Obsessiveness, Headaches, Hormones

Dear Dr. Dean,My husband has been serotonin deficient and has had migraines since his late teens. He becomes violent when not on his medication and deals with obsessive behavior. Through trial and error, I have gotten him onto almost all natural substances but we are hitting a brick wall now. He takes the following in the a.m.: Effexor XR® 150 mg, Chromium Picolinate 600 mcg, DHEA 100 mg. At night, he takes 2 capsules of 5-HTP, 120 mg of Lithium Orotate, and 400 mcg of Chromium Picolinate. The doctor put him on the lithium for migraines (for 4 years now) but now it is causing what he says is a dehydration headache. He tries to go off of Lithium Orotate, and although the headaches disappear, he becomes horribly obsessive and gets grumpy. He also tries to get off the Effexor (has been on it for 5 years) and trade it completely with 2 of the 5-HTP, but after only 2 days off the Effexor he becomes mean and flies off the handle about everything. So for the sake of the marriage he went back on the Effexor. He has weight gain and he can’t seem to get the pounds off. He is tired all the time, apathetic, has poor sex drive, and at his wits end. He wants to get off the lithuim because it causes dehydration headaches (even if he drinks a lot of water or iced tea) and off the Effexor because of the weight gain. What can we do about the lithium causing dehydration headaches since not taking it will mean he starts obsessing? And how can he get off the Effexor and onto something else so that he can lose this weight and not end up in jail for someone looking at him wrong. Can you help? Also, we did a saliva test through VRP and the results were estradiol 2.8 high, progesterone 46.2, ratio of pg/e2 16.2 low, testosterone 85, DHEA 524 high, cortisol am 7.3, cortisol pm 5.4. The test was taken on 6-14-06 and we have to decrease the DHEA to 100 mg once per day. When should we retest the DHEA and why is the estrogen so high? Thank you.Mrs. A.

Dear Mrs. A.,Sorry for the delay in responding. Quite a complex problem.Since the Lithium Orotate seems to help, I’d try to keep your husband on that. If the headache is truly a "dehydration headache," then I would make special effort to keep him hydrated in an attempt to prevent the headache.You said he had decreased his DHEA to 100 mg per day. How much was he taking? For men, I usually recommend a dosage of 50 mg per day, unless otherwise indicated. Since his DHEA level is so high, I think he may be able to get along on that lower dose.With a high estradiol, and a low testosterone, your husband may be converting testosterone to estrogen more efficiently than most. I suggest the drug, Arimidex®, at a dose of 1/2 to 1 mg once or twice per week. Arimidex is a very potent aromatase inhibitor. Aromatase is the enzyme that causes the conversion of testosterone to estrogen. Resveratrol is a natural (but slightly less effective) aromatase inhibitor. (It’s also a lot less expensive).Another way to reduce estrogen is to use BioDIM®. BioDIM acts as an estrogen "Vacuum Cleaner," to help metabolize and remove estrogen from the body.Have you ever thought about your husband’s thyroid status? Please read my article Neuroendocrine Theory of Aging, Part IIIb - The Energy Homeostat (Thyroid Complex) available on our website. Review the list of hypothyroid-related symptoms, and see if they describe your husband.If so, you might also review some of the Iodine-related articles on our website, and consider an Iodine Sufficiency Test, to check you husband’s iodine status (closely related to thyroid hormone sufficiency).If he appears to be hypothroid and/or iodine deficient, I recommend starting him on Armour® Natural Thyroid and/or Iodoral®. As his thyroid and iodine status return to normal, you may note a dramatic reduction in many of your husband’s symptoms (depression, cognitive function, alertness, weight gain, etc.).Since your husband seems to require Effexor (at least for the time being), I suggest continuing Effexor, while simultaneously taking 5-HTP. I think anyone who is taking an SSRI (Paxil, Prozac, Zoloft, etc.) should be taking supplemental 5-HTP or L-Tryptophan. I think the SSRIs tend to "burn up" these serotonin precursors (5-HTP, L-tryptophan), resulting in a drug-induced deficiency.To help reduce his cortisol, I suggest AdaptaPhase® I and Advanced Inflammation Control or Cortisol Control. After instituting the above changes, I suggest repeating his salivary hormone test after about one month. That should be long enough for the situation to "re-equilibrate."Hope these suggestions are helpful.Ward Dean, M.D.