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Treating GABA/Glutamate Dysregulation in Fibromyalgia & ME/CFS

A Look at Your Options

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Updated September 28, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The neurotransmitters GABA and glutamate both appear to be dysregulated in fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS). This may contribute to symptoms; altering activity of these substances may help alleviate symptoms. (For a look at the roles of GABA and glutamate in FMS and ME/CFS and the related symptoms, see: GABA & Glutamate: Part 1.)

If you believe you have GABA/glutamate dysregulation, you should talk to your doctor about treatment options. Remember that even natural treatments can have serious side effects.

Diet & Supplements

Supplements for altering the function of GABA and glutamate in your brain have not been studied specifically for FMS and ME/CFS, but we do have some general knowledge about them.

A synthetic form of GABA is available as a supplement. However, current medical opinion is that it doesn't cross the blood-brain barrier (BBB) and therefore does nothing to correct neurotransmitter imbalance. Some practitioners recommend taking precursors to glutamate (which is itself a precursor to GABA) that are known to cross the BBB.

Some precursors include:

  • 5-HTP: Your body converts 5-HTP into serotonin, and serotonin can enhance GABA activity. 5-HTP is a synthetic form of tryptophan, which is found in turkey. However, food-based sources of tryptophan are not thought to cross the BBB the way 5-HTP does.

  • Glutamine: Your body converts this amino acid into glutamate. Glutamine is available in supplement form and is present in meat, fish, eggs, dairy, wheat and some vegetables.

  • Taurine: This amino acid has been shown in rodents to alter brain levels of both GABA and glutamate. You can take it in supplement form and get it naturally in meat and seafood. Taurine is frequently added to energy drinks.

  • Theanine: This precursor of glutamate appears to lower glutamate activity in the brain by blocking receptors, while also boosting GABA levels. It's found naturally in tea and also is available as a supplement.

A probiotic called Lactobacillus rhamnosus may also alter the function of GABA in your brain, according to a 2011 study. Researchers say mice who ate the bacteria had lower anxiety levels when placed in stressful situations. However, this needs a lot more research before it can become a recommendation.

Before you start new supplements or make significant dietary changes, talk to your doctor and pharmacist about potential risks and drug interactions. For information on starting supplements, see: 7 Things You Need to Know About Supplements.

Drugs

Several drugs currently on the market alter brain activity of GABA and glutamate. Many have been tested and/or used as FMS treatments, but less so for ME/CFS.

These drugs are called agonists. They don't causes neurotransmitter levels to rise, but instead increase activity by stimulating receptors. Basically, they make your brain use more of what's already there.

GABA agonists include:

  • Benzodiazepines: These drugs depress the central nervous system. Common benzodiazepines include Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam) and Xanax (alprazolam). Benzodiazepines are sometimes prescribed for FMS, especially when insomnia and anxiety are present.

  • Xyrem (sodium oxybate) & GHB (Gamma-Hydroxybutyric acid): These closely related drugs also depress the central nervous system. GHB's street name is the "date rape drug." Xyrem is approved for some symptoms of narcolepsy, and studies have shown it's effective as an FMS treatment; however, the U.S. Food and Drug Administration (FDA) rejected it for FMS over safety concerns.

  • Non-Benzodiazepine Hypnotics: This drug class includes the popular sleep medications Ambien (zolpidem), Sonata (zaleplon) and Lunesta (eszopiclone). These drugs are chemically different from benzodiazepines but work similarly. Some studies (including Gronblad and Moldofsky, below) have shown that this class of drugs may improve sleep and possibly pain in FMS. None of these drugs has gone before the FDA for approval.

Yoga?

Yoga is generally believed to be calming. Could it actually increase GABA in the brain? One small study suggests that it might. Researchers reported a 27% rise in post-yoga GABA levels in eight practitioners.

This is only a single study, however, so we need further research on whether yoga raises brain GABA and whether it does so more than similar activities.

Neurotransmitter Dysregulation

Learn more:

Sources:

Bravo JA, et. al. Proceedings of the national academy of sciences of the United States of America. 2011 Sep 20;108(38):16050-5. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve.

Gronblad M, et. al. Clinical rheumatology. 1993 Jun;12(2):186-91. Effect of zopiclone on sleep quality, morning stiffness, widespread tenderness and pain and general discomfort in primary fibromyalgia patients. A double-blind randomized trial.

Jacobs GE, et. al. Progress in neuro-psychpharmacology and biological psychiatry. 2010 Apr 16;34(3):486-91. Hypothalamic glutamate levels following serotonergic stimulation.

Kimura K, et. al. 2007 Jan;74(1):39-45. L-Theanine reduced psychological and physiological stress responses.

Malemud CJ. Clinical and experimental rheumatology. 2009 Sep-Oct;27(5 Suppl 56):S86-91. Focus on pain mechanisms and pharmacotherapy in the treatment of fibromyalgia syndrome.

Molchanova SM, Oja SS, Saransaari P. Proceedings of the western pharmacology society. http://www.ncbi.nlm.nih.gov/pubmed/17532734 Effect of taurine on the concentrations of glutamate, GABA, glutamine and alanine in the rat striatum and hippocampus.

Moldofsky H, et. al. Journal of rheumatology. 1996 Mar;23(3):529-33. The effect of zolpidem in patients with fibromyalgia.

Nathan PJ, et. al. Journal of herbal pharmacotherapy. 2006;6(2):21-30. The neuropharmacology of L-theanine (N-ethyl-L-glutamine).

Spitzer AR, Broadman M. Pain Practice. 2010 Jan-Feb;10(1):54-9. Treatment of the narcoleptiform sleep disorder in chronic fatigue syndrome and fibromyalgia with sodium oxybate.

Streeter CC, et. al. Journal of alternative and complementary medicine. 2007 May;13(4):419-26. Yoga Asana sessions increase brain GABA levels.

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