A painful reminder: drugs aren't always the answer

I have two reasons for writing this post this morning.

First of all, I spend a couple of hours a day reading new research on psychiatric medications, and it seems that there is a real trend toward throwing all kinds of medications at people with neuropathic pain. If you're the head of marketing at a major pharmaceutical organization, and you're looking at the health statistics in this country, and you see how many people are overweight and headed toward a diagnosis of diabetes...well...anyone looking at you sitting at your desk looking at those numbers is going to see a gazillion dollar signs in that cartoon bubble floating over your head.

To put it another way, anyone who can come up with a sure-fire way to treat neuropathic pain is sitting on a pile of money.

My second reason for posting this is a lot more personal. I have a private client, not overweight at all, whose bulimia has progressed to the point where she has developed diabetes. She got herself into big trouble with her medications because the one she wanted to use, insulin, was the only one she felt controlled her neuropathic pain. Her physician didn't see eye to eye with her...so she decided to use both his meds and hers. We almost lost her over the conflict.

I know why the physician is holding his ground, and I support his choice. But I also have compassion for the physical pain this person must be enduring, which must be a constant reminder, thanks to the ruthless negative voices in her head, that she's really screwed up this time.

So...I've been researching some other options that would allow her to manage her pain, allow her to focus on recovering from the eating disorder, and make the doctor happy.

Enter alpha-lipoic acid. This is an anti-oxidant that isn't all that easy to find in foods, but is right there in the health food store. Not only does it help to regulate diabetes, it's turning out to be very effective in addressing neuropathic pain.

A European study looked at a group of 443 patients who had successfully managed their neuropathic pain with alpha-lipoic acid for at least 5 years. About 300 of them were switched to gabapentin (Neurontin), and 150 of them with no acute symptoms went without any treatment at all during this period of time.

Seventy-three percent of the untreated group started experiencing pain as early as two weeks after discontinuing alpha-lipoic acid. In the gabapentin group, 45% had to stop taking the drug because they could not tolerate its side effects. Fifty-five percent of those using the drug, even though they had done well with alpha-lipoic acid, did not respond to gabapentin. They ended up requiring another medication...which in this study ended up being pregabalin, carbamazepine, amitriptyline, tramadol, and/or morphine .

The researchers commented on the cost of using alpha-lipoic acid as compared to a prescription medication. Not only was there the direct medication cost, but those on medication had almost twice as many office visits during the three months of the study as those who were on the supplement. Not mentioned but important to consider, was the likely additional costs of treating the medication side effects.

The moral of the study? Drug companies, the better mousetrap has already been built. Let's do the right thing and, rather than looking at those dollar signs, get it into the nerves of people like my client who deserve to not have to live like this anymore.

Ruessmann HJ; on behalf of the German Society of out patient diabetes centres AND (Arbeitsgemeinschaft niedergelassener diabetologisch tätiger Ärzte e.V.). Switching from pathogenetic treatment with alpha-lipoic acid to gabapentin and other analgesics in painful diabetic neuropathy: a real-world study in outpatients. J Diabetes Complications. 2008 Apr 8

Can a pill really cure stress?

It used to be that when I met people, and they asked what I did for a living, that I told them I was a nutritionist. Until a few years ago, on a flight back from an eating disorder conference in Washington, DC. I had the window seat and my boss had the aisle seat. The woman in the middle appeared to be excited about her trip to Phoenix, and wanted to chat things up with the two of us. She started with me.

"Are you from Phoenix or DC?"

"I'm on my way home from a conference."

"What was the conference about?"

"Eating disorders. I work in a treatment center."

Without any closure, she physically picked herself up, turned toward my boss, and started the same conversation a second time...only to discover that it went in the exact same direction. She turned her body away from my boss and sat rigidly, staring at the back of the seat in front of her.

Airlines still served meals back then, and when the three of us received ours, I realized that the seating pattern that evening was an anorexic's worst nightmare. It was clear from the way she was manipulating her food, moving it around to look like she'd eaten more than she had, and picking as much fat off of her sandwich as she could, that this young woman had a pretty serious eating disorder.

I felt for her. I knew in the right setting, at the appropriate time, having the two of us to share perspective and compassion with could have been a gift. But not on that day.

I don't talk about eating disorders anymore unless I'm prompted to. I tell people I specialize in stress-related disease. That is, if I'm in the mood to talk. I can't get people to stop talking when they learn that this is my area of interest!

It's the exact same specialty, just a different spin. I help people who manage their stress in ways that can get them into trouble. No one wants to admit they have an eating disorder. But e-v-e-r-y-o-n-e wants a place to unload their stress!

I get to help a lot more people by focusing on the stress instead of its resulting dysfunction. Apparently the drug companies have figured this out, too. (But did you have to read this far into this blog post to figure that out---have you ever seen an ad on the evening news for a drug that successfully helps with bulimia? Erectile dysfunction--yeah, we got a pill for that. Urinary incontinence--yeah, we can help you with that. Starving yourself to death? Sorry, we're just not comfortable going there...too personal!)

It's been proposed for awhile that depression often results when the stress hormone system doesn't properly regulate itself and stress hormones are oversecreted. Scientists recently injected stress hormones into mice and then evaluated what kind of changes they observed. They discovered that stress hormones reduce the ability of the hippocampus (brain's memory center) to generate new cells, which, understandably, over time, reduced hippocampal volume. Acute exposure to stress hormones created more of a "depressed" response in these mice, while prolonged exposure seemed to elicit an "anxious" presentation.

Antidepressant medications administered at the same time the stress hormones were administered prevented these changes.

OK, but instead of waiting until stress is at a point where it's doing damage...what about reducing stress from the source? What about taking on fewer responsibilities? Setting boundaries? Prioritizing sleep? Developing a support system, especially one outside of your work connections? Picking up a hobby? Not buying into the mentality that the harder you work and the less you sleep and the more e-mails you have...the better person you are?

I'm not arguing that the meds aren't a valuable tool. But I do know that people who push themselves to the point where they need medication to undo what stress has done have been out there for a long time pushing themselves before they finally admit maybe they need to do something about it. What about all the oxidative stress and aging and other physical damage that happened on the road to Prozac? We're able to measure some of the things we can reverse with medication...but I sure hope that doesn't leave us falsely reassured that everything we did to ourselves because we didn't want to relax a little bit more can be fixed when we get to that item on our "to do" list.

Murray F, Smith DW, Hutson PH. Chronic low dose corticosterone exposure decreased hippocampal cell proliferation, volume and induced anxiety and depression like behaviours in mice. Eur J Pharmacol. 2008 Mar 31;583(1):115-27.