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Question. Prime Time Live recently aired a story on treatment of depression, obesity and insomnia with 5-hydroxytryptophan (5-HTP). Is 5-HTP effective and safe?

Answer. Well, the media are often ahead of the scientists on these things, but I must say I am very skeptical about the 5-HTP story (although I did not see the Prime Time piece). By the way, 5-HTP is the precursor chemical for serotonin, which as you probably know is the neurotransmitter heavily involved in depression, appetite regulation, pain perception and sleep. In the first place, very few clinicians, to my knowledge, are prescribing or recommending 5-HTP to patients, at least among psychiatrists. Thus I suspect we are hearing about a handful of “testimonial” cases rather than seeing the results of methodical research or even clinical case reports. In fact, I didn’t find a single clinical case report or recent controlled study of 5-HTP for the uses you mention in the professional literature within the past 5 years!

However, there was one report in the British Journal of Psychiatry (July 1985 pp. 16-22) comparing the L isomer of 5-HTP with a classic antidepressant called tranylcypromine (termed an MAO inhibitor). These patients had not responded to several antidepressant medications, including SSRI-type antidepressants like Luvox (fluvoxamine). Of 17 patients given L-5-HTP, none responded. In contrast, 15 of 26 responded to tranylcypromine. The authors concluded that L-5-HTP was not therapeutically effective in such refractory patients. Of course, the possibility remains that milder cases of depression may respond to 5-HTP.

A precursor of 5-HTP, tryptophan, was used for many years as a sleeping aid, before being removed from the U. S. market after contaminated batches caused serious muscle problems. Serotonergic agents in general are thought to reduce carbohydrate craving and promote weight loss. However, experience with the SSRI (selective serotonin reuptake inhibitor) group of antidepressants – Prozac, Zoloft et al – suggests that while they may initially take off a few pounds, the weight creeps back up over a year or two.

5-HTP is an interesting agent, and is used in research settings to “probe” the serotonergic system. However, I think it is far too early to conclude that it is safe and effective for any of the uses you mentioned.