Gingko does Zilch for the brain! Part 2

Says Dr DeKosky, vice dean School of Medicine, "For me, this kind of closes the book on whether or not, if you start taking ginkgo later in life, you are going to have cognitive benefit. We don't have good evidence that it maintains good brain health."
He goes on to add, "Quite frankly, one of the things that surprised us was that for an extract that has been around for this long, there ought to be a signal of some sort, or we ought to see some effect for it to have maintained its reputation for so long. And we didn't."

And what do alternative health care workers say about the study?

Says Douglas Mackay, vice president of scientific and regulatory affairs for the Council for Responsible Nutrition, a principal trade association of dietary-supplement makers, "What we would really like to see is additional research. What we would not like to see is this study closing the door on answering other questions or subsets of questions on ginkgo."

So what does all this mean for the consumer?

There are always some die hard alternative health care fans who will continue to believe in the mythological properties of gingko. For those who are undecided and have common sense- save your hard earned money on gingko. If you want to have a healthy brain- eat well, exercise regularly and stop believing everything that you read on cyberspace!

Dec. 29, 2009 Journal of the American Medical Association

Gingko does Zilch for the brain! Part 1

For decades, alternative health care practitioners have been hyping the long term benefits of ginkgo for maintaining good mental function and cognition. There are thousands of anecdotal reports from vendors of this herbal supplement that it has “magical” brain stimulating properties. Now there is a study that finds that all the hype about gingko is false- the herb really does not slow down mental decline.

Led by Dr Steven DeKosky from the University of Virginia, six major US institutions looked at Gingko supplements and showed no discernible differences in the herb versus a sugar pill. The researchers looked at the effects of gingko on several brain tasks including attention, memory, concentration, language and cognition. The results revealed that gingko did not make one iota of difference compared to the sugar pill in improving any single brain function. This is the largest and longest study spanning over a mean of 6 years which has looked at effects of gingko on the brain. An earlier study led by the same team showed that ginkgo did zilch in preventing or delaying Alzheimer’s dementia. In the present study, more than 3,000 elderly volunteers between the ages 72-96 participated.

Mother’s depression worsens asthma in children! Part 2

"Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise. The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first," Riekert said.

Since depression can profoundly affect mental health concentration, cause fatigue and diminish concentration, it may weaken the mother’s ability to manage her child’s asthma. Asthma is a common respiratory ailment which often gets worse in winter and some children require daily treatments and multiple doctor visits.

"Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," said chief scientist Michiko Otsuki said in news press release.

This simple observational study may be true but there are many other factors in African Americans that have not been looked at. The economy, finances, physical health, obesity or lack of transport- all these can lead to worsening of not only asthma but many other medical disorders.

The study can be viewed online on the Journal of Pediatric Psychology Nov 2009.

Mother’s depression worsens asthma in children! Part 1

US researchers say that a mother’s depression can worsen her child’s asthma symptoms. The 6 month study done by researchers at John Hopkins university looked at 262 black mothers and their children. What they observed was that mothers who had severe depression also often had children with frequent asthma attacks. On the other hand, women who had less depression had children with fewer asthmatic symptoms.

The John Hopkins Children's Center team looked at black mothers and children because black children are excessively affected by asthma and are seen more often in the Emergency room than other ethnic groups. Says lead investigator Kristin Riekert, a pediatric psychologist and co director of the John Hopkins Adherence Research Center, "Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier.“

On the other hand, children who had less asthma did not necessarily have mothers with less depression. Based on these observations the researchers say that depression may be an independent risk factor that can forecast the severity of asthma in a child.

Can some diets improve cognitive performance? part 2

So what should the average individual eat?

The above study has important implications for not only airline pilots, truck drivers, military personnel but also for patients with dementia. Alzheimer’s disease (AD) and other related dementias carry a high morbidity, and have a significant impact on families and care givers. As of today, no drug has made any impact on either prevention or treatment of the various dementias.

The question that remains to be answered is whether such diets can help improve cognition in patients with AD. Even though the study was done in pilots, preliminary results indicate that such a diet may also be applicable in individuals with dementia. At the moment, the data are preliminary and one does not have to eat a high carb diet or a high fat diet all the time. It is well known that the brain’s primary source of energy is glucose and a high carbohydrate diet does supply adequate sugar. However, with the obesity epidemic in society, one certainly cannot over indulge on a high carbohydrate diet.

The role of diet and its role in improvement of cognition and mental function has only now been appreciated. To improve long-term mental cognition, the answer may be more in the diet than consuming pills with unknown chemicals. However, a few more studies are needed to understand the complete role of nutrition and its impact on the brain. The take home message is that all individuals should eat at a well-balanced diet that has a lot of carbohydrates and a reasonable amount of fat. Moreover, one should not forget to exercise and stop smoking at the same time.

http://www.medscape.com/viewarticle/708241

Can some diets improve cognitive performance? Part 1

For many years, clinicians have been wondering if certain diets can help improve cognitive performance, concentration, and mental aptitude. Over the past few decades, there has been a strong belief that diets high in protein are supposed to be better than high carb or high fat diets for good mental health. However, recently, there have been many isolated reports suggesting that diets high in carbohydrates or fat can lead to better concentration and attention span.

In the last two decades, evidence has accumulated that human error is a major cause of accidents in the airline industry. Further, long working hours, flying along several time zones and lack of proper nutrition have also been other factors associated with pilot errors. There is currently little data on the potential association between dietary intake and cognitive performance.

In the present study investigators sought to compare diets high in carbohydrates, fat, or protein to test their effects on cognition, flight performance, and pattern of sleep. Forty-five pilots were registered in this 14-week study during which individuals were randomized to be given a diet high in fats, diet high in carbs, a diet high in protein or a controlled diet.

The results showed that a diet high in carbohydrates or fat could lead to markedly enhanced cognitive performance and awareness testing score in pilots than a diet high in protein. Further, the study revealed that a high-carbohydrate diet helped pilots sleep better and longer, and a high-fat diet seemed to lead to a significantly quicker recollection of short-term memory. Finally, the results showed that by and large, flight-performance scores for pilots consuming a high-protein diet were considerably inferior than for those consuming a high-carbohydrate or a high-fat diet.

Can Axona help prevent Alzheimer’s Dementia? Part 2

So where does the consumer stand with Axona?

There have been numerous dietary substances hyped up to cure or prevent dementia and none has so far proven to be effective. AD is a complex disorder with numerous physiological and neurological changes. Inability to utilize glucose by brain cells is just one more hypothesis. Now we have axona and its ketone building properties. If high levels of ketone were the panacea for treating dementia, then all type 1 diabetics would never develop dementia and this is not true at all. In fact, diabetics have one of the highest rates of dementia and other cognitive problems—so the ketone theory is hogwash. Secondly, high levels of ketones can cause very unpleasant symptoms. Thirdly, despite Axona being available on the market for some time, very little has been reported about it. There are only anecdotal reports by a few individual who seem to have reported improved symptoms after taking axona. There is not a single patient whose dementia has completely reversed when taking axona.

More disturbing is that many individuals in the study were also allowed to continue their current AD medications and their diets were not altered in anyway. This makes it impossible to know what actually caused the mild improvement in these patients.

Further, many studies on axona have been sponsored by the company that manufactures the product –a conflict of interest is a major issue. Cardiologists claim that ingesting a saturated fatty acid like caprylic acid, on a daily basis can clog up blood vessels and induce heart attacks. The Food and Drug Administration claims that it does not know if Axona works, only that it is safe to consume and that it aims to correct a recognized nutritional deficiency.

Even though the company has made a lot of hype about Axona, none of the clinical studies has been published in reputable clinical medical journals where the work can be critiqued and analyzed. Axona does not come cheap either. A month’s supply is about $80 and requires a prescription. That is about $1000 a year.

Final Point

Axona is just another food product that is being promoted to treat AD. In reality, it is still too early to develop axona mania yet. Finally remember, the field of medical foods and health supplements is not innocuous especially when one looks back at recent data on weight loss products. Moreover, it looks like Axona is no different- a lot of false promises and disappointments is what most people will get. Until more is acknowledged about this medical food, Alzheimer’s Association does not advocate use of Axona for treatment of AD.

http://www.alzheimersweekly.com/Treatment/introducing-axona-a425.html
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Can Axona help prevent Alzheimer’s Dementia? Part 1

Axona is a relatively new medical food product that is heavily touted to improve cognition and memory in patients diagnosed with mild to moderate Alzheimer’s Dementia (AD). Axona is sold as a dietary food product but requires a physician’s prescription. Axona is manufactured by the pharmaceutical company Accera. Research done in Accera laboratories has shown that treatment of metabolic deficiencies may help decrease devastating effects of AD.

In a few small-randomized studies, axona did show mild improvement in patients with dementia. The manufacturers of axona claim that that this health supplement provides an alternative source of energy to the brain cells. By providing energy to the brain, axona helps protect nerves against injury.

So does axona work?

In normal individuals, glucose is a primary source of energy for the brain. In patients with Alzheimer’s disease, there is a marked decrease in ability of brain cells to utilize glucose. The hypothesis is that when brain cells fail to use up glucose, this results in impaired memory and cognition. These metabolic defects are said to occur at least a decade earlier before symptoms of Alzheimer’s are evident.

Axona when ingested is converted by the liver into ketone bodies that provide an efficient alternative fuel for brain cells. Ketone bodies do occur naturally in our body during extended periods of fasting. There is some laboratory evidence that ketone bodies protect nerve cells. The key ingredient in Axona is a saturated fat called caprylic acid. The liver converts a portion of it into ketones, regardless of whatever nutrition the individual consumes.

At present axona has been specially formulated as a medical food for clinical management of mild to moderate AD. Axona is available as a powder and taken once a day. The company claims that there are no adverse effects of axona. The few reported side effects of axona include nausea, diarrhea, and bloating.

Axona is only available with a prescription from a physician.

Does high cholesterol increase the risk for alzheimer's disease? part 2

This is the first study that clearly shows that dementia can be delayed or prevented by modifying life style factors and lowering cholesterol.

At the moment, data clearly show that life style influence can lead to an increased risk for dementia. However, the role of genetics is not well established. In any case, there is now a clear trend among some physicians recommending life style changes to reduce blood cholesterol. Reducing cholesterol may help reduce risk of heart disease, diabetes, obesity, and dementia later in life.

So how should consumers reduce cholesterol levels?

Keeping fit, eating right and exercising regularly not only maintains the heart healthy but also keeps the brain intact and sharp. For most consumers the good news is that cholesterol lowering does not always have to be done with use of drugs. Changes in diet and life style in middle life are the cheapest and most efficient ways to reduce cholesterol. Irrespective of the genetic make up, walking everyday, eating healthy and keeping your weight down may go a long ways towards reducing the risk of dementia.

For more on cholesterol monitors, please visit www.medexsupply.com

Does High cholesterol increase the risk of dementia? Part 1

For decades, it has been known that high cholesterol levels are not good for the heart. High cholesterol levels have been associated with high blood pressure, increased risk of heart attacks, strokes and generalized narrowing of blood vessels. Now there is a study that shows that moderately elevated levels of cholesterol in middle-aged adults may be an increased risk factor for developing Alzheimer’s disease and other dementias.

Researchers recently published data on 9,800 individuals who were followed for more than 4 decades for development of dementia. It was observed that individuals who had high or even moderately elevated levels of cholesterol in their mid 40s had a significantly increased risk of developing Alzheimer’s disease later in life.

In the past, scientists have always tended to think of the brain and heart as two distinct organs that are affected by different pathology. However, we are now learning that what is good for the heart is also good for the brain. This concept is now being applied by physicians in recommending changes in life style in middle age to help prevent onset of dementia.

The one minor negative of the study was that researchers did not distinguish between the HDL (good) and LDL (bad) cholesterol, chiefly because the significance of these different subtypes of cholesterol was not well understood forty years ago. At present, the current guidelines mention that total cholesterol of 240 or higher is considered high, and a cholesterol of 200 to 239 is considered borderline high. Cholesterol levels less than 140-160 are being recommended.....

IS Amisulpride a great drug for Schizophrenia? Part 2

So what does this mean for the consumer?

The studies by the reviewers confirmed that Amisulpride is an effective 'atypical' antipsychotic drug for patients with schizophrenia. Amisulpride also is just as effective as risperidone or olanzapine. Overall, it was discovered to produce improved results such as enhancement of overall mental state and wide-ranging negative symptoms. Amisulpride may be more tolerable and acceptable than the conventional antipsychotics, especially when it comes to the motor side effects (e.g. extrapyramidal side effects).

The individual who is being treated with an older conventional anti psychotic may want to switch to Amisulpride if he or she has developed motor side effects or has negative symptoms of schizophrenia. For those individuals who are on risperidone or olanzapine, there is no solid evidence that Amisulpride is any better or worse. More studies are required to determine what role Amisulpride has on family responsibility, quality of life, and expense of the drug in the long term.

http://www.cochrane.org/reviews/en/ab001357.html

IS Amisulpride a great drug for Schizophrenia? Part 1

Drugs for the treatment of schizophrenia have been available for more than 50 years. Even though the older anti psychotic drugs are effective, they have many side effects. Over the years many newer anti psychotics have been developed. One of the most recent anti psychotic drug on the market is Amisulpride. Amisulpride is said to be an "atypical" antipsychotic that induces less movement disorder and is effective for the negative symptoms of schizophrenia. The “negative” symptoms include an inexpressive faces, blank looks, monotone, monosyllabic speech, few gestures, seeming lack of interest in everything, inability to feel pleasure or act spontaneously.

Many physicians have started to prescribe Amisulpride for treating their schizophrenic patients. The overall feeling is that the drug is safe and has fewer side effects compared to the older conventional anti psychotic drugs. However, Amisulpride is a much more expensive compared to the traditional drugs but is the expense worth it?

Cochrane reviews recently looked at several studies that compared Amisulpride with placebo, typical and atypical antipsychotic drugs for schizophrenia. The researchers looked at 19 randomized clinical studies with 2443 individuals. Data from four studies indicated that schizophrenics with negative symptoms did show improvement at doses of up to 300 mg/day. Not only was Amisulpride more effective than a placebo, but also it was better tolerated than the typical anti psychotic drugs. Amisulpride was less prone to cause strange motor symptoms. When Amisulpride was contrasted to one of the other atypical anti psychotic medication. Risperidone, with the exclusion of agitation, which was more common in the Amisulpride group no significant differences were documented on effectiveness or tolerability.

Aroma Oil Therapy for Dementia: Part 2

Evaluation of results revealed that there was a statistically significant treatment effect in support of aroma oil therapy intervention on measures of anxiety, agitation and neuropsychiatric symptoms.

So what does this mean for the consumer?

The results of one small study do indicate that aroma oil therapy has some benefits in individuals with dementia. However, it is hard to draw conclusions because the study was short, the number of patients small and there were some methodological problems in evaluating the study. Only a well designed randomize controlled study will determine if the effects of aroma oil therapy are real and beneficial in patients with dementia. In any case, the study did not reveal any major side effects from use of aromatic oils and there is little harm in trying these products.

No one really knows when one should start aromatic oils and for how long the treatment has to be continued in order to prevent or diminish symptoms of dementia. Until more data are available, consumers will have to make their own decisions on use of aromatic oils for dementia.

http://www.cochrane.org/reviews/en/ab003150.html

Aroma Oil Therapy and Dementia: Part 1

The treatment of dementia is not satisfactory and many caregivers/patients have been opting for non-conventional therapy. One such alternative therapy that has been hyped up to delay or prevent dementia is aroma oil therapy. Aroma oil therapy has been widely used to treat a number of medical ailments including insomnia, depression, anxiety and pain. Aroma oil therapy essentially involves use of pure essential oils from various fragrant plants like peppermint, sweet marjoram, and rose. The apparent minimal side effects of aromatherapy has been of magnetic attraction to alternative health care practitioners and patients.

Many herbal and health food stores advertise aromatic oils as first choice therapy in order to reduce symptoms of dementia and disturbed behavior. Anecdotal reports indicate that aromatic oils can also promote sleep and stimulate motivational behavior. It is for these reasons that many patients have increasingly turned to aromatic oils rather than pharmacological therapies.

At present, thousands of individuals use aromatic oils for personal health care. These products are readily available, do not require a prescription, and are relatively inexpensive. The question is. “do aromatic oils help treatment of dementia?”

The number of randomized studies looking at the benefits of aromatic products are small and solid data are difficult to come by. Recently Cochrane reviews looked at data from one small study where aromatic oil therapy was used for the treatment of agitation and other neuropsychiatric symptoms in individuals with dementia.

Do centrally acting anti hypertensive medications reduce dementia? Part 2

So what should patients do in the meantime?

It is far too early to start advocating ACE inhibitors for all elderly patients. Switching patients to centrally acting ACE inhibitors is a difficult and an expensive undertaking and should only be done on a case-by-case basis. The director of the above study, Dr Sink, recommends that, “if the patient does not have a contraindication for an ACE inhibitor, then switching to a centrally active ACE inhibitor is a reasonable choice. In addition, for those already on ACE inhibitors, our study results would support the use of a centrally active ACE inhibitor over a non–centrally active one."

Centrally active ACE inhibitors included captopril (Capoten, Bristol-Myers Squibb), fosinopril (Monopril, Bristol-Myers Squibb), lisinopril, perindopril, ramipril (Altace, King Pharmaceuticals), and trandolapril (Mavik, Abbott Laboratories). Non–centrally active ACE inhibitors included benazepril (Lotensin, Novartis Pharmaceuticals), enalapril (Vasotec, Merck), moexipril (Univasc, Schwarz Pharma), and quinapril (Accupril, Pfizer).

The study is published in the July 13 issue of Archives of Internal Medicine.

http://www.medscape.com/viewarticle/706401

Can Centrally Acting anti hypertensive medications reduce Dementia? Part 1

Angiotensin-converting enzyme (ACE) inhibitors are important for control of blood pressure and have made a profound impact on patients with diabetes and congestive heart failure. The ACE inhibitors, which act outside the brain, have had minimal impact on dementia of any cause. However, there is now evidence indicating that ACE Inhibitors which act inside the brain, may have the ability to reduce cognitive decline.

Recent observational data from the Cardiovascular Health Study revealed that that centrally active ACE inhibitors did diminish cognitive decline by 65% per year of exposure, an effect that is likely related to the drug’s ability to cross the blood-brain barrier.

The study included 414 subjects who had been administered ACE inhibitors and 640 who had taken other antihypertensive medications. The researchers found no connection between exposure to all ACE inhibitors and risk for dementia, difference in cognitive-function scores, or odds of disability.

However, further analysis according to type of ACE inhibitor showed an unusual benefit. The results revealed that centrally active ACE inhibitors were associated with 65% less decline in cognitive-function scores per year of exposure.

This lessening in cognitive decline is not felt to be due to better control of blood pressure but most likely related to the drug’s effects on the brain's intrinsic renin-angiotensin system, which is felt to be valuable in memory and cognition. There is some laboratory evidence showing that stimulation of the renin-angiotensin system also provokes activation of inflammatory mediators which have been implicated in causing degenerative dementias.

For patients with dementia, this may be good news. There has been a huge public demand to find an intervention that can prevent or slow cognitive decline. However, the above study has to confirmed in a randomized clinical trial to determine if the above results are in fact a true observation.

Finally a treatment for hair pulling? Part 2

How N acetyl cysteine prevents hair pulling is not fully understood but is believed to act in the brain and reduces activity of a neurotransmitter, called glutamate. It is believed that glutamate mat play a role in the compulsion to pull hair. When levels of glutamate are reduced, the drive to pull hair also disappears.

There have been previous anecdotal reports and case series which have also reported that N acetyl cysteine may reduce the urge to use illicit drugs like cocaine.

The dose of N acetyl cysteine used in the study varied from 1.2- 4 grams per day. Even though hair-pulling episodes declined, most individuals did not see a marked improvement in their quality of life.

So what about the individual who has Trichotillomania?

One should understand that this is only one study that shows benefits of N acetyl cysteine for hair pulling. The supplement is easily available without a prescription from any health food store and is relatively safe to ingest. The cost of N acetyl cysteine is also substantially lower than all presently prescribed drugs for the disorder. Therefore, if you have a habit of puling your hair and would like to stop it, N acetyl cysteine may not be a bad idea. Of course, if it does not work within 2-3 months, then the above study was hogwash.

Archives of general psychiatry, 2009-07-18

Finally a treatment for hair pulling? Part 1

Hair pulling is a relatively common disorder in the general population. This agonizing disorder is more common in females and is often associated with an obsessive compulsive personality. Current estimates indicate that at least 2 million adult Americans over the age of 20 have this disorder. There are countless more individuals who have not been diagnosed or are too shy to visit a physician. Despite being aware about this disorder for decades, the treatment for hair pulling or Trichotillomania has not been very satisfactory. Over the years, countless treatments have come and gone. Today, pharmacological drug therapy and behavior alterations are the mainstay of treatment but have limited success.

Recently a paper published in the Archives of General Psychiatry offers new hope for patients who suffer from Trichotillomania. In a small trial involving 50 individuals, it was observed that those who took the health supplement, N acetyl cysteine, had marked improvement of symptoms after only 12 weeks. N acetyl cysteine used in the study was obtained in a pill form from health food stores like GNC and Vitamin Shoppe.

If these studies do hold up, then this may herald a potentially new treatment for this disturbing disorder.

Why people pull hair remains a puzzle and there are countless theories. The bottom line is that chronic hair pulling is a diversion from a stressful situation, which eventually turns into addictive psychological relief. The majority of individuals not only pull hair from the scalp but also from other parts of the body. At least 20 percent of individuals even eat their hair and a very few minority pull other people’s hair. While hair-pulling sounds painful, most trichotillomanics claim that it provides a calming feeling and relief from the acute anxiety.

Can the Mediterranean diet prevent Alzheimer’s dementia? Part 1

Over the years, there has been a great interest in ways to delay or prevent Alzheimer’s dementia. Besides use of drugs, some researchers feel that perhaps a change in diet may help prevent the decline in cognitive impairment that occurs in old age. It is widely believed that a healthy diet may help prevent development of mild cognitive impairment (MCI) and delay onset of Alzheimer’s disease (AD).

Current estimates indicate that about 10% to 15% of individuals with MCI convert to AD each year.

One of the diets thought to have some benefit in delaying mild cognitive impairment is the Mediterranean diet. Previous clinical research revealed that conformity to a Mediterranean diet was linked to a reduced risk for AD, but its effect on developing MCI was unknown.

The recent study from Washington Heights Inwood Columbia Aging Project (WHICAP) looked at the benefits of adherence to a Mediterranean diet and development of mild cognitive impairment over several years.

To explore whether cognitively normal individuals whose food intake was more representative of a Mediterranean diet were less likely to develop MCI, the researchers examined data from 1393 cognitively normal individuals and 484 individuals with MCI who were participants in the WHICAP multiethnic community study in New York. The majority of individuals studied were in the 7/8th decade of life. Study participants were given a score of 0 to 9 based on their faithfulness to a Mediterranean diet, where 9 indicated greatest adherence to this diet.

Strong adherence to a Mediterranean diet was characterized by a high intake of fish, fruit, vegetables, legumes, cereals, and unsaturated fat; a low intake of dairy products and meat; and a moderate intake of alcohol/wine.

Melatonin and jet lag?

One of the hassles about long distance air travel is jet lag. Jet lag occurs when the body’s internal rhythms no longer work in synchrony. The day and night cycle become disturbed and the individual often requires several days to get back into his/her normal rhythm. There is evidence that melatonin, a hormone released from the pineal gland, is important when it comes to regulating many body rhythms and the sleep-wake cycle. For decades, melatonin has been sold in health stores as an aid for sleep and help recovery from jet lag.

Millions of pills of melatonin are bought by consumers to treat jet lag, but is melatonin effective?

Cochrane reviews recently looked at 10 randomized clinical trials in which melatonin were used by airline personnel, military employees and other regular airline passengers. Melatonin was compared to a sugar pill. The outcome measures looked at subjective well being daytime tiredness, onset, quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms.

The studies found that melatonin was quite effective when taken close to the target bedtime at the destination, decreased jet lag from flights crossing 5 or more time zones. Daily doses of melatonin between 0.5 and 5mg were both equally effective, except that people started to fall asleep a lot faster when using the higher dose. Doses above 5mg appeared to be no more effective than the lower doses of melatonin.

A slow release preparation of 2 mg melatonin also worked well at inducing sleep. Some studies indicated that this formulation may be of more benefit when greater than 4-5 time zones are crossed.

The studies revealed that timing of the melatonin dose was important. If the melatonin was taken at the wrong time or very early in the day, it was likely to cause sleepiness and delay adaptation to local time. The incidence of other side effects was low. A number of case reports have also suggested that individuals with epilepsy and patients taking warfarin (blood thinner) might come to harm from melatonin.

Conclusion

Melatonin is quite effective in preventing or reducing jet lag, and for short-term use appears to be safe. It may be a choice for jet lag treatment for travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys. Despite these positive reports, there are a lot of anecdotal reports that melatonin often fails to work. The reason(s) for these discrepancies are not well understood, but more likely than not, are probably related to fake or counterfeit products.

http://www.cochrane.org/reviews/en/ab001520.html

Can testosterone supplements help relieve schizophrenia?

Schizophrenia is a common malady in our society. Estimates indicate that close to 1% of people in North America suffer from schizophrenia. The disorder affects all races, cultures, and both genders. The disorder is associated with inability to determine what is real. These individuals may develop false beliefs, hallucinations, distorted perceptions and have emotional withdrawal. Over time, most schizophrenics develop apathy.

Over the years, the major treatment for schizophrenia has been based on use of drugs. Each and every pharmaceutical anti psychotic drug available today has its pros and cons; there is no ideal drug and many of these drugs also have profound side effects. In the last two decades, there has been a push by some health workers to recommend sex hormones, estrogen and testosterone, for the treatment of schizophrenia. So far, there is not a single study that has shown a correlation between low levels of testosterone and schizophrenia, and in fact, many individuals with low levels of testosterone never develop schizophrenia. Nevertheless, like all things in medicine, there are always some unorthodox health care workers who view things differently and put into practice unsubstantiated theories.

Over the decades, many individuals with schizophrenia have been treated with dehydroepiandrosterone (DHEA) as an adjunctive therapy to standard anti psychotic drugs.

The question remains, is testosterone helpful for schizophrenia?

Literature analysis of three small studies compared anti psychotic drugs to DHEA and a sugar pill.

What about the results?

There was no evidence that supplementing testosterone benefitted schizophrenics. Even though the number of patients studied was small, there was no benefit seen. Testosterone did not help improve any of the symptoms of schizophrenia. The only positive thing to come out of the study was that short-term use of testosterone was not found to be associated with any harmful side effects.

Therefore, for the moment, schizophrenia is still treated with conventional pharmaceutical drugs and use of sex hormones remains experimental. Individuals who want to use testosterone or any other supplement for schizophrenia should first consult with their psychiatrist. All individuals should be aware that long-term use of testosterone is associated with many side effects including masculinization; a number of side effects are irreversible even when the hormone is stopped

http://www.cochrane.org/reviews/en/ab006197.html

Should I take Kava extract for my anxiety?

Generalized anxiety is a common medical ailment in North American society. This medical disorder can present with a range of symptoms. In severe cases, anxiety can be disabling and affect one’s life style. For decades, the only treatment available for generalized anxiety has been pharmaceutical drugs. There are many drugs which have been used to treat anxiety, and while effective, drugs also possess adverse side effects. For this reason, many patients have been turning to alternative health care for managing their anxiety.

One of the products frequently consumed by individuals with anxiety is kava. Kava is easily available in most health food stores and estimates indicate that sell of this herbal extract brings in hundred of millions of dollars. The question remains, "is Kava effective for treating anxiety?"

Cochrane reviews recently published the results of twelve trials that looked at kava versus placebo in the management of anxiety. The study looked at the oral preparation of kava extract. Out of the 12 studies, results of 7 studies were compared and assessed using stringent clinical criteria.

Compared with a sugar pill, kava extract was more effective for symptomatic relief of anxiety. Even though the number of patients assessed was small, the results did show a mild to moderate improvement in patients treated with kava. Further, kava was also found to be safe and relatively free of side effects when treatment was conducted anywhere from 1-24 weeks.

So what does mean for the consumer who has anxiety?

For once at least, some herb appears to be effective in treating a medical ailment. Kava has been shown to be safe for short-term usage and it does relieve anxiety. What is not known so far is whether kava works in all people with anxiety. Kava is a lot cheaper than all currently available pharmaceutical medications. For the individual with anxiety, one should perhaps try out kava for at least 4-6 weeks to determine if it works. If kava makes no difference after a 2-month period, it is not going to work at all. Before doubling up on the dose, perhaps one should discuss this situation with a health care professional. In the end when all else fails, one has no choice but to revert back to the pharmaceutical drugs.

http://www.cochrane.org/reviews/en/ab003383.html

Is Valerian effective for anxiety?

Anxiety disorders are quite common in our society. Anxiety can vary in intensity and can severely affect one’s lifestyle. There are many medications available to treat anxiety but none is ideal and all of them have side effects. For this reason, many individuals with anxiety have now been turning to alternative health care for treatment of anxiety. One of the natural substances high highly recommended by the herbalist for anxiety is valerian.

Valerian is a herb sold as a dietary supplement in health food stores. It is a common ingredient in natural products recommended for sleep, tension, and stress relief. As far as clinical evidence about its sedating ability is concerned, most of the data are inconclusive and not supportive. Nevertheless, the herb is found to be safe when ingested for a short time, but there are no long-term data.

As far as anxiety is concerned, the effectiveness of Valerian is a puzzle. To date, all reports about valerian for treatment of anxiety are anecdotal and most are made by the vendors of this product. Individuals who take valerian seem to indicate that it does not work all the time. Other individuals have tried out different brand names of the same herb and found no difference in the anxiety symptoms.

As far as clinical evidence is concerned, there is very little data. However, recently Cochrane reviews looked at one randomized study involving 36 patients with generalized anxiety. This 4-week study compared valerian to diazepam and a placebo. The patient population was homogenous and various scales were used to measure anxiety symptoms. At the end of 4 weeks, valerian was no different from the sugar pill when it came to relief of anxiety symptoms. Diazepam was more effective than valerian when it came to symptom relief for anxiety. The only good news about valerian was that no patients reported side effects.

So what about the consumer with anxiety?

This was only one small study but again, despite all the hype about valerian, it did nothing for relief of symptoms of anxiety. Even though benzodiazepines have side effects and are addictive, these drugs still remain effective for anxiety. The other negative about benzodiazepines is that they are expensive and often interact adversely with other drugs. For the individual with anxiety, the choice of how to treat anxiety is difficult. Should one take a herb which is useless and moderately expensive or take a drug which is very expensive, has side effects but works?

The answer- neither. Try Buspirone. This non-addictive drug does not impair mechanical performance such as driving. Response to Buspirone occurs approximately in two weeks, as compared to the more rapid onset associated with benzodiazepines. The only negative- individuals who have previously taken benzodiazepines for the treatment of anxiety generally do not respond well to Buspirone.


http://www.cochrane.org/reviews/en/ab004515.html

Can inositol help reverse depression?

Over the years, alternative health care practitioners have been advocating a variety of herbs and nutrients for the treatment of depression. One of nutrients which is widely consumed by depressed individuals is inositol.

Inositol is a simple molecule and used by the body to make important components of the cell membrane. Products made from inositol are believed to play a vital role in signaling events in the body. Most individuals get adequate levels of inositol from food and no one has ever been identified as having inositol deficiency. Further, there is no relationship between depression and inositol levels in the body.

Inositol is readily available in most health food stores without a prescription and recommended for the treatment of a variety of mental disorder including depression. Because many depressed patients take a number of health supplements and other products, it has been difficult to evaluate the role of inositol. Of course, as with all supplements the vendors of inositol claim it is a miracle product. As far as consumers are concerned, there are a few anecdotal reports of inositol and depression. The majority of depressed individuals claim that the supplement does nothing.

In the past few years, four double blind trials have evaluated 141 depressed individuals who took inositol. Inositol was compared with an anti depressant or a placebo.

The Results?

The results did not show any evidence that inositol had anti depressant activity. Even though most of these studies were of short duration and the sampling population was small, inositol turned out to be just another hyped up supplement. The only good thing to come of the trials was that the supplement was safe and not associated with any side effects.

So where does the individual with depression stand?

Like many nutrients and herbs, inositol has failed to live up to expectations when it is properly evaluated in clinical studies. Nevertheless, the health supplement industry continues to market the product for many illnesses. A month’s supply of inositol is about $30. For those who are depressed and do not have money to spare, forget inositol and spend your money wisely on something that works. For those who are depressed and have money, cherries are in season- go eat some.

Shock Therapy for OCD

Obsessive Compulsive Disorder (OCD) is a difficult disorder to treat. The disorder is associated with distressing obtrusive thoughts which so far have only been partially controlled with drug therapy. Well, there is something new now. Shock therapy, similar to one that is used to treat depression is now being used to treat certain patients with OCD. However, there is one major difference between the device that is used to treat depression. The latest devices made by Cyberonics and Medtronic’s are the size of a small pacemaker which is implanted in the body. The pacemaker does not cause seizures but delivers stimulation to certain nerves that relieves the disturbing thoughts. The first Medtronic’s Reclaim Deep Brain Stimulator has just been approved for use on people with chronic OCD.

Even though there are millions of people who suffer from OCD, this device is only available for individuals with severe OCD who have failed drug therapy. At present the Medtronic’s device is set to be inserted in less than 4,000 individuals per year.

But the question is does this device work? Well, from the limited clinical studies the device has relieved obtrusive thoughts in some individuals but patients still need to continue to take their medications.

Reclaim is not a cure for OCD but just another modality of treatment which is more invasive.

The device is about 3 x 3 cm, circular and has four electrodes running out of it. The device is implanted superficially in the chest wall and four electrodes are tunneled underneath the skin and implanted in the brain. The pacemaker is adjusted so that signals are delivered to the brain and block abnormal brain thoughts.

Medtronic’s is currently designing similar devices for use in patients with depression. Similar devices have been used in the treatment of patients with Parkinson’s disease but the results have been mediocre at best.

At present, Medtronic’s says that it will allow the device to be used free on a “humanitarian basis” (a better word is guinea pig). The aim is to get more patients fitted with the device and follow up them before more making the device available to the public at large.

Depression and pregnancy: Part 2

Unlike post partum depression, antenatal depression has not been studied well. There are no studies that have followed these women to determine how long the depression lasts, its severity, and what the relapse rates are. So far, most studies have only identified depressed pregnant women based on their symptoms but the chronology of depression has not been studied well.

The criteria for making a diagnosis of depression in pregnancy are the same as in the non-pregnant state. However, making a diagnosis of depression in pregnancy is somewhat difficult. Many women develop fatigue, sleeping difficulties, change in weight and appetite during a normal pregnancy and these symptoms cannot automatically all be ascribed to depression.

Given this dilemma in making a firm diagnoses, screening tools have been developed to help physicians in indentifying women with clinical depression. The Edinburgh Postnatal Depression Scale has been endorsed for use, screening not only postpartum depression but also depression during pregnancy.

Some of the factors that increase risk of depression during pregnancy include:

- prior history of depression
- prior history of premenstrual dysphoric disorder
- younger age
- limited social support
- living alone
- greater number of children
- marital conflict
- Ambivalence about pregnancy.

A history of depression during the antenatal phase is considered to be the strongest predictor of depression during any following pregnancy and during the early postpartum period.

http://www.medscape.com/viewarticle/584773_4

Depression and Pregnancy

The majority of women who do get pregnant are delighted and looking forward to having a baby. It is a time of joy and there is a gradual change in life style. Women who are pregnant often get doted upon and are treated well. Great effort is made in society to protect the physical well being of the pregnant mother. However, it is now recognized that pregnancy is also a time of emotional stress and a fair number of women do develop depression. Even though it is well known that post partum women do develop depression and the blues, it was not appreciated until recently that depression during the pregnancy can also be quite moderate to severe in intensity. Many pregnant women with depression have been overlooked and underdiganosed. Unfortunately, depression during pregnancy has often been disregarded and never adequately treated.

The exact number of females who develop depression during pregnancy is not known but is believed to be quite common. One large study indicates that anywhere from 7-12 percent of pregnant women may develop depression. Further, women who already have been diagnosed with major depression are at a high risk for relapse during pregnancy. One has to remember that many women stop their anti depressants during pregnancy to avoid damage to the fetus, thus making them even more vulnerable to relapse.

The question being asked to day is if there is a link between perinatal depression and adverse neonatal outcomes. Even though the topic is controversial, one review did conclude that presence of depression during pregnancy might be an independent risk factor for later adverse effects on both the mother and the fetus.

There is now ample evidence that when depression is untreated during pregnancy, it may lead to poor prenatal care. Medical and obstetrical difficulties, self-medication, illicit substance abuse, weaken bonding, suicide, and a higher risk of relapse of depression in the postpartum period.

What is of concern today is that despite the high number of females who develop depression during pregnancy, very few actually are diagnosed and adequately treated

Borderline Personality: Part 3

SYMPTOMS

Individuals with borderline personality often develop symptoms from acute events like loss of a job, failure at work, breakup of friendship, lack of career goals and most of all, a sense of having no identity

Many of these individuals view themselves as worthless or bad. Often they feel as they have been mistreated or deceived. They often complain of feeling bored, empty and lack of self recognition is quite common.

The symptoms of BPD generally are more severe when the individuals have little family support and no friends. The individual in turn makes desperate attempts to socialize.

Because of the persistent negative feelings or emotional traits, BPD individuals have few friends. While they do develop intense attachments, these are often stormy. These individuals are very labile in their feelings with emotions switching from love to hate in a matter of minutes. Loyalty to a friendship is rare because they constantly switch their feelings at the slightest hint of feeling poorly treated. Being highly sensitive to rejection, they often react with anger, self injury and spontaneous unrealistic decisions. In the middle of a vacation, they many cancel the trip and return back home. Sudden changes in plans are not common with these individuals.

Like manics, BPD individuals also act with impulsivity and may go on a spending spree, practice risky behaviors like sex with strangers, binge eating and drinking. In most cases BPD occurs as an isolated disorder but can occur in association with other mental health disorder like depression, substance abuse, mania and anxiety.

Borderline personality: part 2

At any one point in time, at least 1/5 individuals afflicted with BPD need long term mental health services and/or repeated admissions to psychiatric facilities. If help is sought out early, many individuals can improve with time, and lead fairly normal and productive lives.

Unlike individuals who have depression or manic disorder, BPD individuals develop similar but more intense feelings of anger, depression, anxiety and sadness –but the feelings only last a few hours. Associated with these symptoms are spontaneous acts of impulsive behaviors such as anger, self injury, drug or alcohol abuse.

Borderline Personality- just what is it?

These days whenever there is a fall out in a relationship or disagreement among friends/colleagues, at once, the term borderline personality (BPD) is used to describe the individual. Even though the term BPD is used liberally, very few people have little idea about the disorder.

Borderline personality disorder (BPD) is a somber mental illness distinguished by a pervasive instability in moods, interpersonal interactions, self-image, and conduct. Asides from the individual, everyone around him/her experiences turmoil.

Individuals who have BPD usually have difficulty with family and work relationships. The individual has no long-term plans and there appear to be a lack of identity. These individuals suffer from a problem with emotion control. The disorder is fairly common and affects nearly 2/100 young women. Many of these women do have a history of repeated self injury but without an intent to commit suicide but completed suicides are not unheard of.

Weight gain and anti psychotics: Part 3

What next?

A few years ago, there was a study from China on how to treat weight gain induced by medications. The Chinese study involved use of the drug, metformin, to help reduce weight gain. Metformin is a very old anti diabetic drug and today is widely used in the treatment of type 2 diabetics. The drug can help reduce weight and decrease glucose levels. In the Chinese study, treatment with Metformin, in addition to dietary changes and increased physical activity, reversed weight gain in some people who took antipsychotic medications. Not everyone had the same result but overall it is claimed the drug did wonders.

There is no question that metformin is a good anti diabetic drug and can help obese individuals lose weight. However, this Chinese study is very questionable. Metformin is only recommended for use in type 2 diabetics. The drug can significantly lower blood sugars. If a non-diabetic takes metformin, he or she will develop hypoglycemia and if not treated urgently, can go into a coma. There is no sane physician in North America who will prescribe metformin to a non diabetic- this is a sure invitation for a lawsuit. Therefore, results of the Chinese study should be taken with a grain of salt.

Metformin may however be a worthwhile option in a type 2 diabetic, who is obese and has psychosis. Other than these individuals, the drug should not be empirically prescribed for weight loss. The courageous physician who wants to prescribe metformin to a non diabetic should ensure that these individuals always carry a sugar drink with them all the time, have blood glucose levels checked regularly and increase his/her malpractice insurance.

So for the time being, unfortunately, there is very little in terms of medication that can help one lose weight while taking anti psychotic drugs. The safest way to reduce weight is to eat less and walk more. This may sound dull and boring- but it works better than any other weight loss therapy- and it saves you a lot of money.

Weight gain and anti psychotics: part 2

So how can one avoid or treat this weight gain?

Changing to other anti psychotic medications does not help at all. Almost all such pills can cause the same side effect. Further, many psychotic individuals have a tendency to respond well to one particular anti psychotic drug and mucking around with pills often leads to worsening of symptoms.

Other experts recommend a change in diet (stop eating fatty foods and sugars) and start an exercise program. Does this work? No- most patients with mental disorders have very little motivation to start running across America. Secondly, anti psychotics medications also diminish energy and induce lethargy- so exercise may sound great but is not practical.

How can I prevent weight gain while taking antipsychotic drugs?

One of the most well known side effects of almost all anti psychotic drugs is weight gain. Despite the availability of newer atypical antipsychotic drugs, weight gain still continues to occur.

The weight gain induced by these drugs is not miniscule and is believed to be one major cause of early mortality in these patients. Studies reveal that individuals who suffer from psychosis die 2-3 decades earlier than the average population.
Why weight gain occurs with these pills is not entirely understood, but rest assured there are countless theories. As always besides the medication, genetics and bad luck seem to be an answer to all health problems these days.

Not everyone who takes an antipsychotic develops weight gain. While numbers are hard to come by, it is estimated that close to 40-60 percent of individuals who take anti psychotics will develop weight gain.

Weight gain is one of the chief reasons why patients stop taking the drug and thus partially explains the poor drug compliance seen in these individuals. It is highly recommended that if weight gain occurs, one should not stop taking the medication- as this will only result in recurrence of the psychotic illness.

Memantine: Part 3

Does the drug work immediately?

No, the effects of memantine take time. Experts claim that it takes an average of 2-3 weeks to see full benefits of the drug. If the drug has not worked at the end of 4 weeks, it is unlikely to work at all. One can always increase the dosage, but you also increase the incidence of side effects.

So what does all this mean?

Memantine does have a mild beneficial effect at 6 months in patients with moderate to severe AD. In individuals who have early or mild AD, there is no benefit. From the many patient testimonials (which are more honest than what the company claims) on cyberspace, Memantine does appear to show very mild benefits in less than 5% of patients with AD. The majority of testimonials on memantine claim that the drug does nothing and a few patients had to discontinue the drug because of side effects. Many patients found no change after months of taking memantine.

Of more importance is the fact that memantine is one of the most expensive drugs around. Each tablet costs anywhere from $2.-$3. You take two pills a day and that averages to about $120-$180 a month. Moreover, there is zero guarantee that the drug will work. In Britain, the UK National Institute for Clinical Excellence has voted against the use of this drug on grounds that its high cost outweigh any benefits- I wholeheartedly agree.

http://www.cochrane.org/reviews/en/ab003154.html

Memantine: Part 2

Does memantine really work?

There have been several double blind studies (meaning the patient does not know what he/she is taking and neither does the doctor- evaluations are done by an independent investigator).

For moderate to severe Alzheimer’s disease, 2/3 studies showed a small benefit at 6 months. there was mild improvement in cognition, improved daily living activities and behavior. For mild to moderate AD, there was no improvement seen with memantine. In those individuals with mild to moderate vascular induced dementia, memantine at 6 months only a small benefit in behavior and cognition. Overall, patients taking memantine were slightly less likely to develop agitation. There are no long-term studies to see if the effects of memantine are sustained.

Does the drug have side effects?

In general, memantine is well tolerated. Side effects include constipation, confusion agitation, drowsiness, headache, insomnia, hallucinations, increased libido and cystitis. These side effects are reported to occur in less than 5% of individuals at low doses. When the dose is increased, side effects also increase.

Memantine does not cure Alzheimer’s, it does not slow progression of disease, nor does it reverse any deterioration that has already occurred. It just decreases symptoms.

Namenda is available as a tablet and a liquid. It is usually started at 5 mg twice a day. One must always wait at least 7-10 days before increasing the dose. Most people find that Namenda at 10 mg twice a day works best. The maximum dose of memantine is 20 mg twice a day. The drug does not require any type of laboratory monitoring.

Memantine: another expensive drug for Alzheimer’s Dementia!

There are millions of elderly individuals who have some degree of dementia. With the aging population, these numbers are going to increase a lot more in the next 2 decades. Alzheimer’s disease (AD) can create havoc in the life of the affected individual and all those who surround him/her. Despite decades of research, we still do not know what causes AD, how to prevent or treat it. The few drugs that have been developed only help relieve symptoms of AD. One of the latest drug hyped up as a miracle for patients with AD is memantine (Namenda).

Memantine has been around for decades but only recently has it been approved for treatment of dementia. Unlike Aricept, Namenda targets a different chemical in the brain- glutamate. In the laboratory, Glutamate has been shown to help improve learning and mental cognition.

Memantine works on certain areas of brain and has been shown to alter levels of a several neurotransmitters, including glutamate. The company that makes Memantine claims that the drug can help individuals who have AD.

Serenity: part 3

So what about the consumer?

For those who decide to take Serenity, start at the lowest dose. The supplement has been deemed safe when it is taken alone. The starting dose is about 150-200 mg/day. However, if you already taking other medications for your depression or bipolar disorder it is wise to discuss the issue with your physician before embarking on a complex hodge podge of drugs.

A month’s supply of Serenity can cost anywhere from $20-$40. Remember, many such herbal supplements are made in India and China, where unscrupulous manufacturers have sometimes added the actual drug inside the supplement. Further, dangerous contaminants in herbal products are not unheard off. Fakes and counterfeits are also abundant in the health supplement market. So in the end the caveat “buyer beware” should be well heeded.

Serenity part 2

However, there are no clinical studies on Serenity and bipolar disorder. For example what happens if an individual takes several Serenity pills, does Serenity interact with other drugs or herbs, or can one overdose with serenity? Answers to these questions remain unknown.

The problem with conventional lithium is that it is a difficult drug to administer. Even the slightest changes in dose can either make the drug toxic or ineffective. So what happens if one combines the traditional lithium pill with Serenity- will there be more side effects? will it be more effective? Again answers to these questions remain answered.

To date, there is very little information on Serenity. Is there evidence that lithium orotate (serenity) works for bipolar?

None. There are no clinical studies on this supplement. There are some positive testimonials from individuals who have taken serenity, but there are a lot of negative testimonials about the supplement also. On most part, consumers claim Serenity does diddly squat and is a waste of money. Moreover, there is evidence that the product quality and quantity of Lithium orotate varies from store to store and even among the same brand.

Can I take Serenity for my bipolar disorder?

Bipolar is a very complex disorder and its treatment is not very satisfactory. The majority of patients with bipolar remain dis-satisfied with current day treatment. Besides lithium, there are several other medications used to treat bipolar disorder.

As predicted, someone always comes up with a health supplement to counter the available traditional drugs for bipolar disorder. One health supplement that has been touted as a treatment for bipolar disorder is a product called Serenity. There are many Serenity type products on the market and one of them is hyped up to treat all types of mental disorders, including bipolar disorder. Serenity contains lithium orotate. The company which makes this product claims that it is a very safe mood stabilizer and relieves anxiety.

Serenity is widely available as a health supplement. It is available as powder, capsule, tablet and a liquid.

The lithium found in serenity is coated with orotate and also contain a number of other natural supplements. The enteric coating protects the supplement from breaking down by acid in the stomach. However, experts indicate that a single pill of Serenity is unlikely to make any difference in treatment of bipolar disorder because the amount of lithium found in the Serenity is miniscule. In fact, even the manufacturer claims that lithium levels are not high with serenity-this may be just to get the FDA off its back. Lithium in therapeutic doses needs a prescription. When lithium is sold in sub therapeutic doses and mixed with some herbs, it can be sold as a supplement and does not need to undergo the scrutiny that other drugs go through.

Acupuncture and Depression: Part 2

In two trials, when acupuncture was compared to sham control, it did not do much.

In the other five trials, acupuncture did not significantly improve symptoms in patients with mild to moderate depression. The most surprising data revealed that there was no evidence that the anti depressant medications were better than acupuncture. Of course, the usual arguments were that these studies were poorly designed and numbers were small.

So what does all this mean for the consumer?

On cyberspace, it appears that there are hundreds of practitioners offering acupuncture as a treatment for depression. On the other hand, psychiatrists also claim that their medications are working fine. There seems to be no shortage of patients for either health care professional.

Depression is a complex topic and no one really knows what is the best treatment. Questions still remain about efficacy of acupuncture, but if you are thinking about it, one should know that the cost of each treatment is anywhere from $50-$100 per session. In addition, most medical insurance plans do not cover the cost. On the other hand, anti depressant drugs are also expensive and often not covered by insurance plans.

If you are on an anti depressant medication, hang on to your pill. While there are a lot of negative sentiments about doctors and drugs, there is still a fair amount of decent information that reveals that anti depressant drugs do work in a number of patients. Even though these drugs have side effects and often fail to work in the long term, there is no other therapy at the moment which works better. Remember, acupuncture is still looking for a disease it can cure and solid evidence about its efficacy is still lacking.

http://www.cochrane.org/reviews/en/ab004046.html

Acupuncture and Depression: Part 1

Despite what some physicians claim, the treatment of depression with drugs is not great. The majority of individuals who have depression remain dis-satisfied with current day anti depressant drugs. Initially most drugs work to relieve symptoms of depression but after sometime, relapses are common. Moreover, the majority of drugs have side effects. For this reason, many patients have been turning to alternative health. One of the treatments that has advocated for treating depression is acupuncture.

Acupuncture has been widely touted to treat many types of pain syndromes, anxiety disorders and a whole host of other organic disorders. Now the alternative health care practitioners claim that acupuncture can be used to treat depression. Even though acupuncture has been practiced for decades in North America, not many randomized studies have been done to determine its efficacy. In the last decade, seven trials have compared acupuncture versus anti depressant medications in the treatment of mild to moderate depression. Most of these trials were conducted fairly, with proper inclusion and exclusion criteria. Patients were evaluated carefully and followed.

Can Gingko Biloba prevent dementia? part 2

This was the first comprehensive study with a large number of volunteer community members. The study included individuals with mild cognitive impairment but those with moderate to severe dementia were excluded. Individuals who were on other types of memory drugs like Aricept were also excluded. All individuals underwent comprehensive neurophysiological testing and were randomized to receive either placebo (sugar pill) or G Biloba (120 mg twice a day). Re-evaluations were done every 6 months.

Individuals who started to develop cognitive impairment had to undergo neuropsychological testing and results were evaluated by an independent panel. MRI was done to confirm dementia.

After 6 years, the results between placebo and Ginkgo were no different. Ginkgo did not prevent dementia nor did it enhance memory. While ginkgo was found to be safe, a few individuals did develop bleeding in the brain.

Final point

This study finally answered the question whether G Biloba prevents dementia. The conclusion is that even in individuals with the mildest dementia, it did nothing. There are some who argue that perhaps G Biloba should have been administered for a longer period of time. However, researchers point out that if a supplement has not worked for 6 years, it is unlikely to work at all. Further and most important Gingko supplements do not come cheap and the cost of pills does add up. Considering that Gingko Biloba has finally been shown to be ineffective in treatment of dementia, it is time the consumer use his/her hard earned money for better use- like eating healthy and saving up for future home care services in case they are needed.

http://www.medscape.com/viewarticle/584660

Can Gingko Biloba prevent dementia?

Health supplements have become a billion dollar industry. Every type of grass, weed, herb, plant, or fruit is now being advocated as a health supplement. Extracts from these products are extracted and made into a pill, liquid, potion, lotion, or cream and sold in mega amounts to consumers. One of these supplements is Gingko Biloba. It is perhaps one of the oldest natural health food supplements around and hyped up to treat many medical disorders. It is also one of the biggest money-maker in the field of herbal medicine.

Ginkgo Biloba leaf extracts have a long history in European medicine, where they have been used to treat early symptoms of Alzheimer’s disease, vascular dementia, tinnitus and peripheral claudication. In the USA, Gingko is classified as a dietary supplement and there are various brands available.

The widespread use of Ginkgo for decades has led to many questions about its effectiveness. Over the years, many clinical trials have been conducted on gingko. The results have been mixed partly because some trials were not randomized, numbers of patients were small, proper inclusion and exclusion criteria were omitted and follow up was limited. Some clinical studies indicated that Gingko may have mild benefits in Alzheimer’s dementia but other studies claimed that it had no effect. Americans spend close to $100 million annually on gingko in the hope of preventing memory loss and also to boost memory.

To finally establish whether G. Biloba can prevent all types of dementia and Alzheimer disease, a group of researchers recently conducted the Ginkgo Enhancement of Memory (GEM) study, a multisite, randomized, controlled 6-year trial.

Treatment for hair pulling (trichotillomania) part 3

Coping with hair pulling

Because cure is not always possible, most individuals need to learn some method(s) to help cope with the disorder. The following steps may help coping with hair pulling:

- Write down on a piece of paper all situations
which lead to hair pulling. Most individuals
tend to pull hair while watching TV, reading,
driving, or when they are alone and frustrated.
Try and change the situation or environment to
reduce the hair pulling.
- Keep your self busy with activities that engage
your hands. For example, start knitting, drawing,
writing, painting or play a sport like tennis.
- If you pull hair at night or are not aware of
the situation, wear gloves.
- Join a support group because there are many
individuals with this problem. With these support
groups one can get advice, moral support and
treatment help. While support groups are not for
everyone, they can be helpful for advice.
- If you are bothered by your hair loss, buy a wig,
wear a hat, apply make-up or see a hair expert.
- One way to prevent hair pulling is to keep the
hair short.
- If you do tend to pull hair without being aware,
ask your family members or friends to alert you.
- Learn how to reduce stress
- Talk to your family, educate members in your home
or circle of friends about this disorder.

Trichotillomania is a distressing disorder without a good treatment that works in everyone. Because there is no cure for the disorder, one should learn how to cope with the condition. While the condition is embarrassing and filled with anguish, one should be aware that given time, many individuals will outgrow hair pulling. For those who continue to be tormented by this dreadful disorder, the first place to start is by going to see a health care professional who specializes in psychiatry.

Treatment for hair pulling (trichotillomania) part 2

What about medications?

The use of medications to treat Trichotillomania is empirical. Because so little is known about the disorder, no one really knows what the best medications are, when to start the pill and for how long the treatment should be continued. The most common class of medications used to treat Trichotillomania are the anti depressants. There are no clinical trials on effectiveness of these drugs, but anecdotal reports do indicate that some patients do improve over time. Some patients need to take the anti depressants for 3-9 months to see an improvement. Because of side effects, compliance with these drugs is poor. Many patients stop taking the drug after 2-4 months. The most common complications of these drugs include weight gain, loss of libido, fatigue, and dry mouth. The side effects do stop when the drug is discontinued. Most experts recommend drug therapy with CBT for the best results.

The unfortunate thing is that not all individuals respond to drugs or CBT therapy. Many individuals do relapse even when the treatment is initially successful. Because the disorder can create havoc in one’s life it is recommended that one see a health care worker for help. Even though present day treatments are not ideal, in some individuals, drugs or CBT can help one make a dramatic recovery.

Alternative medicine

Because conventional medicine has not been successful in treatment of many mental disorders, including trichotillomania, many patients have been turning to alternative health care. There are reports that some individuals do benefit from hypnotherapy. When this treatment is combined with drugs or CBT, the frequency of relapse is much less. Alone, hypnotherapy works in less than 5% of individuals. The treatment is prolonged and requires patience and commitment.

Another technique that has been reported to help individuals with Trichotillomania is biofeedback. In this therapy, one is taught how to control or change certain physical responses. For example, when one encounters a certain stress, headache or a frustrating situation, biofeedback can help reduce tension and erases the urge to pull hair. The technique can also help decrease anxiety and helps control negative behaviors like pulling hair. However, on its own biofeedback often fails to work. For the best results, it must be combined with drug therapy or CBT.

Treatment for hair pulling (trichotillomania)

Trichotillomania is a dreadful disorder and very little is known about it. For one thing, the disorder is associated with a lot of torment and internal turmoil. The most important aspect of this disorder is that the individual is not to be blamed for it. why Trichotillomania happens is not well understood and like most medical disorders bad luck or bad genes seem to part of the problem.

One reason why there is little known about Trichotillomania is because many individuals who have this disorder do not go and see their health care worker. Over the years, fear, embarrassment and lack of family support has driven these individuals into the closet. Medical professionals rarely come across individuals with Trichotillomania and most health care professionals have no idea how to treat it. Nevertheless, if one does seek help, there are some treatments that can improve the disorder. Two basic treatments are currently available for hair pulling.

Psychotherapy or cognitive behavior therapy (CBT) is an effective treatment for Trichotillomania. It is a slow process but helps one understand the disorder and brings awareness to the problem. Over time, some individuals learn not to pull their hair. The therapy centers around control of emotions, stress and trigger factors. The triggers and negative behaviors are then substituted for positive things. For example, if one used to pull hair, then now one will go for a swim, read a book or cook a meal. CBT requires commitment and patience. It is not a one shot deal because recovery can take 3-8 months. Frequently CBT also entails family involvement to help members understand the disorder and what they can do to help the affected individual. Over time, CBT can help diminish urges to pull hair and relieves strong impulses causing disruptive behavior.

Does CBT always work? No. CBT does work when treatment is sought out early. In normal people who have capacity to understand and comprehend, the results are good. Individuals who have other problems like drug abuse, alcoholism or personality disorders, CBT does not work well. From anecdotal reports, about 30-50 percent of individuals do benefit from this therapy.

Can thiamine help reverse or delay Alzheimer’s dementia? part 2

It has been observed that individuals who develop Wernicke’s Korsakoff syndrome have a deficiency of thiamine. The most common cause of this disorder is alcoholism. These individuals develop dementia, have memory loss, unsteady gait, and muscle weakness. When individuals with this disorder are treated with thiamine, the symptoms do dramatically reverse. Thus, there has been a recent trend to recommend thiamine to patients with Alzheimer’s dementia.

Thiamine is one of the Group B vitamins and known as B1. It is found in both plants and animals. Thiamine is vital for many metabolic functions in the body that use energy. Thiamine deficiency is quite rare but individuals who drink excess alcohol can develop deficiency of this amino acid.

Because lack of thiamine can cause dementia in Wernicke’s Korsakoff syndrome, it has been proposed that perhaps thiamine can also be used to reduce severity of Alzheimer’s disease. Almost every health food stores sells thiamine and this amino acid is widely hyped up as a cure for many dementias. Thiamine has been marketed heavily for treatment of many medical disorders including Alzheimer’s, but does it work?

Several years ago several controlled studies looked at the effects of thiamine on dementia. Thiamine was administered daily and compared with a sugar pill. The three studies from the 90s did not reveal any benefit of thiamine in patients with Alzheimer’s disease. The only positive observation was that thiamine had no side effects. Since then many anecdotal reports have been published and countless patient testimonials indicate that thiamine does not reverse or slow down dementia in patients with Alzheimer’s disease.

For the moment, thiamine cannot be recommended as a treatment for Alzheimer’s. For individuals who still believe in thiamine and would like to treat their family members with dementia, foods containing thiamine are much better than pills.

Capsules or pills containing thiamine have often been found to contain fake and counterfeit products Foods which are rich in thiamine include whole grains, rice, bran, brewer’s years and wheat germ. These foods are cheaper and also more nutritious than any pill.

Can thiamine help reverse or delay Alzheimer’s dementia?

Alzheimer’s is a devastating disorder that gradually results in memory impairment, disorganized thoughts, and poor reasoning. Over time, these cognitive impairments become so severe that there is a gradual decline in the individual’s usual level of functioning. Although all individuals have some degree of memory loss as part of aging, these cognitive changes generally do not interfere with level of function. In Alzheimer’s, the memory loss is much faster and associated with severe impairment in cognition. The disease progresses relentlessly and most individuals become incapable of independently looking after themselves. During the later stages of the disorder, depression, paranoia and delusions often accompany the illness and usually persists for long periods.

Today we have no cure for Alzheimer’s disease, but there are a few treatments available to alleviate some symptoms that are causing suffering.

The management of alzheimer's consists of use of medications and non-medications based treatments. The two different class of medications that have been approved by the FDA for treating Alzheimer’s include choline esterase inhibitors like Tacrine (Aricept) and partial glutamate antagonists. However, both class of drugs only work during early dementia and do not slow rate of progression of Alzheimer’s disease. Recently, there has been a surge in alternative care for patients with Alzheimer’s dementia.

What are options for treating PICA (eating crap)? Part 2

The role of Social worker

In toddlers and young children, pica behavior training must also bring about a positive appreciation of the environment and/or sensory stimulation. In young children with PICA, other issues that may need to be addressed are improvement of financial problems, schooling, social welfare, and prevention of isolation. One may also need to assess cultural beliefs and practices, educate both child and family, and teach about the harm of PICA. In children, it is vital that the surrounding environment be free of lead based paints, toys and furniture.

Medications

The majority of health care workers believe that PICA resolves spontaneously or can be improved with behavior treatment. Moreover, this is true in a number of individuals. However, there are many reports of adults with PICA who realize that their eating habits are troublesome. Many of these individuals have tried behavior therapy and have not improved. There are no approved drug regimens for PICA. In the literature, all drug therapy treatment for PICA is anecdotal and only isolated case reports exist. No one really knows what the ideal drugs are and how long to treat PICA.

However, based on case reports and effectiveness, the drugs with the best benefit for PICA are the atypical anti psychotics. Drugs like olanzapine, risperidone, or clozapine have shown to be more easily tolerated and produce relief in many cases.

Isolated reports do indicate that with time PICA does diminish and the drugs can be stopped. Some individuals required drug therapy for 3-9 months. The principal brain target of all antipsychotic drugs is the dopamine D2 receptor. One should be aware that a few mentally handicapped individuals who have been treated with anti psychotics have gone on to develop worsening of PICA. This may be due to ineffective dose, improper diagnosis or a combination of other emotional problems.

It is highly recommended that one follow up with a psychiatrist when using these drugs. The lowest dose of drug should be used. The effects of anti psychotics are not immediate and can take anywhere from 2-4 weeks to manifest. Other drugs which have been tried for treatment of PICA with some benefit include bromocriptine and methylphenidate.

At low dose, these drugs are fairly well tolerated and to avoid side effects one should not practice polypharmacy. Careful titration of dose with gradual increases can have a major impact on PICA

(http://www.psychiatrictimes.com/display/article/10168/1159376?pageNumber=4)

What are options for treating PICA (eating crap)?

Pica is an eating disorder typically characterized by the continual eating of nonnutritive substances for a period of at least 4 weeks at an age in which this behavior is developmentally inappropriate (e.g., >18-24 mo). Today, the definition of PICA has been expanded to include eating of nonnutritive substances.

Individuals who are diagnosed with pica have been reported to mouth and/or gulp down a wide variety of nonfood materials, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.

In the majority of cases of children who have been diagnosed with PICA, natural recovery occurs with time. Most children who have no mental problems simply grow out of the disorder. However, some children may need a multidisciplinary approach involving psychologists or social workers. The role of physician in early treatment stage is that of reassurance.

When spontaneous recovery does not take place, some type of treatment must be offered. Expansion of management plan must take into relation symptoms of pica and causative factors, as well as treatment of potential complications of the disorder.

The variety of behavioral strategies that have been proven to be effective in treating PICA include

- Antecedent treatment
- Distinction guidance between edible and
non-edible items
- Self-protection equipment that prevent
insertion of objects in the mouth
(mouth guards)
- Sensory strengthening of proper foods
- Differential strengthening of other or
unrelated behaviors, such as screening
(covering eyes briefly), or performing
exercise (or watching TV) is encouraged
- Conditional aversive oral taste (silver
acetate, lemon)
- Conditional aversive smell consciousness
(sulfur or ammonia),
- Conditional aversive physical awareness
(water spray, mild static shock therapy),
- Brief time out with physical restraint of
arms
- Correction of the environment
- Administer appropriate responses to
reinforce positive behavior

How can I improve my libido while taking an antidepressant? part 3

Some individuals prefer to use only an SSRI. However, almost all SSRI have the ability to induce sexual dysfunction. Recently Fluvoxamine (luvox) has been speculated to help individuals with sexual dysfunction. At present Luxol is used to treat OCD and does work well. The drug does maintain sexual function but it has two side effects of concern. When the drug is abruptly discontinued, it can cause withdrawal symptoms of dizziness, fatigue, nausea, vivid dreams, irritability, and headaches. The other problem is that luvox may increase the risk of suicide in young adults and children. Individuals who are depressed have been found to have worsening of depression and suicidal thoughts when taking Luvox. Therefore, at the moment, the drug is rarely prescribed without close supervision.

Some physicians do try an add a psychostimulant to the patient’s regimen to counter the sexual dysfunction. Addition of drugs like Ritalin or methyl phenidate have been shown to work, but often the side effects of anxiety and insomnia also dominate. Further, these drugs have ability to cause physical dependence and cause withdrawal reactions when the drugs are abruptly stopped.

The latest and perhaps the one with the least controversy are Viagra and Tadalafil. Since the availability of Viagra and related drugs, there have been a few studies to see if the sexual dysfunction can be reversed. There have been a few studies which showed that both tadalafil and sildenfail both slightly improved sexual function in individuals who took anti depressants. However, most of the studies included small numbers and long-term data are not available. Anecdotal reports indicate that while Viagra does work, the effects are not sustained in the long run. In any case, Viagra is perhaps the best option for individuals with sexual dysfunction which occurs with anti depressants. The few negatives about viagra are that it is expensive and fake/counterfeit products are common.

How can I improve my libido while taking an antidepressant? part 2

The other option for treatment of sexual dysfunction includes lowering dose of the anti depressant. This is often a tricky option as most antidepressants have a fine line between effectiveness and no effect. Lowering the dose may reduce sexual dysfunction but may also decrease effectiveness of the drug- most patients are reluctant to try this option.

The other option includes adding another medication to counter the sexual dysfunction or one can switch to another anti depressant with a lower incidence of side effects.

One of the alternative drugs, which has often been prescribed to counter sexual dysfunction is bupropion. Bupropion is an effective anti depressant and does not cause a change in sex drive or weight gain. Bupropion, also sold as Wellbutrin, is an atypical antidepressant that does work well. There are several studies which have shown that bupropion can reverse sexual dysfunction in normal healthy individuals. The improvements were observed in terms of arousal, orgasm, and overall sexual satisfaction. However, it was observed that sexual benefits usually were more prominent at a higher dose (300 mg). A lower dose (150 mg) was not much different compared to placebo

However, at high doses, bupropion often has many side effects including inability to sleep, anxiety, and intense headaches. Most people stop taking the drug because of headaches and mouth dryness.

Another drug recommended to counter the sexual dysfunction is to use selegeline. This anti parkinsonian drug when applied as a patch (6 mg) does work as an antidepressant and has minimal sexual side effects.

How can I improve my libido while taking an antidepressant?

A fairly high number of individuals who take anti depressant medications complain that they have decreased libido, lack of sexual desire, failure to achieve an erection or inability to ejaculate. The exact numbers of people who have sexual dysfunction from anti depressant medications is not known, but anecdotal reports suggest that the numbers are high.

The sexual dysfunction that occurs with anti depressants has been known for decades and is somewhat difficult to resolve. Almost every class of anti depressant drugs has been associated with sexual dysfunction and lowered sexual excitement. The sexual dysfunction generally occurs after the patient has been on the drug for a few months. In some cases, the sexual dysfunction improves with time, but in many cases, the problem only gets worse. These sexual side effects while not life threatening, seriously affect an individual’s lifestyle. Often the patients solve the problem by refusing to take their medication. This lack of compliance then leads to worsening of the mental health problem.

So how can this problem be resolved?

When an individual first complains of sexual dysfunction, a wait and see approach may be appropriate because some individuals will improve with time. The wait and see period should not be more than 2-4 months. If the patient has not improved by then, he/she is unlikely to improve.

PICA- eating crap part 2

Once the patient has recovered from surgery, a consultation is made with a psychiatrist to evaluate the individual. Close monitoring of the patient is necessary. Many individuals continue to persist with this bizarre eating habit even after surgery.

While pica is common in childhood and occasionally there may be just one episode, there are developmentally delayed children who do persist with this eating habit. The treatment of pica is behavior management.

Close supervision is required of children known to put things in their mouth. Unfortunately developmentally disturbed children fare well with psychotherapy and many require medications. Healthy adults generally recover spontaneously or with some type of behavior management.

PICA- eating crap

Pica is an exotic name for a mental disorder which is characterized by persistent eating of non food substances such as hair, paint, paper, soil, pencils, metal pins, etc. However, some individuals may eat foods like raw rice, excess salt or sugar, flour, etc. The disorder is quite common and is estimated to occur in 4-25% of the population. A fascinating observation is that the majority will continue to eat only one these non nutritive items during the course of the disorder. Of course, there are others who will eat multiple items.

Pica is most commonly observed in the 1st-3rd decade of life. It may occur early in children but is often mistaken for just children being foolish. To make a diagnosis of Pica, one must persist with these eating habits for more than one month at an age where such a habit would be considered developmentally unsuitable.

Most individuals who develop Pica are healthy individuals. Pica has often been reported during pregnancy where females suddenly develop a taste for bizarre items. The disorder is also seen in wide variety of mental disturbed individuals, esp. those with dementia and some types of schizophrenia.

The majority of healthy individuals eat the non nutritive substances secretly and often are brought to hospital with symptoms of bowel obstruction. Some children eat plaster from the walls and in the past, lead poisoning was a common emergency admission. A number of individuals require surgery because the foreign material may have either blocked the bowel or caused a perforation in the stomach. At surgery, the diagnosis of pica is usually made by the findings of hair, soil or plastic straws, etc.

Emsam; An Anti depressant which is applied as a patch. Part 2

Emsam patch is changed once daily at the same time. The patch does tend to get stick to the skin rather firmly and most people need to apply an adhesive remover or mineral oil to get it off. The new patch should always be rotated a new skin site. Once the patch is applied firm pressure with the palm should be applied for a few seconds to ensure proper contact with skin. Emsam comes in various doses and it is recommended that depressed patients start with the 6mg/24 hr formula. At this does level there are no dietary restrictions. However, if the higher doses of 9 and 12 mg are used every 24 hrs, dietary restrictions do apply.

So does Emsam work?

Several studies have shown that compared to placebo, Emsam is a superior anti depressant. At present Emsam is used to treat clinical depression and has even been found to be useful in patients who have failed to respond to other SSRI and tricyclic anti depressants. The most common side effect is at the application site and is redness caused by the adhesive tape. Other rare side effects include headache, lack of sleep, diarrhea dry mouth, and gastric upset. These side effects occur in less than 5-10 percent of individuals. There are a whole list of drugs which cannot be taken while taking Emsam and the list is no different when one takes the other anti depressants.

Emsam has been on the market for only 2 years to treat depression but the results indicate that it does help some individuals who have failed to respond to other anti depressants. So far it has remained a decent drug with not as many side effects as the tricyclics. Furthermore, weight gain has not been a problem with this agent. How long it will continue to work in depressed patients remains to be seen.