Tag Archives: depression

Quick Hits: FDA Approves New Antibiotic, ADHD Med, and Opioid Use in Depressed Patients

The FDA has approved Baxdela (delafloxacin), a fluoroquinolone antibiotic that is used to treat acute bacterial skin and skin structure infections (ABSSSI). The drug is available as a tablet or intravenous injection. Labeling for the drug includes a “black box” warning due to serious adverse and potentially irreversible reactions that have been associated with fluoroquinolones, such as tendinitis and tendon rupture, peripheral neuropathy and central nervous system effects. In trials, the most common adverse reactions in patients observed were nausea, diarrhea, headache, elevations of the enzyme transaminase, which can indicate liver damage, and vomiting. Posted June 19, 2017. Via Melinta Therapeutics.

A new once-daily treatment for attention deficit/hyperactivity disorder (ADHD) has won FDA approval. Mydayis, a stimulant for patients 13 years and older, contains the same active ingredients as Adderall (amphetamine/dextroamphetamine), but lasts for up to 16 hours compared to up to 6 for Adderall and 12 for Adderall XR. Adderall and Adderall XR are both available as a generic. Like other stimulant medications, such as methylphenidate (Ritalin, Concerta, Daytrana), Mydayis has a “black box” warning because it has a high chance for abuse and can cause physical and psychological dependence. Posted June 20, 2017. Via Shire.

Patients with low back pain who also suffer from depression are more likely to be given opioids that are prescribed at higher doses. This is problematic, since patients with depression are at a higher risk of misuse and overdose of opioids. Researchers examined data on opioid prescriptions from 2004-2009 and found that those with low back pain who also had depression were twice as likely to be prescribed an opioid than those without depression. And over a year, they typically got more than twice the usual dose, according to the study published in the journal Pain Reports. The authors noted more study is needed to determine the risks and benefits of prescribing such powerful painkillers to those who are depressed. Posted June 20, 2017. Via University of Rochester Medical Center.

Feeling Anxious? Depressed? Check Your Meds

If you find yourself feeling on edge for no apparent reason while taking a cold medicine or diuretic, you most likely wouldn’t connect the two. However, anxiety happens to be just one of many mood-altering symptoms that can be brought on by certain meds.

“Many medications, whether prescribed or found over the counter, can cause psychiatric symptoms,” says Shiyun Kim, PharmD, BCACP, BCPP, CDE, a clinical pharmacist and clinical assistant professor at the University of Illinois Hospital & Health Sciences System, and a spokesperson for the American Pharmacists Association.

She explains that a wide range of factors influence the way a drug affects each person, including things like metabolism, underlying illness, and interactions with other drugs. “Any variations that occur, such as with improper doses or individual reactions, can result in undesirable psychiatric symptoms,” though they are relatively uncommon.

If you feel that you may be suffering from these side effects, notify your providers immediately. “Keep in mind that some medications can be stopped abruptly, while others need to be tapered to prevent further adverse effects,” Dr. Kim emphasizes. “Your provider can make the best decision with you.”

Take note of the following medications that can have these kinds of effects, and read on to find out how to minimize the risks.

Oxycontin and Similar Pain Medications

“Most prescription pain medication, such as oxycodone (OxyContin) or hydrocodone, can cause drowsiness, which can make one feel ‘cloudy’ and lack motivation — and these symptoms closely mimic depression,” according to Bree Meinzer, PharmD, CTTS, a pharmacy practice resident at Ohio Northern University. Opioids can also lead to more severe symptoms like paranoia, hallucinations, psychosis and dementia, especially at high doses. Signs that you may have taken too much of an opioid include trouble breathing and unconsciousness. People with opioid dependence and those who suffer from HIV, liver or lung disease or suffer from depression may be more susceptible to these effects, according to the World Health Organization. If you are on a pain medication that makes you drowsy or “cloudy” and you do not like how it makes you feel, you should talk to your doctor about other ways to adequately manage your pain.

Lasix, Microzide and Other Diuretics

Medications that reduce fluid retention and swelling, including furosemide (Lasix) and hydrochlorothiazide (Microzide), increase urination. This can lead to dehydration, especially in the elderly, and can result in hallucinations and dizziness, says Dr. Meinzer. SGLT2 inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance), which are drugs used to treat diabetes, can also increase urination and cause dehydration. If you are taking these types of medication, be sure to drink plenty of water to stay sufficiently hydrated. The amount of water to drink should be discussed with your doctor and is dependent on your weight. “These medications should also be taken in the morning or early afternoon to avoid frequent urination at night,” which could disrupt sleep, she advises.

Ask your doctor to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.

Requip and Other Dopamine Agonists. Medications like ropinirole (Requip), often prescribed for restless leg syndrome and Parkinson’s disease, increase the brain chemical dopamine, which helps regulate mood and behavior. Too much dopamine can cause hallucinations, notes Dr. Meinzer, and more extreme potential side effects include confusion, mania, depression and impulse control disorders like compulsive gambling or eating. “There are other options for restless leg syndrome that don’t increase dopamine, though medications like ropinirole typically work best.” There are also different medications for Parkinson’s, though you and your doctor should carefully consider your particular treatment needs. If you experience these kinds of symptoms while taking this type of medication, it may be that your dose is too high.

Ritalin, Adderall and Other Stimulants

Drugs that are commonly used for the treatment of attention-deficit hyperactivity disorder (ADHD) include those sold under the brand names Ritalin and Adderall. Although these stimulant medications “help children and adolescents focus and stay on task, side effects include increased heart rate and insomnia, which can often cause anxiety and restlessness,” says Dr. Meinzer. Stimulants “excite the central nervous system and can disrupt normal communication between cells in the brain,” adds Dr. Kim. “This class of drugs may also cause bizarre behavior, agitation, mania, paranoia and nightmares.” Dr. Meinzer suggests talking to your healthcare provider if you feel extremely restless and anxious while taking this type of medication. Again, it is possible that your dose is simply too high.

Corticosteroids

Medications like prednisone, cortisone and methylprednisolone are often prescribed “to help respiratory symptoms and decrease inflammation with chronic diseases,” Dr Meinzer explains. They are typically only “used for a short term to help alleviate symptoms, but if you are on these medications for a long time, they can cause some unwanted side effects.” Use of these drugs for more than a few months can increase the chances of experiencing mania, anxiety, depression, paranoia and psychosis, which have mostly been reported by patients using high doses or abusing the medication, says Dr Kim. Though experts are unclear about the exact reasons for such side effects with these drugs, research suggests that it may have to do with the way steroids work in the area of the brain that influences memory and emotion. It is also possible that “high levels of steroids result in brain damage and cause cognitive dysfunction.”

Zarontin and Other Anticonvulsants

Medications such as ethosuximide (Zarontin), which are used to control seizures in people with epilepsy, can cause symptoms resembling depression. These drugs have also been found to increase suicidal thoughts and behavior. “If you start to experience these symptoms on an anticonvulsant, you should talk to your doctor about other regimens,” Dr. Meinzer recommends. “There are other medications in the same class that are less likely to cause this side effect,” though your doctor may want you to stay on the medication because it may be the one that is most effective for you. “Anticonvulsants are usually tricky to dose and may need lab monitoring to make sure they are in the proper range.”

Dr. Kim offers the following general tips to help prevent or deal with these side effects:

  • When you are prescribed a drug, ask your provider about potential side effects that are commonly noted and reported.
  • Ask your provider to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.
  • Withdrawal of some drugs can cause symptoms such as anxiety, agitation or depression. Therefore, call your doctor before stopping medications on your own.
  • When purchasing an over-the-counter (OTC) medication, take the time to read the instructions on the package. If anything is unclear, ask the pharmacist for guidance.

Effective Natural Alternatives for Fibromyalgia Sufferers

From the outside, a person with fibromyalgia looks perfectly normal. But on the inside, it can feel like the pain volume dial has been cranked up to high and can’t be turned down. On top of this, the high level of fatigue can interfere with life on every single level.

“Fibromyalgia is a very interesting illness,” says Dr. Jordan Tishler, a Harvard-trained physician who focuses on holistic care. “Twenty years ago we felt that it was largely a psychological illness, partly because we couldn’t find much else wrong, and partly because it responds, at least for some, to antidepressants like SSRIs.

“We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on,” he adds. “There is clearly a psychological component, but this exists on top of a vague immune condition that we’re still working to define.”

The symptoms of fibromyalgia are widespread diffuse pain; psychological symptoms such as depression and anxiety; and somatic symptoms such as fatigue, memory difficulties and poor sleep quality. Due to these wide-ranging symptoms, there are an equally wide number of medications commonly prescribed for fibromyalgia — everything from strong pain medicines and sleeping pills to antidepressants.

While medications may provide benefits, all pharmaceutical drugs come with side effects that may contribute to more negative outcomes, rather than the positive improvements you might hope for. That’s why we’re here to inform you about the possible side effects of commonly prescribed medications and to provide more information about natural treatment options that are known to be effective.

MEDICATIONS

Lyrica (pregabalin)

You may have heard of the heavily advertised fibromyalgia drug, Lyrica (pregabalin). It’s an antiepileptic, anticonvulsant medication that slows down seizure-related impulses in the brain, and also influences nervous system pain-signalling chemicals in the brain, which is why it’s commonly prescribed for fibromyalgia.

According to a recent review of studies on Lyrica, using the drug daily does reduce pain by 30 to 50%. But 70 to 90% of people also experience side effects, the most common being dizziness (38%), drowsiness (23%), weight gain (9%) and peripheral edema (8%).

Common side effects of Lyrica are:

  • dizziness
  • drowsiness
  • loss of balance or coordination
  • problems with memory or concentration
  • breast swelling
  • tremors
  • dry mouth
  • constipation

There are more serious side effects that can also occur:

  • mood or behavior changes
  • depression and anxiety
  • panic attacks
  • trouble sleeping
  • feeling impulsive
  • irritable, agitated, hostile, aggressive behavior
  • suicidal tendencies, or having thoughts about suicide or hurting yourself

If you experience any of these more serious symptoms, consult with your doctor immediately.

Antidepressants

Antidepressants such as tricyclics (amitriptyline and cyclobenzaprine), selective norepinephrine reuptake inhibitors (SNRIs) such at Cymbalta (duloxetine), Savella (milnacipran) and the SSRI Prozac (fluoxetine) are often prescribed. Though they can be effective, nearly all antidepressants are associated with side effects and can sometimes result in serious adverse events, too.

‘We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on.’
— Jordan Tishler, MD

Opioids

For more severe pain, opioid receptor agonists may be prescribed, the side effects of which are sedation, dizziness, nausea, constipation (very high rate), tolerance (requiring higher doses) and psychological addiction/physical dependence on the drug. Chronic opioid use leads to changes in brain neuroplasticity, which is what causes this.

As you can see, it’s important to read up on the possible side effects because if you find your fibromyalgia symptoms are getting worse, not better, it could be the type of medication you’ve been prescribed. Don’t be afraid to ask your doctor to review your options.

Alternatively, you could try some natural treatments that have demonstrated efficacy.

NATURAL TREATMENTS

Regular Exercise

“Even though it seems counteractive due to the high levels of fatigue experienced by fibromyalgia sufferers, exercise (both aerobic and strength-based approaches) actually works to decrease symptoms and fatigue,” says Dr. Tishler. “The message here, though, is to ‘start low and go slow.’”

Eliminate Inflammatory Foods

Registered dietitian Ryan Whitcomb recommends identifying inflammatory and allergenic foods through a food sensitivity test known as an MRT (mediator release test.)

“This is my first go-to line of defense because it eliminates all the guesswork when it comes to problematic foods,” says Whitcomb. “Once these foods are identified, they are removed from the diet and we slowly add in safe, non-reactive foods.”

One such inflammatory food identified as a problem is gluten. Studies have shown that people with fibromyalgia commonly have non-celiac gluten sensitivity — not an allergy, but an intolerance to gluten. In one small study with fibromyalgia patients, 75% of them experienced a dramatic reduction in widespread pain after eliminating gluten. Some even no longer had pain at all. And in a few of the patients taking opioid medications, the drugs were discontinued, simply by following a gluten-free diet.

Address Nutrient Deficiencies

Once inflammatory foods are removed from the diet, it may be that people have nutrient deficiencies that also need to be addressed.

“Magnesium and vitamin D are common deficiencies,” says Whitcomb. “But rather than assuming that’s the patient’s issue, I run a comprehensive micronutrient panel that looks at 33 nutrients to get a broad overview of what’s really going on in their body.

“Once we know their deficiencies, we can talk about repleting through food and supplements. Food is preferable, but some nutrients, like vitamin D, need to be supplemented since there aren’t many foods that contain it.”

Examine Sleep Quality

“Poor sleep seems to be a major contributor to this illness, so good sleep habits, such as reducing stimulants like coffee, and the occasional use of prescription sleep aids are important approaches,” says Dr. Tishler.

Try Medical Cannabis Therapy

“I have many fibromyalgia patients in my practice and have found cannabis can be a very effective treatment,” says Dr. Tishler, who is also a medical marijuana specialist. “Cannabis is great for pain control and equally good for promoting sleep. In fact, it’s considerably better for sleep than any conventional medication. It’s also considerably safer for pain control than opioid options.

“And on top of this, cannabis is effective for mild depression and anxiety, both of which are associated with fibromyalgia as well. I have certainly found cannabis to be truly effective for fibromyalgia patients because it addresses the illness on so many levels,” he adds.

Quick Hits: Nighttime Urination Treatment Approved, Using Aricept & More

Noctiva (desmopressin acetate), a prescription nasal spray for adults who urinate frequently throughout night, was approved by FDA. The drug is the first FDA-approved treatment for the condition known as nocturnal polyuria, which is overproduction of urine during the night. Patients who plan to take this Noctiva should take precautions since the drug has a boxed warning. Noctiva can cause hyponatremia, which is low sodium levels in the blood. If it is not promptly diagnosed and treated, hyponatremia can be fatal — leading to seizures, coma, respiratory arrest or death. Doctors should ensure that a patient’s sodium level is normal before prescribing Noctiva, and should check sodium levels within 1 week and approximately 1 month after starting treatment and periodically thereafter. Posted March 3, 2017. Via FDA.

People with milder cognitive impairment should be given a genetic test before using Aricept (donepezil) to treat Alzheimer’s disease. Researchers at the UCLA School of Nursing found Aricept could speed mental decline in someone with mild cognitive impairment who has a specific genetic variation, they reported in the Journal of Alzheimer’s Disease. Patients with the K-variant of the butyrylcholinesterase (BChE) gene who took Aricept deteriorated faster than those who took a placebo. Posted March 7, 2017. Via Medline Plus.

Patients who have psychiatric ailments are more likely to reject treatment if only medication is involved. Researchers analyzed 186 studies of patients who sought help for mental health conditions. The results, published in the journal Psychotherapy, found that the treatment refusal rate was more than 8% on average. Patients were almost twice as likely to refuse drug treatment alone compared to those offered talk therapy alone. Patients with depression were more than 2 times more likely to refuse drug therapy alone and patients with panic disorders were nearly 3 times more likely to refuse drug therapy alone. Researchers explained that patients usually prefer talking with a caring individual who could talk them through their emotional distress. Posted March 6, 2017. Via Medline Plus.

Genetic Testing May Predict Side Effects to Drugs

What if you could find out if a drug would cause you side effects or wouldn’t work at all before you started taking it? That now may be possible for 150 drugs used for depression, cholesterol, heart disease and pain through a swab of the cheek as part of a genetic test.

The test, which costs about $266, is called the mygeneRx. It was developed by a South African company, DNAlysis. It works by examining genetic variation in genes that influence enzymes involved in the metabolizing of medications.

The enzymes control how fast the drug is used by the body. If a drug is metabolized too quickly, it won’t have time to work. But if it metabolizes too slowly, it can provoke an overdose or side effects.

The testing is part of the field of pharmacogenomics, which can help to predict a person’s likelihood to have a bad reaction to a drug.

However, some medical experts say the tests are not yet advanced enough to be used regularly by patients.

“Most of the [laboratories] only test for a few genetic markers‚ as also indicated in this test‚ which are not enough for personalized treatment,” Mamoonah Chaudhry‚ PhD, a postdoctoral fellow at the University of Pretoria’s Institute for Cellular and Molecular Medicine, told the Sunday Times.

Are There Any Side Effects From Psychotherapy?

The vast majority of people who receive psychotherapy through the Internet benefit from the treatment, though a small number do experience some kind of side effect.

Alexander Rozental, PhD, a psychologist, decided to explore the side effects of online cognitive behavioral therapy (CBT). Online CBT is similar to the CBT one would get from seeing a mental health professional directly or reading a self-help book, but support is given through email with a psychiatrist. The dissertation is thought to be the first examination of the side effects of Internet-based therapy.

Rozental’s research found that only 6% of 3,000 patients receiving Internet-based therapy got worse during treatment.

When he examined patients who received psychotherapy in an outpatient setting that were asked if they had negative effects of the treatment, one-third said they had a difficult memory resurface, had more anxiety or felt stressed. In addition, some said they had a poor relationship with their therapist or the treatment was subpar.

Rozental explained that what is needed in further research is a better understanding of therapy side effects, both to identify patients who become worse early in treatment and to shield patients from bad therapists.

“’I hope that psychologists and psychotherapists become more aware that there can actually be side effects and that they need to ask patients whether they are experiencing any,” he said.

Quick Hits: Brain Scan Can Predict Antidepressant Response, Economic Cost of Smoking & More

A functional MRI (fMRI) brain scan may be able to predict whether a patient will respond to an antidepressant. Researchers at the University of Illinois and the University of Michigan gave an fMRI scan to patients with major depressive disorder who were about to begin antidepressant therapy. Some of those patients would receive 1 of 2 antidepressants, while the others would receive no drug at all. The researchers looked at activity patterns of the brain while participants executed a cognitive-control task that would determine whether the scan predicted a response to drug treatment. The results showed that the tested model predicted which patients would respond well to antidepressant treatment, and which would not with a 90% accuracy rate. Being able to predict a response to drugs could reduce the time it takes patients to begin feeling better since antidepressants typically take 8 to 12 weeks to take effect. Posted January 24, 2017. Via Brain.

The total economic cost of smoking was more than $1.4 trillion in 2012, or 1.8% of the world’s GDP. In addition, diseases attributable to smoking accounted for 12% (2.1 million) of all deaths among working age adults (30–69 years of age), with a high proportion in Europe and the Americas, according to data from the World Health Organization and the World Bank. Researchers also say that due to smoking-related ill health, the number of working years lost added up to 26.8 million, 18 million of which were lost to death with the remainder lost to disability. Smoking-related health expenditures accounted for $422 billion, with again, the highest share being in Europe and the Americas. Posted January 30, 2017. Via Tobacco Control.

Men who are suspected to have prostate cancer can avoid an unnecessary biopsy and overdiagnosis by receiving an MRI scan. About 1 in 4 men can avoid a biopsy if a Multi-parametric MRI (MP-MRI) test is given beforehand. If men experience prostate cancer symptoms or have a “prostate specific antigen (PSA)” that reveals elevated levels of the PSA protein in their blood, then they usually receive a biopsy. But PSA tests are sometimes inaccurate, resulting in many men undergoing unnecessary biopsies. A new study found that the MP-MRI should be used before a biopsy procedure. There were 44 serious adverse events during the study, but they resulted from biopsies rather than the MP-MRI scan. The scans could reduce overdiagnosis of harmless cancers by 5%, as well as improve the detection of aggressive cancers. Posted January 19, 2017. Via The Lancet.