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Adding 5-HTP to Phen-Pro: An interview with Dr. Dennis Padla
Wednesday, September 10, 2003 4:27 pm Email this article
Psychiatrist Dr. Dennis Padla 5-HTP may help patients who have plateaued but may also increase the incidence of some side effects.
This interview was first published in Obesity Research Update, September-October 2000, Volume 5 Number 5 Page 37.
Dennis Padla, M.D. is a psychiatrist in St. Joseph, Mich. board certified in general and forensic psychiatry and an adjunct professor for the physician assistant program at Western Michigan University.
He previously co-authored a paper showing that the combination of phentermine and Prozac caused as much or more weight loss than Fen-Phen and that lower doses (20 mg) of Prozac were more effective than higher doses (40 mg). (See ORU, Oct. 1997, p. 73.)
Dr. Padla can be reached by phone at (616) 983-3885, or by fax at (616) 983-5763.
Hobbs: How often do you use each of these SSRIs or drugs with phentermine and what doses do you use?
- Prozac 50 percent of patients 10-20 mg
- Celexa 20 percent of patients 20-40 mg
- Effexor XR 20 percent of patients 75 mg
- Zoloft 5 percent of patients 25-50 mg
- Wellbutrin 5 percent of patients 150 mg bid
- Trazodone 0 percent of patients —
- Luvox 0 percent of patients —
- Serzone 0 percent of patients —
- Paxil Never. Paxil can cause weight gain.
Hobbs: How do you decide which drug to use?
Padla: I use Prozac when a patient wants a drug with a familiar name. I use Celexa when a patient is afraid of Prozac or tries Prozac and complains of vague side effects. Effexor works best in patients who are more depressed. And I use Wellbutrin to avoid sexual side effects.
Hobbs: What side effects are most common with each drug?
Padla: Sleep disturbance and sexual dysfunction with Prozac. Sedation with Celexa. Headache and nausea initially with Effexor especially if they have missed some doses and are starting again, and diarrhea with Zoloft.
Hobbs: Do you ever add 5-hydroxytryptophan (5-HTP) to Phen-Pro (Phentermine-Prozac or other SSRI)?
Padla: Yes. I give it along with 50 mg of vitamin B6.
Hobbs: In what percent of patients?
Padla: 20 percent.
Hobbs: When do you add 5-HTP?
Padla: I’ve used it mostly in patients who’s weight loss has plateaued—that is they have stopped losing weight—and those patients who have a bias against serotonin reuptake inhibiting drugs and prefer something “natural”.
Hobbs: Does it help to break plateaus?
Padla: Not as much as I’d like—it’s hit or miss.
Hobbs: How often does it work?
Padla: 30-40 percent of the time.
Hobbs: Does it reduce cravings?
Padla: It reduces sugar cravings somewhat. It’s very much like SSRI’s in that respect—maybe equivalent in efficacy.
Hobbs: Does 5-HTP help reduce the symptoms of PMS?
Padla: Probably, but I still prefer the SSRI’s for reducing PMS.
Hobbs: Do you know why it is that sometimes 5-HTP doesn’t help?
Padla: No, I don’t. I can’t tell who it is going to help and who it isn’t.
Hobbs: Do patients notice any subjective differences when 5-HTP is added to Phen-Pro?
Hobbs: Does it provide better appetite suppression?
Padla: Yes, it does in some patients, but not by a tremendous amount.
Hobbs: Does it help to reduce night time eating?
Padla: I don’t know.
Hobbs: Have patients reported any effect on insomnia, headaches, fibromyalgia?
Padla: Some patients have reported an improvement in sleep although I’ve also had reports of insomnia with the addition of 5-HTP. I think headaches are probably more common with the addition of 5-HTP. I haven’t tried it for fibromyalgia.
Hobbs: What is the average weight loss with Phen-Prozac versus Phen-Prozac-5HTP?
Padla: I don’t know. I haven’t calculated it yet. However my feeling is that the difference is probably minimal.
Hobbs: Do patients report any effect on mood with the addition of 5-HTP?
Padla: No, not that I have noticed.
Hobbs: Do patients report any effect on energy or fatigue?
Padla: Yes. Some patients have reported a decrease in energy with the addition of 5-HTP.
Hobbs: Have you had any reports of daytime sleepiness?
Padla: Yes, sometimes.
Hobbs: What time of the day do you give it—before meals or before bedtime?
Padla: At breakfast or lunch along with phentermine or at bedtime.
Hobbs: Is 5-HTP any less effective when taken with food?
Padla: Not that I have seen.
Hobbs: Do you ever vary the dose depending on the response, that is increase the dose if it doesn’t seem to be working?
Padla: Yes. I start with 50 mg per day and increase it to 100 mg, 200 mg or 300 mg if necessary.
Hobbs: What is the smallest dose that you have found effective?
Padla: 50 mg per day.
Hobbs: What is the largest dose that you have found necessary?
Padla: 300 mg, although patients did not like staying on this dose for too long.
Hobbs: Why is that?
Padla: Side effects.
Hobbs: Do you ever vary the dose depending on a woman’s cycle or if a person is under additional stress?
Padla: No, I have not tried adjusting the dose under these situations.
Hobbs: Do you keep patients on 5-HTP continuously?
Padla: Yes, if it’s effective. However, if it doesn’t seem to be working after two months I have them stop.
Hobbs: Do you have any patients taking it intermittently only when they feel it is necessary?
Hobbs: Have you noticed any difference in response between men and women?
Padla: No, not that I have seen.
Hobbs: Have you found any difference in the response to 5-HTP depending on which SSRI you used?
Padla: I have not tried to analyze this.
Hobbs: With the addition of 5-HTP how much more common are: Nausea? Headaches? Sexual dysfunction?
Padla: Nausea and headaches are probably about 10 percent more common with the addition of 5-HTP. I don’t know if sexual dysfunction is more common or not with the addition of 5-HTP.
Hobbs: Have you had any suspected cases of serotonin syndrome with the addition of 5-HTP?
Padla: No—never. I haven’t had any suspected cases with and of the combinations used for weight loss with or without 5-HTP.
Hobbs: Have you tried adding carbidopa with 5-HTP as Richard Rothman suggests?
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