Thursday, January 31, 2008

Epileptic medications and suicidal risk

This just in from the FDA.... placebo-controlled trials of 11 different medications used to treat epilepsy (and other disorders as detailed in previous posts), individuals using these medications experienced twice the risk of suicidal thoughts and/or behaviors. It didn't take long for some, only a week, to experience this very significant side effect. The risk WAS higher for those given these medications for epilepsy than those given the medications for other reasons.

This is the FDA's list of medications evaluated in this study:

Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR)
Felbamate (Felbatol)
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Oxcarbazepine (Trileptal)
Pregabalin (Lyrica)
Tiagabine (Gabitril)
Topiramate (Topamax)
Valproate (Depakote, Depakote ER, Depakene, Depacon)
Zonisamide ()

Here is the FDA reference for more information:


Just a note from a oil can help reduce seizure activity. I AM NOT, I repeat AM NOT, advising anyone reading this post to discontinue their medications and replace them with a nutritional supplement. However, I AM encouraging you to discuss the possibility of a blend of nutrition therapy AND medication for a potentially gentler approach to safely managing a very serious medical issue.

Sunday, January 27, 2008

Metabolic syndrome and psychiatric medications

I've been busy videotaping a home study course in my home office, but today it's pouring rain and I don't have enough light. It's a good time to get caught up on blogging.

One of the reasons I designed the home study course I'm videotaping is because of the rapid increase in the use of psychiatric medications for more than purely psychiatric reasons. The metabolic side effects of these medications caught a lot of health professionals off guard. Most nutrition professionals do not anticipate that they will be working in psychiatry when they decide to enter the field.

So people come into their office for help losing weight, and as well-intended as the professional in that office might be...they don't have all the information they need in order to provide the right kind of help.

Many psychiatric medications cause hormone changes, high cholesterol, diabetes, weight gain, and other changes. In women, this cluster of problems can also cause infertility. If you're reading this blog and it sounds like you might benefit from more information on eating well when you have this combination of problems to manage, I wanted to let you know about a second blog that I write. Its original intent is for women with polycystic ovary syndrome (PCOS), the infertility syndrome I just described. But the information is also very pertinent to others who may not be female or who may not be worried about fertility.

If you're interested, please visit us!

Sunday, January 20, 2008

More about the ads

Hello everyone,

Just want to reassure you, my commitment to having appropriate ads is important to me. When I've had a chance I have been checking to see what's popping up...and I've been filtering out ads that are counterproductive to the mission of this blog.

I have seen some public service ads and some others for websites with good information, so I'm glad I took the chance to try this. But I don't want to turn people off on my concept before they've had a chance to benefit, because they feel like I'm using them for personal gain.

I can only see the ads that pop up when I look, so I welcome any feedback for ads you see that you'd rather not see when you're looking for the kind of information I provide.

I look forward to your feedback, have a wonderful week!


Saturday, January 19, 2008

If you like the information you've been reading...

...I am putting the finishing touches on my 3rd version of "Nutritional Implications of Psychotropic Medications." It is a series of fact sheets on the hormonal and nutritional influences of medications designed to affect nervous system function. As of tonight, I have almost 200 pages of references alone, so I can guarantee you I was thorough.

I put this reference together when I became frustrated at the responses I was getting from drug companies to my questions about the relationship between some of these medications and changes in weight I and my colleagues were seeing. The answers were not always forthcoming, and I felt like individuals with mental health issues didn't really have anyone in the nutritional world to advocate for them. So...I developed this reference to help my colleagues become those advocates.

Because of the amount of time that I have put into this resource, I will need to raise the price by $15 on February 1. But since I finished it up a little bit early, I'm willing to keep the lower price until the officially announced release date.

For more information you can visit the link just above my photo to the left.

I hope I've created a product that helps you or someone you love!

Friday, January 18, 2008

Serious side effect warning for Chantix

Pfizer just issued a press release warning about potential serious side effects for their smoking cessation medication, Chantix (varenicline). These side effects include agitation, depression, suicidal thoughts and suicidal behaviors.

Here is a link to the original release:

Apparently when this drug was in the testing phase, individuals with psychiatric diagnoses were not included in the test population. In the world of pure study design, that makes sense...but...sigh...if you've ever worked in the world of psychiatric diagnoses or have one, you know how prevalent smoking is within this demographic.

Chantix is not a medication I regularly review, or plan to, but since my intended audience may very well be the population most at risk for experiencing the reported problems, I wanted to be sure this information reached its potentially most relevant audience.

Thursday, January 17, 2008

The multi-talented Topamax?

I just finished adding new references to my Topamax page. I was surprised at how many off-label uses needed to be added to the list!

As I mentioned in an earlier post, off-label uses aren't a bad thing, provided the prescribing physician understands the rationale for the use and the patient understands the nature of off-label uses.

Here is my list, with references posted below.

Alcohol dependence, aggression, alternating hemiplegia, binge eating disorder, bipolar disorder, borderline personality disorder, catatonia, cerebellar tremors, chronic low back pain, chronic paroxysmal hemicrania, cocaine dependence, cyclic vomiting, depression, ejaculation pain, essential tremor, hemiballism, hemicrania continua, hemifacial spasm, idiopathic intracranial hypertension, impulsive behavioral disorders, infantile spasms, kleptomania, neuropathic pain, nicotine dependence, nocturnal eating, obesity, obsessive-compulsive disorder, paraphilic sexual disorders, paroxysmal kinesigenic choreoathetosis, pathologic gambling, pervasive developmental disorders, phrenic nerve palsy, post-traumatic stress disorder, Prader-Willi Syndrome, pseudotumor cerebri, restless legs syndrome, sexual compulsions, sleep-related eating disorder, smoking cessation, spinal myoclonus, trichotillomania.

Rubio G, Ponce G, Jimenez-Arriero MA, Palomo T, Manzanares J, Ferre F. Effects of topiramate in the treatment of alcohol dependence. Pharmacopsychiatry. 2004 Jan;37(1):37-40.

Heilig M, Egli M. Pharmacological treatment of alcohol dependence: target symptoms and target mechanisms. Pharmacol Ther 2006 Sep;111(3):855-76.

Collins GB, McAllister MS, Adury K. Drug adjuncts for treating alcohol dependence. Cleve Clin J Med 2006 Jul;73(7):641-4, 647-8, 650-1, passim.

Ma JZ, Ait Daoud N, Johnson BA. Topiramate reduces the harm of excessive drinking: implications for public health and primary care. Addiction 2006;Nov;101(11):1561-8.

Fernandez Miranda JJ, Marina Gonzalez PA, Montes Perez M, Diaz Gonzalez T, Gutierrez Cienfuegos E, Antuna Diaz MJ, Bobes Garcis J. Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study. Actas Esp Psiquiatr 2007 Jul-Aug;35(4):236-42.

Hargreaves GA, McGregor IS. Topiramate moderately reduces the motivation to consume alcohol and has a marked antidepressant effect in rats. Alcohol Clin Exp Res 2007 Nov;31(11):1900-7.

Johnson BA. Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings. Biochem Pharmacol 2008 Jan 1;75(1):34-56.

Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, McKay A, Ait Daoud N, Anton RF, Ciraulo DA, Kranzler HR, Mann K, O’Malley SS, Swift RM; Topiramate for Alcoholism Advisory Board; Topiramate for Alcoholism Study Group. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA 2007 Oct 10;298(14):1641-51.

Johnson BA. Topiramate-induced neuromodulation of cortico-mesolimbic dopamine function: a new vista for the treatment of comorbid alcohol and nicotine dependence? Addict Behav. 2004 Sep;29(7):1465-79.

Gobbi G, Gaudreau PO, Leblanc N. Efficacy of topiramate, valproate, and their combination on aggression/agitation behavior in patients with psychosis. J Clin Psychopharmacol 2006 Oct;26(5):467-73.

Navarro JF, Buron E, Martin Lopez M. Antiaggressive effects of topiramate in agonistic encounters between male mice. Methods Find Exp Clin Pharmacol 2007 Apr;29(3):195-8.

Nickel MK, Loew TH. Treatment of aggression with topiramate in male borderline patients, part II: 18-month follow-up. Eur Psychiatry 2007 Nov 14.

Jiang W, Chi Z, Ma L, Du B, Shang W, Guo H, Wu W. Topiramate: a new agent for patients with alternating hemiplegia of childhood. Neuropediatrics 2006 Aug;37(4):229-33.

Appolinario JC, McElroy SL. Pharmacological approaches in the treatment of binge eating disorder. Curr Drug Targets. 2004 Apr;5(3):301-7.

Zilberstein B, Pajecki D, Garcia de Brito AC, Gallafrio ST, Eshkenazy R, Andrade CG. Topiramate after adjustable gastric banding in patients with binge eating and difficulty losing weight. Obes Surg. 2004 Jun-Jul;14(6):802-5.

De Bernardi C, Ferraris S, D'Innella P, Do F, Torre E. Topiramate for binge eating disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2005 Feb;29(2):339-41. Epub 2004 Dec 28.

Kotwal R, Guerdjikova A, McElroy SL, Keck PE Jr. Lithium augmentation of topiramate for bipolar disorder with comorbid binge eating disorder and obesity. Hum Psychopharmacol 2006 Oct;21(7):425-31.

Tata AL, Kockler DR. Topiramate for binge-eating disorder associated with obesity. Ann Pharmacother 2006 Nov;40(11):1993-7.

McElroy SL, Hudson JI, Capece JA, Beyers K, Fisher AC, Rosenthal NR; Topiramate Binge Eating Disorder Research Group. Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biol Psychiatry 2007 May 1;61(9):1039-48.

Claudino AM, de Oliveira IR, Appolinario JC, Cordas TA, Duchesne M, Sichieri R, Bacaltchuk J. Double-blind, randomized, placebo-controlled trial of topiramate plus cognitive-behavior therapy in binge-eating disorder. J Clin Psychiatry 2007 Sep;68(9):1324-32.

Lykouras L, Hatzimanolis J. Adjunctive topiramate in the maintenance treatment of bipolar disorders: an open-label study. Curr Med Res Opin. 2004 Jun;20(6):843-7.

McDaniel WW, Spegel DR, Sahota AK. Topiramate effect in catatonia: a case series. J Neuropsychiatry Clin Neurosci 2006 Spring;18(2):234-8.

Sechi G, Agnetti V, Sulas FM, Sau G, Corda D, Pitzolu MG, Rosati G. Effects of topiramate in patients with cerebellar tremor. Prog Neuropsychopharmacol Biol Psychiatry 2003 Sep; 27(6): 1023-7.

uehlbacher M, Nickel MK, Kettler C, Tritt K, Lahmann C, Leiberich PK, Nickel C, Krawczyk J, Mitterlehner FO, Rother WK, Loew TH, Laplan P. Topiramate in treatment of patients with chronic low back pain: a randomized, double-blind, placebo-controlled study. Clin J Pain 2006 Jul-Aug;22(6):526-31.

Cohen AS, Goadsby PJ. Paroxysmal hemicrania responding to topiramate. J Neurol Neurosurg Psychiatry 2007 Jan;78(1):96-7.

Camarda C, Camarda R, Monastero R. Chronic paroxysmal hemicrania and hemicrania continua responding to topiramate: Two case reports. Clin Neurol Neurosurg 2008 Jan;110(1):88-91.

Kampman KM, Pettinati H, Lynch KG, Dackis C, Sparkman T, Weigley C, O'Brien CP. A pilot trial of topiramate for the treatment of cocaine dependence. Drug Alcohol Depend. 2004 Sep 6;75(3):233-40.

Sofuoglu M, Kosten TR. Novel approaches to the treatment of cocaine addiction. CNS Drugs. 2005;19(1):13-25.

Sofuoglu M, Kosten TR. Emerging pharmacological strategies in the fight against cocaine addiction. Expert Opin Emerg Drugs 2006 Mar;11(1):91-8.

Ohnez A, Kose G, Turanli G. Cyclic vomiting with generalized epileptiform discharges responsive to topiramate therapy. Pediatr Neurol 2006 Nov;35(5):348-51.

Jordi P, Maria-Jose A, Luis-Alfonso M, Mauro S. Management of ejaculation pain with topiramate: a case report. Clin J Pain. 2004 Sep-Oct;20(5):368-9.

Lyons K, Pahwa R, Comella CL, Eisa MS, Elble RJ, Fahn S, Jankovic J, Juncos JL, Koller WC, Ondo WG, Sethi KD, Stern MB, Tanner CM, Tintner R, Watts RL. Benefits and risks of pharmacological treatments for essential tremor. Drug Saf 2003; 26(7): 461-81.

Ondo WG, Jankovic J, Connor GS, Pahwa R, Elble R, Stacy MA, Koller WC, Schwarzman L, Wu SC, Hulihan JF; Topiramate Essential Tremor Study Investigators. Topiramate in essential tremor: a double-blind, placebo-controlled trial. Neurology 2006 Mar 14;66(5):672-7.

Gatto EM, Uribe Roca C, Raina G, Gorja M, Folgar S, Micheli FE. Vascular hemichorea/hemiballism and topiramate. Mov Disord. 2004 Jul;19(7):836-8.

Brighina F, Palermo A, Cosentino G, Fierro B. Prophylaxis of hemicrania continua: two new cases effectively treated with topiramate. Headache 2007 Mar;47(3):441-3.

Alonso Navarro H, Rubio L, Jimenez Jimenez FJ.
Topiramate as treatment for hemifacial spasm. Clin Neuropharmacol 2007 Sep-Oct;30(5):308-9.

Palacio E, Rodero L, Pascual J. Topiramate-responsive headache due to idiopathic intracranial hypertension in Behcet syndrome. Headache. 2004 May;44(5):436-7.

Tang RA, Dorotheo EU, Schiffman JS, Bahrani HM. Medical and surgical management of idiopathic intracranial hypertension in pregnancy. Curr Neurol Neurosci Rep. 2004 Sep;4(5):398-409.

Celebisoy N, Gokcay F, Sirin H, Akyurekli O. Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand 2007 Nov;116(5):322-7.

Dolengevich Segal H, Rodriguez Salgado B, Conejo Garcia A, San Sebastian Cabases J. [Efficacy of topiramate in children and adolescent with problems in impulse control: preliminary results]. Actas Esp Psiquiatr 2006 Jul-Aug;34(4):280-2.

Hosain SA, Merchant S, Solomon GE, Chutorian A. Topiramate for the treatment of infantile spasms. J Child Neurol 2006 Jan;21(1):17-9.

Hsieh MY, Lin KL, Wang HS, Chou ML, Hung PC, Chang MY. Low-dose topiramate is effective in the treatment of infantile spasms. Chang Gung Med J 2006 May-Jun;29(3):291-6.

Kwon YS, Jun YH, Hong YJ, Son BK. Topiramate monotherapy in infantile spasm. Yonsei Med J 2006 Aug 31;47(4):498-504.

Zou LP, Ding CH, Fang F, Sin NC, Mix E. Prospective study of first-choice topiramate therapy in newly diagnosed infantile spasms. Clin Neuropharmacol 2006 Nov-Dec;29(6):343-9.

Kaplan Y. Epilepsy and kleptomania. Epilepsy Behav 2007 Nov;11(3):474-5.

Chong MS, Libretto SE. The rationale and use of topiramate for treating neuropathic pain. Clin J Pain 2003 Jan-Feb; 19(1): 59-68.

Kline KM, Carroll DG, Malnar KF. Painful diabetic peripheral neuropathy relieved with use of oral topiramate. South Med J 2003 Jun; 96(6): 602-5.

Petit WA Jr., Upender RP. Medical evaluation and treatment of diabetic peripheral neuropathy. Clin Podiatr Med Surg 2003 Oct; 20(4): 671-88.

Vu TN. Current pharmacologic approaches to treating neuropathic pain. Curr Pain Headache Rep. 2004 Feb;8(1):15-8.

Bischofs S, Zelenka M, Sommer C. Evaluation of topiramate as an anti-hyperalgesic and neuroprotective agent in the peripheral nervous system. J Peripher Nerv Syst. 2004 Jun;9(2):70-8.

Benoliel R, Sharav Y, Eliav E. Painful posttraumatic trigeminal neuropathy: a case report of relief with topiramate. Cranio 2007 Jan;25(1):57-62.

Moulin DE, Clark AJ, Gilron I, Ware MA, Watson CP, Sessle BJ, Coderre t, Morley Forster PK, StinsonJ, Coulanger A, Peng P, Finley GA, Taenzer P, Squire P, Dion D, Cholkan A, Gilani a, Gordon A, Henry J, Jovey R, Lynch M, Mailis Gagnon A, Panju A, Rollman GB, Velly A; Canadian Pain Society. Pharmacological management of chronic neuropathic pain - consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag 2007 Spring;12(1):13-21.

Codd EE, Martinez RP, Molino L, Rogers KE, Stone DJ, Tallarida RJ. Tramadol and several anticonvulsants synergize in attenuating nerve injury-induced allodynia. Pain 2007 May 24.

Winkelman JW. Treatment of nocturnal eating syndrome and sleep-related eating disorder with topiramate. Sleep Med 2003 May; 4(3): 243-6.

Gabriel A. Adjunctive topiramate treatment in refractory obese bipolar patients: a descriptive open label study. Eat Weight Disord 2007 Mar;12(1):48053.

Van Ameringen M, Mancini C, Patterson B, Bennett M. Topiramate augmentation in treatment-resistant obsessive-compulsive disorder: a retrospective, open-label case series. Depress Anxiety 2006;23(1):1-5.

Hollander E, Dell’Osso B. Topiramate plus paroxetine in treatment-resistant obsessive-compulsive disorder. Int Clin Psychopharmacol 2006 May;21(3):189-91.

Shiah IS, Chao CY, Mao WC, Chuang YJ. Treatment of paraphilic sexual disorder: the use of topiramate in fetishism. Int Clin Psychopharmacol 2006 Jul;21(4):241-3.

Huang YG, Chen YC, Du F, Li R, Xu GL, Jiang W, Huang J. Topiramate therapy for paroxysmal kinesigenic choreoathetosis. Mov Disord. 2005 Jan;20(1):75-7.

Dannon PN, Lowengrub K, Gonopolski Y, Musin E, Kotler M. Topiramate versus fluvoxamine in the treatment of pathological gambling: a randomized, blind-rater comparison study. Clin Neuropharmacol. 2005 Jan-Feb;28(1):6-10.

Hardan AY, Jou RJ, Handen BL. A retrospective assessment of topiramate in children and adolescents with pervasive developmental disorders. J Child Adolesc Psychopharmacol. 2004 Fall;14(3):426-32.

Khan S, Liberzon I. Topiramate attenuates exaggerated acoustic startle in an animal model of PTSD. Psychopharmacology (Berl). 2004 Mar;172(2):225-9. Epub 2003 Oct 30.

Asnis GM, Kohn SR, Henderson M, Brown NL. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs. 2004;64(4):383-404.

Berlant JL. Prospective open-label study of add-on and monotherapy topiramate in civilians with chronic nonhallucinatory posttraumatic stress disorder. BMC Psychiatry. 2004 Aug 18;4(1):24.

Aalbersberg CF, Mulder JM. [Topiramate for the treatment of post traumatic stress disorder. A case study]. Tijdschr Psychiatr 2006;48(6):487-91.

Tucker P, Trautman RP, Wyatt DB, Thompson J, Wu SC, Capece JA, Rosenthal NR. Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2007 Feb;68(2):201-6.

Smathers SA, Wilson JG, Nigro MA. Topiramate effectiveness in Prader-Willi syndrome. Pediatr Neurol 2003 Feb; 28(2): 130-3.

Shapira NA, Lessig MC, Lewis MH, Goodman WK, Driscoll DJ. Effects of topiramate in adults with Prader-Willi syndrome. Am J Ment Retard. 2004 Jul;109(4):301-9.

Alore PL, Jay WM, Macken MP. Topiramate, pseudotumor cerebri, weight-loss and glaucoma: an ophthalmologic perspective. Semin Ophthalmol 2006 Jan0Mar;21(1):15-7.

Perez Bravo A. [Topiramate use as treatment in restless legs syndrome] [Article in Spanish] Actas Esp Psiquiatr. 2004 May-Jun;32(3):132-7.

Khazaal Y, Cornuz J, Bilancioni R, Zullino DF. Topiramate for smoking cessation. Psychiatry Clin Neurosci 2006 Jun;60(3):384-8.

Winkleman JW. Treatment of nocturnal eating syndrome and sleep-related eating disorder with topiramate. Sleep Med 2003 May; 4(3): 243-6.
Winkelman JW.

Efficacy and tolerability of open-label topiramate in the treatment of sleep-related eating disorder: a retrospective case series. J Clin Psychiatry 2006 Nov;67(11):1729-34.

Martinez Salio A, Soler Algarra S, Calvo Garcia I, Sanchez Martin M. [Nocturnal sleep-related eating disorder that responds to topiramate]. Rev Neurol 2007 Sep 1-15;45(5):276-9.

Siniscalchi A, Mancuso F, Russo E, Ibbadu GF, De Sarro G. Spinal myoclonus responsive to topiramate. Mov Disord. 2004 Nov;19(11):1380-1.

Lochner C, Seedat s, Niehaus DJ, Stein DJ. Topiramate in the treatment of trichotillomania: an open-label pilot study. Int Clin Psychopharmacol 2006 Sep;21(5):255-9.

How effective is your medication....REALLY?

The New York Times today reports that drug researchers are more likely to publish data reporting positive effects of medications than they are negative ones. Here's the full story for any of you who are interested.

This disturbs me. My graduate school program taught me that ANY outcome, positive, negative, or neutral, is significant to consider and report to colleagues. In the pharmaceutical industry, it would seem to me that recognizing that a medication is not as effective, in the development stage, would save money in the long run. There is always time to go back to the drawing board and build a better mousetrap.

Is it only me who gets tired of turning on the news and hearing that a medication was recalled for side effects/problems that could have been headed off with a little patience and integrity on the front end?

Understanding why a medication isn't effective should be challenging scientists to better understand the brain and develop medications that are effective.

In mental health, especially, it can be dangerous to convince someone with depression, bipolar disorder, or schizophrenia, that a medication that they are taking is more likely to help them than it really is. Self-destructive behaviors, not to mention suicide and homicide, hurt more than just the person taking the ineffective medication.

I understand that medications cannot even be developed if there is not a way to pay for the cost of research, development, production, and distribution. But c'mon, colleagues, aren't we also in this work, at least a little bit, to perform a public service? Isn't the better public service to steer people away from nonproductive choices (including medications that are not likely to help) and challenging ourselves to find newer, better options that can truly make a difference? Even if it it means exercising humility and admitting we may not have gotten it right the first time?

Thomas Edison had to go back to the lab many times before he successfully created an invention as simple as a light bulb that actually worked. To think we can always develop a medication that positively impacts something as awesome and complex as the human brain, on the very first try, well, I don't know about you, but I prefer humility.

A little slower pace in the development stage to be sure our talents are actually helping people (those with mental health diagnoses) who can have a hard time finding advocates who take them and their safety not just an ethical issue. Even for those concerned mainly with with profits, proactive thinking can prevent having to spend money on recalls and litigation, improving profitability in the long run.

Wednesday, January 16, 2008

Antidepressants and weight gain

If you're coming directly to this blog instead of linking through my website, you may be interested in a chart I have posted on that website, listing references referring to antidepressants and their potential for causing weight change (gain or loss). This particular chart ONLY covers antidepressants, but it is a very popular page and I wanted to let you all know about it.

The medications included to date are: Celexa/citalopram, Cymbalta/duloxetine, Effexor/venlafaxine, Elavil/amitryptyline, Ludiomil/maprotiline, Nardil/phenelzine, Norpramin/desipramine, Parnate/tranylcypromine, Paxil/paroxetine, Prozac/fluoxetine, Remeron/mirtazapine, Doxepin/sinequan, Tofranil/imipramine, Wellbutrin/bupropion, and Zoloft/sertraline.

The link to this chart is

Tuesday, January 15, 2008

About the ads

I'm experimenting with Google a way to offset the cost of researching and writing the material I present. (I hope you can see I spend quite a bit of time on this!). The Google terms of service explicitly stated that pharmaceutical companies will not be allowed to advertise, which was my main concern about "going commercial". However, I am closely watching the ads pop up anyway, to be sure that for the most part they are appropriate.

Since my job here is to serve you, the reader, if you feel in any way that any ad that pops up in the process of getting information that is helpful and useful, is offensive, insulting, or counterproductive, I NEED TO HEAR FROM YOU.

Please let me know when you see anything that does not fit with the overall energy of better mental health through informed choices.

Thank you!

Monday, January 14, 2008

Is Fibromyalgia A Real Disease? Does It Need Its Own Medication?

If you are interested in this debate, you may be interested in this New York Times article that was published today:

Lyrica (pregabalin), the medication that is mentioned in this article, is a medication I've been researching for my psychotropic medication publication. This drug was first approved for use in the US in 2005, for the treatment of epilepsy, diabetic neuropathy pain and post-herpetic neuralgia. In 2007 it was also approved for treating fibromyalgia.

In addition, in my own research, I found publications describing 10 off-label (non-FDA approved)uses for this medication. One of these off-label uses, anxiety disorder, is actually an approved use in the European Union but not the United States. The references for these off-label uses, excerpted from my CD, are posted below.

Pregabalin is supposedly a more potent form of another popular medication, gabapentin (Neurontin). The use of this medication has been questioned, as at one point, it was estimated that 90% of its prescriptions were written for off-label uses. From what I could see when I was researching pregabalin, the trend with the newer version is not dissimilar.

From a biochemical standpoint, many of the off-label uses do make sense, as many of these issues have very similar biochemical origins. Off-label uses are not always inappropriate. However, it is important to make sure you know exactly WHY you are being prescribed a medication. You are entitled to ask your physician whether or not the medication you are being prescribed is FDA approved for your diagnosis, or if the use she is asking you to try is off-label. It's your body, and you have a right to make the most informed decision possible.


Jatzko A, Stegmeier Petroianu A, Petroianu GA. Alpha-2-delta ligands for singultus (hiccup) treatment: three case reports. J Pain Symptom Manage 2007 Jun;33(6):756-60.
Yokoyama T, Maeda Y, Audette KM, Sluka KA.Pregabalin reduces muscle and cutaneous hyperalgesia in two models of chronic muscle pain in rats. J Pain 007 May;8(5):422-9.

Zesiewicz TA, Ward CL, Hauser RA, Pease Campbell JA, Sullivan KL. Pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jan;22(1):139-41.
Zesiewicz TA, Ward CL, Hauser RA, Salemi JL, Siraj S, Wilson MC, Sullivan KL. A pilot, double-blind, placebo-controlled trial of pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jun 19.

Maizels M, McCarberg B. Antidepressants and antiepileptic drugs for chronic non-cancer pain. Am Fam Physician 2005 Feb 1;71(3):483-90.

Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, Young JP, LaMoreaux LK, Martin SA, Sharma U,Pregabalin 1008-105 Study Group. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2005 Apr;52(4):1264-73.
Rooks DS. Fibromyalgia treatment update. Curr Opin Rheumatol 2007 Mar;19(2):111-7.

Owen RT. Pregabalin: Its efficacy, safety and tolerability profile in fibromyalgia syndrome. Drugs Today (Barc). 2007 Dec;43(12):857-63.

Pande AC, Crockatt JG, Feltner DE, Janney CA, Smith WT, Weisler R, Londborg PD, Bielski RJ, Zimbroff DL, Davidson JR, Liu Dumaw M. Pregabalin in generalized anxiety disorder: a placebo-controlled trial. Am J Psychiatry 2003 Mar;160(3):533-40.

Van Ameringen M, Mancini C, Pipe B, Bennett M. Antiepileptic drugs in the treatment of anxiety disorders: role in therapy. Drugs 2004;64(19):2199-220.

Baldwin DS, Polkinghorn C. Evidence-based pharmacotherapy of Generalized Anxiety Disorder. Int J Neuropsychopharmacol 2005 Jun;8(2):293-302.

Pohl RB, Feltner DE, Fieve RR, Pande AC. Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of BID versus TID dosing. J Clin Psychopharmacol 2005 Apr;25(2):151-8.

Rickels K, Pollack MH, Feltner DE, Lydiard RB, Zimbroff DL, Bielski RJ, Tobias K, Brock JD, Zornberg GL, Pande AC. Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Arch Gen Psychiatry 2005 Sep;62(9):1022-30.

Keck PE, Strawn JR, McElroy SL. Pharmacologic treatment considerations in co-occurring bipolar and anxiety disorders. J Clin Psychiatry 2006;67 Suppl 1:8-15.

Montgomery SA, Tobias K, Zornberg GL, Kasper S, Pande AC. Efficacy and safety of pregabalin in the treatment of generalized anxiety disorder: a 6-week, multicenter, randomized, double-blind, placebo-controlled comparison of pregabalin and venlafaxine. J Clin Psychiatry 2006 May;67(5):771-82.

Frampton JE, Foster RH. Pregabalin: in the treatment of generalised anxiety disorder. CNS Drugs 2006;20(8):685-93.

Montgomery SA. Pregabalin for the treatment of generalised anxiety disorder. Expert Opin Pharmacother 2006 Oct;7(15):2139-54.

Bendelow B, Wedekind D, Leon T. Pregabalin for the treatment of generalized anxiety disorder: a novel pharmacologic intervention. Expert Rev Neurother 2007 Jul;7(7):769-81.

Owen RT. Pregabalin: its efficacy, safety and tolerability profile in generalized anxiety. Drugs Today (Barc). 2007 Sep;43(9):601-10.

Kitchener JM. Glossopharyngeal neuralgia responding to pregabalin. Headache 2006 Sep;46(8):1307-8.

Hurley RW, Chatterjea D, Rose Feng M, Taylor CP, Hammond DL. Gabapentin and pregabalin can interact synergistically with naproxen to produce antihyperalgesia. Anesthesiology 2002 Nov;97(5):1263-73.

Field MJ, Holloman EF, McCleary S, Hughes J, Singh L. Evaluation of gabapentin and S-(+)-3-isobutylgaba in a rat model of postoperative pain. J Pharmacol Exp Ther 1997 Sep;282(3):1242-6.

Jones DL, Sorkin LS. Systemic gabapentin and S(+)-3-isobutyl-gamma-aminobutyric acid block secondary hyperalgesia. Brain Res 1998 Nov 9;810(1-2):93-9.

Hill CM, Balkenohl M, Thomas DW, Walker R, Mathe H, Murray G. Pregabalin in patients with postoperative dental pain. Eur J Pain 2001;5(2):119-24.

Sommer M, Bachmann CG, Liebetanz KM, Schindehutte J, Tings T, Paulus W. Pregabalin in restless legs syndrome with and without neuropathic pain. Acta Neurol Scand 2007 May;115(5):347-50.

Jefferson JW. Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder). J Clin Psychiatry 2001;62 Suppl 1:50-3.

Pande AC, Feltner DE, Jefferson JW, Davidson JR, Pollack M, Stein MB, Lydiard RB, Futterer R, Robinson P, Slomkowski M, DuBoff E, Phelps M, Janney CA, Werth JL. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol 2004 Apr;23(2):141-9.

Muller JE, Koen L, Seedat S, Stein DJ. Social anxiety disorder : current treatment recommendations. CNS Drugs 2005;19(5):377-91.

Cottraux J. Recent developments in research and treatment for social phobia (social anxiety disorder). Curr Opin Psychiatry 2005 Jan;18(1):51-4.

Davidson JR. Pharmacotherapy of social anxiety disorder: what does the evidence tell us? J Clin Psychiatry 2006;67 Suppl 12:20-6.

Davidson JR. Pharmacotherapy of social phobia. Acta Psychiatr Scand Suppl 2003;(417):65-71.

Antidepressants and sexual dysfunction

I just ran across a research abstract sharing three case studies in which sexual dysfunction persisted after the individual discontinued taking antidepressant medication. In each case, psychological factors, hormone imbalances, and other medical explanations were ruled out. Two of the men described were not even 30 years old. The problems listed in these three cases included: erectile dysfunction, loss of sex drive, loss of pleasure with ejaculation, and loss of sensation in the genital area.

A change in sexual function with the use of antidepressants is a fairly common side effect, but most people expect that discontinuing the cause of this change will restore the function. Apparently, in some individuals, this is not the case.

What I found interesting was that in each of the three cases described, the solution to the new problem, caused by a medication was....a new and different medication. Hmmm...

It is important not to jump to conclusions with this post and assert that all antidepressants cause sexual problems. Some antidepressants can actually HELP sexual problems.

The moral in this post is, that it is very important, as soon as you notice side effects to ANY medication you are on, psychotropic or not, to report these changes to your prescribing physician. Don't allow yourself to be suggested that you just need to accept the side effect. Don't adjust or discontinue the medication independently of your physician, either. Be sure that you communicate what you observe and what you need your physician to do in order to maximize the benefit of your medication while minimizing any short- or long-term side effects.

Csoka A, Bahrick A, Mehtonen OP. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. J Sex Med. 2008 Jan;5(1):227-33.

Sunday, January 13, 2008

Potential nutritional help for antipsychotic side effects

One of the most distressing side effects of antipsychotics is a syndrome called "tardive dyskinesia," in which a person develops involuntary movements and tics throughout the face and body.

Researchers in India report that rutin, an antioxidant, may actually help lessen the degree of these involuntary movements. In this particular study, the effect of rutin on vacuous chewing movements, tongue protrusions and facial jerking was studied in a population of rats who developed these behaviors after being given the drug Haldol. Rutin significantly inhibited all of these movements.

The researchers hypothesize that in the process of doing the work that it is supposed to do to help the schizophrenia, oxidative damage occurs which degrades the nervous system and induces involuntary movements. Rutin is a powerful antioxidant which appears to directly reduce this particular type of oxidation.

What is rutin? It is a flavonoid that is primarily found in buckwheat, citrus fruits, noni, black tea and apple peel. It is also available as a supplement, though until researchers pursue this relationship more thoroughly, it is probably best to include more of these listed foods in the diet. Sometimes adding too much of a "good thing" can disrupt the therapeutic potential of medications.

An additional note, rutin is also used in some cultures as an emergency contraceptive. So if you are of child bearing age and are on Haldol, it is important to use this information with caution.

Bishnoi M, Chopra K, Kulkarni SK. Protective effect of rutin, a polyphenolic flavonoid against haloperidol-induced orofacial dyskinesia and associated behavioural, biochemical and neurochemical changes. Fundam Clin Pharmacol. 2007 Oct;21(5):521-9.

Sunday, January 6, 2008

Fish oil, anxiety, and anger

I am noticing in my most recent medication reviews, that more and more psychotropic medications are being tested as treatments for aggressive behavior. I've worked in treatment centers and I know that the kind of aggression seen in substance users is more than just being "a little pushy"...and that this behavior, if it can be intervened on, can help a person with this problem to have more productive relationships and overall life successes.

A recent study found that substance abusers have dietary habits that promote poor omega-3 balance. (Anyone reading this who has attended a 12 Step meeting will attest to the donuts and sugared coffee these meetings are known for!)

In this study, 3 months of using 3 grams per day of fish oil (containing both EPA and DHA), anger and anxiety on test scores decreased significantly.

Interestingly, EPA and anxiety were most closely associated, and DHA and anger were most closely associated. For anyone using fish oil as a supplement, this distinction is likely moot. However, for anyone who is vegetarian and using marine algae or marine algae-supplemented foods as their omega-3 source, they may not see the reduction in anger that a fish-eating person may eat.

I just love it when nature shows us ways to feel better that don't always have to involve medication!

Buydens-Branchey L, Branchey M, Hibbeln JR. Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Nov 1 [Epub ahead of print]

Friday, January 4, 2008

How many drugs are you taking?

Metabolic syndrome (the cluster of hypertension, hyperlipidemia, and insulin resistance, often seen with weight gain around the midline) is a common side effect of psychotropic medications. A recent study found that when two or more antipsychotics are simultaneously prescribed, the risk of incurring metabolic syndrome significantly increases. The researchers acknowledge that other factors such as weight, gender, race, and age may weaken this association...but the association was still stronger when more than one antipsychotic was being used.

I have noticed with time that the number of medications my clients are on has gradually increased. It is not uncommon for them to show me a basket of prescription medications they are taking, which was rare when I started in this business 25 years ago.

It makes perfect sense that every chemical introduced into a system is going to react not only with the system but with every other chemical that has been artificially induced. It will be especially challenging to figure out where the interaction is occurring if multiple prescriptions are initiated simultaneously.

I know it's not always possible to introduce one chemical influence at a time and wait to see what happens, but it would be nice if, when that IS possible, that we work through diagnosing and treating in a stepwise progression to minimize the risk of serious medical complications.

Correll CU, Frederickson AM, Kane JM, Manu P. Does antipsychotic polypharmacy increase the risk for metabolic syndrome? Schizophr Res 2007 Jan;89(1-3):91-100.

Thursday, January 3, 2008

Hello to everyone

This site is an offshoot of my most frequently visited web page, which is a list of which antidepressants affect weight. I never intended this to be such a focus of my website, but since there is apparently a demand for the information, I decided to start a blog that I can more frequently update. I hope for those of you who use psychiatric medications, or who have friends/loved ones who do...that the information I provide here allows you to maximize the benefits of these medications while minimizing the side effects.

I personally have no opinion about any medication discussed here. I know that psychiatric medications can be life-saving. I also know, and have seen first hand, that many of these medications are more effective when used in conjunction with healthy eating, activity, sleep, and stress management behaviors.

This blog was never and will never be intended to substitute for medical advice. I will provide references if you wish to share them with your prescribing caregiver, but I do not and will not ever recommend that anyone adjust or discontinue a medication without first consulting a medical professional who is licensed to prescribe controlled substances.