Which came first...the hair or the hormones?

This abstract caught my eye because I also have a blog about polycystic ovary syndrome (PCOS) and finasteride is sometimes used to treat the hirsutism (hair growth in women) that this syndrome often causes. It has now been observed to have antipsychotic properties and is being proposed as a treatment for psychosis.

Antipsychotics are increasingly being used to treat depression, and at least 85% of women with PCOS have some kind of anxiety, depression, or other mood disorder associated with this diagnosis. If you have PCOS, please do not jump to the assumption that I am saying you are psychotic. What I am trying to point out here is that there is a huge mind-body connection in the syndrome that is often ignored. Physicians can be so compartmentalized with their treatments that they focus on the acne, the hair, the infertility...and completely ignore the moods, the mood swings, the associated disrupted eating patterns...and then they and their patients wonder why treatment is not successful.

I am posting this abstract to challenge anyone who treats PCOS to figure out what is going on in the brain of the woman with PCOS since it is, after all, the brain that controls hormones. Rather than mess with hormones and create even more problems, why aren't we going to the source and looking THERE for potential solutions? Let's make this the day we shift our thinking.

Bortolato M, Frau R, Orrù M, Bourov Y, Marrosu F, Mereu G, Devoto P, Gessa GL. Antipsychotic-like properties of 5-alpha-reductase inhibitors. Neuropsychopharmacology. 2008 Dec;33(13):3146-56. Epub 2008 Mar 19.

I chose the photo I did not to be funny, demeaning, or hurtful. I did it for the benefit of those who truly do not understand what many women go through because of their PCOS. Hair growth can be devastating and lead to horrible issues with self-image. Long ago it was often called "diabetes of the bearded ladies". If you can imagine what it's like to look in the mirror and feel as though you're losing your femininity, often at a time when you're trying to conceive and desiring to be attractive to your partner...it's a situation deserving of much more attention than it often gets by physicians.

Pregnant women and psychotropic medications really don't mix

What I hate about this study is that we even have to study whether or not a pregnant woman should be given psychotropic medications during pregnancy. It disturbs me that this many studies surrounding this question are showing up in Pub Med. My common sense would tell me absolutely not, without even having to do the research. However, I guess there are some situations where it is more dangerous to have a pregnant woman's psychopathology left completely untreated for an entire 9 months. So, despite my personal feelings, I'll share the findings.

Pregnant mice were given fluoxetine (Prozac) throughout their pregnancy and kept on the medication until their pups were weaned. The pups were then given other medications and their responses to those medications were evaluated. The effects seemed to be more significant in the female offspring, who did not seem to have normal responses related to dopamine function. (Dopamine is important for impulse control, which influences potential for chemical dependencies and troubles such as addictions, gambling, shoplifting, and carbohydrate bingeing). The researchers also suggested that if this relationship existed in humans, daughters of women who took Prozac during pregnancy may not effectively respond to certain medications later in life. Two important classes of medications this might include are Parkinson's medications and antipsychotics, both of which attempt to correct problems in dopamine systems.

So, MY take on this is that given the fact that fish oil is such a powerful antidepressant and it is important to have enough of it during pregnancy for both mother and baby, perhaps we're learning that we should lean more in that direction on behalf of the two individuals involved in a pregnancy.

My CONCERN is that a drug company R and D person is likely to read the very same study and think, "Hmmm...if we get started right now, we can have a new drug ready for all those babies coming down the pike whose dopamine systems aren't responding to anything we can currently script."

We'll see which direction this information takes science. I sure hope it's the one involving fewer trips to the pharmacy in 20 years.

Favaro PN, Costa LC, Moreira EG. Maternal fluoxetine treatment decreases behavioral response to dopaminergic drugs in female pups. Neurotoxicol Teratol. 2008 Nov-Dec;30(6):487-94. Epub 2008 May 14.

"Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania."

Bipolar disorder, to me, is a fascinating disorder. It seems to affect some very intelligent and creative people, and that, I believe, is precisely why it is so hard to treat. The manic episodes it can produce can be part of the thrill of having the disorder. I've had more than one client who accepted medical treatment for bipolar disorder complain that the medication took away the "edge". People started to ask if anything was wrong. We kind of like manic people for their charisma, for the creative performances, work output, etc., that they give us. And, because mania is a natural kind of high, giving it up can be somewhat of a chemical straight jacket.

However, bipolar disorder is also neurodegenerative. Meaning if it progresses unchecked, all that extra brain energy that's requiring oxidation of glucose to fuel all those charismatic neurons is also creating a process that's not unlike a "rusting out" of the brain. So, if we want to preserve the creativity and contributions of people born with this kind of hardwiring, we have to work harder to understand the hardwiring, and develop medications that don't leave people feeling zombied. Plus, we have to encourage lifestyle choices that promote longevity.

One of the worst risk factors, it appears, (in other words, a group of people we now know we have to work extra hard to learn how to help), is people with bipolar disorder who smoke. In this study, what was found was that the subjects who smoked did not respond as well to the medications they were given.

What is really interesting about this study, is that the medications tested happened to be antipsychotics that have been found to be helpful in some cases of bipolar disorder. No traditional mood stabilizers, such as lithium, were used. I wish that had been included in this study, because this study may not be saying that bipolar smokers have worse treatment outcomes, as much as it says when a patient is diagnosed with bipolar disorder who smokes, they may do better with a different category of medication.

Our patients depend on us to be diligent with scientific process and not let our bias interfere with their well-being.

Berk M, Ng F, Wang WV, Tohen M, Lubman DI, Vieta E, Dodd S. Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania. J Affect Disord. 2008 Sep;110(1-2):126-34. Epub 2008 Feb 15.

When you play with antipsychotics, you play with fire.

Antipsychotic medications have worked wonders to enhance the lives of many people. However, in recent years, antipsychotics have also been used for an increasing number of off-label uses and in progressively younger populations than they ever were before. Before handing these medications out like they are candy, it's important to evaluate the risks associated with using these medications. A recent study suggested that we should be much more careful about choosing our treatment populations than we have been to date.

Before I get to the meat of the study, I'd like to preface this post with an explanation of the study design. The authors of this study are concerned about safety risks in young children and pregnant women when they are given antipsychotic medications. However, they had to develop a research model that did not place young children and pregnant women at risk in the process of looking into this issue. So...rather than give antipsychotics to these two populations, they chose to administer a battery of antipsychotics to a group of roundworms. Roundworms were chosen because they are an accepted research model for investigating matters related to brain and nervous system development. That is definitely a limitation of the study, as most people I know would not say they have much in common with this guy...but that's one of the tough things about studying medications and their risks...how to investigate those risks without causing more damage.

Anyway...when the roundworms were given three of these medications, clozapine (Clozaril), fluphenazine (Prolixin), and haloperidol (Haldol), there was less development of neurons in general and axons (a specific anatomical feature of a neuron) in neurons devoted to mechanosensory function (that's touching and registering what you're touching). Neurons that were produced also tended to not migrate to the location where they would be expected to migrate, meaning there might have been neurons there, but they were, so to speak, all dressed up with no place to go.

In some neurons, axons grew past their functional anatomical size. And some had abnormal anatomical features.

Other antipsychotics produced similar results, although not to as significant a degree. The drugs mentioned included: risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), trifluoperazine (Stelazine) and olanzapine (Zyprexa).

I'm not going to pontificate about the ethical dilemma encountered when treating a pregnant woman with schizophrenia. The choices made in those situations involve complex risk/benefit considerations that are the responsibility of the patient and her physician.

However, I will say that responsible use of these medications in women of childbearing age is imperative. Forty-nine percent of all pregnancies ending in childbirth in 1994 were unintended, and 48% of all women aged 15-44 in 1994 had had at least one unintended pregnancy at some point in their life. It happens, and it happens a lot.

So if you're a physician and you're handing out prescriptions for antipsychotics for off-label uses to women of childbearing age...no matter how much judgment, education, evaluation, etc. you think you're providing, you really are playing with fire.




Donohoe DR, Weeks K, Aamodt EJ, Dwyer DS. Antipsychotic drugs alter neuronal development including ALM neuroblast migration and PLM axonal outgrowth in Caenorhabditis elegans. Int J Dev Neurosci. 2008 May-Jun;26(3-4):371-80.

http://www.guttmacher.org/pubs/journals/3002498.html

Antipsychotics and cardiac-related sudden death: could selenium be important?

Scientists have started to notice that there is a relationship between the use of antipsychotic (neuroleptic) medications and the development of heart lesions. They have also noticed that these lesions, in other individuals, can be related to selenium levels. So, one research group in France decided to see what was happening to selenium levels in the presence of antipsychotic medications. (This study was done on rabbits.)

Half of the rabbits were given risperidone (Risperdal) and the other half levomepromazine (not available in the US), via intramuscular injection. Another group of rabbits was given a saline injection instead of medication.

Blood samples at the end of 3 months had 20% less selenium than blood samples taken at the beginning of the study. Heart tissue had 50% less selenium at the end of the study. In addition, these rabbits' hearts had disorganization of cardiac fibers, myolysis (dissolved muscle tissue), interstitial and endocardial fibrosis (development of fiber-like tissue), and necrosis (dead tissue) were noted in medication-treated animals, but not in controls.

The next step is logically going to be, whether or not supplemental selenium can help to prevent these negative side effects, and if so, how much is needed.

In the meantime, sounds to me like making sure if you are on an antipsychotic, that you take a supplement including selenium, and that you schedule regular visits with your cardiologist.

It's another reason I feel that eating well when on psychiatric medications is so important. If you're optimizing your diet, you may be able to minimize the amount of medication you need, ultimately reducing the potential for side effects that are at least as troublesome as the problem you're trying to help.

Vaillant F, Turrel F, Bost M, Bricca G, Descotes J, Bui-Xuan B, Tabib A, Manati W, Timour Q. Role of selenium in heart lesions produced by neuroleptics in the rabbit. J Appl Toxicol. 2008 Mar;28(2):212-6.

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.
http://www.phytochemicals.info/phytochemicals/rutin.php

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.