Antidepressants and weight gain

For anyone looking for a list of antidepressants and weight gain, I have a summary chart on my website: http://afterthediet.com/antidepressant_medications.htm

This listing is an excerpt from my CD, Nutritional Implications of Psychotropic Medications, a collection of fact sheets on the neuroendocrine and nutritional considerations of 59 different medications and over the counter supplements used for brain and nervous system conditions. Antidepressants are just one category.

I'll keep the link on the blog for anyone wanting it in the future.

Happy Fourth!

Zzzzzzzzzzap that snoring!

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Snoring is one of those things we do that we tend to laugh at, but which is important not to ignore. Snoring not only impairs the sleep of the person who does it, but that of the poor loved one who tries to sleep in the same bed with a snorer.

Today's post is devoted to snorers, and their loved ones...especially my loved ones who have patiently tolerated my snoring. I promise...I'm working on it! :)

(Since I am a guilty party, I wanted a photo of a couple in which the woman was the snorer, but there appears to be a clipart gender bias when it comes to this issue. Trust me, women snore too, and when we do it ain't a dainty thang!)


One of the primary reasons people snore is because they have obstructive sleep apnea (OSA). This is a condition in which, due to certain sleep postures, the airway is obstructed during the night, cutting off oxygen supply. At multiple intervals during the night, air supply is completely cut off...snoring is the result of trying to breathe through an impaired airway. One of the more common cures for this type of snoring is a CPAP (continuous positive airway pressure) machine, fashioned after the oxygen masks used by fighter pilots. It works, but honestly, sleep docs, it's really not the most amorous solution if you're working on behalf of both people affected by this problem.

Often times the culprit in OSA is excess weight. Obesity can force new and different sleeping positions that challenge healthy breathing during sleep. People who don't sleep well can easily fall into a habit of living on caffeine and sugar for energy during the day, which can worsen the cycle of poor sleep and weight problems. Before you know it...you're backed into a corner!

My programs all stress the importance of good sleep hygiene, in other words, making sure that most of what you do in the evenings is about signaling to your brain that sleep is coming...and then quieting your environment in order to promote that actually happening. Even little things such as changing into casual clothing, sitting in a reading chair, having a cup of chamomile tea, avoiding violent television shows and movies, minimizing alcohol intake, and avoiding intense exercise...can all help promote healthy sleep.

A very important issue to keep in mind is that with OSA, part of the problem is oxidative stress. In other words, little things you're doing that stress the brain promote degeneration of the cells in the brain that help to regulate breathing. It's not all about your weight or your habits.

Nutritionally, eating more fruits and vegetables and fewer simple carbohydrates (sweets and refined breads/pastas) can be very good anti-oxidative strategies. So can increasing your intake of omega-3 fatty acids and decreasing your intake of omega-6 fatty acids.

Recently, some researchers reported that the sleep aid melatonin may also be helpful.

What they found in rats that had been exposed to hypoxic conditions was that indices of inflammation started to show up. Brain cells started to die. And the brain, ironically, started making less of the enzymes needed to make antioxidants. When melatonin was provided, cell death was completely prevented, there were fewer inflammatory markers to measure, and antioxidant production increased.

There are two important things this study tells us. (1) When our sleep is impaired, and we're not producing enough of our own melatonin, we have potentially created an environment that gradually kills brain cells. As annoying as snoring is, the problem is about a whole lot more and it needs to be addressed. (2) Melatonin supplements can help correct the imbalance that caused the problem.

Just a footnote, I've had many clients tell me they started taking melatonin and when it didn't help them sleep...they stopped. The authors in this study did not seem to care whether or not melatonin produced sleepy rats. They focused on and reported cellular changes. These can occur whether or not you feel sleepy the first few times you try melatonin. If snoring is an issue for you, consider trying melatonin and being consistent with its use, whether or not it's immediately improving your sleep quality.

Hung MW, Tipoe GL, Poon AM, Reiter RJ, Fung ML. Protective effect of melatonin against hippocampal injury of rats with intermittent hypoxia. J Pineal Res. 2008 Mar;44(2):214-21.

Some help for skin problems

About a week ago I was visiting an addictions treatment center and something that really struck me was the severity of skin issues I saw in many of the residents. Part of that may be due to poor nutrition, part to stress, and part as a result of drug use itself.

In any case, there's a great website I found with information on healthy skin care that I thought would be of interest to some of you reading this blog. I'll post the information as a permanent link, but if you are interested now, the name is http://www.highonhealth.org.

Cigarettes and coffee for breakfast...why it's so easy to get stuck in that rut

My teaching assistant today comes from Star Wars. He is here with me, because I have lost track of the number of times, when trying to do a serious presentation about neurotransmitters, I have said, "R2D2" when I meant to say "DRD2". I will have to check the Universal Diagnostic and Statistical Manual to see if I meet the criteria for Intergalactical Dyslexia...

What R2D2 and I would like to tell you about his almost-namesake today, the DRD2 receptor, is that this subset of dopamine receptors is sensitive to how we eat. DRD2 is responsible for impulse control. People who have a disturbed DRD2 system are more prone to problems such as shoplifting, gambling, alcohol addiction, nicotine addiction, and binge eating. They also seem to have more intensive carbohydrate cravings.

Scientists recently reported that this receptor is especially sensitive to food restriction. That is, people who restrict their food intake seem to be more sensitive to the reinforcing effects (the effects that make you feel good and want to use) of several addictive substances, including opiates, nicotine, and psychostimulants.

(That is why R2D2 is a little wired today; he was running late and drank his coffee but skipped breakfast to be sure we got this posted.)

This particular study suggests that the same effect can be provoked when restricting food and using dopamine-promoting medications such as pramipexole (Mirapex). For anyone taking medications for Parkinson's disease or restless legs syndrome, this could be important information to discuss with a nutritionist.

One of the enhanced responses with food restriction is locomotion. And that makes me think of people who abuse some of these chemicals. They stimulate themselves, which suppresses their appetite, which enhances their stimulation and increases their physical activity. On an ongoing basis, (and people who abuse drugs tend to not only use them just once) that can create a calorie deficit which reinforces the positive effects of the drug use. And that can reinforce staying addicted.

Even if you're not using illicit drugs, maybe not eating and living on cigarettes and coffee is kind an offbeat, roundabout way to jumpstart the dopamine system into motion. I have had many, many clients who tell me they feel addicted to sugar, and when they simply don't eat it they feel better. Maybe this is one of the reasons for that relationship.

Just a little fun fact on this Friday that will hopefully give you something to think about.

R2D2 and I are now going to eat breakfast.

Collins GT, Calinski DM, Newman AH, Grundt P, Woods JH. Food restriction alters N'-propyl-4,5,6,7-tetrahydrobenzothiazole-2,6-diamine dihydrochloride (pramipexole)-induced yawning, hypothermia, and locomotor activity in rats: evidence for sensitization of dopamine D2 receptor-mediated effects. J Pharmacol Exp Ther. 2008 May;325(2):691-7.

Great video on why we need omega-3 fats

http://www.youtube.com/watch?v=eIgNpsbvcVM

I'll let Susan take credit for today's lesson. :)

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

Who is the real addict?

Friday I participated in a meeting at a chemical dependency treatment center. This is a place where people have been medicating their problems with stimulants and who are learning to use communication, conflict resolution, and coping skills to ride through life's challenges so that life does not defeat them. One of the biggest problems in this population is stimulant use, in the form of methamphetamine.

The message this and other treatment centers are working hard to encourage...is that when you listen to your body, it will tell you if you need to sleep, eat, address a conflict, or participate in a relaxing activity to help ride through situations that cannot be immediately addressed. When you push through feelings and ignore what they're telling you, you can push yourself to a point so low that it becomes tempting to use chemicals to pull out of the situation.

Today, I was reviewing research and ran across an abstract that completely contradicts this point of view. This article discusses the "potential" for treating CFS with neurostimulants, such as bupropion (Wellbutrin), dextroamphetamine (Dexedrine), and methylphenidate (Ritalin, Concerta).

No wonder treatment centers abound. The drug industry is advocating throwing stimulants at problems that very well may best respond to intensive self-care. I'm not trying to say that chronic fatigue is not a genuine problem. I just wonder where the logic is in trying to blast a person out of a fatigued state that may be telling us something very important about the person's overall health, their lifestyle choices, and the way they deal with stress.

It's no wonder our many public service attempts at reducing illicit drug use fall on deaf ears. The message seems to be that if you can figure out a way to present your problem to the doctor in a way that fits with an "official" medical problem, you can legally buy a way out of your problem. If you're less savvy, or don't have access to a doctor who is open to such creative thinking, you can still get the job done. It just might land you in jail at some point down the road.

An addict is an addict, whether legally managed or scoring treatment off the street.

Valdizán Usón JR, Idiazábal Alecha MA. Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate. Expert Rev Neurother. 2008 Jun;8(6):917-27.