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.