Topamax and kidneys...these two will probably never be BFF's

I've noticed in looking at my blog statistics that a previous entry on kidney stones resulting from topiramate (Topamax) use continues to be one of my most visited pages on this blog. So when I found more information about this medication and its effect on kidneys I wanted to be sure to share it.

Within 5 days of starting topiramate, the six subjects in this study experienced an average drop of calcium in their urine of about 31% and of citrate by about 40%. When calcium and citrate are not showing up in the urine, it's likely because it's accumulating elsewhere. Like in kidney stones.

Interestingly, increasing the topiramate dose seemed to improve calcium readings and to worsen citrate readings. Meaning you might get less of one kind of kidney stone and more of another.

The authors of this study said that the degree of reduction of urinary citrate was profound enough to be compared to the clinical presentation of renal tubular acidosis. This is a condition in which the body's pH is shifted to an unhealthy level, promoting important changes such as bone demineralization. And THIS will cause rickets in children and osteomalacia in adults. These are not things you will see or feel in those first few days. You need to measure them clinically.

I would strongly recommend, if you and your physician have concluded that the absolute only way to manage your bipolar disorder, your migraine, or your epilepsy, is with topiramate, that you closely monitor your urinary metabolites to be sure you're not doing more harm than good.

And if you're one of those souls who's been convinced that it might be nice to try topiramate to see if it helps you lose weight, consider that you might not just be
losing fat, you might also be losing bone. What's the point of being thin if you have to be sick when you get there?

The only way to know is to monitor. Please don't stick your head in the sand and hope it's not happening to you.

Warner BW, LaGrange CA, Tucker T, Bensalem-Owen M, Pais VM Jr. Induction of progressive profound hypocitraturia with increasing doses of topiramate. Urology. 2008 Jul;72(1):29-32; discussion 32-3.



I found a photo of a kidney stone on the 'net. Imagine trying how it feels to pass something this big through an opening about as big as a piece of cooked pasta. Now you know why I'm trying to get your attention!

This topic hit home for me and because of that I want to pass along a very important warning

Hello everyone,

Last night I attended a memorial service for a neighbor. A month ago she committed suicide, in a very violent fashion. Most of us were dumbfounded, as this neighbor, to all of us, was a healer, kind, loving, always smiling. What most of us did not know, until last night, as her daughter spoke, was that our friend struggled with bipolar disorder. She had been on many different medications, and apparently had a rotation going of different medications. The issue seemed to be that she would develop a tolerance to one regime, so she would rotate through different cocktails as one set lost its effect.

Apparently, on her own, she decided to wean herself off the medications. No supervision from her doctor.

I wonder if this is how she got herself into trouble.

I do my best in this blog to stay neutral, and let you, the readers, decide if medication is for you, or if you'd rather choose an alternative option. I still feel that way.

However, what I do want to insist on, after this personal experience, is that if you are on medications, that you do not manage the use of these medications, or even alternative options, on your own. Whether it's in a bottle or from a plant or a food, when you use chemicals to alter your brain chemistry, you alter your brain chemistry. Once the compound is in your body, regardless of its origin, you really don't have any control over where, when, and how this compound is going to work.

Please do not operate on the assumption that because you are "getting off meds", that what you are doing is safe. It can be, but only if done correctly. Please do not assume that because what you are taking is organic and/or was not sold to you by a pharmaceutical company, that you're in good hands. You may...or you may not be.

It can be very hard to reach out for help when the problem you have is a mental health issue. I lived just yards from this neighbor, she knew what I did for a living, and never once did she ask me for any information. But the important thing to remember about a mental health issue is that it affects how you think, reason, feel, and act. Even if you feel that you're in control, it's always important to have at least one human sounding board to depend on when making decisions affecting how your brain functions.

I don't want any of you to ever think I said anything to encourage you to endanger yourself. If I present new information that you think might be helpful, please download it and share it with your provider. Don't act on it alone. I want all of you to be around as long as I can come up with new and helpful information to post on this blog.

Fifty Ways to Boost Your Energy Without Caffeine

Here's a great piece by Christina Laun at the Nursing Online Education Database:

http://noedb.org/library/features/50_ways_to_boost_your_energy_without_caffeine

I am continually concerned about the number of people I'm seeing on sleep medications who have never been given information about natural options. This article is a great place to get you started thinking.

Lamotrigine may cause cleft palate

It is very important for women of childbearing age to know how medications they may be on might affect the health of their children. I've posted the statistics before regarding the percentage of births resulting from unintended pregnancies, so this warning goes out to ALL women, not just those intentionally trying to conceive.

In this case, the issue is Lamictal (lamotrigine). I work a lot with polycystic ovary syndrome. This is a medication often used with women needing anticonvulsants because it is one of the few in that category that does not seem to wreak havoc on the management of that syndrome. So the population I work with the most is especially sensitive to the risk I describe here.

The medical records of 684 women who had taken lamotrigine during pregnancy were reviewed for the incidence of birth defects. These results were compared to trends in children born to women who had not taken this medication during their pregnancy. The incidence of cleft palate-type birth defects was 10.4 times greater in the lamotrigine-exposed infants than it was in the non-exposed infants. The exposure noted to be most important was that which occurred in the first trimester of pregnancy.

Just be aware, if you're female and there is any chance at all that you might conceive, that you would benefit from working closely with any physician prescribing you any medication at all, for any reason, to be sure there is no unconsidered risk lurking beneath the issue being focused on with the writing of a prescription.

Holmes LB, Baldwin EJ, Smith CR, Habecker E, Glassman L, Wong SL, Wyszynski DF. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008 May 27;70(22 Pt 2):2152-8. Epub 2008 Apr 30.

Life-threatening constipation associated with clozaril

This one is short, and sweet, and there is no need for me to paraphrase what the authors report. The one thing I will point out is that even in combination with a laxative, clozapine was not productive in this case. Persons taking clozaril may not be the best historians or the most assertive regarding medication complications and side effects, so it is important to be thorough from evaluation all the way through treatment in order to prevent problems.

OBJECTIVE: The aim of this paper was to describe the association of clozapine with life-threatening constipation. METHOD: Case report. RESULTS: A 53-year-old man presented to the emergency department with severe abdominal pain and bilious vomiting after being on clozapine for over a year for schizoaffective disorder. Surgery revealed severe faecal impaction in the large and small bowel. Clozapine was ceased. There were significant difficulties in the subsequent psychiatric management. Clozapine was gradually reintroduced with concurrent laxative administration, which resulted in another episode of severe constipation with faecal impaction. CONCLUSIONS: Clozapine can be associated with potentially life-threatening constipation. Psychiatrists, especially consultation liaison psychiatrists, physicians, surgeons and radiologists, should be aware of the seriousness of clozapine-induced constipation and its potentially fatal complications.

Rege S, Lafferty T. Life-threatening constipation associated with clozapine. Australas Psychiatry. 2008 Jun;16(3):216-9.

Mixing old and new to create something better

I've got friends on both sides of the medication issue reading this blog. Some are vehemently anti-medication, while others are suspicious of natural alternatives. My desire is to make this as balanced a blog as possible, and fair to both sides. Maybe that's the Libra in me...maybe it's just that I think there are positive and negative aspects of each approach, and there are safety issues with each approach. It's not so important WHAT treatment is used, as it is WHY and HOW.

I really like this study because it integrates both schools of treatment in a promising way.

Two of the medications I write a lot about, olanzapine (Zyprexa) and clozapine (Clozaril), are notorious for their effects on blood lipids, weight gain, and diabetes risk. I'm not a big fan of either, but I do know because I work with a very skilled psychiatrist in town who completely supports my nutritional and complementary suggestions, that there are simply some people who need the medication in order to be safe to self and others. And because of that, they are simply at risk of metabolic syndrome-related side effects. I am always looking for ways that high-risk-of-side-effects medications can be used in combination with therapies that minimize the actual dose that needs to be used.

Gingko biloba is primarily recognized for its use in preserving memory. However, it was also recently tested on 42 patients with refractory schizophrenia who were maintained on stable doses of clozapine. A dose of 120 mg per day helped to reduce the negative symptoms of schizophrenia. It did not, however, reduce psychopathology symptoms.

So what's the point of taking it if it didn't reduce the medication need? I have read study after study after study over the years and it is clear, people stop taking medications when they don't like the side effects. If you can help push the balance of effects of a medication over to the positive, you might just increase compliance. And compliance to a medication regime means, potentially, better quality of life.

Who would have thought that beautiful tree with the funny shaped leaves had such a great little secret in its biochemistry?

Doruk A, Uzun O, Ozşahin A. A placebo-controlled study of extract of ginkgo biloba added to clozapine in patients with treatment-resistant schizophrenia. Int Clin Psychopharmacol. 2008 Jul;23(4):223-7.

Do you need medication...or do you need to de-clutter?

We are a sleepless nation. Practically every client I have counseled over the past 6 months has complained of fatigue and some type of disturbed sleep pattern. There is a lot of money, in other words, for whoever can figure out how to put the "zzzzzz's" back into the average American's life.

One group of researchers was hopeful that atomoxetine, (Strattera), a drug approved for attention deficit-hyperactivity disorder, would do the trick. What the researchers found was that this medication helped to decrease the sleepiness related to poor sleep, but it didn't improve the metabolic parameters associated with sleep disorders.

I think an important take away message here is that, like it or not, we need to sleep, and we suffer without it.

Years ago, I was the nutritionist for Apple Computers at their headquarters in Cupertino, California. Clients used to come in to see me about their weight gain, and invariably they'd tell me about the 128 hour work week they'd just completed, or the 3 hour one way commute to work, or the jaunt to Tokyo then Sydney and back to Cupertino in time to report to the boss on Monday morning. And then they wondered why they felt so horrible, why their concentration wasn't what it used to be, and why they were gaining weight.

You can't just put a bandaid on sleepiness and assume that it makes things better. You get sleepy for a reason. Melatonin levels rise when it's time to do some internal housecleaning. If you've been busy, stressed, thinking, etc., etc., etc, you've been oxidizing brain cells. You need melatonin to clear out the clutter. If you don't give your brain that melatonin one-on-one time...the things the brain can do when it's not cluttered with stress remnants, just can't get done.

Think of how long it takes to get a simple task done when you walk into your office and there are piles of papers everywhere. You have to sort through everything, clean out a work space, think about what you're going to do...and you spend a lot of extra time digging through the piles to find the papers you need to do what you need to do.

Your brain is no different. If you let the hormonal housemaid come in and organize things for you, your hormones function, you can actually be in a good mood, you can finish tasks more quickly, and you can be more creative.

So don't think of being sleepy as something annoying that you need to fix with a "fix"...you're not feeling sleepy because you're caffeine deficient or running low on Red Bull. You're sleepy because your brain's trying to tell you to log off of life for a few hours and refresh.

Bart Sangal R, Sangal JM, Thorp K. Atomoxetine improves sleepiness and global severity of illness but not the respiratory disturbance index in mild to moderate obstructive sleep apnea with sleepiness. Sleep Med. 2008 Jul;9(5):506-10. Epub 2007 Sep 27.