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Primum Non Nocere: “Above All, Do No Harm!” Part 1

By Dr. Dean Raffelock D.C., Dipl. Ac., CCN, DIBAK

The popularity and profitability of far too many of the most commonly prescribed drugs have nothing to do with real science… or avoiding doing harm to patients.

The robust sales of these drugs far too often represent a triumph of advertising over science.

Most physicians consider themselves to be medical scientists trained to believe that the double-blind, placebo- controlled clinical study is the ‘gold standard’ of medical science. Drug companies claim to implement this unbiased gold standard on the studies they pay for to test their own products. This has become alarmingly less true. “Above all, do no harm!” has too often been replaced by “Above all, profits!”…and the truth be damned.

One of the most glaring examples of this is the 30 million or more people in the U.S. taking SSRI drugs. The meta-studies are conclusive that SSRIs work only for the most severe cases of serotonin mediated depression. Yet despite all the harmful side-effects (effects!) of these drugs, millions of people with mild to moderate depression are condemned to suffer. Significant weight gain, sexual dysfunction, suicidal ideation, murderous violence, loss of dopamine and the resultant vulnerability toward Parkinson’s disease are just a few of the potential effects from SSRIs. Reflexively prescribing this class of drugs first (especially before counseling lifestyle changes and nutritional strategies) often violates our first priority ‘Primum non nocere.’

In a recent ten-year period, pharmaceutical company spending on ‘direct-to-consumer’ antidepressant ads increased from $32 million to $122 million! During this time many studies that demonstrated no benefits or serious adverse effects were suppressed. Pharmaceutical companies are depending upon the old adage “if they hear it enough, they will eventually believe it.” That is not science, it is the power of repetitive suggestion.

Even very smart physicians with years of medical training are vulnerable to this type of unrelenting, repetitive advertising. What doctor has all the time it takes to read complete original studies and evaluate all the data? Most of the time reading the abstract will have to do. Or… reading the interpretation of the study written by a doctor on the pharmaceutical company’s payroll.

I’ve coached many physicians to learn nutriceutical approaches to mood and sleep disorders. This is always gratifying. Surprising was the fact that some did not know that SSRIs yield no net gain in serotonin. Shocking was the fact that these physicians were not taught enough clinical nutrition to know that our brains and intestinal tracts synthesize serotonin from two simple nutritional precursors…5- hydroxy-tryptophan and pyridoxal-5-phosphate (P-5-P). It is important to remember that we need to have enough serotonin in order for SSRIs to have something to re-uptake!

Unlike tryptophan, 5-hydroxy-tryptophan (5-HTP) does not need a carrier protein to ferry it across the blood-brain barrier, so it is highly effective for increasing serotonin production in the Raphe nuclei. Unlike tryptophan, 5-HTP’s conversion into serotonin within the brain is not blocked by excessive cortisol or catecholamine production. This makes 5-HTP a very effective nutriceutical intervention for many people.

Pyridoxine (B-6) is converted into P-5-P with the assistance of magnesium and riboflavin-5-phosphate. Again...5-HTP and P-5-P are required for the body to make it’s own serotonin. This simple knowledge is critical to know in order to assist a patient wean off SSRIs that either are not helping or making them worse.

Helping patients wean off norepinephrine related drugs and SNRIs requires the knowledge of the nutritional co-factors required to produce and excrete catecholamines. The amino acid L-tyrosine, iron, P-5-P, vitamin C, copper, methycobalamin, 5-methyltetrahydrofolate and P-5-P are all required to make catecholamines. Adequate magnesium is essential for efficient catecholamine excretion.

Atypical antipsychotic drugs are now prescribed on top of SSRIs, even when the SSRI has proven ineffective or is causing very troubling effects. This often deleterious cocktail is ruining the quality of life of millions of Americans.

Three atypical anti-psychotic drugs now top the list of the ten best selling drugs in the U.S. They cause an alarming incidence of blood clots, strokes and diabetes. According to, there are presently over 22,000 atypical antipsychotic related lawsuits against pharmaceutical companies and the doctors who have prescribed them.

Physicians recommending these drug cocktails should know the functions and nutritional precursors of all the major neurotransmitters before prescribing drugs that up or down-regulate their function. If for no other reason, avoid a lawsuit. Better yet, learn enough nutritional biochemistry and clinical nutrition to help most mild to moderate mood and sleep issues with nutriceutical not pharmaceutical interventions.

We now need thousands of clinics specializing in helping patients wean off unhelpful or harmful psychoactive drugs! Relatively few of these clinics are now in existence and they can not keep up with the demand to help the millions of patients whose lives have been damaged by the effects of these drugs. Interested physicians just need the knowledge and entrepreneurial spirit to help these people regain their quality of life.

Primum non nocere!

About: Dr. Dean Raffelock is a nationally known expert in integrative health care and consults for physicians nation-wide at Raffelock and Associates. You may contact him at 303.541.9019.

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