Mental health is so underfunded in the UK that pills can be used as the quick-fix option. In 2014/15, 57.8 million prescriptions for antidepressants or selective serotonin re-uptake inhibitors (SSRIs) were filled out in England alone. You can wait months on a waiting list for cognitive behavioral therapy or to see a psychiatrist, and as you wait, medication is a lifeline. In addition to this mess, pharma giants have stopped looking for the "next Prozac," cutting funding into new treatments by 70 percent in the last decade. The bottom line is clear: SSRIs, with all their pros and cons, are here to stay.
Obviously nobody is suggesting coming off your medication, and for many cases of depression and anxiety, a course of SSRIs and/or CBT can be life-saving. For me, during a period of bad anxiety, when I was torn between the idea of going back on antidepressants or not, I began searching for some sort of alternative aid online and soon came across a video of Jim Carrey. Carrey has struggled with depression for the majority of his adult life; he's a classic case of the sad clown. "I take... supplements," he tells Larry King in the clip I found. "Vitamins?" asks King. Not quite, but not far off either. A natural substance called 5-HTP. "It's a wonderful thing," Carrey smiles. "It's amazing." His description of how 5-HTP worked made it sound like a super-drug, a cure-all. All it would take for me would be an anonymous trip to a health food store and 15 bucks. Like every other young person, I knew it as a quick fix for MDMA comedowns, but never considered buying it as a medication replacement. Obviously for severe depression and anxiety, a serious course of SSRIs or cognitive behavioral therapy would be more appropriate. But at this point, I was ready for something to ease the transition.
I bought 200 mg "double strength" tablets off Amazon. Immediately after taking them, I felt slightly better. After a week of taking one of these with my breakfast, I could easily get through a working day without being too panicked to concentrate on a screen. I still woke up with "the fear," but it was lessened. Better yet, there seemed to be no notable side effects. I started recommending it to all my friends with mild depression or anxiety. I was in love.
In humans, 5-HTP is the nutrient precursor to the neurotransmitter serotonin—widely known as the "happy neurotransmitter"—meaning 5-HTP converts directly into serotonin in the brain. As well as being in our bodies, it's found naturally in the seeds of a woody shrub native to West Africa. By taking it as a supplement, in theory, you will end up with more serotonin in your brain. Serotonin deficiency is linked to depression, anxiety, and a whole host of physical and mental ailments. Raising its levels seems to help brain cells send and receive chemical messages, which in turn boosts mood.
In reality, SSRIs and 5-HTP aren't so different. Both affect serotonin. SSRIs work by blocking serotonin from being reabsorbed by nerve cells so more serotonin is available to help brain cells work efficiently. As a doctor would later tell me, 5-HTP, on the other hand, "provides your body with the tools to make more serotonin, as opposed to antidepressants, which are just working with the serotonin that you have already."
"I used to have an inner voice that was male and used to bully me during PMT time. Noises seemed too loud, even like somebody eating a bag of crisps. Topping up with 5-HTP has stopped all this."
People are using 5-HTP for absolutely everything from sleep disorders to OCD symptoms. After asking people in mental health Facebook groups whether they used it and why, I was inundated with responses. Sach Tennant, from London, takes it for her premenstrual dysphoric disorder (PMDD). "I only take it when I feel low, and it only takes one hour to feel calm," she told me. "This month, I only needed one to feel better. I don't get the zombie antidepressant feeling—you still have your emotions. Sleep is good on it. I used to have an inner voice that was male and used to bully me during PMT time. Noises seemed too loud, even like somebody eating a bag of chips. Topping up with 5-HTP has stopped all this."
James Bates* who recently started taking it for panic attacks, said, "A friend who had anxiety recommended 5-HTP to me. I used to take beta-blockers and Valium, but the doctors have gotten funny about giving them to me. I needed an alternative and didn't fancy getting back on Prozac. I've only been taking the supplements for a month, but so far, it's helped a lot. I've only had two panic attacks, whereas usually I'd have four or five."
There is one glaring problem, however: The supplements come with a disclaimer that recommends not taking them for more than three months. Most of the information out there on 5-HTP is anecdotal, and most of them are stories of it helping people, rather than hard facts about its scientific properties. I approached neurologists, psychologists, and experimental doctors about 5-HTP, and many responses were strange. Not many people were willing to speak about it, saying they weren't qualified or hadn't read the relevant material, but there isn't much material to speak of. The main source of legitimate scientific evidence came from the University of Maryland Medical Center website, which stated that 5-HTP may work as well as certain antidepressant drugs to treat people with mild-to-moderate depression. But all the studies that support that statement were done in the 1980s and 1990s. I wanted to know if 5-HTP was a realistic alternative to SSRIs. Could I stay on 5-HTP forever, basking in its natural glory?
Eventually, I found Dr. Kristaps Paddock, a naturopathic doctor and 5-HTP expert from Maryland in the US. He said one benefit 5-HTP has over SSRIs is that it kicks in quickly for those with anxiety and depression. "Serotonin has a short metabolic half-life, so it metabolizes very, very fast. It goes into the body and out at a great speed, unlike SSRIs, which take a while to take effect so a sufferer wouldn't be feeling good during that time, and in fact may be feeling more suicidal. SSRIs also then have to be weaned off slowly, whereas you can stop taking 5-HTP instantly." Another bonus, of course, is that it's natural rather than synthetic. "If you're seriously considering the supplement, you have to weigh the positives and negatives against each other. The toxicity with 5-HTP is lower than that of SSRIs, since it's natural. Also, because it's metabolized much quicker, it'd get out of your system more quickly if there were any problems. On the other hand, the research basis for 5-HTP is dramatically lower, so it's important to think of that."
There are a number of professionals out there who support its use. Dr. Nicole Rush, a neuropathic doctor based in Ontario, Canada, believes it should and could be a legitimate alternative to SSRIs in the future. "When used safely and at an adequate dose, it has promise for supporting mild to moderate depression, and doesn't carry the side effects."
Dr. Sohère Roked is a GP in the UK with a specialist interest in integrative medicine. She prescribes 5-HTP to patients with anxiety and depression, alongside vitamins and other natural supplements, and sees no problem with it being used for mild conditions. "With the patients I see, generally I've seen good results with it. Antidepressants do work for some people, so I'm not against them completely, but others don't want to go down that path straight away. This gives them another option."
But what about the three-month warning? Rush, while an advocate for the supplement, sees it as a short-term solution, and not something to rely on long-term, for good reason. "Technically taking 5-HTP alone can deplete important brain chemicals such as dopamine and adrenaline. While 5-HTP is aimed at increasing the amount of serotonin in the body, dopamine and adrenaline are also important for positive mental health states. In order to prevent the depletion of important brain chemicals, taking 5-HTP would need to be balanced with amino acids that support the production of dopamine and adrenaline." That's L-tyrosine, which you eat in soy, chicken, and beef, and can also be found in health food shops as a supplement.
The reality is that people are always going to self-medicate. Boots, Amazon, and H&B all sell 5-HTP with no enforced age limit, and in theory you could keep buying it and taking it for as long as you like.
Even if you did look after yourself adequately and monitor the amount of 5-HTP you were taking, it doesn't appear to be a permanent or lasting solution. A couple of the doctors talked about something that comes up time and time again with long-term SSRI use: a dissipating effect, meaning the pills can feel less and less effective over time. It seems that people may have the same problem with 5-HTP. "If you push on your biochemistry hard enough, it may downregulate," Paddock explained. "If you're taking SSRIs your body may downregulate the amount of serotonin it puts out, so you get waning effects over time. It's similar with 5-HTP. There may be a certain level of serotonin your body is keeping you at, and if you raise it or push it, your body then may say, 'OK, we're above the set point, let's then raise that point again.'"
Though it may be unlikely to form part of any official psychiatric program in the UK, Phil Cowen, professor of psychopharmacology at Oxford, admitted that there are various groups for whom it could be helpful. "About half of people with severe depression never see a doctor anyway, so it's reasonable to think it's fine for them to treat themselves with something like a supplement. Perhaps if you had mild symptoms, a smaller dose would be helpful. I'd also prefer to prescribe things like exercise or computer-based CBT if it's that stage, though. But depression and anxiety is very different between people. That's important to keep in mind. No treatment is the same for anyone."
The reality is that people are always going to self-medicate. CVS, Amazon, and Whole Foods all sell 5-HTP, and in theory, you could keep buying it and taking it for as long as you like. But it's important to know the facts. It shouldn't be used in conjunction with an SSRI, for example. In that situation, if the body is preventing serotonin breakdown while also getting extra serotonin, it will lead to seriously unhealthy levels of serotonin activity.
Until there are more clinical studies, I'll probably stay on 5-HTP along with Jim Carrey, albeit carefully, until I find better long-term solutions. But perhaps it isn't the wonder drug I thought it was. As usual, if something seems too good to be true, it always fucking is.
*Name has been changed at the request of the subject, who asked to remain anonymous.
Follow Hannah Ewens on Twitter.
If you are concerned about your mental health or that of someone you know, visit the Mental Health America website.