眠的过程。

 

The bottom line is that 5-HTP is equal to or better than standard antidepressant drugs, and the side effects are much less severe. In addition, many people prefer to use a natural substance like 5-HTP rather than synthetic drugs.

底线是5-HTP相当于或优于标准抗抑郁药物,而副作用不太严重。此外,许多人宁愿使用天然物质(像5-HTP)而不是合成药物。

 

In the study comparing 5-HTP with fluvoxamine, here is how the physicians described the differences among the two groups: “Whereas the two treatment groups did not differ significantly in the number of patients experiencing side effects, the interaction between the degree of severity of the side effects and the type of medication was highly significant: fluvoxamine predominantly produced moderate to severe side effects, and 5-HTP produced primarily mild forms of side effects. Fourteen (38.9%) of the patients receiving 5-HTP reported side effects compared with 18 patients (54.5%) in the fluvoxamine group. The most common side effects with 5-HTP were nausea, heartburn, and gastrointestinal problems (flatulence, feelings of fullness, and rumbling sensations). These side effects were rated as being very mild to mild. In contrast, most of the side effects experienced in the fluvoxamine group were of moderate to severe intensity. The only subject to drop out of the 5-HTP group did so after five weeks, while four subjects in the fluvoxamine group dropped out after only two weeks. On the basis of studies on weight loss, the longer 5-HTP is used (e.g., after 4–6 weeks of use), the less the problem with mild nausea.” 

该研究比较了5-HTP和氟伏沙明,以下就是医生描述了两组之间的差异:“这两个治疗组中出现副作用的患者数量、副作用的严重程度和药物的类型之间的相互作用没有显著差异是非常重要的:氟伏沙明主要产生中度到重度的副作用,而5-HTP主要产生温和形式的副作用。14(38.9%)接受5-HTP的患者报告有副作用,而氟伏沙明组的患者有18(54.5%)。服用5-HTP最常见的副作用是恶心、胃灼热、肠胃问题(肠胃气胀、饱腹感和隆隆的感觉)。这些副作用被认为是非常温和的。相比之下,氟伏沙明组经受的大多数的副作用是中度至重度的强度。5-HTP组在五周后仅有一个受试者退出,而四氟伏沙明组的受试者仅两周后有4个受试者退出。基于减肥的研究,时间越长5-HTP(如使用4 - 6周后),轻度恶心的问题就越少。

 

 (编译自《压力、焦虑和失眠》,作者 Michael T. Murray, N.D

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