Aging brains and medicine

How medications work at different points in life can be a very important consideration. I see many, many studies looking at the viability of antidepressant therapy in the elderly. Recently there seems to be a flurry of research looking at how to medicate (note I did not use the word "treat") depression when it occurs as a comorbidity with diagnoses such as stroke or Alzheimer's disease.

In this study, the naturalistic finding was that as rats (and probably humans, too) age, the rate at which they are able to generate new neurons declines. The survival rate of those new cells starts to deteriorate as well.

The good news is that the response to fluoxetine (Prozac) was the same across the board.

The bad news is, that in none of the groups, even the young rats who had a better ability to make new neurons, did fluoxetine enhance that ability.

Hmmm...is it just me, or does it make sense that if a medication is going to work, it needs some brain cells to work on?

Cowen DS, Takase LF, Fornal CA, Jacobs BL. Age-dependent decline in hippocampal neurogenesis is not altered by chronic treatment with fluoxetine. Brain Res. 2008 Sep 4;1228:14-9. Epub 2008 Jun 24.

Sneak peek at new drug booklet

Here is a sample page from the newly released booklet, This Is Your Brain On Psych Drugs. You can order this booklet by clicking here.

This study gives new meaning to the term, "mama's boy"...

Several years ago I was diagnosed with uterine fibroids. For all of my medical knowledge and connections, I was very distressed to learn that the treatments for this very common gynecological condition seemed to be very crude and invasive. There really wasn't much research into gentle, natural, or nutritional solutions. Every physician I spoke to just wanted to give me a hysterectomy, despite my young age. Some couldn't figure out why I wouldn't consent, given the fact I was not going to have children and my uterus was, therefore, essentially useless and unnecessary.

When I shared my situation with another female friend, she immediately said, "Well, if it was men who got fibroids on THEIR reproductive organs, you can guarantee there would be a gazillion dollars devoted to researching any possible way to treat them without removing the affected body part!"

Ever since, when I see some kind of gender inequity in medicine, I think of that conversation and remind myself that, unfortunately, sometimes men have to hurt in a unique and most unexpected place in order for them to think more creatively about how they treat women, personally and clinically.

This study is about depression and not fibroids, but it makes my point. Something I find very frustrating with my work in polycystic ovary syndrome is the reluctance on the part of some endocrinologists who treat the disorder to acknowledge the extreme anxiety, depression, and mood swings this disorder promotes. Even though 85% of the over 1,000 women who answered a survey on my website reported at least one of these problems, there are physicians who will flat out say depression is not part of the disorder. Or, rather than trying to understand what may be driving the depression, they simply write a script for an antidepressant.

Well...here's what might happen if you treat depression so superficially. Female rats were treated, throughout pregnancy and lactation, with fluoxetine (Prozac). Later on, the sexual behavior of their male offspring was observed. They appeared to have less incentive to participate in sexual activity. This lack of libido wasn't coming from any measurable, explainable change in hormones, these guys just didn't seem to want any.

With all due respect, knowing that fish oil/omega-3 fatty acids are a great option for depression as well as promoting libido, this kind of problem simply shouldn't be something we have to encounter or research. Except to identify and define precisely why we shouldn't be encountering or researching it.

Oh! And if you're male and you're feeling a little uncomfortable while reading this, you've just experienced what every woman in history has felt when she was told she had to have a hysterectomy that may have been unnecessary. Welcome to the world of medicine without compassion.

Gouvêa TS, Morimoto HK, de Faria MJ, Moreira EG, Gerardin DC. Maternal exposure to the antidepressant fluoxetine impairs sexual motivation in adult male mice. Pharmacol Biochem Behav. 2008 Sep;90(3):416-9. Epub 2008 Apr 4.

Be sure to vote! No one knows what's best for you but YOU.

"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.

New booklet: This Is Your Brain On Psych Drugs

As this blog grows, it is harder to read in a logical, stepwise fashion. So, I've taken the information from the most commonly read posts and compiled a 26 page booklet that summarizes this information.

If you'd like ordering information, it is available at this link.

I was prompted to do this by seeing the information be so widely read, and so to those of you who have done this, thank you so much for the inspiration!

Which came first? Who's on first? Medications and weight gain

As I mentioned in a recent post, olanzapine (Zyprexa) is strongly correlated with weight gain. It's no ordinary kind of weight gain, it's the kind that is associated with hyperlipidemia, diabetes, and even diabetic ketoacidosis. Because of this, it is a popular drug for researchers to study, with regards to its nutritional and metabolic implications. My own fact sheet lists almost 300 references with regard to these interactions.

Now, researchers are starting to look at whether or not certain genetic profiles are more likely to induce weight gain when using this drug. And it turns out, how the leptin gene is expressed may be significantly affecting how a person responds to this medication. Leptin is a hormone that helps to regulate body weight, metabolism, and even reproductive function.

What is interesting is that as I read the research, there are also studies coming out suggesting that the people who best respond to some of these medications may also be the ones who experience the most weight gain when using them. And the whammy there is that the people who experience the most weight gain when using the drugs, are the ones most likely to have low compliance with regard to using them. A medical "Who's on first?" dilemma.

It's fascinating that the brain, weight, and metabolism are all so intricately linked. It certainly means there will be plenty of information for me to blog about, way into the future.

I very much look forward to that!

Srivastava V, Deshpande SN, Nimgaonkar VL, Lerer B, Thelma B. Genetic correlates of olanzapine-induced weight gain in schizophrenia subjects from north India: role of metabolic pathway genes. Pharmacogenomics. 2008 Aug;9(8):1055-68.

Kuzman MR, Medved V, Bozina N, Hotujac L, Sain I, Bilusic H. The influence of 5-HT(2C) and MDR1 genetic polymorphisms on antipsychotic-induced weight gain in female schizophrenic patients. Psychiatry Res. 2008 Sep 30;160(3):308-15. Epub 2008 Aug 20.