Tag Archives: antidepressants

Can a Test Take the Guesswork Out of Prescribing Meds?

Here’s the promise: A simple test, taken in a doctor’s office or even a drug store, will predict which medicine is the right one for you. No guessing, no false starts, no terrible side effects.

Here’s the reality: Not yet.

This is the growing area of pharmacogenomic testing, which for medications means predicting which drugs will work well inside of your body based on certain genes you possess. But at the moment, the testing has not demonstrated it is as good as its developers make it out to be.

The testing is of particular interest for those taking psychiatric drugs, where it can often take several tries before a medication that works for a given condition is found. For example, only 40 to 60% of those with depression find success with the first antidepressant prescribed.

Pharmacogenomic tests are becoming more widely available. As an example, back in May, grocery chain Albertsons, which also operates drug stores, began offering pharmacogenomic testing for psychiatric medications for customers at 28 of their pharmacy locations through a partnership with Genomind.

‘The Marketing Is Way Out Ahead of the Data’

A recent article in JAMA discussed psychiatric pharmacogenomic testing, interviewing doctors and other health care professionals. The bottom line: Pharmacogenomic testing for psychiatric meds may work, but the evidence so far is limited.

James Potash, MD, with the department of psychiatry and behavioral science at Johns Hopkins, said that the evidence for the tests has come mostly from small trials conducted by the manufacturers. Perhaps that’s why he told JAMA that for some tests, “the marketing is way out ahead of the data.”

A piece published in August in JAMA Psychiatry examined the trials behind 10 pharmacogenomic tests that are marketed to help determine the ideal medication choice for treating major depression. The authors found issues with the way all 10 trials were conducted.

A consensus is growing, according to the JAMA article, that pharmacogenomic testing may be more useful for predicting side effects than for a person’s response to a particular drug. So far, there is no test than can tell you, for example, what the “right” antidepressant is for a given patient, according to Potash.

An American Psychiatric Association task force this year also came to the conclusion that there is not enough evidence to support widespread use of pharmacogenomic testing, though “it may be informative, particularly in predicting side effects.”

There are other concerns. Just because an individual has a gene linked to a particular side effect doesn’t guarantee they will definitely experience that side effect. Along the same lines, lacking that gene doesn’t mean you won’t experience it or other effects. Many genes influence side effects you might experience, as do other health conditions and medications you are taking. In other words, pharmacogenomic tests can complement, not replace, existing clinical tools.

And then there is the cost — pharmacogenomic tests can easily cost hundreds of dollars.

To me, pharmacogenomic testing for drug side effects and efficacy holds great promise, but we are not there yet. If you decide to get a test, understand its limitations.

Jonathan Block
Jonathan Block

Jonathan Block is MedShadow’s content editor. He has previously worked for Psychiatry Advisor, Modern Healthcare, Health Reform Week and The Pink Sheet.

Mediterranean Diet’s Newest Benefit: Curbing Depression

The Mediterranean diet has been highly touted for helping to improve physical health, and a new study indicates that it may also help to curb the risk of developing depression.

Researchers conducted a review of 41 studies that examined the connection between diet and depression risk. Four of them, which included more than 36,000 people in the US and Europe, looked specifically at the Mediterranean diet and depression risk. The Mediterranean diet is one that is rich in in fish, olive oil, nuts, fruits and vegetables. It minimizes meat consumption and avoids processed foods and those that are high in saturated fats and sugars.

People that followed a Mediterranean-style diet had a 33% lower risk of developing depression, according to results presented in the journal Molecular Psychiatry.

As to why the Mediterranean diet may protect against depression, researchers say that anti-inflammatory and anti-oxidant elements found in the foods help protect the brain from oxidative stress and inflammation. Inflammation in the brain can also impact chemicals there known as neurotransmitters, which send messages between nerve cells that regulate mood.

A study published last year assigned people with depression to start either a Mediterranean-based diet or a social support group. While depression symptoms in both groups improved, those in the Mediterranean group saw bigger improvements.

Jonathan Block
Jonathan Block

Jonathan Block is MedShadow’s content editor. He has previously worked for Psychiatry Advisor, Modern Healthcare, Health Reform Week and The Pink Sheet.

Quick Hits: FDA Raids E-Cig Manufacturer, Asthma Drugs’ Side Effects & More

The FDA conducted a surprise inspection of JUUL Labs as part of the agency’s effort to gain more information on the e-cigarette company’s sales and marketing practices. The FDA reportedly seized more than 1,000 documents. The action comes just weeks after the FDA ordered JUUL and four other manufacturers to come up with plans to curb use of e-cigs by teens. JUUL has the largest share of the e-cig market, and its sales grew more than seven-fold from 2016 to 2017, according to newly released data from the CDC (Centers for Disease Control and Prevention). The CDC also noted that JUUL has among the highest nicotine content of e-cigs available. Posted October 2, 2018. Via CDC.

More than half of people with asthma that take oral steroids such as prednisolone experience significant side effects, according to a new survey. Asthma UK, a charitable organization, interviewed 1,200 patients with severe asthma, most of whom had at least two asthma attacks in the prior year and were on an oral steroid. Of those on a steroid, about 56% experienced weight gain, 55% had trouble falling asleep, 43% were more irritable and more easily upset. And 37% said they were more anxious and had less energy. Asthma UK said that healthcare providers should use newer biologic-based drugs known as monoclonal antibodies to treat asthma, as they have been shown to reduce asthma attacks by up to 50%. Some of these medications include Xolair (omalizumab), Cinqair (reslizumab) and Nucala (mepolizumab). However, they are more expensive than oral steroids. Posted October 2, 2018. Via The Times.

About 20% of people with Alzheimer’s disease use two or more psychotropic drugs that can raise the risk of experiencing adverse events. Researchers in Finland examined the medical records of more than 70,000 people diagnosed with the disease. Antipsychotics were eight times as likely to be prescribed in those with Alzheimer’s compared to those without the disease. The use of at least two psychotropics together was three times more common among people with Alzheimer’s. The most common combination was an antidepressant with either an antipsychotic or benzodiazepine, a class of medications used for anxiety and sleep. Use of acetylcholinesterase inhibitors, a first-line dementia treatment, such as Aricept (donepezil), was associated with less risk for psychotropic polypharmacy, while use of Namenda (memantine), another dementia drug, was associated with a higher risk. Posted October 1, 2018. Via European Neuropsychopharmacology.

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Jonathan Block
Jonathan Block

Jonathan Block is MedShadow’s content editor. He has previously worked for Psychiatry Advisor, Modern Healthcare, Health Reform Week and The Pink Sheet.

‘It’s a Gamble:’ St. John’s Wort, Depression and Drug Interactions

In my 20s, I wasn’t much for traditional medicine. For one thing, navigating our labyrinthine health care system seemed like a lot of unnecessary work. For another, I was broke. Plus, I used henna to dye my hair. I wanted something natural.

That meant that when I felt down in the winter and was quick to worry and anxiety, I didn’t go to the doctor. I went to the drug store and got myself a bottle of St. John’s wort (Hypericum perforatum).

By the time I started taking St. John’s wort around 2003, the plant had been used to rid the environment of evil spirits in ancient Greece and medicinally to menstrual cramps, heal wounds, and treat kidney conditions in later centuries. Today, it’s primarily used to treat depression.

What those early practitioners didn’t know and what I didn’t, either, was that St. John’s wort can interact with prescription medicines in ways that can be serious. With everything from hormonal contraception to organ-transplant drugs interacting with the supplement, the more you know about the interactions, the better off you are.

Powerful or Placebo

In 1998, St. John’s wort was the second most popular supplement in the US, according to the nonprofit supplement industry group the American Botanical Council.

That’s when I first heard about it. But what I didn’t know was that, 4 years earlier, passage of the Dietary Supplement Health and Education Act created the category of dietary supplements and prevented the FDA from requiring supplement companies to prove their products were safe, certify levels of active ingredient or produce evidence that they work.

So, I was working with spotty knowledge. I wasn’t the only one.

Research on St. John’s wort was positive early on, but over the years, the findings have been more muddy, said D. Craig Hopp, PhD, deputy director of the Division of Extramural Research, National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH) . St. John’s wort seems to be associated with a “strong” reduction in depressive symptoms, including lack of interest in once-pleasurable activities, sleep or eating changes, hostility, irritability, and feelings of guilt, worthlessness or helplessness.

“But you get the same response from the placebo,” he said. “It’s not real clear whether it has [any] benefit.”

A 2002 NCCIH-funded study found that neither St. John’s wort nor the antidepressant tested was any more powerful than placebo for major depression. Another study found the same for mild depression.

On the other hand, a 2008 Cochrane review of 29 studies on the herb found that St. John’s wort is as effective as antidepressants in ameliorating mild to moderate depressive symptoms. But there was a catch: In countries where supplements are regulated and prescribed, the results were more positive. Studies conducted in the US had less positive results.

In any case, Hopp added, “St. John’s wort by itself is safe. But when taken in combination with something else, it dramatically influences how well those medicines work.”

Multiple Interactions

That’s because when you’re taking a whole-herb supplement, you aren’t just getting whatever the active ingredient of the herb is — you’re getting everything else that comes with it, too.

It’s unclear what St. John’s wort’s active ingredient is, though researchers have studied 2 components, hyperforin and hypericin. What researchers do know is that St. John’s wort also delivers significant doses of enzymes that help the body break down medications.

Any drug that is broken down by these particular enzymes breaks down a lot faster than it would otherwise. Drugs include the heart medication digoxin, the opioid oxycodone, some HIV medications, cancer drugs like irinotecan, cyclosporine for organ transplants, and the anticoagulant warfarin. That means that the medication exits the body more rapidly.

In the case of HIV medications, that could mean that the virus mutates and develops resistance to the drug so it never works as well again. In the case of heart medicines, it can increase the risk of a cardiac event.

And in the case of organ transplants, it can be fatal.

“Studies have shown that St. John’s wort would clear immunosuppressive medicines 10 times faster,” Hopp said, “That could cause organ rejection and organ failure.”

Plus, because St. John’s wort is unregulated, you don’t know exactly how much active ingredient you’re getting. That limits doctors’ ability to adjust dosages to accommodate St. John’s wort use, said Austin De La Cruz, PharmD, BCPP, a clinical pharmacist who treats mental health disorders. In addition, he teaches psychiatric treatment and over-the-counter medications at the University of Houston College of Pharmacy.

“It is definitely a gamble,” he said. “If you’re taking St. John’s wort with digoxin and switch to a different St. John’s wort brand that has lower amounts of active ingredient, that can lead to significant toxicity with digoxin.”

Birth Control and St. John’s Wort

Notably, since the majority of people reporting depressive symptoms are women, St. John’s wort seems to break down the contraceptive hormone ethinyl estradiol, a component of most estrogen-containing birth control, about twice as fast as when it is taken alone.

“There were also a number of unintended pregnancies because women taking oral birth control were not getting effective doses,” Hopp said of studies on the topic. “This isn’t fatal [the way organ failure is] but it is still a serious adverse event.”

Treating Accurately

For De La Cruz, all of this makes it hard for him to recommend St. John’s wort. He also pointed to a ban on sale of St. John’s wort in France and Ireland, and careful regulation in other countries as evidence of concern.

If people are interested in non-pharmacological approaches to depression, he recommends therapy. Cognitive behavioral therapy has been found to be more effective than antidepressants alone, he said, and carries no risk of side effects.

Then he’ll make sure patients are trying everything that drugs can’t address — like exercise, food and sleep habits — and light therapy lamps if the depression is seasonal.

“It’s important to identify if the depression can be managed by self-care,” De La Cruz said. For instance, a patient may only come in when they feel depressed, but they may also have bouts of mania. Using only St. John’s wort or an antidepressant could exacerbate manic episodes in bipolar disorder.

Besides, he said, 800,000 people die by suicide related to depression every year.

“Depression is a serious illness,” he said. “I have a hard time recommending St. John’s wort.”

NCCIH’s Hopp was less absolute. If you don’t take any of the medications that interact with St. John’s wort, its risk is essentially zero. But because it interacts with so many medications, people should tell their doctors they are taking it.

“It’s not that you can’t take St. John’s wort,” he said. “But it warrants a high level of extra care.”

Heather Boerner
Heather Boerner

Heather Boerner is a healthcare and medical journalist based in Pittsburgh. Her work has appeared in The Washington Post, The Atlantic, TheBody.com and the Daily Beast. Her book, Positively Negative: Love, Pregnancy, and Science’s Surprising Victory Over HIV, came out in 2014.

Many Children At Risk for Serious Drug-Drug Interactions

Nearly 20% of children have taken at least 1 prescription medication in the last month, and 7.5% took 2 or more, according to a new study. Researchers note that many children taking multiple drugs are at risk for major drug-drug interactions.

The study looked at data from the 2013-14 period of the National Health and Nutrition Examination Survey. The data was based on prescriptions for more than 23,000 children and adolescents. Prescription drug use was highest in adolescent girls (28%) followed by boys between the ages of 6 and 12 years old (26.5%), the researchers reported in the journal Pediatrics.

Overall, in adolescents between 13 and 19 years old, about 23% had taken a prescription drug in the last 30 days. In the 6-to-12 age group, 21% of children reported using a medication.

Respiratory drugs, such as those used for asthma and allergies, were the most commonly prescribed to children, followed by psychotherapeutic agents, which include drugs such as stimulants for ADHD (attention deficit/hyperactivity disorder) and antidepressants.

Researchers noted that 8.2% of children and adolescents taking more than 1 drug were at risk for a potentially serious drug-drug interaction, and the majority of those interactions were because of antidepressants. Put another way, 1 in 12 children face a potentially dangerous drug-drug interaction.

Data indicated that the percentage of children taking a prescription drug in the last 30 days has actually been declining since the 2005-06 period, when it was just over 25%.

Jonathan Block
Jonathan Block

Jonathan Block is MedShadow’s content editor. He has previously worked for Psychiatry Advisor, Modern Healthcare, Health Reform Week and The Pink Sheet.

Symptom or Side Effect? Why Doctors Too Often Choose A Over B

By Marlene Beggelman, MD
Right Care Alliance

Years ago, after I suffered a deep personal loss, my doctor prescribed Prozac, and I joined the millions of Americans who have taken an antidepressant. A few weeks later, I had my first panic attack -— heart racing, sweating profusely, gasping for breath —- sensations of terror normally reserved for life-threatening events. Attacks continued every half-hour and were so incapacitating that I could not even leave my house. My doctors were confounded. Perhaps the attacks were related to grieving, they thought.

It wasn’t until weeks later when a friend, a mental health nurse, showed me a study about Prozac that the situation became clear. The study described high rates of suicide in Prozac-takers who developed severe panic attacks on the drug, and it noted that it would take months for the drug to fully clear from the bloodstream for any side effects to resolve. Predictably, 3 months after stopping the drug, I never had another attack.

As both a patient and physician, the experience left me with questions.

  • Why didn’t my clinicians recognize the side effect?
  • Why did they choose a long-acting drug with common side effects when there were other, safer choices?
  • Why didn’t I do my homework before agreeing to this medication?
    • Clinicians often misdiagnose problems caused by medications, especially when patients take multi-drug combinations. In a 2007 study, when patients told their doctors they had symptoms that are widely known reactions to the drugs they were taking, almost half the doctors told them there was no connection. A typical report: the “doctor suggested it was (my) imagination” or that “it’s all in my head.”

      Why Side Effects Might Be Ignored

      There are various reasons that drug side effects might go unrecognized: the shrinking time physicians have to spend with patients; the fact that doctors receive lots of information about the benefits of drugs but not much on their dangers; and cognitive dissonance or denial about the negative effects that drugs can have.

      Cognitive dissonance, a universal human phenomenon, is based on the assumption that people want consistency between their expectations and reality, and twist their thinking into knots to make that happen. In the case of drug reactions, to preserve the notion that our efforts help rather than hurt, our impulse is to attribute the harm to something other than our intervention.

      But when doctors fail to connect symptoms to medications, not only do they fail to help their patients, but they also fail to report the side effects to the FDA. As a result, the FDA is likely underestimating the reactions, leading other doctors and patients to believe some drugs are safer than they are.

      We could all benefit from more efforts to correct widespread misperceptions that impede the recognition of side effects — beginning with the assumption that the safety profile of most medications is well understood.

      In fact, a high percentage of serious reactions have never even been investigated. Since drug reactions are often the cause of even the most frequent symptoms (such as fatigue, achiness, depression and cognitive dysfunction), medications should always be considered as a potential cause.

      How to Change the Thinking

      Patients may be the most reliable sources to report side effects. In fact, they are often the only information source about reactions to medications. Their observations deserve serious consideration.

      Federal money for drug research and safety has declined to the point that pharmaceutical companies now fund over 85% of all research, medical journal publications and medical conferences, where physicians receive much of their educational information –- a clear case of the fox guarding the chicken coop.

      Restoring federal funding to the National Institutes of Health to support more research on medications would go a long way to assure that accurate and unbiased information is available. If we want to change how doctors respond when patients with possible drug reactions walk through their doors, we also need to emphasize misdiagnosed side effects more in formal education and accreditation programs, such as continuing medical education, board certification and grand rounds.

      For their part, pharmaceutical companies could support impartial research creatively — for example, by pooling and distributing funds through independent third parties.

      A large-scale educational campaign such as the one that targeted smoking would increase public awareness and encourage direct patient reporting to the FDA when a side effect is suspected.

      Pharmacists have an important role to play here too, and could be the point of contact where FDA reporting is initiated. It’s easy to imagine a sign at the pharmacy counter that says, “Ask me about side effects.”

      It may also be time to expand our vision about how drug-safety research can be conducted. Social media provides a rich source of data, with hundreds of thousands of internet users communicating with each other monthly about their medication-related experiences. This “big data” source offers the massive number of data points required to understand the safety of multi-drug combinations — something that we currently know very little about.

      Recently, my friends’ 13-year-old developed the same problem I had experienced with Prozac, and missed school for several months as a result. The parents had not been informed about this relatively common side effect and, as in my case, months passed before the correct diagnosis was made.

      Almost 3 out of 5 Americans take a prescription medication and nearly 15% take 5 or more, while children are the fastest growing market for drug companies. With drug reactions already the third-leading cause of hospital deaths in the US, we desperately need more focused, sustained and unbiased research and education to put the brakes on what is already an epidemic of medication-driven catastrophes.

      This article was originally published by WBUR’s Commonhealth. It is republished with permission by the author.

      Marlene Beggelman, MD
      Marlene Beggelman, MD

      Marlene Beggelman, MD, is an internist in Cambridge, Mass., and a member of the Right Care Alliance, a network of health professionals, patients, religious and community groups who are working toward a society in which the right care is accessible by all.

Quick Hits: Troubled Birth Control Device, Antidepressants and Blood Clots & More

Bayer will stop selling its troubled permanent birth control device Essure by the end of the year. As of 2015, there were more than 17,000 adverse event reports worldwide associated with Essure, which looks like a tiny coil and is made of nickel. Bayer says it will no longer sell Essure because of financial reasons. The FDA responded to Bayer’s announcement noting that their own review of adverse event reports found there are certain risks associated with Essure. The risks include persistent pain, perforation of the uterus or fallopian tubes from device migration, abnormal bleeding and allergy or hypersensitivity reactions. In 2016, the FDA required a “boxed warning” be placed on Essure to alert women to these risks. Posted July 20, 2018. Via FDA.

Taking antidepressants along with having depression itself may be associated with a higher risk of potentially life threatening blood clots. Venous thromboembolism is a blood clot that develops in the leg, groin, arm, or heart. Researchers conducted a meta-analysis that included 8 observational studies involving VTE. An analysis of 3 studies that compared people with depression to those without it found those in the former group had a higher risk of developing VTE. And among antidepressants, those taking SSRIs (selective serotonin reuptake inhibitors) had the highest VTE risk among antidepressant classes. The researchers cautioned that the findings do not prove cause and effect and further studies are needed to demonstrate if the associations are causal and whether it is depression or antidepressant use or both which is responsible for an increase in VTE risk. Posted July 24, 2018. Via University of Bristol.

Adhering to a Mediterranean diet — one that is rich in fish, olive oil, nuts and vegetables — may help to lessen the severity of psoriasis. Researchers examined 3,557 people who’d reported that they had the inflammatory skin condition. Participants were asked about their diet and were given a score based on their adherence to a Mediterranean diet. A MEDI-LITE score of 0 meant no adherence to the diet, while a score of 18 meant full adherence. Patients with the most severe psoriasis had the lowest MEDI-LITE scores, the researchers reported. The diet may work to inhibit psoriasis because of the anti-inflammatory properties of foods in the diet. They are rich in dietary fiber, antioxidants and polyphenols — the latter two especially act to protect cells. Posted July 25, 2018. Via JAMA Dermatology.

Sarah Rosenthal
Sarah Rosenthal

Sarah Rosenthal is an intern at MedShadow. She is majoring in Biology and Society in the College of Agriculture and Life Sciences at Cornell University with a concentration in food, health, and sustainability, and minoring in Viticulture and Enology.

Antidepressants May Boost Risk of Death in COPD Patients

Older patients with COPD (chronic obstructive pulmonary disease) should take precautions when using certain antidepressants because they may increase the risk of death.

Researchers analyzed 28,360 new users of serotonergic antidepressants – such as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin norepinephrine reuptake inhibitors) – that had COPD and were aged 66 and older, then matched them to 28,360 non-users. SSRIs and SNRIs are among the most commonly prescribed antidepressants.

The results, published in the European Respiratory Journal, indicated that new users of these antidepressants have a 20% increased risk of death related to respiratory issues, as well as death overall compared to non-users of the medication.

Also, antidepressant use among those with COPD – a progressive lung disease characterized by breathlessness – was associated with a 15% increased risk of hospitalization and emergency room visits due to related symptoms. The results demonstrate a strong association, but not a definite cause and effect, the researchers caution.

According to lead author Nicholas Vozoris, MD, a respirologist at St. Michael’s Hospital in Toronto, the findings were not surprising because “there are biological reasons why antidepressants could lead to respiratory issues.

“These drugs can cause sleepiness, vomiting and can negatively impact immune system cells. This increases the likelihood of infections, breathing issues, and other respiratory adverse events, especially in patients with COPD.”

Researchers noted that the findings shouldn’t alarm COPD patients who are currently using antidepressants, but rather increase awareness among users and prescribers.

Alanna McCatty
Alanna McCatty

Alanna McCatty is founder and CEO of McCatty Scholars, an organization that devises and implements financial literacy programs for students to combat the nationwide issue of the loss of educational opportunity due to the ramifications of burdensome student debt. At MedShadow, she reports on new findings and research on the side effects of prescription drugs. She is a graduate of Pace University.

Can Cannabis Control Depression?

Untreated and inadequately controlled depression is a big problem. In 2016, 16.2 million American adults experienced at least one major depressive episode, according to the National Institute of Mental Health. Approximately 37% did not receive any kind of professional treatment –- no counseling, no antidepressants, no mental health evaluation. That’s nearly 6 million people living, working and parenting under a cloud of depression.

Additionally, somewhere between 10 and 30% of those who receive treatment for depression do not improve or only improve partially. Many eventually quit their antidepressant medication and therapy due to frustration.

Could cannabis help these patients? At least one doctor thinks so. Jordan Tishler, MD, a Harvard-trained internal medicine physician who currently serves as the president of the Association of Cannabis Specialists and treats patients via his private practice, Inhale MD, recommends cannabis as a substitute for or adjunct to prescription antidepressants.

“Cannabis can be a good substitute [for medication], but only under certain circumstances,” Dr. Tishler says.

Marijuana & Mood: What We Know – and What We Don’t

To date, scientific research regarding the effects of Cannabis sativa (marijuana) on mood have been mixed. Some studies suggest that marijuana usage has a negative impact on mood; that cannabis use over time can cause or worsen depression. Other studies suggest that cannabis can alleviate depression.

The problem with the research is that it’s incomplete. Under US federal law, marijuana is still a Schedule I drug and therefore subject to strict rules. Researchers can’t, for instance, give subjects cannabis. “The best they can do,” Dr. Tishler says, “is have them bring their own cannabis or talk about their cannabis use.”

Such studies don’t allow researchers to control or compare strains of cannabis, and make it difficult to accurately assess dosage. That’s a problem because “that’s exactly where the devil lies in this particular discussion,” Dr. Tishler says.

The only source of marijuana approved for medical studies is under control of the National Institute for Drug Abuse (NIDA) at the University of Mississippi. And it requires researchers to complete a mountain of paperwork just to have NIDA consider such a request.

One researcher who requested marijuana from NIDA — and was approved — is Sue Sisley, MD, the president and principal investigator at Phoenix’s Scottsdale Research Institute, arguably the nation’s foremost private research institute investigating medicinal uses of marijuana.

Sisley echoed Tishler’s concerns. Speaking at a panel on marijuana at the American Psychiatric Association Annual Meeting in New York City earlier this month, she mentioned one problem with NIDA’s marijuana once it arrived at her offices. The marijuana had not only the leaves, but stems and other parts that are considered non-therapeutic. In other words, much of the marijuana sent to her via FedEx was useless.

But that wasn’t the worst of it. Sisley added that she suspected the marijuana was bagged years ago and not stored under proper conditions in Mississippi, because mold was present.

A 2007 study published in the Journal of Neuroscience examined the impact of cannabis on rats, concluding that tetrahydrocannabinol, or THC, cannabis’ psychoactive chemical, has antidepressant effects at low doses. High doses of THC, however, can worsen depression, at least in rats.

Data on cannabis’ effect on human mood is sparse. “We don’t have clean data in patients with depression. We have data from people who suffer from multiple sclerosis or other diseases, such as epilepsy,” says Gabriella Gobbi, MD, PhD, CSPQ, a psychiatrist in the Mood Disorders

Program at the McGill University Health Centre in Montreal. In other words, some researchers who were assessing the effectiveness of marijuana to treat multiple sclerosis, epilepsy and other diseases asked subjects about the drug’s impact on their mood, but no one has formally studied cannabis as a treatment for depression.

“We need to do randomized clinical trials in people with depression,” Dr. Gobbi says. Such trials would compare cannabis versus a placebo, and assess the treatment’s effect on depressive symptoms.

Available human and animal studies suggest that adolescents and adults respond differently to cannabis. “In animal experiments, it’s very clear: Cannabis given during adolescence every day increases the risk of developing depression in adulthood,” Dr. Gobbi says. “If you start cannabis later in life, this risk to develop depression is less important.”

The Risks & Benefits of Using Cannabis to Treat Depression

Although cannabis is known for inducing euphoria, “it’s a relatively weak antidepressant,” Dr. Tishler says. Therefore, it’s not likely to be an effective stand-alone treatment for many people with depression. Cannabis can also trigger mania or psychotic episodes in people with bipolar depression or a family history of psychosis or bipolar depression.

Other risks of cannabis use include “the acute risk of impaired judgment and driving,” says Kevin Hill, MD, MHS, director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center and author of Marijuana: The Unbiased Truth About the World’s Most Popular Weed. Risks from chronic use, he says, include “worsening depression or even addiction.”

Dr. Tishler tries to control risks by carefully selecting patients for treatment. “If a patient comes in and says, ‘Doc, I’m on a starter dose of Zoloft (sertraline), 25 milligrams, and it’s working but I want to get off it because of side effects,’ then I think cannabis is reasonable substitution,” he says. “But if somebody is on a high dose – 100 milligrams or more –- then I don’t think it’s reasonable or responsible to try to do a substitution.” Instead, he might suggest cannabis as an adjunct to prescription antidepressant medication.

“Adding cannabis on top of a selective serotonin reuptake inhibitor (SSRI) can let some of the joy of life come back,” Dr. Tishler says. “The other thing we should mention is that SSRIs, generally speaking, are terrible for one’s libido. Cannabis is good for libido.”

Medical professionals agree that it is not a good idea to self-treat depression with cannabis. Dr. Tishler says that patients who are considering using cannabis should consult with a physician. “Even physicians who don’t know very much about cannabis, assuming they are open-minded to it, still know more about human biology and healthcare” than the clerk at the nearest weed shop, he says.

Dr. Hill says it’s critical for patients to discuss their mood openly with their physicians. “Decisions about how to treat depression should be made as part of a conversation between a patient and a doctor who knows them well,” Dr. Hill says. “Patients should collaborate with their physician to make sure that evidence-based treatments have been given a chance to work before turning toward treatments like cannabis that have no evidence behind them.”

Jennifer L.W. Fink

Jennifer L.W. Fink is a Registered Nurse-turned-freelance writer based in Wisconsin. Her work has appeared in The Washington Post, Parents, Cancer Today and Ladies’ Home Journal. Jennifer is also the founder and creator of BuildingBoys.net.

Can Using Dumbbells Help Alleviate Depression?

Resistance exercise training (RET) may significantly curb depressive symptoms, according to a study published in JAMA Psychiatry.

Though previous reviews have shown that exercise provides physical health benefits, the new study attempted to determine whether exercise — specifically resistance training — could combat or prevent mental health problems.

Researchers looked at 33 clinical trials that included 1,877 participants between 25 and 60 years old. Some of them were battling major or minor depression as well as generalized anxiety disorder. Over 16 weeks, the participants engaged in RET for 2 to 7 days per week.

Study results indicated that continuous resistance training — such as using free weights and weight machines — significantly reduced depressive symptoms in participants, regardless of their age, sex, and health status. The results indicated that RET can be considered an alternative and/or adjuvant therapy for depressive symptoms.

Alanna McCatty
Alanna McCatty

Alanna McCatty is founder and CEO of McCatty Scholars, an organization that devises and implements financial literacy programs for students to combat the nationwide issue of the loss of educational opportunity due to the ramifications of burdensome student debt. At MedShadow, she reports on new findings and research on the side effects of prescription drugs. She is a graduate of Pace University.

Quick Hits: Pregnant Moms and Antidepressants, Deaths Linked to Parkinson’s Drug & More

Mothers-to-be who take common SSRI antidepressants, such as Lexapro (escitalopram) and Prozac (fluoxetine), may unknowingly alter the brain development of their unborn child. Researchers from Columbia University Medical Center examined brain scans of nearly 100 newborns. Some of those babies were born to mothers who took SSRIs (selective serotonin reuptake inhibitors) while pregnant. The scans revealed that babies who were exposed to certain antidepressants while in the womb had alterations in both the gray and white matter of their brains. Researchers indicated that these alterations could ultimately increase the child’s risk of depression and anxiety. Alarmingly, the changes identified were “much greater than the brain changes or abnormalities associated with psychiatric disorders” that the researchers usually detect in children or adults. The study did not demonstrate cause and effect and did not test long-term consequences of the brain changes linked to antidepressant use during pregnancy. Posted April 9, 2018. Via JAMA Pediatrics.

The Parkinson’s disease drug Nuplazid may be responsible for hundreds of deaths. Nuplazid (pimavanserin), manufactured by Acadia Pharmaceuticals in San Diego, was created to regulate Parkinson’s disease psychosis. A CNN article reports that more than 700 patients have died after they started taking Nuplazid. A report from the non-profit Institute for Safe Medication Practices indicated that 244 patients who took the drug died between the drug’s launch in 2016 and March 2017. The FDA approved Nuplazid in 2016, and the agency classified the drug as a “breakthrough therapy” and granted a “priority review,” which sped up the review process. Posted April 9, 2018. Via CNN.

Increasing cigarette prices would curb extreme poverty and poor health around the world. According to an analysis, low-income people would benefit from the price increase the most. After examining 500 million male smokers in 13 countries, researchers discovered that a 50% price increase in cigarettes would lead to 67 million men abandoning cigarettes. Also, the price increase would allow 15.5 million men to dodge catastrophic health spending in the 7 out of 13 countries without universal health coverage. “A higher price would encourage cessation, lead to better health, and save money much more strongly for the poor than the rich,” said lead researcher Prabhat Jha, MD, DPhil, director of the Centre for Global Health Research of St. Michael’s Hospital. Posted April 11, 2018. Via BMJ.

Alanna McCatty
Alanna McCatty

Alanna McCatty is founder and CEO of McCatty Scholars, an organization that devises and implements financial literacy programs for students to combat the nationwide issue of the loss of educational opportunity due to the ramifications of burdensome student debt. At MedShadow, she reports on new findings and research on the side effects of prescription drugs. She is a graduate of Pace University.

Combining Migraine Meds With Antidepressants Safe

Taking certain migraine medications in combination with antidepressants does not increase the risk of serotonin syndrome, according to a new study published in JAMA Neurology. In 2006, the FDA issued an advisory about triptan migraine drugs being associated with serotonin syndrome when combined with selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), which are both a common class of antidepressants. However, researchers are suggesting that the advisory should be reconsidered based on new findings.

Over the course of 14 years, researchers analyzed over 47,000 people who were prescribed triptan migraine drugs. Out of that demographic, 21% to 29% of people took antimigraine meds and antidepressants at the same time.

The results indicated that serotonin syndrome was rare in patients who took antimigraine drugs in combination with SSRIs and SNRIs. Serotonin syndrome was suspected in 17 patients. Only 2 patients were classified as having definite serotonin syndrome, while 5 patients were classified as having possible serotonin syndrome. Based on the new findings, the researchers believe that the 2006 FDA advisory is invalid.

Alanna McCatty
Alanna McCatty

Alanna McCatty is founder and CEO of McCatty Scholars, an organization that devises and implements financial literacy programs for students to combat the nationwide issue of the loss of educational opportunity due to the ramifications of burdensome student debt. At MedShadow, she reports on new findings and research on the side effects of prescription drugs. She is a graduate of Pace University.