PsychoPoet Research Initiative
Aut viam inveniam aut faciam
I am starting to get snowed under with PM'd requests for information about Inositol and I am noticing the same questions being asked in brand new threads every day, so I am going to solve that by posting everything I have been able to learn about inositol here. If you see anyone in the other forums asking about inositol, please direct them here to save everyone some time.
This is the first in a planned series of Research Initiative threads in which all the known facts are explored and myths are given the heave-ho.
You can also find a discussion of inositol in my Citalopram Survival Guide
. If you haven't checked the Survival Guide out, please do so as soon as you can cos there is a very large amount of information about fighting back against anxiety and depression.
Sponsored by David Bowie's trouser bulge in "Labyrinth"
Inositol: The Basics
What is inositol?
Inositol is a naturally occurring substance which is found in human spinal fluid. It's also, rarely, known as vitamin B8. Inositol is chemically similar to sugar and inositol powder has a sickly, sugary taste.
How is inositol linked to emotional difficulties?
People who suffer from depression are often found to have a reduced amount of inositol in their spinal fluid. No-one knows whether the lack of inositol causes depression, or depression leads to a lack of inositol.
Can I take inositol with antidepressants?
Can inositol cure anxiety and depression?
No, it is not a cure, and it seems to be more effective for some people than for others. At this stage a medical cure for anxiety and depression is beyond our technology. (See this thread for more information about upcoming and experimental treatments for depression and anxiety.
) Inositol is most useful in combination with other therapies such as counselling, hypnotherapy, exercise, relaxation and so on, so in this respect it is similar to all existing antidepressant medication.
On the other hand inositol can be very helpful at reducing feelings of anxiety and depression. It has helped me every time I have taken a dose.
Does inositol really work?
Yes, I believe that it has consistently helped me during my very worst bouts of anxiety. I also used self-help techniques such as deep breathing and positive affirmations (such as repeating "today is a good day", "this is just another harmless blip" over and over). There is no single path to recovery from anxiety, so make sure that you don't rely on inositol alone, you will still need to seek therapy and practice self-help techniques.
How long does inositol take to work?
The major medical trial which seemed to prove inositol's effectivness states that inositol reaches its full effectiveness within several weeks. However, people reported results very quickly, and panic attacks were decreased in frequency and severity within one week in some people.
I consistently find that taking a full teaspoon of inositol coincides with a reduction in my negative thoughts, feelings of depression and general anxiety.
Where can I buy inositol?
I used to buy mine in powder form from Holland & Barretts. Nowadays people are reporting that Holland & Barretts don't stock it any more or sell it combined with choline in pill form. While a small amount of choline may help alleviate depression, higher doses may actually make symptoms of depression feel worse, so depressed people should speak to a pharmacist or doctor first.
You can buy pure inositol powder from www.healthmonthly.co.uk
. It is expensive, but you may think the price is worth paying.
Inositol is also found in a varied, healthy diet, though not in depression-treating amounts.
Powder versus Pills
Which do I want - powder form, or tablet form?
This depends on your needs. Powder form is the most expensive by a quid or so and it is difficult to gauge exact doses (although your dose strength does not have to be exact). Depending on use, one tub of inositol powder can last for a few months. By contrast, tablet tubs are only slightly cheaper and do not last nearly as long, but you know exactly how much you are taking. If you intend to take inositol in larger doses there is no advantage to buying tablet form, so realistically most people will want to look for the powder form.
How do I take inositol?
Tablets are 650mg each (in the UK). The usual supplementary dose is 1-3 tablets per day, taken with food. If you take powder, the usual daily dose is 1/4 of a teaspoon three times per day, taken with food. 1/4 of a teaspoon is approximately 1g, or 1000mg. Be sure you do not get teaspoons (the little ones) confused with tablespoons (the big ones)! You can dissolve the powder in water and drink the lot or you can eat the powder and wash it down with water.
When do I take it?
If you split your dose up through the day, standard practice would be morning, noon and night, taken with food.
If you find inositol makes you tired, take it at night before bed.
If you are suffering from sleeplessness, take it at night, at least an hour before bed.
What does "take with food" mean?
You take it with a drink during or just after your meal. This helps the body to absorb the supplement. Obviously you don't mash it all in with your food.
What happens if I miss a dose?
It doesn't really matter that much. Just take some more when you remember. Inositol isn't like a medication and there is no apparent risk from doubling the dose, although you might want to look at the list of side effects first.
Benefits of Inositol
What can I use inositol for?
Inositol can be used to treat:
* Obsessive Compulsive Disorder
* Panic attacks
Inositol is also very effective against:
* Distressing negative thoughts
You may notice that inositol's greatest use is its ability to help you sleep. This provides a tremendous boost to your recovery by improving your mental and emotional resilience. You probably noticed that you feel worse when you are tired. Your mental shields are down and you do not have the strength to resist your negative thoughts and feelings. A tired mind can be an unhealthy mind. Once you start sleeping properly again, you could find your symptoms improve significantly. This is one of the more important steps on the road to recovery.
What are the actual benefits of taking inositol for anxiety and depression?
* Noticeably reduced impact of negative thinking
: Some things just don't bother you so much, or they don't dominate your thoughts and feelings so easily, meaning you can get on with other things (distraction) which is extremely useful if you're experiencing a "blip", that is a temporary worsening of your symptoms.
* Improvements to sleep pattern
: People who take inositol have experienced improvements to their sleeping patterns. Their quality of sleep improves (more restful, less troubled or stressful dreams), falling to sleep much more easily, staying asleep for longer. Anyone who has suffered even one bad night of anxiety attacks, or woke up at 4am shivering and feeling like they're going to die (and that seems to be all of us), will know what a blessing a full night's sleep can be. A good night's sleep can be so effective it works almost like magic
* General improvement of mood and outlook
: This follows on to the previous benefits. If you're tired, you are more prone to bad moods, negative thinking and anxiety etc, and I don't know about you but I get into a real temper sometimes if I'm very tired. Dr Claire Weekes says that we become less emotionally and mentally resilient when placed under prolonged stress. Anxiety, fatigue, depression and basically anything unpleasant that goes on for a long time can wear down our resilience. Once we lose this resilience, we start to feel low and upset, and negative events have far more impact on us than they should. Our outlook becomes far healthier if we are alert, well-rested and relaxed, and we are better able to cope with life's events.
Getting decent rest and being free from constant negative thoughts will help you to regain some of your strength so that if the anxiety does try to come back, you will be more capable of dealing with it. Also, with the negativity backing off a bit, you may find yourself better able to cope with whatever else you need to deal with now or in the immediate future. Finally, your reduced interest in your own problems gives you more freedom to take an interest in the world, which reinforces your recovery and further distracts you from worrying.
Can I take inositol even if I do not have an inositol deficiency?
If you are suffering from any of the conditions listed above, you can take inositol supplements, even if you do not think you have an inositol deficiency. If you are unsure, consult a doctor or pharmacist.
What CAN'T I use inositol for? (Inositol contraindications)
You should avoid taking inositol if you suffer from very pronounced mood swings and/or bipolar disorder. At this time, no-one really knows if inositol can actually trigger these mood swings, so you are better off avoiding inositol if you suffer from bipolar. Studies are trying to ascertain whether inositol is effective against schizophrenia; early evidence suggests it does not make any difference, but there is not enough information available at this time.
How does inositol work?
The exact mechanism of inositol is still under investigation by medical researchers. Your aim is to take enough inositol to gradually improve your body's stores of inositol and eventually to get it into the brain. You do this by taking the right daily dose. Inositol has a similar beneficial effect to SSRIs but it CAN be safely combined with an SSRI.
How does inositol compare to placebo?
In medical trials, inositol significantly outperforms placebo.
How does inositol compare to medication?
It even outperformed fluoexetine at reducing panic attacks and can become effective within days. Medical evidence so far seems to conclusively prove that inositol is effective against anxiety, depression and obsessive compulsive disorder, and criticism of the effectiveness of inositol when used in this role is rare. The side effects tend to be much less severe, meaning that someone who is feeling extremely vulnerable may get a lot of benefit from using inositol without most of the usual pitfalls.
Inositol and Choline
As I have mentioned earlier, a lot of people are saying they can only find inositol combined with choline. Health shops often combine the two because inositol complements the effects of choline. When used together, they supposedly improve the functioning of your nerve impulses and also help you to metabolise cholesterol, as well as other beneficial effects. However, high doses of choline have been linked to causing or increasing feelings of depression.
Choline Side Effects
Doses from 7.5mg upwards may cause slight reductions in blood pressure, leading to dizzy spells. Much higher doses can result in fishy body odour, although I work with a few people who don't need choline for that!
This is the big one: it appears that large doses of choline can cause or worsen feelings of depression. I am not sure exactly what dose contributes to depression, and I am somewhat confident that low doses may not have any negative effects, but you should definitely speak to a pharmacist before using choline supplements.
The Verdict on Inositol combined with Choline
You should try to find "pure" inositol if you wish to use it as an anti-anxiety supplement. Otherwise, follow a pharmacist's advice.
Inositol Side Effects
Medical trials indicate few or no side effects from taking up to 18g of inositol a day. That is a very substantial dose and, in practice, it is more than most people will want or need to take.
However, if you start taking higher doses you should be aware of the following possibilities:
* Stomach upset/nausea
* Increased need for the toilet
* Possible increase in mood swings (for bipolar or psychosis sufferers)
Compare those side effects to the effects for SSRI medication, which include temporary worsening of depression/anxiety, a small chance of suicidal feelings, sleeplessness, temporary sexual impotence or other sexual malfunctions, etc - all of which will start to show up long before any of the benefits from taking SSRIs become apparent. I'd take a few toilet-related shenanigans over the SSRI circus.
Not only are the side effects for inositol less numerous than SSRIs, they are also far less severe.
However, if you have been diagnosed with bipolar disorder or a bipolar-spectrum disorder, you should consult a pharmacist before using inositol.
Can I take inositol instead of a "proper" medication?
It was recognised during medical trials that inositol is
a possible, effective alternative to medication for people suffering from anxiety, depression and obsessive compulsive disorder.
While I would NEVER say medication is worthless (because it isn't), and I would NEVER tell people to delay going onto medication if they are suffering badly, I would recommend getting hold of inositol at the first opportunity. If inositol doesn't seem to help too much, then go to your doctor about a formal medication.
Don't delay this process too long though. If you feel that you need medication, go to your doctor and ask for it.
What is the daily dose of inositol?
Standard dietary supplement dose is up to 3g per day (in the UK).
Clinically effective dose for depression and anxiety is 12g per day.
Clinically effective dose for obsessive compulsive disorder (OCD) is 18g per day.
These doses are the ones used in medical trials which, after a period of 3 months, showed significant relief of symptoms in most people. Some people showed improvements within one week. I personally noticed an improvement within 3 days. Inositol works for many people in much lower doses than 12-18g. Build your dose up slowly, don't suddenly start at 12g per day.
It may not be necessary to go as high as 12 or 18 grams per day; medical trials need quick and measurable results to justify their funding, and they may have given participants higher doses of inositol than were strictly necessary in order to obtain these results. What this means is, inositol may be just as effective in much smaller doses. For example, I usually notice benefits when taking 3-4g per day, and I begin to notice an upset stomach after several days on a 6g dose. It seems common for people to experience benefits when taking 2g-6g per day.
What dose do I (PsychoPoet) take?
As I have improved via CBT and self-help, I no longer take inositol; when I started with inositol I was also taking 20mg-30mg of citalopram, but I am now on 30mg of mirtazapine and I am not sure if there would be an interaction between the two. While mirtazapine is generally safe with just about anything except alcohol, I don't want to be trailblazing new types of treatment any more since I don't want to put my growing recovery under more pressure. Also, I don't generally need inositol any more.
I found that large doses of inositol had a noticeable impact against my anxiety, depression and negative thinking patterns. I found myself slightly mentally tired, as opposed to normal where my thoughts raced like rats trapped in a wheel. This gave me a very welcome relief from over-thinking and over-analysing myself, and it allowed my battered mental defences some respite. A large dose for me might have been approximately 6 grams of inositol.
Note that the problems I just mentioned have been much reduced this year. At the time of writing, I have been undergoing CBT for 3 months and I have been creating and using positive self-help mp3s for at least 6-8 weeks. I am not the same person as when I started this Guide. I strongly recommend people going through similar issues consider starting CBT. If you cannot get CBT through the NHS or the waiting list is too long, contact Anxiety UK (or your country's equivalent).
I found that if I took 6g for more than 2-3 days I began to suffer an upset stomach and nausea. I have woken up a couple of times this week needing the toilet badly. When I first took inositol I felt tired and dreamy for 2-3 days, during which my duration and quality of sleep were massively improved, and the tiredness/dreaminess wore off before they could become a nuisance.
When I experience a "blip", I find that it is somehow worth risking the stomach upset! Improvements in my mood and reductions in my negative thinking do tend to coincide with 6g doses of inositol, every single time.
How long does inositol take to work?
As previously mentioned, inositol works quite quickly. It may be working fully within three weeks. However a lot of people notice benefits very quickly. In a major study, inositol vastly outperformed fluoexetine at reducing panic attacks within one week of treatment beginning.
Will inositol help me to control my mood swings?
Anecdotal evidence from bipolar and psychosis sufferers who have taken inositol suggests that inositol may actually trigger
mood swings, or somehow make them worse. More research is required before anyone can say for sure.
If you are suffering from bipolar disorder, contact a pharmacist and/or avoid taking inositol until further research has been done.
Can I take inositol if I am pregnant?
No. Research is inconclusive, but experts warn pregnant women not to take inositol supplements until more is known.
Is inositol safe for my children?
Currently there is no medical evidence to tell us whether inositol can be safely used by children. It is recommended by some that children take no more than 500mg per day (500mg being the dose strength of a single tablet in the USA - in the UK, a single tablet is usually 650mg because we are harder!).
Is inositol safe in the long term?
During clinical trials, people took 18g of inositol per day for 3 months with no adverse side effects. There were no unusual readings in blood and liver tests. There are no indications that inositol use is damaging to the human body. I first read about these trials 2 years ago and to date, no warnings about inositol have sprung up - just a few more good news stories.
What are the risks of inositol overdose?
At this time it seems that the human body can tolerate very large doses of inositol. Excess inositol may be passed out of the body via the urine, just like most types of vitamins.
However any side effects you experience may be increased in severity if you take high doses.
You should start with a low dose and gradually increase over a period of days or weeks until you find the dose that suits you.
Is inositol addictive?
No. However if you discontinue a course of inositol before your depression or anxiety have been beaten, and the inositol was helping, you may find your symptoms start to return.
Does inositol cause withdrawal or discontinuation symptoms?
Is it possible my body could be short of inositol (inositol deficiency)?
Highly unlikely. In clinical trials, they actually had to induce
inositol deficiency in the participants to study its effects. Inositol deficiency is apparently quite rare. However, I am not a doctor, so get yourself checked out if you wish to. It is possible that some people suffer from anxiety symptoms because of inositol deficiency but I am yet to hear from anyone who is.
Does inositol really work or is it just the placebo effect?
Since inositol vastly outperforms placebo in medical trials, and according to health supplement websites inositol is increasingly used to fight depression and anxiety, there is documented evidence that inositol does work.
If I find relief by taking large doses of inositol, then I stop taking the inositol, I do notice the anxiety gets worse. There is definitely a link between my doses of inositol and my anxiety. It has happened too many times to be a coincidence.
Why doesn't my doctor prescribe inositol instead of an SSRI?
Because the drug companies can't make money out of inositol, so we get stuck with anti-depressant drugs instead. This is the same reason why more research hasn't been done into inositol by medical companies. Also, as far as I know, you can't "prescribe" vitamin supplements. Some people are skeptical that inositol really works against anxiety. Evidence and personal experience shows that it does help, but then again it might not work for everyone.
A final and probably more important reason: if you are debilitated by stress, anxiety or depression, you may in some cases require medical treatment. Inositol should probably only be considered as a first-line treatment if you have either failed to improve by using medications, or your symptoms are not severe.
Should I try inositol if my anti-depressants don't work?
Research indicates that inositol may not benefit people who get no benefit from anti-depressant medication. Nobody is sure why at this moment. However anything is worth a try, so have a go.
Remember that a large number of people who claim anti-depressants don't work for them actually gave up before their medication had any chance of working properly, so if you belong to this group of people, you may find inositol does work for you. A major factor in "treatment-resistant" depression is people not taking their doses properly or stopping the medication altogether, either because they start to feel better or because they cannot tolerate the side effects.
As an interesting aside, medical treatments may become more aggressive for treatment-resistant depression: for example, combinations of medications may be used, and the UK government has recently started throwing money into CBT, since CBT typically has good cure and relapse prevention rates (both of which increase exponentially when CBT is combined with Mindfulness and/or interpersonal skills).
What if inositol doesn't work for me?
There are plenty of other things for you to try.
Can I combine inositol with Kalms?
Kalms contain valerian, which is used for relief of mild stress and anxiety. There is nothing to suggest that valerian and inositol cannot be mixed but if you want to try it you might want to check with a pharmacist first (you could phone your local Boots and speak to the pharmacist over the phone). Kalms should not be used for long-term treatment of stress or anxiety, and Kalms should not be seen as an alternative to medication if your symptoms are long-lasting or severe.
Inositol, on the other hand, may be used as a substitute for antidepressants and anxiolytics if you do not want to try taking medication.
Why do you claim to know so much about inositol?
Because I've used it during the worst phases of my illness (I took regular doses for several weeks at a time) and it has benefitted me every single time.
I've extensively researched the uses, benefits and drawbacks of inositol, including reading medical reports available online - try reading one of those and you'll know how much fun that wasn't.
In the early days, if I stopped taking inositol, I tended to find myself going into a "blip", although I cannot conclusively prove that this has anything to do with reducing my inositol intake.
Currently I am taking inositol in powder form, since I am no longer taking SSRI medication.
Supporting the Research Initiative
Please mention this thread whenever anyone needs information about inositol. It saves NMP getting one new inositol thread per day.
Check this thread. Please leave any questions or comments about Anxiety UK in that thread, not this one!