In the last decade, there have been some advances in treatment of a variety of neurological disorders like Parkinson’s disease with deep brain stimulation. Essentially the technique involves inserting very thin electrodes into appropriate parts of the brain and stimulating nerves to mimic the real physiological situation. Now researchers want to apply similar techniques (but without electrodes) to treat depression and a variety of other mental health disorders. Transcranial magnetic stimulation involves the use of an electromagnetic coil around the brain. The electromagnetic field generated results in a number of effects- one of which is an antidepressant effect.
Transcranial magnetic stimulation is not clinically available at the moment and is still in the experimental stages. The treatment has not even been approved by the FDA. Currently some large centers are conducting clinical trials.
At the moment, clinical trials are including patients who have severe drug resistant depression. Individuals who have metal clips, pacemakers or other metal implants in the brain are excluded from the trials. Also excluded are pregnant females because effects of the magnetic field on the fetus have not been thoroughly studied. One other group which has also been excluded from the clinical trials, are individuals who are at high-risk for seizures.
Unlike Electroconvulsive therapy, Transcranial magnetic stimulation does not require use of anesthesia or any type of shock therapy. One does not even require any type of anesthesia. From the limited clinical trials, the observed side effects have been minimal. The majority of individuals only complain of a slight tingling feeling at the site or a mild headache. The only disadvantage of therapy is that one lies on a bed and the head is placed inside a tunneled device (like a CT Scan). The machine is loud but the patient is given a pair of ear muffs. Individuals who do not like enclosed spaces may not be keen to undergo this type of therapy.
One simply lies on the flat bed for a few hours until the treatment is completed. At the end of the treatment, one can go home. The protocol involves five treatment sessions per week for 4-6 weeks. While this may sound like a lot of time commitment, it is better than taking drugs for the rest of life. In addition, the drugs for depression also have many side effects and often the drugs do not work.
At the moment enrollment is free in clinical trials. To participate in a trial, you need to speak to your health care worker and get a referral. The trials do have inclusion and exclusion criteria but it is definitely worth a try. It is not often that one gets a chance to receive free treatment, which has minimal side effects. However, like all treatments for depression, Transcranial magnetic stimulation is not a cure for depression.
Tuesday, March 31, 2009
Does Caffeine worsen depression?
There are some individuals who drink coffee (caffeine) and are worried that it may worsen or even cause depression. Today, there is very little evidence to link caffeine and depression. Despite the fact that Caffeine is a brain stimulant; it does worsen depression in a fair number of individuals. Why this brain stimulant induces depression is a mystery. There are suggestions that caffeine may alter blood sugar levels and this may be one cause for the mood alterations. Other experts claim that perhaps caffeine induces a severe state of alertness and anxiety and thus the individual is no longer able to sleep or function properly and hence gets depressed
The number of individuals whose depression is worsened by caffeine is not known. In any case, if your depression gets worse after consuming caffeine, one should limit the intake of caffeine containing beverages. The caffeine beverages should be gradually deceased because abrupt discontinuation of caffeine can also lead to mild withdrawal symptoms such as headaches, lethargy, irritability, and anxiety. There are a few anecdotal reports indicating that lessening caffeine intake can lessen the severity of depression.
Caffeine is not as bad as what is made out in the lay media. It does have a few proven health benefits including ability to improve alertness, increasing concentration and allowing one to be more sociable. A number of French studies have shown that a daily cup of coffee can lead to a lesser degree of cognitive impairment with age. However despite its potential benefits, too much caffeine also has adverse effects. For the depressed individual, the trick is to consume the right balance of caffeine.
The number of individuals whose depression is worsened by caffeine is not known. In any case, if your depression gets worse after consuming caffeine, one should limit the intake of caffeine containing beverages. The caffeine beverages should be gradually deceased because abrupt discontinuation of caffeine can also lead to mild withdrawal symptoms such as headaches, lethargy, irritability, and anxiety. There are a few anecdotal reports indicating that lessening caffeine intake can lessen the severity of depression.
Caffeine is not as bad as what is made out in the lay media. It does have a few proven health benefits including ability to improve alertness, increasing concentration and allowing one to be more sociable. A number of French studies have shown that a daily cup of coffee can lead to a lesser degree of cognitive impairment with age. However despite its potential benefits, too much caffeine also has adverse effects. For the depressed individual, the trick is to consume the right balance of caffeine.
Tuesday, March 24, 2009
Fish oil supplements for depression
Over the last few years, there have been a few small studies indicating that perhaps fish oil supplements can help reduce the symptoms of depression. Anecdotal reports indicate that some individuals do better with fish oil supplements alone.
Fish oil is known to be a good source of omega 3 fatty acids. These fatty acids have been shown to play a role in the normal functioning and development of brain. A few isolated reports indicate that depressed individuals also have low levels of eicosapentaneoic acid, which is a long chain fatty acid.
However, the evidence for fish oil and depression is very scant and only sporadic reports are available. One study showed that taking 2 gr of fish oil had no effect but a 4 gr dose did show some improvement in symptoms. Current research is now taking place to determine what percentage of patients can improve and how long the effects of the fish oil last.
At this point, fish oil is not recommended as a substitute treatment for depression. For the time being anti depressants still remain the standard of therapy and before one starts to embark on a therapy of fish oil only, discuss this issue with your physician. However, since fish oil is known to be beneficial for heart disease, there is absolutely no harm in taking fish oil with the present day anti depressants.
Rather than taking fish oil pills to get omega 3 fatty acid, a better alternative is eat more fish. The pills are expensive and who knows what else they contain. Other foods, which also have high levels of omega 3 fatty acids, include flaxseed, canola oil, Soya beans, and walnuts. Unlike pills, natural foods are less likely to be contaminated with fake products or artificial ingredients (remember melamine?)
Fish oil is known to be a good source of omega 3 fatty acids. These fatty acids have been shown to play a role in the normal functioning and development of brain. A few isolated reports indicate that depressed individuals also have low levels of eicosapentaneoic acid, which is a long chain fatty acid.
However, the evidence for fish oil and depression is very scant and only sporadic reports are available. One study showed that taking 2 gr of fish oil had no effect but a 4 gr dose did show some improvement in symptoms. Current research is now taking place to determine what percentage of patients can improve and how long the effects of the fish oil last.
At this point, fish oil is not recommended as a substitute treatment for depression. For the time being anti depressants still remain the standard of therapy and before one starts to embark on a therapy of fish oil only, discuss this issue with your physician. However, since fish oil is known to be beneficial for heart disease, there is absolutely no harm in taking fish oil with the present day anti depressants.
Rather than taking fish oil pills to get omega 3 fatty acid, a better alternative is eat more fish. The pills are expensive and who knows what else they contain. Other foods, which also have high levels of omega 3 fatty acids, include flaxseed, canola oil, Soya beans, and walnuts. Unlike pills, natural foods are less likely to be contaminated with fake products or artificial ingredients (remember melamine?)
Friday, March 20, 2009
Vitamin B12 and depression
Physicians have known for a long time that individuals who have low levels of Vitamin B 12 develop many problems in their body, including depression. Vitamin B12 and related health supplements like folate are essential for function of neurochemicals in the brain. Many of minerals and vitamins act as co-factors and help in the synthesis of vital neurotransmitters in the brain.
However, the problem is that the brain is too complex. There are millions of nerves in the brain, each intricately linked and all working in harmony. Where B12 fits into this grand picture has remained a mystery. Besides B12, many other minerals have been linked to depression include, cooper, zinc, selenium and iron.
The most common cause of B12 deficiency is poor nutrition. One also has to remember that once depression sets in, the individual will further worsen the problem by not eating healthy. Individuals who develop depression often show little interest in food and tend to eat unhealthy foods thus worsening the cycle of depression.
While there has been a lot of hype about Vitamin B12 as a cure for depression, one should know that replenishing the diet with this vitamin does not always reverse the depression. However, that does not mean one should not eat healthy. All individuals who are depressed should eat a well balanced diet that contains all essential minerals, and vitamins including B 12. There is absolutely no point in buying vitamins from a health store. Vitamin B12 is found in ample amounts in many foods like breakfast cereals, meat, poultry, milk, and seafood.
For those who are on a vegetarian diet an over the age of 50, perhaps obtaining extra vitamins supplements may help.
All patients with depression should ensure that the health care professional has addressed any underlying medical disorder that can make your depression worse. Some of the common conditions that affect depression include under activity of the thyroid (hypothyroid) vitamins deficiencies and pernicious anemia. Once these conditions are treated, the depression may improve.
However, the problem is that the brain is too complex. There are millions of nerves in the brain, each intricately linked and all working in harmony. Where B12 fits into this grand picture has remained a mystery. Besides B12, many other minerals have been linked to depression include, cooper, zinc, selenium and iron.
The most common cause of B12 deficiency is poor nutrition. One also has to remember that once depression sets in, the individual will further worsen the problem by not eating healthy. Individuals who develop depression often show little interest in food and tend to eat unhealthy foods thus worsening the cycle of depression.
While there has been a lot of hype about Vitamin B12 as a cure for depression, one should know that replenishing the diet with this vitamin does not always reverse the depression. However, that does not mean one should not eat healthy. All individuals who are depressed should eat a well balanced diet that contains all essential minerals, and vitamins including B 12. There is absolutely no point in buying vitamins from a health store. Vitamin B12 is found in ample amounts in many foods like breakfast cereals, meat, poultry, milk, and seafood.
For those who are on a vegetarian diet an over the age of 50, perhaps obtaining extra vitamins supplements may help.
All patients with depression should ensure that the health care professional has addressed any underlying medical disorder that can make your depression worse. Some of the common conditions that affect depression include under activity of the thyroid (hypothyroid) vitamins deficiencies and pernicious anemia. Once these conditions are treated, the depression may improve.
Thursday, March 12, 2009
Why will my Anti Depressant medication not work anymore?
One common complaint among many depressed patients is that their medication no longer works. The majority of individuals notice that the depression just will not go away with the medication that helped them previously. So what gives?
Well, failure of anti depressants to work on long-term basis has been known for decades. The exact number of people affected by this so called “POOPING OUT” effect is not known, but is said to be quite high – at least 20%-40% of individuals.
This phenomenon where anti depressants fail to work has not been thoroughly studied but there are a few speculations as to why this may happen.
Most psychiatrists feel that depression is a chronic disease that does get worse with age. Why depression worsens with age is not understood but is felt to be due to depletion of certain neurochemicals in the brain. With age, the depressive episodes also are more frequent and more intense. Often the depression is affected by daily stresses in life and is harder to control
In a few individuals, the reason why anti depressants fail to work all of a sudden is presence of another medical disorder. The most common disorder that can worsen depression is hypothyroidism. If you are on an anti depressant and the medication fails to work, go and get your thyroid hormone levels checked out.
Often the failure of medications to work is because of interaction with other medications. Most individuals who are on anti depressants are on a hodge podge of many different medications, including sleeping pills, sedatives and anti anxiety pills. In many cases, the use of the other depressant drugs or even alcohol has been found to be the reason why anti depressants no longer work.
There are rare cases when the there has been a confusion in the diagnosis. Often some individuals are diagnosed with depression when they actual have manic depression, a disorder where depression is a well-known element.
Whenever an anti depressant fail to work, your health care professional will adjust the dose. Sometimes an additional drug may be added or a completely new class of anti depressant drug may be prescribed.
For those individual who have depression not responsive to their old prescription, it is essential to follow up with your psychiatrist. Depression is not curable but it is treatable with a number of drugs and psychotherapy.
Well, failure of anti depressants to work on long-term basis has been known for decades. The exact number of people affected by this so called “POOPING OUT” effect is not known, but is said to be quite high – at least 20%-40% of individuals.
This phenomenon where anti depressants fail to work has not been thoroughly studied but there are a few speculations as to why this may happen.
Most psychiatrists feel that depression is a chronic disease that does get worse with age. Why depression worsens with age is not understood but is felt to be due to depletion of certain neurochemicals in the brain. With age, the depressive episodes also are more frequent and more intense. Often the depression is affected by daily stresses in life and is harder to control
In a few individuals, the reason why anti depressants fail to work all of a sudden is presence of another medical disorder. The most common disorder that can worsen depression is hypothyroidism. If you are on an anti depressant and the medication fails to work, go and get your thyroid hormone levels checked out.
Often the failure of medications to work is because of interaction with other medications. Most individuals who are on anti depressants are on a hodge podge of many different medications, including sleeping pills, sedatives and anti anxiety pills. In many cases, the use of the other depressant drugs or even alcohol has been found to be the reason why anti depressants no longer work.
There are rare cases when the there has been a confusion in the diagnosis. Often some individuals are diagnosed with depression when they actual have manic depression, a disorder where depression is a well-known element.
Whenever an anti depressant fail to work, your health care professional will adjust the dose. Sometimes an additional drug may be added or a completely new class of anti depressant drug may be prescribed.
For those individual who have depression not responsive to their old prescription, it is essential to follow up with your psychiatrist. Depression is not curable but it is treatable with a number of drugs and psychotherapy.
Sunday, March 8, 2009
Anti Psychotics and Weight Gain
One of the most common side effects of anti psychotic drugs is weight gain. Even the newer anti psychotics like olanzapine and risperidol have been associated with weight gain. There are a number of individuals who will not take their anti psychotic medications because of this disturbing side effect.
Over the years, it has become known that individuals who take anti psychotics do develop a multitude of complications related to weight gain and in fact, these individuals do have a higher death rate than the average population. Why weight gain occurs with these anti psychotic drugs is not full known but is believed to be related to genes or a biochemical change in the brain.
There is evidence that some individuals may have genetic make-up, which causes the drugs to influence their eating habits. This is just speculation because the majority of individuals who take anti psychotics put on weight. The anti psychotics do not discriminate against any gene(s), race, gender, age, color, or ethnicity- everyone gain weight.
A few recent animal studies have shown that anti psychotics drugs can increase the activity of an enzyme known as the appetite-regulating enzyme commonly known as AMPK. Further, all anti psychotics also limit the ability of insulin to work; the resulting insulin resistance has also been associated with weight gain.
So what are the treatment options for these individuals?
Well to begin with, all individuals who take anti psychotics should be encouraged to eat healthy and enter into an exercise program. A decrease in calorie consumption is important.
A single study from China showed that the anti diabetic drug, metformin, did reverse the weight gain induced by anti psychotics. These effects were observed in diabetics who were on anti psychotic drugs. Metformin should not be taken by individuals with normal blood sugar because this can lead to a severe lowering of blood sugars, that can be life threatening. This may not be of great importance in China but in North America prescribing a diabetic drug to a non-diabetic is one “great method” of generating a medical malpractice claim.
Unfortunately, all anti psychotics induce weight gain, so switching to a different medication is useless.
For the time being, there is no magic bullet to solve weight gain induced by anti psychotics. Adhering to a strict diet and exercise is probably the best advice- the point is that many people simply are not motivated.
Over the years, it has become known that individuals who take anti psychotics do develop a multitude of complications related to weight gain and in fact, these individuals do have a higher death rate than the average population. Why weight gain occurs with these anti psychotic drugs is not full known but is believed to be related to genes or a biochemical change in the brain.
There is evidence that some individuals may have genetic make-up, which causes the drugs to influence their eating habits. This is just speculation because the majority of individuals who take anti psychotics put on weight. The anti psychotics do not discriminate against any gene(s), race, gender, age, color, or ethnicity- everyone gain weight.
A few recent animal studies have shown that anti psychotics drugs can increase the activity of an enzyme known as the appetite-regulating enzyme commonly known as AMPK. Further, all anti psychotics also limit the ability of insulin to work; the resulting insulin resistance has also been associated with weight gain.
So what are the treatment options for these individuals?
Well to begin with, all individuals who take anti psychotics should be encouraged to eat healthy and enter into an exercise program. A decrease in calorie consumption is important.
A single study from China showed that the anti diabetic drug, metformin, did reverse the weight gain induced by anti psychotics. These effects were observed in diabetics who were on anti psychotic drugs. Metformin should not be taken by individuals with normal blood sugar because this can lead to a severe lowering of blood sugars, that can be life threatening. This may not be of great importance in China but in North America prescribing a diabetic drug to a non-diabetic is one “great method” of generating a medical malpractice claim.
Unfortunately, all anti psychotics induce weight gain, so switching to a different medication is useless.
For the time being, there is no magic bullet to solve weight gain induced by anti psychotics. Adhering to a strict diet and exercise is probably the best advice- the point is that many people simply are not motivated.
Pristiq- a newer antidepressant
Recently the FDA approved a new anti depressant called Pristiq. Known as desvenlafaxine, it has been in use for about 10 months. It works like the other anti depressant medications and brings back the balance of certain neurotransmitters in the brain. Pristiq is quite long acting and is taken once a day. Just like the earlier generation of anti depressants, it also has a few side effects that include:
Nausea
Lightheaded
Excess sweating
Constipation
Generalized tiredness
Diminished appetite
Anxiety, apprehension
Decrease libido in men
While Pristiq does not cure depression, it remains an option for individuals who do not respond to the older anti depressants. The other advantage of Pristiq is that it has been shown to be an excellent drug for treatment of melancholia that occurs during menopause.
From recent clinical trials, it has been shown that about 70% of individual with major depression do respond to Pristiq. Further, the trials also showed that remission rates for Pristiq were much lower than the older anti depressants. Whether the drug works for chronic depression has not been fully evaluated.
Nausea
Lightheaded
Excess sweating
Constipation
Generalized tiredness
Diminished appetite
Anxiety, apprehension
Decrease libido in men
While Pristiq does not cure depression, it remains an option for individuals who do not respond to the older anti depressants. The other advantage of Pristiq is that it has been shown to be an excellent drug for treatment of melancholia that occurs during menopause.
From recent clinical trials, it has been shown that about 70% of individual with major depression do respond to Pristiq. Further, the trials also showed that remission rates for Pristiq were much lower than the older anti depressants. Whether the drug works for chronic depression has not been fully evaluated.
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