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As a psychiatrist familiar with MAOIs, tryptophan, etc, I have the following thoughts re: the combination of tryptophan and and MAOI.

1) Dietary tyramine is restricted with use of MAOIs, not tryptophan. Ordinary dietary intake of tryptophan should be safe.

2) Large amounts of tryptophan, given IV, produce some of the symptoms of serotonin syndrome. Some of these effects may be mediated outside of the brain.

3) Physiologically, the body uses most tryptophan in protein synthesis. If enough tryptophan is not available after protein synthesis, brain serotonin with decrease. However, excessive doses of tryptophan do necessary increase serotonin. Like most other nutrients, excesses beyond physiological needs are generally wasted in terms of physiological processes. If the substance has a physiological effect of its own, such as antioxidant vitamins do, does beyond requirements may be helpful.

4) MAOIs inhibit the breakdown of serotonin, norepinephrine, and dopamine in the after reuptake from the synaptic space. Since SSRIs prevent reuptake, the interaction is really not that strong, but none-the-less there is a danger of serotonin sydrome when combining the agents.

5) The serotonin sydrome is rather unpredictable, and there are anectodal reports of many different combinations of serotonergic agents causing it. The interactions of these agents are largely unknown, and individual differences regarding enzymes etc are great. Even Saint John's Wort, in combination with an SSRI like Prozac, can cause serotonin syndrome.

6) In view of the above, I would not recommend use of an MAOI with high doses of either tryptophan or 5-HTP, and, to do so as a physician, I think, could be malpractice. I do not believe that either tryptophan or 5-HTP, beyond physiological doses, are therapeutically useful in treatment of anxiety or depression, nor do I believe they are "neuroprotective" with respect to serotonergic neurons.

MG M.D.