Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs.

As much trouble as I have with indiscriminate use of antipsychotic medications, I do think they have important uses in certain situations, and that we have to be very careful about overgeneralizing their negative aspects.

For example, these medications are increasingly being used to help control side effects in some serious illnesses such as Parkinson's disease and Alzheimer's disease. In some cases, especially when not managing these side effects can make things hard to manage for these individuals' caregivers (who are often family in a home situation), it is important to balance considerations about overall quality of care, caregiver sanity and health, and weight. Each situation is different, and there are no easy answers.

Sixty-one Parkinson's patients on either quetiapine (Seroquel) or clozapine (Clozaril) for at least six months were compared to 28 Alzheimer's patients in similar situations. The weight changes, though small, were statistically significant. Parkinson's patients trended toward weight loss compared to controls, and Alzheimer's patients trended toward weight gain.

It may not be that these medications cause weight changes in one direction or the other...but rather, they foster metabolism moving in a direction that genetic tendency long ago pre-programmed. It is important to not be afraid of a medication that can help ease the life of the caregiver. Of course, judicious use and close monitoring are always the caveats that go with any medication decision. Alzheimer's patients seem to be prone to developing diabetes and that should not be ignored.

I was glad to see this study attempt to parse out exactly what these medications do and why. That's a great use of scientific minds.

Sitburana O, Rountree S, Ondo WG. Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs. J Neurol Sci. 2008 Sep 15;272(1-2):77-82. Epub 2008 Jun 16.

Smoking reduces serum levels of lamotrigine.

If you smoke, and you are using seizure medications, take notice--smoking was shown in a recent study to reduce blood levels of lamotrigine (Lamictal). That means that, in order for the medication to be effective in a smoker, you need more of it.

The obvious solution here...is to quit smoking. You'll save money on cigarettes as well as medication. Hopefully at some level any smokers reading this will file this information into their "reasons to quit" pile and eventually think about doing so!

Reinsberger C, Dorn T, Krämer G. Smoking reduces serum levels of lamotrigine. Seizure. 2008 Oct;17(7):651-3.

Television, epilepsy, and children

When I first read the title to this abstract I knew I had to use it in the blog. Here scientists have determined that television exposure can cause epilepsy in some children...and instead of working to minimize exposure to the trigger, they're looking for a pill that allows the child to continue the behavior causing the problem.

I could tell you what medication was found to be most effective, but that would make me part of the problem. If you're a parent who knows your kid's brain doesn't tolerate television...get rid of the television and teach him how to otherwise spend his free time! Here's a concept, interact with him like parents used to do in the old days.

That's kind of how we do things anymore, isn't it?

We know too much food can cause weight gain, but rather than stop eating...we spend billions of dollars looking for ways to allow us to, quite literally, have our cake and eat it too.

We know we need a minimum amount of sleep in order to properly function. But in this day and age of 24 hour schedules, a whole new pharmaceutical specialty has sprung up, medications that drive wakefulness in people who simply need to make more time for sleep.

Instead of suggesting to the parents of these children that they might best be encouraged to learn to play the piano, play a sport, or, God forbid...READ...we want to figure out how to medicate the kids so they stay on our revenue-generating map.

I give up. But what I would like to request, if we're going to encourage studies like this one and call it science, is that we at least make the study designs interesting for the reader.

I mean, if kids who probably shouldn't be watching television are allowed to watch television anyway because they're another important profit niche for certain drug manufacturers, wouldn't it be more important to know whether Sesame Street or Spongebob Squarepants is more effective at creating seizures? Seems to me that kind of information could be really important when it comes to marketing plans. Not just for the drug companies but all those companies who love to use those programs to sell junk to kids, who need to hold on to their audience.

The best part is going to be when Bert and Ernie are called to testify in court. Now THAT will be television worth watching.

Etemadifar M, Raoufi M, Maghzi AH, Ebrahimi A, Kaji-Esfahani M, Mousavi SA. Television-provoked epilepsy in children: a follow-up survey from isfahan, iran. Arch Iran Med. 2008 Nov;11(6):649-53.

Your brain loves lipoic acid!

I'm primarily a food first, supplements second kind of person. However, lipoic acid is a supplement I love to recommend. It's not something that you can readily find in food, but it does a whole lot of good, especially in the brain.

It can delay and prevent Alzheimer's disease, and dementia, in a variety of ways. It helps to increase acetylcholine levels. Acetylcholine is the neurotransmitter in charge of memory function. It helps to bind free radicals, preventing them from doing damage. It prevents the formation of proteins associated with inflammation.

Not a bad friend, is it?

The amount given in the two studies evaluating lipoic acid's effect on the brain was 600 mg per day.

Lipoic acid is also unique in that it has the ability to make other antioxidants more powerful. The authors of the article reviewed here suggested that in combination with curcumin, EGCG (active ingredient in green tea), and DHA (in fish oil and marine algae), lipoic acid could be a very powerful warrior in the fight against degenerative brain disease.

Hmmmm...anyone for some fish curry, with a green tea chaser?

Maczurek A, Hager K, Kenklies M, Sharman M, Martins R, Engel J, Carlson DA, Münch G. Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer's disease. Adv Drug Deliv Rev. 2008 Oct-Nov;60(13-14):1463-70. Epub 2008 Jul 4.

Folic acid and brain health--don't forget it!

As my last post discussed, depression is not just about mood. It's about the integrity of neurons and the systems that support them. One very strong connection that research is increasingly supporting, is the link between depression and inflammation. Inflammatory markers commonly used to identify heart disease, such as homocysteine, are being correlated as well with depression.

Here, 27 subjects were divided into two groups. One group was given fluoxetine (Prozac) and folic acid, while the other was given fluoxetine and placebo. (Folic acid was given because it has been shown to help prevent elevated homocysteine.) Another 15 subjects were given nothing at all, for a basis of comparison.

As happens in cardiovascular studies using folate as an intervention, plasma homocysteine levels dropped with folate supplementation. The interesting finding, however, was that when subjects took the Hamilton Depression Rating Score, those who had received the folate showed greater improvement than those who only received the fluoxetine. There was no significant difference in serotonin levels, so the researchers concluded that folate was not affecting the mechanism by which fluoxetine works.

So the bottom line seems to be...you can't just fix depression with a pill. How you take care of yourself (i.e., how you choose to eat) can be a crucial factor in whether or not your brain works at its absolute best.

If you want to add more folate to your diet, here are your best food choices: fortified breakfast cereal, whole wheat products, meat, beans, liver, eggs, sunflower seeds, asparagus, leafy green vegetables, oranges, strawberries, melons.

Resler G, Lavie R, Campos J, Mata S, Urbina M, García A, Apitz R, Lima L. Effect of folic acid combined with fluoxetine in patients with major depression on plasma homocysteine and vitamin B12, and serotonin levels in lymphocytes. Neuroimmunomodulation. 2008;15(3):145-52. Epub 2008 Aug 21.

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.