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.
Friday, May 22, 2009
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.
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.
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.
Monday, May 18, 2009
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
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.
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.
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.
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.
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