Experts in Prescription Drug Withdrawal
Anxiety medications may be tied to Alzheimer's Risk
(Amy Norton) - TUESDAY, Sept. 9, 2014 (HealthDay News) -- Older adults who habitually use sedatives for anxiety or insomnia may have a heightened risk of developing Alzheimer's disease, a new study suggests. The drugs in question are benzodiazepines, a widely prescribed group of sedatives that include lorazepam (Ativan), diazepam (Valium) and alprazolam (Xanax). Older adults commonly take the drugs for anxiety or insomnia, often long-term, according to background information in the study. That's despite the fact that guidelines call for only short-term use of the drugs, at most. In 2012, the American Geriatrics Society (AGS) put benzodiazepines on its list of drugs considered "potentially inappropriate" for seniors, because of risks like confusion, dizziness and falls. The current study isn't the first to link benzodiazepines to Alzheimer's risk, but it adds to evidence that longer-term use of the drugs -- beyond three months -- might be a risk factor, according to lead researcher Sophie Billioti de Gage, a Ph.D. candidate at the University of Bordeaux, in France. "For people needing or using benzodiazepines, it seems crucial to encourage physicians to carefully balance the benefits and risks when renewing the prescription," Billioti de Gage said. But the study was only able to find an association between the drugs and Alzheimer's risk. It wasn't designed to definitively prove that the drugs caused the memory-robbing condition, according to geriatrics specialist Dr. Gisele Wolf-Klein, who was not involved in the research. One reason is that the findings are based on prescription records. "We know the drugs were prescribed, but we don't know how often people took them, or if they took them at all," said Wolf-Klein, director of geriatric education at North Shore-LIJ Health System in New Hyde Park, N.Y. Regardless, she said, benzodiazepines have enough known risks to warrant concern. "There is absolutely no doubt these drugs have dangerous side effects," Wolf-Klein said. "It's important for people to understand that they can be addictive, and increase the risk of confusion and falls." The study was published online Sept. 9 in BMJ. For the study, Billioti de Gage's team examined the histories of nearly 1,800 older adults with Alzheimer's, comparing each one with four dementia-free people of the same age and sex. They found that people who'd been prescribed benzodiazepines for more than three months were 51 percent more likely to develop Alzheimer's, versus people who'd never used the drugs. The risk was almost doubled if they'd taken the medications for more than six months. According to Billioti de Gage, people in the early stages of Alzheimer's can have symptoms like sleep problems and anxiety. That raises the possibility that benzodiazepine use is the result of Alzheimer's, and not the cause of the disease. But she said her study was designed to counter this possibility. They only considered prescriptions that were started at least five years before a person's Alzheimer's diagnosis. Billioti de Gage said the medications can be useful short-term. And, she pointed out, the study found no increased Alzheimer's risk among older adults who were prescribed the drugs according to international guidelines; that means using them no longer than one month for insomnia, and no more than three months for anxiety symptoms. Dr. Malaz Boustani, who cowrote an editorial published with the study, said older adults have to be cautious about using the drugs, or any medication that can affect mental function. "We need to take the side effects of these medications much more seriously," said Boustani, an investigator with the Regenstrief Institute and the Indiana University Center for Aging Research in Indianapolis. According to the AGS, a number of drugs can cause older adults to feel groggy and confused. They include other types of sleeping pills, like zaleplon (Sonata) and zolpidem (Ambien); antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (AllerChlor, Chlor-Trimeton); and muscle relaxants. Both Boustani and Wolf-Klein suggested looking for non-drug therapies for sleep problems and anxiety -- partly because medications don't address the underlying problems. When an older person seems to have sleep problems, Wolf-Klein said, changes in routine may be all that's needed -- like avoiding caffeine or limiting liquids at night. When an anxiety disorder is the problem, Boustani said, cognitive behavioral therapy (talk therapy) is often effective. "The bigger message is that we need to take care of our brains," Boustani said. "And the first step is to do no harm." Read original article…
Z Drugs and the world of Ambien, Sonata and Lunesta
(Mathew Edlund) - The back of the alphabet is pushing for primacy. The masked avenger Zorro appeared in 1919; the remarkably popular Z cars television crime series transfixed Britain in the 1960s.
Now is era of Z drugs. Zolpidem, zaleplon, and eszopiclone - respectively named for the commercially minded ambien, sonata and lunesta - are today’s wildly popular sleeping pills culled from the older and still very commonly used benzodiazepines. The Z drugs have done more than take over the sleep by pill industry; they are now the leading cause of psychiatric adverse drug reactions.
The numbers come from large scale surveys done by the Centers for Disease Control in the years 2009-2013. Ambien is number one.
Last year Dan Kripke and colleagues reported these same Z drugs increased death rates in regular, daily users five fold. Scandinavian research puts the increased death rates as not quite as severe, but uniformly higher.
How Do Zs Work? The human information system possessed on cell surfaces many benzodiazepine receptors. Two prominent forms are found in the central nervous system (brain and spinal cord) while one version is located on nerve cells everywhere else. Plug a drug into those three receptors like a key into a lock, and people often become sedated, relaxed, less agitated, mellow. Thus was spawned the famous benzodiazepines (BZs) of the 1960s - valium, Librium, ativan and their many cousins.
Looking for the perfect Sleeping Pill, industry logically looked for drugs that would hit one or two but not all three BZ receptors. In the Z drugs, they found ones that hit only one receptor in the brain, producing quick sedation. Many billions of dollars in profit followed. So did reports of bizarre behavior plus falls, accidents and deaths.
Why The Trouble? There are probably many reasons. One is that hitting only one BZ receptor doesn’t appear to produce normal sleep. Some researchers describe the Z drugs’ effects as a sort of “pre-coma” which then allows the body to more quickly fall into sleep.
t’s the “pre-coma” part that begins creating problems. If you take drugs like ambien and don’t immediately get into bed, the “inbetween” states produced by these drugs - neither sleep nor wake - may cause very odd results.
My media favorite - the Calgary man who declared ambien made him sleepwalk to his refrigerator where he downed a quart of vodka and promptly drove his car into several accidents. A more recent example comes from a lovely woman I treat - a strict vegetarian - who woke up with hamburger in her teeth, having devoured her carefully packed husband’s lunch in a middle of the night. She had no idea how that hamburger got there.
Visit a group of sleep labs and you’ll find many of their adult sleepwalking episodes are linked to Z drugs.
A further difficulty arises from the supposed advantage of these medications - their short duration of action.
With a half life of one to two hours, ambien should be “out of your system” well before you awake. It’s gone, so there’s no problem, right?
Wrong. A previous drug company incarnation of such a “safe” short acting sleeping agent was the drug triazolam, or halcion. Several European governments banned it after it caused numerous psychotic reactions, particularly among the elderly.
Next - a further difficulty of these drugs is that they produce amnesia. People don’t know what they did “under the influence.” They can’t remember.
It’s also one of the reasons people feel they slept “well.” Drugs like ambien make people forget how often they woke up. So they feel as if they “slept through the night.”
Amazingly, despite the potential warning of short acting halcion, the FDA allowed a “smaller” dose of zolpidem/ambien to be marketed under the name “Intermezzo” for middle of the night insomnia.
If something provokes psychotic reactions, sleepwalking and higher death rates, taking a lower dose at 3 AM can’t be that bad, can it?
In 21st century America, sleep is not so natural. Human sleep used to be consist of three phases - first sleep, after lights out; second sleep, with perhaps an hour of musing following first sleep, ending with “final” waking around dawn; and third sleep, or what we call naps.
Of course that’s a fantasy for almost all of us. But drug companies like selling fantasies. And they will sell you the pills to fulfill the fantasy.
But as most of us know, living on fantasies sometimes provokes tragedies. Humans are not machines. If we treat our bodies as machines, we face peril.
The answer is much more interesting - getting people to use their wondrously regenerative bodies the way they’re actually built.
That means having a rhythm to the day, a time to move and a time to rest. To take the time and make the “effort” to rest before sleep. To not turn sleeping into a job. To recognize that sleep restores, refreshes, and literally rebuilds much of the body, beautifully and regeneratively.
You are partially reborn every morning you awake.
Sleeping certainly pills have their place, especially for brief use, for sleeplessness in times of storm and stress. But they don’t produce “normal” sleep. And the people who take them habitually, lured by the promise of “perfect sleep” should be carefully coaxed off of them, so that they can enjoy the astonishing merits of their normal regenerative activity.
It’s time to say goodbye to the equation pill=sleep. The public health costs - in money, emergency room visits, increased accidents and deaths, are too large.
And yes, there will be an apps for sleep - many apps. But the simplest trick is to rest before sleep.
That's what regeneration is all about. Read original article.
Longboat Key News | Mathew Edlund | Sept. 6, 2014
Alprazolam misuse still send tends of thousands to emergency room
(Donna Leinwand Leger) - Misuse of the popular sedative alprazolam, known by the trade name Xanax, sent more than 123,000 people to the emergency room in 2011, slightly fewer than the year before but more than double the number who went to the emergency room in 2005, a new report shows.
The report was issued Thursday by the Substance Abuse and Mental Health Services Administration.
More than 1.2 million people sought emergency care in 2011 for abusing prescription drugs, the SAMHSA's Drug Abuse Warning Network reported.
Alprazolam, also sold as Xanax XR and Niravam, was the most commonly prescribed psychiatric medication in 2011. It is used to treat anxiety, depression and insomnia.
"We're seeing growth in the number of people who are getting into trouble with these drugs," says Pete Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality. "Patients really need to be educated that if these drugs are misused, they can be really, really dangerous."
Taking the drug with other central nervous system depressants, such as prescription pain killers, can result in depressed breathing and heart rate, and a loss of consciousness, which can lead to death.
DAWN tracks non-medical use of prescription drugs, including taking more than the prescribed dose, taking a drug prescribed for someone else, deliberate poisoning and abuse.
In 2005, 57,419 people sought medical help after misusing Xanax, DAWN reported. In 2010, the number reached a high of 124,902, a 118% increase. In 2011, the number dropped slight to 123,744.
In 81% of the cases, the patient had used the Xanax in combination with other prescription drugs or alcohol, the report found. Nearly two-thirds of those patients used the drug with another prescription drug, including more than a third who used the drug with a prescription pain reliever such as oxycodone.
Nearly 52,000 patients used Xanax with two or more drugs. Of those patients, 85% combined the drug with other prescriptions, 46% used it with illicit drugs and 39% had alcohol. Read original article…
Donna Leinwand Leger | USA Today
Wake-up call: FDA lowers starting dose of sleep drug Lunesta, citing safety concerns
(Peter Eisler) - Seniors and prescription drugs: Hundreds of thousands of the nation's seniors are misusing prescription drugs, including narcotic painkillers, anxiety medications and other pharmaceuticals, for everything from joint pain to depression. As the problem has grown, so have the consequences, from treatment program admissions to emergency room visits and overdose deaths.
When Betty Van Amburgh began treatment last year for her addiction to prescription painkillers, she was told to bring along all her medication.
She arrived with a shopping bag - boxes of transdermal patches laced with fentanyl, a narcotic up to 100 times stronger than morphine; bottles of hydrocodone, another powerful opioid; packages of Xanax, an addictive sedative.
"They kept saying, 'How did you get so much?' " recalls Van Amburgh, 68, who'd been on an increasingly potent mix of medications since a series of back surgeries 20 years earlier. "The doctors just kept prescribing them. It was always, 'Do you have pain? Let me give you a prescription. ...' But I got addicted. I was a zombie."
Hundreds of thousands of the nation's seniors are misusing prescription drugs, spurred by a medical community that often is quick to offer narcotic painkillers, anxiety medications and other pharmaceuticals for everything from joint pain to depression. And despite a push by public health officials to slash dispensing rates, doctors are prescribing the highly addictive drugs at record levels.
By many measures - rising overdose deaths, a spike in emergency room visits, increasing admissions to addiction treatment programs - the toll on the senior community is enormous, a USA TODAY review of government data finds.
"There's this growing group of seniors, they have pain, they have anxiety … and a lot of (doctors) have one thing in their tool box - a prescription pad," says Mel Pohl, medical director at the Las Vegas Recovery Center, which treats seniors for pain and drug dependence. "The doctor wants to make their life better, so they start on the meds."
Over time, patients build up a tolerance or suffer more pain and they ask for more medication, Pohl says. "And without anyone necessarily realizing, it begins a downward spiral with horrible consequences."
Older brains and bodies are prone to drug complications, from falls and respiratory failure to cognitive problems and dementia. Yet studies project the number of seniors misusing pharmaceuticals will continue to grow, fueled by aging Baby Boomers and the medicate-first approach many doctors take in treating them.
BIG PROBLEM, BIG TOLL
To assess the scope and impact of the prescription drug problem among older Americans, USA TODAY studied data from an array of federal agencies and private firms. Key findings:
More prescriptions: The medical community is increasingly giving older patients prescriptions for two especially addictive drug classes: opioid pain relievers and benzodiazepines, psychoactive medications such as Xanax and Valium often used for anxiety. According to data collected from IMS Health, which tracks drug dispensing for the government, the 55 million opioid prescriptions written last year for people 65 and over marked a 20% increase over five years - nearly double the growth rate of the senior population. The number of benzodiazepine prescriptions climbed 12% over that period, to 28.4 million.
More misuse: In 2012, the average number of seniors misusing or dependent on prescription pain relievers in the past year grew to an estimated 336,000, up from 132,000 a decade earlier, according to survey data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Misuse is defined as using the drugs without a prescription or not as prescribed.
More damage: Among people 55 and older seeking substance abuse treatment from 2007-11, there was a 46% jump in the share of cases involving prescription narcotics, SAMHSA data show. Annual emergency room visits by people 65 and over for misuse of pharmaceuticals climbed more than 50% during that time, to more than 94,000 a year. And the rate of overdose deaths among people 55 and older, regardless of drug type, nearly tripled from 1999-2010, to 9.4 fatalities per 100,000 people, based on data from by the Centers for Disease Control and Prevention.
The misuse of prescription medication by seniors has the hallmarks of an "emerging epidemic," says Wilson Compton, a psychiatrist and deputy director of the National Institute on Drug Abuse, part of the National Institutes of Health. Both prescribers and patients need better education on the uses and risks of painkillers and psychoactive drugs, Compton says. "We have not focused as specifically on this older population as we might. ... It's a serious problem."
LIVES TAKEN OVER
Van Amburgh figures the doctors treating her back pain wanted to help; by the time she figured out that they were doing just the opposite, it was too late.
Through two decades of back pain, she saw general practitioners, orthopedists, pain specialists. Each would assess her drug regimen, maybe switch a narcotic, tweak a dosage.
"No one ever told me to cut back," she says.
Over time, Van Amburgh felt too foggy to drive, so she gave up her license. She grew isolated, distant from friends, even her two grown daughters. By last summer, she was sleeping through her cherished family vacations.
"For my husband, my family, I was non-existent," she says.
It's a common pattern - an older patient is medicated for a chronic problem, dosages escalate over time, leading to dependence. But different people take different paths.
Some are Boomers who grew up with drug use and never shook it. David Walsh, 62, a facilities services foreman in Boston, has struggled with substance abuse since his teens in the late '60s, including treatment for alcohol, cocaine and heroin. As he aged, he turned to opioid painkillers.
"It was mostly Percocet and Vicodin - I'd buy them off the street, steal them from my wife, my son, from friends' (medicine chests)," says Walsh, who completed treatment last fall. "And if I had an operation or something and the doctor didn't know I was an addict, I'd always ask for Vicodin."
Then there are the seniors who never touched drugs until they were prescribed late in life.
Retired dentist Keith Blair was put on narcotics in his mid-80s to treat back pain. His daughter, Marian Hollingsworth, says he initially was prescribed Percocet. Taking it left him too dazed to get out of bed. After moving to a hospital for back scans, doctors added powerful anti-psychotics to a mix of painkillers. He fell into a semiconscious state. Over the following weeks, as he bounced between two hospitals and a nursing home, his heart and kidney functions declined, then failed.
Blair died without returning home.
"All of these drugs were being given to him without our knowledge; nobody talked about the risks," says Hollingsworth, who later got her father's medical records and complained to the state health department that the medications were inappropriate. Some had "terrible side effects for someone with the (health) problems he had. ... This was stuff he never should have been given."
1 IN 4 OLDER ADULTS ON RISKY DRUGS
No other segment of the population is prescribed more drugs than seniors, and none faces higher risks of complications.
"The elderly take more prescriptions than other people partly because they have more (medical) conditions, (and) there are special concerns about prescribing to these people," says Leonard Paulozzi, a CDC epidemiologist specializing in drug-related injury. "Everybody needs more education about the use of these drugs, whether it's prescribers or patients."
About one in every four adults 50 and over use psychoactive medications - mostly opioids for pain and benzodiazepines for anxiety - according to research cited in a 2012 brief prepared by SAMHSA and the Administration on Aging. And because older bodies metabolize drugs less quickly, those medications tend to build up in their bodies.
The problem, according to Paulozzi and other experts, is that both types of drugs can cause disorientation and affect balance, compounding the risk seniors face of falling. And combining the two, which many physicians do, can depress respiratory function at high doses - a potentially fatal problem for older people, who often are weakened by other ills.
CDC data from 2010 show that 75% of pharmaceutical overdose deaths involved opioid painkillers, and nearly a third of those cases also involved benzodiazepines.
Yet the number of seniors using - and misusing - those drugs continues to climb.
"The problem really is being fueled by over-prescribing," says Andrew Kolodny, chief medical officer for Phoenix House, which runs scores of addiction treatment programs nationally, and president of Physicians for Responsible Opioid Prescribing.
Kolodny notes that the graying of the Baby Boomers has created a bubble of people inclined to seek drugs for chronic pain, menopause-related anxiety and other age-related afflictions. And patients who ask their doctors for narcotics are far more likely to get them prescribed - a phenomenon documented this year in a study in Medical Care.
Researchers see two underlying factors: Drug companies are aggressively marketing pain medications for older consumers, and physicians are treating more aging patients without proper training in addiction.
"Many physicians are not well trained on the consequences of using these drugs so widely," says Susan Foster, who heads policy research at CASAColumbia, a non-profit that studies strategies to prevent and treat addiction. "They're not attending to the fact that these are highly addictive substances that can cause a lot of complications for older patients."
WHEN IT'S TIME TO SAY 'NO'
Part of the challenge is determining which patients truly need prescription drugs - and how long they should stay on them.
Long-term treatment with opioids and benzodiazepines is widely accepted in some cases, especially for patients with certain cancers and end-of-life conditions, and there is debate on whether efforts to constrain prescribing might limit legitimate use of the drugs.
But multiple studies show that opioids lose their effectiveness as patients build tolerance and have little value as a long-term tool for managing chronic pain. Benzodiazepines, such as Valium, also are not considered effective for long-term use.
As those realizations have taken hold, fewer new patients are being introduced to those medications, says David Oslin, an addiction specialist and psychiatry professor at the University of Pennsylvania's Perelman School of Medicine. The bigger challenge is weaning elderly patients who were put on the drugs years ago.
"It's really hard to get them off," Oslin says. "And there's a stigma - people don't want to take away a 70-year-old's medications."
Van Amburgh's dependence on painkillers grew inescapable; when she forgot to put on a fresh fentanyl patch, she felt nauseated, feverish.
"I wanted my life back," she says.
She returned to her most recent doctor, who agreed that her course of pain medicine had become a concern, and she ended up in Pohl's Las Vegas treatment program. The withdrawal was gut-wrenching, but she emerged with less back pain than she had during all her years on narcotics - a common outcome among people who build a tolerance to opioids.
"They told me I'd be in less pain and I didn't believe them, but I'm like a new person," she says. "The thing that still pisses me off, though, is that nobody tried to take me off the drugs sooner. From one doctor to another to another, they just wrote more prescriptions.
"Really," she adds. "I think it was just ignorance." Read original article
Article by USA Today, written by Peter Eisler
4 Drug Combinations That Can be Accidentally Lethal
(Carrie Arnold) - Anti-depressants, painkillers, anti-fungals and muscle relaxants should be taken at the same time only with the most care. Here's some must-know information for anyone who fills, or takes, prescription drugs.
Nearly 28 percent of adults ages 20 to 59 hold multiple drug prescriptions at any given time, per Centers for Disease Control data. In some cases, double (or tripling) up is necessary-but the wrong combo could have critical consequences, says epidemiologist Leonard Paulozzi, M.D., M.P.H. Beware these potentially toxic matches, and always ask your doctor before mixing. And definitely check out our must-read article about accidental overdoses, a problem plaguing a scarily high number of women each year: The Silent and Growing Health Danger That All Women Need to Know About.
SSRIS + Opioids (antidepressants + painkillers)
Some antidepressants work by increasing brain levels of the “happy hormone” serotonin. Certain painkillers can have the same effect-leading to way too much of a good thing. Sky-high serotonin levels can cause agitation, high body temperature, and rapid heart and breathing rates.
Opioids + Benzodiazepines (painkillers + anti-anxiety meds)
Both types of drugs act as depressants, which can spell sweet relief if you’re super anxious or in serious pain-or super anxious about being in serious pain (think dental surgery). But the pills can also lower heart and breathing rates, sometimes too much.
Statins + Fluconazole (cholesterol-lowering drugs + antifungal medication)
Anyone who’s had a yeast infection (75 percent of you) is likely familiar with fluconazole. And statins are among the world’s most prescribed drugs, making this a highly likely duo that could cause muscle weakness or kidney damage.
Opioids + Benzodiazepines + Carisoprodol (painkillers + anti-anxiety meds + muscle relaxers)
Most M.D.’s know this combo could turn deadly. Yet a patient might still find herself taking all three-potentially prescribed by different doctors-if, say, she threw out her back and is fighting intense stress at work.
Prescription Drug Combinations to Avoid
It's pretty common to take multiple pills. Nearly as common are adverse drug-combo reactions like drowsiness and stomach problems. Check out drug compatibility before ingesting via your doctor or a reputable Web site such as medscape.com. Here are some misguided mixtures that women frequently make.
Antibiotics and Birth Control Pills
Although only one antibiotic (Rifampin) is proven to interfere with the effectiveness of the Pill, doctors still suggest using a backup contraceptive while on any antibiotic.
Antihistamines and Sleeping Pills
The combo keeps you sedated for too long and groggy the next day.
Vicodin and Tylenol
Both meds contain acetaminophen, putting you at risk for a potentially dangerous overdose.
Aspirin and Ibuprofen
When taken together, they raise the risk of gastrointestinal problems.
Certain Antidepressants and Migraine Meds
Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as Prozac and Paxil, are a bad mix with migraine meds like Imitrix and Zomig. The combo can lead to anxiety and muscle tremors. Read original article
Article by Carrie Arnold | Time
FDA-approved painkiller Zohydro 'will kill people'
(Arden Dier) - A new FDA-approved painkiller isn’t set to hit pharmacy shelves until next month, but critics are already warning it could kill - with just two pills.
Zohydro, which the FDA gave the green light in October against the advice of its advisory panel, will serve as a powerful pain pill for those who can’t get relief from what’s already out there.
It contains the same basic ingredient (hydrocodone) as Vicodin, but it has 5 to 10 times the power, Forbes notes, and without the added acetaminophen.
An expert on the advisory board who voted “no” tells NBC News that acetaminophen deters savvy addicts from loading up on Vicodin for fear of liver damage.
Like OxyContin, Zohydro is a “pure narcotic,” but unlike OxyContin, the Zohydro set to be released isn’t tamper resistant and can easily be crushed, then snorted or injected.
“In the midst of a severe drug addiction epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous, high-dose opioid,” some 40 experts wrote to the FDA in a call for Zohydro’s reevaluation.
“It’s a whopping dose of hydrocodone packed in an easy-to-crush capsule. It will kill people as soon as it’s released,” says one of those experts.
But one doctor points out that “it all depends on how doctors monitor it. It could be lifesaving. But if used the wrong way, like any medication, it can cause trouble.”
On that front, Forbes reports that experts say someone unaccustomed to opioids could overdose with as little as two pills, and that a single pill could kill a child. view article
Article by Arden Dier | Detroit Free Press
7 Drugs that can Kill your Child with a Single Pill
(Mildred Gladdis) - Allison Muller understands the dangers of pills that find their way into a toddler’s hands. As director of the Poison Control Center at the Children’s Hospital of Philadelphia, she knows that one to two tablets of certain medications can be lethal to a toddler.
So when her 1-year-old son had nearly swallowed a potentially dangerous pill, she said she “panicked.”
Upon arriving home from work, Muller learned from her husband that her infant son had found a pill on the floor and put it in his mouth.
“You can’t turn your back for a second, or he’s putting something in his mouth,” she said.
The pill turned out to be Tramadol, a medication known to increase the risk of seizure. She later learned that the pill had fallen out of the pocket of one of her friends who had visited her home recently.
Muller said that the episode showed her that even though she keeps the family’s medications in a locked tackle box, the threat of accidental ingestion remains.
Indeed, such cases are all too common, statistics suggest. According to the American Association of Poison Control Centers in 2002 there were 2.4 million toxic ingestions, and more than half of these occurred in children younger than 6. Children aged 18 to 36 months seemed to be at the highest risk, and in these little bodies, just one pill can be deadly.
Even more worrisome is the fact that, after taking some of these pills, a child can appear perfectly fine until it is too late.
“They may look OK for now, but they’re not,” said Dr. Henry Spiller, director of the Kentucky Regional Poison Center in Louisville. “Within two hours, we have seen patients go from ingestion to death — even after taking only one to two pills.”
A review paper published earlier this month in the journal Pediatric Emergency Medicine Practice outlined the risks of more than three dozen medicines that, the authors noted, could kill kids in a single swallow.
“People don’t know that just one of these pills can cause such bad problems in a child, but it’s true,” said Dr. Erica Liebelt, president of the American College of Medical Toxicology and a pediatric emergency physician at the University of Alabama in Birmingham.
Even parents who keep medicines out of their children’s reach are at risk of such an emergency; the Emergency Medicine Clinics of North America notes that in 50 percent of all childhood accidental poisonings, the medication bottle was only “out” for a short amount of time as it was being used.
Also, as in Muller’s case, a visitor might drop a pill. Or, as Dr. Carl Baum, a pediatric emergency physician and toxicologist at Yale University noted, “Kids find pills off the floor in a hotel room all the time. Parents bring them in having no idea what they took”.
For these reason, emergency medicine specialists urge, parents should recognize the high risk of accidental ingestions and be prepared to act. Call 911 immediately, experts say, or call the Poison Control Center at 1-800-222-1222. Parents should also be prepared to take their child to the hospital immediately, and they should bring the bottle of whatever the child took in the ambulance and to the ER. Importantly, new guidelines from the American Association of Pediatrics urge against the use of Ipecac or any other mechanism to induce vomiting.
Fortunately, once children are in the emergency room, doctors can rapidly respond, as some medications have antidotes, reversal agents or supportive therapy.
Here are seven of some of the more common medicines that, while useful or even life-saving for the patients who take them, can lead to emergencies when accidentally ingested by kids.
Category: Calcium channel blockers
Scientific names: Diltiazem, Verapamil, Amlodipine, Nifedipine
Brand names: Cardizem, Cartia, Norvasc
Indications: High blood pressure (hypertension), angina, atrial fibrillation
Symptoms in children: Dangerously low blood pressure and heart rate, seizures
For patients with heart issues, medications in this family are very commonly prescribed. They are used to treat a number of cardiac conditions, from high blood pressure to fast heart rates. However, in children, they can cause dangerously low blood pressure and heart rate, and even lead to shock.
Symptoms in children who ingest these medications usually show up one to five hours after they take the pill, but in the extended release pills, they may be delayed up to 14 hours — a fact that may make it even more difficult for the parent to figure out why the child is ill.
Spiller, of the Kentucky Regional Poison Center, said that he once treated a 2-year-old girl who, while being babysat by her grandmother, took between two and four of the woman’s Amlodipine (Norvasc) pills. Initially the toddler showed no symptoms, so it was 45 minutes before the family brought her to the hospital. When the girl became drowsy, they rushed her in _ but to no avail. Spiller said her blood pressure was already dangerously low, and within 45 minutes her heart rate plummeted. Eventually, her heart stopped.
“No matter what we did, we were not able to get back a blood pressure or any sort of rhythm,” Spiller said.
“All [calcium channel blockers] in kids are frightening to me,” Spiller said. “If they take them, and take enough, then you’re fighting against a hurricane. They are difficult to rescue.”
Category: Camphor-containing rubs
Scientific name: Camphor
Brand names: Vicks VapoRub, Ben-Gay, Tiger Balm, Save the Baby
Indications: Relieves muscle aches, itching, coughing, and fever blisters
Symptoms in children: Rapid development of seizures, delirium, coma, and death
Camphor is a very common product in over-the-counter products. It also has a very pungent odor and taste, which may make it seem like the last thing a toddler would try to eat.
But according to the AAPCC, in 2001 there were almost 8,000 cases of camphor ingestion in children younger than 6 years old. Camphor is especially dangerous because ingesting it works so quickly; symptoms occur within 10-20 minutes, and often children can go into seizures without any warning. Shortly after ingesting these rubs, children may become hyperactive and restless. The skin around their lips may become blue. In the worst cases, these symptoms can progress to seizures and, eventually, to coma and respiratory depression, in which they may stop breathing altogether. Unfortunately, the amount that it takes to send a child into this downward spiral is very small; toddlers have been known to have seizures within 10 minutes after eating only one to two teaspoonfuls, and even one teaspoon can be lethal.
Emergency medicine experts say that if you think your child has eaten one of these rubs or if you smell camphor on your child’s breath, do not wait for them to develop symptoms. The quicker you call 911, the better their chances of survival.
PRESCRIPTION PAIN MEDICATIONS
Category: Narcotic pain medications
Scientific names: Oxycodone, hydrocodone, methadone
Brand names: Oxycontin, Percocet, Vicodin and others
Indications: Alleviates pain
Symptoms in children: Sleepiness, which proceeds to lethargy. Can eventually stop breathing, which leads to death
Opiates, which are derived from opium, are ubiquitous in prescription pain medications today — a testament to their effectiveness. However, infants and children may be more susceptible to their effects than adults, putting them even more at risk. In fact, opiates and other pain medications, including acetaminophen, were the number one cause of medication-induced fatality from accidental ingestion in children younger than 6 in 2004, with the AAPCC counting 139 such deaths in that year alone.
“You have to be very careful about these medications,” the American College of Medical Toxicology’s Liebelt said. In her emergency room alone, she said, two toddlers have died from these pills in the past two years.
According to one study, 50 percent of toddlers who took two 5 mg tablets became rapidly ill within an hour. For an infant, even half of a tablet of hydrocodone can be lethal.
Sustained-release versions of these pills can be especially lethal, Spiller said, as they contain “such giant doses … which can be lethal for a child with no tolerance.” Spiller said that one 2-year old girl who was brought to his ER had taken two tablets of Oxycontin while her mom was answering the door. For four hours she had no symptoms -- and then she suddenly went into cardiac arrest.
Fortunately, paramedics often carry Naloxone, an antidote to these medications. When parents call 911, it is important that they tell the paramedics that your child took one of these pills, as they may be able to administer this treatment in the ambulance on the way to the hospital.
ASPIRIN AND OIL OF WINTERGREEN
Scientific names: Acetylsalicylic acid, methyl salicylate
Brand names: Bayer, Ecotrin and others
Indications: Alleviates muscle pain, prevents heart attacks, Oil of Wintergreen used for flavoring
Symptoms in children: Nausea, vomiting, agitation, seizures, lethargy, coma and death
This class of medication is very toxic to children in large doses, specifically in the high doses found in oil of wintergreen. Oil of wintergreen is particularly hazardous because its pleasant smell tempts toddlers to ingest it, but one teaspoon of oil of wintergreen is the equivalent of nearly 90 baby aspirins -- a life-threatening dose for a toddler or child.
Additionally, because aspirin is such a commonly used drug, most families are almost certain to have it in the home.
Children who have overdosed on these drugs may initially experience nausea, vomiting, and sweating. These symptoms can soon progress to swelling in the brain, coma and even death. Liquid formulations that contain salicylates are considered by emergency medicine experts to be even more dangerous, as their often concentrated form can lead to severe, rapid-onset toxicity. In many cases, as little as 4 ml in a child can be fatal.
Scientific names: Amitriptyline, imipramine, buproprion
Brand names: Elavil, Tofranil, Wellbutrin, Zyban
Indications: Treats depression, chronic pain and migraines, smoking cessation
Symptoms in children: Seizures, unresponsiveness and heart arrhythmias
After pain medications, antidepressants are the second highest cause of accidental death from poisoning in children younger than 6, according to the 2004 report by the AAPCC.
Symptoms can be delayed for up to six hours, after which children can develop anything from seizures to coma and life-threatening heart rhythms. Liebelt, of the American College of Medical Toxicology, pointed to one toddler who ingested her mother’s migraine medicine as the woman was preparing to take it. The child was later brought into the emergency department with lethargy and a dangerously low blood pressure after taking only one or two pills.
TOPICAL BLOOD PRESSURE PATCHES, EYE DROPS AND NASAL SPRAYS
Category: Topical Eye Drops, Nasal Sprays, and Blood Pressure Patches
Scientific names: Clonidine, oxymetazoline
Brand name: Afrin, Clear Eyes, Clonidine patch
Uses: Eye redness/itchiness, nasal congestion, glaucoma
Symptoms in children: Lethargy, low blood pressure, coma
These medications, designed to be absorbed over time through the skin, can lead to serious consequences when ingested by a toddler. Ever the explorers, children have been known to drink these sprays and eye drops, and they will even lick discarded medication patches. Symptoms from these ingestions can be delayed for four hours, but as little as 6 ml can lead to lethargy or coma, although death from this small of an amount is unlikely.
These dangers have been known for some time. In a case report published in the journal Clinical Toxicology in 1979, a 21-month old girl that developed a dangerously low heart rate and blood pressure and became comatose after taking a single 0.3 mg tablet. In another case report published in the journal Annals of Emergency Medicine in 1988, a 9-month-old boy sucked on a discarded Clonidine patch that had been worn for five days and thrown out. He became lethargic and developed a life-threateningly low blood pressure that required a stay in the intensive care unit.
Category: Diabetes Medications
Scientific Name: Sulfonylureas
Brand name: Glyburide, Glipizide
Uses: Diabetes management (non-insulin dependent, or Type 2)
Symptoms in children: Dangerously low blood sugar, coma, seizures
As these medications are more commonly prescribed, the incidence of pediatric poisonings has also increased, with over 2,500 occurrences in the United States in 2001. Children may not display signs of this until one to six hours later, but symptoms may last for 24 hours, so these children are often hospitalized for observation.
Not only are these medications dangerous for a child that is not diabetic, children have less energy stores in their livers than adults do, making them more susceptible to the effects. They may develop sleepiness, confusion, headache and seizures -- and some children have developed permanent brain damage and even died.
Spiller said he once took care of a young boy who began having seizures after taking one of these pills. Upon arriving in the emergency department, the child was paralyzed on one side. He improved after treatment, but the paralysis lasted for over 18 hours. Fortunately, sulfonylurea poisoning has a “rescue;” giving these children glucose can save their lives. Read original article
Article by Mildred Gladdis | News Talk WCHB Detroit
Why you may not need the flu shot
(October 10, 2013) - Flu season is just around the corner, and the flu shot debate has already begun to create quite the frenzy on social media outlets: To get or not to get a flu shot. As a physician, I'm often asked my opinion on the subject. The issue with vaccinations is very complex. It’s highly individualized and dependent upon your genetics, your current health status, and of course, your own beliefs.
As a functional medicine physician, my goal is get to the root cause and correct any underlying health issues so that you have a solid foundation to fight off any kind of infection, including the flu. Before you run out to the corner of happy and healthy and get your flu vaccine, lets look at the actual ingredients in these vaccines, their effectiveness in preventing illness, your legal rights, and natural alternatives.
Is the Influenza Vaccine Effective?
According to a study in 2008, the influenza vaccine was only 59% successful and benefited only 36% of the healthy children over the age of 2 who received it. Another study from 2008 indicated that the number of children’s doctor visits or hospitalizations did not differ between vaccinated and non-vaccinated children measured over two consecutive flu seasons, suggesting that the influenza vaccine had very little effect on children’s overall health status. Additional studies show that flu vaccines do not prevent influenza transmission to the patients of healthcare workers.
What’s in a flu shot?
-egg protein (cell culture)
-polysorbate 80 (stabilizer)
-aluminum salts (adjuvants)
-formaldehyde (inactivating ingredient)
-penicillin/sulfa drugs (antibiotics)
The manufacturing of the flu vaccine begins with an egg protein, which is used to grow enough virus to make the vaccine. Next, formaldehyde is added to kill the virus, and small doses of antibiotics are included to prevent any bacterial contamination of the vaccine during the manufacturing process. Thimerosal is added as a preservative to prevent any further contamination, and sucrose, polysorbate 80, or gelatin is added to stabilize the vaccine for transportation and storage. Finally, aluminum salts are added in order to help stimulate an immune response to the “dead” virus.
Many of these ingredients are known carcinogens and detergents that have harmful or unknown effects on the human body. Package inserts for Fluarix and Fluvirin even state that they are uncertain as to whether or not your fertility will be affected by the vaccine.
Formaldehyde is a powerful chemical used as a disinfectant and preservative in mortuaries and medical labs. It is listed as a human carcinogen in the 12th Report on Carcinogens published by the National Toxicology Program.
Studies have demonstrated that thimerosal can contribute to the development of autoimmune diseases by suppressing the overall immune system and causing system inflammation.
Polysorbate 80 is a detergent used to help drugs and chemicals cross the blood-brain barrier. Unfortunately, this stabilizer is also used to treat chronic kidney failure and can contribute to liver toxicity. Polysorbate 80 was also shown to cause “severe non-immunologic anaphylactoid reactions” in this study from 2005.
Aluminum is a recognized neurotoxin that can adversely affect the central nervous system and cause cognitive deficiency and dementia if it enters the brain. Numerous studies have linked aluminum to Alzheimer’s disease.
The antibiotics hidden in the flu vaccine include neomycin, streptomycin, or penicillin, which can cause severe allergic reactions in many people. (Not to mention that the overuse of antibiotics can increase your risk for gut infections, like Candida overgrowth.)
Who may need a flu shot?
There is quite a quandary surrounding recommendations for immunocompromised individuals (such as those with autoimmune disease who are on immune-suppressing medications). The original thought was that they would be at higher risk of getting the flu and would benefit from getting vaccinated.
However, recent studies have shown that the flu vaccine is less effective in these immunocompromised individuals. Given that thimerosal has been implicated in triggering autoimmune disease and that those with autoimmune diseases are three times more likely to develop another autoimmune disease, it would seem that the risk of getting a flu vaccine far outweighs any potential benefits.
Certainly those with chronic lung diseases like cystic fibrosis, asthma, or COPD may want to weigh the risk with the benefits.
Functional Medicine Approach to Preventing the Flu:
1. Wash your hands frequently and thoroughly.
This is the number one way to prevent the flu and other respiratory infections. You must scrub your hands thoroughly with soap and water for at least 20 seconds in order to kill viruses. Twenty seconds is about how long it takes to sing the ABC’s one time through. Do not touch your eyes, nose, or mouth without first washing your hands.
2. Heal your gut.
Your gut is the gateway to health, and 80% of your immune system is located in your gut. Make sure your gut is in tip-top shape and take a high quality, multi-strain probiotic with at least 25 billion units.
3. Reduce alcohol and sugar consumption.
Even moderate alcohol consumption suppresses the central nervous system, and therefore your immune system. Consuming too much sugar can suppress the immune system and make it more difficult for your body to fight off infections like the flu.
4. Reduce your stress.
Stress is known to suppress our immune systems. Consider meditation, yoga, or acupuncture for additional relaxation techniques.
5. Get 7-9 hours of sleep every night.
Your body relies on sleep to recuperate from daily exposure to toxins. Chronic sleep deprivation can significantly reduce immune function.
6. Consider supplementing your diet.
-Take glutathione, turmeric, and vitamin C
-Optimize vitamin D
-Consider a zinc supplement.
-Take an immune booster.
Glutathione, turmeric, and vitamin C are all powerful antioxidants that support optimal immune function. Vitamin D is known to be a powerful immune system modulator, and zinc is required for the gene regulation and function of immune cells, like neutrophils, natural killer cells, and lymphocytes. You can also enhance your immune system by taking an Immune Boost supplement, comprised of immunoglobulins and immuno-proteins to help your immune system fight off any kind of infection.
7. Get plenty of exercise.
Exercise can boost your immune system by increasing your circulation and relieving stress. Increased circulation allows antibodies to travel throughout your bloodstream faster, making it easier for your immune system to fight off an illness. Exercise can also enhance your immune system by relieving stress and slowing the release of stress hormones in the body.
What about Vaccine Mandates?
Often employees and healthcare workers are told that they must receive a flu vaccination. It is imperative that you understand your legal rights concerning this issue. There are a number of options available to you if you wish to oppose these vaccine mandates from your employers.
Options for Opposing Vaccine Mandates:
-Ask to wear a mask instead
-Claim medical, religious or union exemption
-Sign a petition
-Write a persuasive letter
Dr. Tenpenny, an outspoken advocate for free choice in healthcare, wrote a template letter explaining why flu vaccines should not be mandatory.
I personally was working as an emergency physician a pediatric emergency department during swine flu and flu season. I was told I was required to get both vaccinations. Knowing my history of autoimmune thyroid disease and my MTHFR genetic mutations, I simply asked my employer if there was an alternatives to the vaccinations. Mutations on the MTHFR gene prevent the body from properly clearing out toxins like mercury, which is found in the flu shot. (One mutation means that your body can clear about half of the toxins that enter your body. Two mutations mean that your body has a very difficult time clearing toxins from your system.) This can lead to heavy metal toxicity or in some cases, the development of an autoimmune disorder. We agreed that I could skip the vaccination in exchange for wearing a respiratory mask during all my shifts.
If you do elect to receive a flu shot, I highly recommend a thimerosal-free vaccine, which are available in a limited supply. If you don’t already know your MTHFR gene mutations, I would definitely get them checked. If you have any mutations at this gene, it's difficult for your body to eliminate mercury from your system, even in trace amounts.
I'd also caution you against taking any over-the-counter pain medications, such as Tylenol, Advil, or aspirin, in conjunction with your vaccine. These have been shown to reduce the effectiveness of vaccines by limiting your body’s proper immune response.
Once again, the decision to receive vaccinations of any kind is highly individualized. My goal, as always, is to empower you with the knowledge to make the best and most informed decision you can for yourself and your health. Read original article…
Written by Dr. Amy Myers, Article reprinted from mindbodygreen.com
Certain Antidepressants may increase diabetes risk
(September 26, 2013) - Researchers at the University of Southampton found that people taking antidepressants may be at a higher risk for developing a metabolic disease. However, the study authors note that they are not completely certain at this time if the medications is responsible for an increased risk of all metabolic health conditions, such as diabetes.
The study reviewed previous findings from 22 studies and three systematic reviews that show the effects of antidepressants on diabetes risk.
Their findings suggest that those taking antidepressants could be at a higher risk for diabetes. However, various medications may determine how high the risk is based on certain side-effects involved.
Obvious reasons that might cause an increased risk of diabetes involving several types of antidepressants may be due to the fact that significant weight gain can be a side-effect.
These and other recent findings show that doctors should be particularly vigilant when prescribing antidepressants.
"Antidepressants are used widely in the UK, with a significant increase in their use recently. Our research shows that when you take away all the classic risk factors of type 2 diabetes; weight gain, lifestyle etc, there is something about antidepressants that appears to be an independent risk factor. With 46 million prescriptions a year, this potential increased risk is worrying. Heightened alertness to the possibility of diabetes in people taking antidepressants is necessary until further research is conducted," Dr. Katharine Barnard, Health Psychologist from the University of Southampton said, via a news release.
More information regarding the findings can be seen via the journal Diabetes Care. read original article
written by Kathleen Lees, Science World Report
Gut feelings: the future of psychiatry may be inside your stomach
(September 26, 2013) - Researchers at the University of Southampton found that people taking antidepressants may be at a higher risk for developing a metabolic disease. However, the study authors note that they are not completely certain at this time if the medications is responsible for an increased risk of all metabolic health conditions, such as diabetes.
The study reviewed previous findings from 22 studies and three systematic reviews that show the effects of antidepressants on diabetes risk.
Their findings suggest that those taking antidepressants could be at a higher risk for diabetes. However, various medications may determine how high the risk is based on certain side-effects involved.
Obvious reasons that might cause an increased risk of diabetes involving several types of antidepressants may be due to the fact that significant weight gain can be a side-effect.
These and other recent findings show that doctors should be particularly vigilant when prescribing antidepressants.
"Antidepressants are used widely in the UK, with a significant increase in their use recently. Our research shows that when you take away all the classic risk factors of type 2 diabetes; weight gain, lifestyle etc, there is something about antidepressants that appears to be an independent risk factor. With 46 million prescriptions a year, this potential increased risk is worrying. Heightened alertness to the possibility of diabetes in people taking antidepressants is necessary until further research is conducted," Dr. Katharine Barnard, Health Psychologist from the University of Southampton said, via a news release.
More information regarding the findings can be seen via the journal Diabetes Care. read original article
Her parents were running out of hope. Their teenage daughter, Mary, had been diagnosed with a severe case of obsessive-compulsive disorder (OCD), as well as ADHD. They had dragged her to clinics around the country in an effort to thwart the scary, intrusive thoughts and the repetitive behaviors that Mary felt compelled to perform. Even a litany of psychotropic medications didn't make much difference. It seemed like nothing could stop the relentless nature of Mary's disorder.
Their last hope for Mary was Boston-area psychiatrist James Greenblatt. Arriving at his office in Waltham, MA, her parents had only one request: help us help Mary.
Greenblatt started by posing the usual questions about Mary's background, her childhood, and the onset of her illness. But then he asked a question that no psychiatrist ever had: How was Mary's gut? Did she suffer digestive upset? Constipation or diarrhea? Acid reflux? Had Mary's digestion seemed to change at all before or during her illness? Her parents looked at each other. The answer to many of the doctor's questions was, indeed, "Yes."
That's what prompted Greenblatt to take a surprising approach: besides psychotherapy and medication, Greenblatt also prescribed Mary a twice-daily dose of probiotics, the array of helpful bacteria that lives in our gut. The change in Mary was nothing short of miraculous: within six months, her symptoms had greatly diminished. One year after the probiotic prescription, there was no sign that Mary had ever been ill.
Her parents may have been stunned, but to Greenblatt, Mary's case was an obvious one. An imbalance in the microbes in Mary's gut was either contributing to, or causing, her mental symptoms. "The gut is really your second brain," Greenblatt said. "There are more neurons in the GI tract than anywhere else except the brain."
Greenblatt's provocative idea - that psychiatric woes can be solved by targeting the digestive system - is increasingly reinforced by cutting-edge science. For decades, researchers have known of the connection between the brain and the gut. Anxiety often causes nausea and diarrhea, and depression can change appetite. The connection may have been established, but scientists thought communication was one way: it traveled from the brain to the gut, and not the other way around.
But now, a new understanding of the trillions of microbes living in our guts reveals that this communication process is more like a multi-lane superhighway than a one-way street. By showing that changing bacteria in the gut can change behavior, this new research might one day transform the way we understand - and treat - a variety of mental health disorders.
For Greenblatt, this radical treatment protocol has actually been decades in the making. Even during his psychiatric residency at George Washington University, he was perplexed by the way mental disorders were treated. It was as if, he said, the brain was totally separate from the body. More than 20 years of work treating eating disorders emphasized Greenblatt's hunch: that the connection between body and mind was more important than conventional psychiatry assumed. "Each year, I get more and more impressed at how important the GI tract is for healthy mood and the controlling of behavior," Greenblatt said. Among eating disorder patients, Greenblatt found that more than half of psychiatric complaints were associated with problems in the gut - and in some patients, he says he has remedied both using solely high-dose probiotics, along with normalizing eating.
Greenblatt's solution might strike us as simple, but he's actually targeting a vast, complex, and mysterious realm of the human body: around 90 percent of our cells are actually bacterial, and bacterial genes outnumber human genes by a factor of 99 to 1. But those bacteria, most of which perform helpful functions, weren't always with us: a baby is essentially sterile until it enters the birth canal, at which point the bacteria start to arrive - and they don't stop. From a mother's vaginal microbes to hugs and kisses from relatives, the exposures of newborns and toddlers in their earliest years is critical to the development of a robust microbiome.
In fact, recent research suggests that early microbiome development might play a key role in at least some aspects of one's adult mental health. One 2011 study out of McMaster University compared the behaviors of normal eight-week-old mice and mice whose guts were stripped of microbes. Bacteria-free mice exhibited higher levels of risk-taking, and neurochemical analysis revealed higher levels of the stress hormone cortisol and altered levels of the brain chemical BDNF, which has been implicated in human anxiety and depression. "This work showed us that anxiety was normal, and that the gut-brain axis was involved in that," Jane Foster, the study's lead author, said. "Everybody knew that stress and anxiety could lead to gastrointestinal symptoms, but we looked at it from the bottom up and showed that the gut could communicate with the brain. It was the first demonstration that the gut itself could influence brain development."
Subsequent research out of McMaster further enforces those findings, by showing that swapping one mouse's gut bacteria with that of another can significantly alter behavior. Researchers transplanted microbes from one group of mice, which were characterized by timidity, into the guts of mice who tended to take more risks. What they observed was a complete personality shift: timid mice became outgoing, while outgoing mice became timid. "It's good evidence that the microbiota houses these behaviors," Foster said.
While researchers have established a compelling link between gut bacteria and mental health, they're still trying to figure out the extent to which the human microbiome - once it's populated in early childhood - can be transformed. "The brain seems to be hardwired for anxiety by puberty and early adolescence," Foster said. If the microbiome is part of that hardwiring, then it would suggest that once we pass a certain threshold, the impact of bacterial tweaks on problems like depression and anxiety might wane.
In one Japanese study, for instance, researchers were only able to change the baseline stress characteristics of germ-free mice until nine weeks of age. After that, no variety of bacterial additions to the mice's guts could properly regulate stress and anxiety levels. The explanation for this phenomenon might lie in what's known as "developmental programming" - the idea that various environmental factors, to which we're exposed early on, greatly determine the structure and function of organs including the gut and the brain.
"There are changes that happen early in life that we can't reverse," said John Cryan, a neuroscientist at the University of Cork in Ireland and a main investigator at the Alimentary Pharmabiotic Centre. "But there are some changes that we can reverse. It tells us that there is a window when microbes are having their main effects and, until this closes, many changes can be reversed."
Even if our gut bacteria carries the biggest influence when we're young, experts like Greenblatt and Cryan are still convinced that tweaking these bacteria later in life can yield profound behavioral and psychological changes. In a study led by Cryan, anxious mice dosed with the probiotic bacterium Lactobacillus rhamnosus (JB-1) showed lower levels of anxiety, decreased stress hormones, and even an increase in brain receptors for a neurotransmitter that's vital in curbing worry, anxiety, and fear.
John Bienenstock, a co-author on that study, compared the probiotics' effects to benzodiazepines like Valium and Xanax. "The similarity is intriguing. It doesn't prove they both use the same pathway [in the brain], but it's a possibility."
Although plenty of questions remain, the benefits of using probiotics to treat human behavior are becoming increasingly obvious. Yogurts like Dannon's Activia have been marketed with much success as a panacea for all of our intestinal ills. Other probiotic supplements have claimed to support immune health. Probiotics' potential to treat human behavior is increasingly apparent, but will manufacturers one day toss an anxiety-fighting blend into their probiotic brews?
It's a distinct possibility: in one 2013 proof-of-concept study, researchers at UCLA showed that healthy women who consumed a drink with four added probiotic strains twice daily for four weeks showed significantly altered brain functioning on an fMRI brain scan. The women's brains were scanned while they looked at photos of angry or sad faces, and then asked to match those with other faces showing similar emotions.
Those who had consumed the probiotic drink showed significantly lower brain activity in the neural networks that help drive responses to sensory and emotional behavior. The research is "groundbreaking," Cryan said, because it's the first trial to show that probiotics could affect the functioning of the human brain. Still, he notes that the results need to be interpreted with care.
As the research community increasingly lends credence to Greenblatt's ideas, and public awareness about gut bacteria grows, he's confident we'll soon know more about the power of probiotics. "Because of the commercials and the other information that's out there, patients are beginning to ask," he said. "They're much more aware of how important probiotics are."
Whether all of our mental woes respond to probiotic treatment as dramatically as Greenblatt's patient Mary remains to be seen. "We have to be very cautious in this field not to be too hyperbolic about what we promise," Cryan said. Indeed, scientists still aren't sure exactly which microbial species are part of a healthy microbiome, nor do they know whether certain bacterial strains are absolutely vital to mental functioning, or whether the right balance is what's key. Furthermore, research still hasn't parsed which illnesses might be affected by the microbiome and, therefore, treatable using probiotics. "There are beginning to be suggestions that this type of probiotic treatment is worth pursuing," Bienenstock said. "Whether we can use this to improve people's lives, well, the door is just beginning to open on this." read original article
article by Carrie Arnold | The Verge
Overdose Epidemic. Steps to reduce opiod deaths in women
(July 17, 2013) - Between 1999 and 2010, there has been a five fold increase in the number of prescription painkiller overdose deaths among women. "Prescription painkillers" refer to opioid pain relievers, such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone.
According to a recent Vital Signs report released by the CDC, there have been nearly 48,000 deaths since 1999 - with 6,600 deaths occurring in 2010 alone. The percentage increase in deaths was far greater in women showing a >400% increase compared to 265% in men. This rise is related closely to the increased prescribing of these drugs during the past decade.
RELATED: Opioids With Abuse Deterrent Properties
The CDC analyzed data from the National Vital Statistics System (1999 - 2010) and the Drug Abuse Warning Network public use file (2004 - 2010). Data included emergency department visits and deaths related to drug misuse/abuse and overdose, as well as analyses specific to prescription painkillers. Basic findings included:
- About 42 women die every day from a drug overdose
- There were four times more deaths among women from prescription painkiller overdose than for cocaine and heroin deaths combined in 2010
- Women ages 45–54 have the highest risk of dying from a prescription painkiller overdose
Studies have shown that women are more likely to suffer from chronic pain, be prescribed prescription painkillers, be given higher doses, and use them for longer periods than men. Women also may be more likely than men to engage in “doctor shopping” (receiving a prescription for a controlled substance from multiple providers), and more likely to be prescribed opioid pain relievers combined with sedatives.
RELATED: Pain Management Resource Center
"Our goal and work with partners is to make sure they are being used in the right patients and right quantities and right dose," stated Christopher Jones, PharmD, MPH, health scientist at the CDC.
Some steps that health care providers can take when treating women include:
1. Recognizing that women can be at risk of prescription drug overdose - it's not just a problem among men.
2. Screening and monitoring for substance abuse and mental health problems.
3. Prescribing only the quantity needed based on appropriate pain diagnosis.
4. Using patient-provider agreements combined with urine drug tests for people using long-term prescription painkillers.
5. Teaching patients how to safely use, store, and dispose drugs.
6. Using their states' prescription drug monitoring program (PDMP) to help identify patients who may be improperly using opioids and other drugs. PDMP is a statewide electronic database which collects designated data on controlled substances dispensed in the state.
7. Discussing pain treatment options, including ones that do not involve prescription drugs.
8. Discussing the risks and benefits of taking prescription painkillers including when painkillers are taken for chronic conditions.
9. Discussing treatment options for pregnant women dependent on prescription painkillers (eg, opioid agonist therapy).
10. Avoiding prescribing combinations of prescription painkillers and benzodiazepines (eg, Xanax (alprazolam) and Valium (diazepam) unless there is a specific medical indication. Benzodiazepines can potentiate CNS depression when combined with opioids - consider reducing opioid doses by at least one-half.
"Health care providers can help improve the way painkillers are prescribed while making sure women have access to safe and effective pain treatment," stated Linda C. Degutis, DrPH, MSN, director of CDC's National Center for Injury Prevention and Control.
Tom Frieden, MD, MPH, director of the CDC concluded, “The bottom line here is that prescription opioid deaths among women have skyrocketed in the past decade. Stopping the epidemic is everyone's business and can be done." - Read original article
Article from MPR | July 17, 2013
70 Percent of Americans on Prescription Drugs
(June 19, 2013) Rochester, Minn. (CBS ATLANTA) - Researchers find that nearly 70 percent of Americans are on at least one prescription drug, and more than half receive at least two prescriptions.
Mayo Clinic researchers report that antibiotics, antidepressants and painkiller opioids are the most common prescriptions given to Americans. Twenty percent of U.S. patients were also found to be on five or more prescription medications.
The study is uncovering valuable information to the researchers about U.S. prescription practices.
“Often when people talk about health conditions they’re talking about chronic conditions such as heart disease or diabetes,” Dr. St. Sauver stated in a Mayo Clinic press release. “However, the second most common prescription was for antidepressants - that suggests mental health is a huge issue and is something we should focus on. And the third most common drugs were opioids, which is a bit concerning considering their addicting nature.”
Nearly one in four women ages 50-64 were found to be on an antidepressant, with 13 percent of the overall population also on antidepressants. Seventeen percent of people in the study were being prescribed antibiotics, and 13 percent were on painkilling opioids.
As a whole, women and older adults received the most prescription drugs. Antidepressants and opioids were most common among young and middle-aged adults.
The percentage of people who took at least one prescription drug in the past month increased from 44 percent in 1999-2000 to 48 percent in 2007-08, the Mayo Clinic reports. Expenditures on prescription drugs reached $250 billion in 2009, and accounted for 12 percent of total personal health care expenditures.
According to the CDC, the percent of persons using at least one prescription drug in the past month increased nearly 50 percent between 2007 and 2010.
And the researchers said prescription drug spending will only increase in the future. Read original article
Article from CBS News Atlanta
"ADHD is a prime example of a fictitious disease"
These were the words of Leon Eisenberg, the “scientific father of ADHD (Attention Deficit Hyperactivity Disorder),” in his last interview before his death.
Leon Eisenberg made a luxurious living off of his “fictitious disease,” thanks to pharmaceutical sales. Coincidentally, he received the “Ruane Prize for Child and Adolescent Psychiatry Research. He has been a leader in child psychiatry for more than 40 years through his work in pharmacological trials, research, teaching, and social policy and for his theories of autism and social medicine,” according to Psychiatric News.
Yes, it was even admitted that they are his THEORIES. The medical industry is using the guise of helping children to depersonalize and disconnect our children from a healthy, normal upbringing. Parents are placing their children on these drugs and subjecting them to what the world has to offer, when in fact all these children are looking for is their parents in hopes of being the blessing that God intended them to be.
In the United States, 1 out of 10 boys among 10-year-olds takes medication for ADHD on a daily basis... with increasing tendency. And with the help of Teen Screen surveys in public schools, they are attempting to set up the student for the fall.
American psychologist Lisa Cosgrove and others reveal the facts in their study “Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry.” They found that “Of the 170 DSM panel members 95 (56 percent) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies.”
And they are reaping major benefits off of this “fictitious disease.”
For example, the assistant director of the Pediatric
Psychopharmacology Unit at Massachusetts General Hospital and associate professor of Psychiatry at Harvard Medical School received “$1 million in earnings from drug companies between 2000 and 2007.”
Marc-Andre Gagnon and Joel Lexchin, a long-time researcher of pharmaceutical promotion, performed a study which shows that the U.S. pharmaceutical industry spent 24.4 percent of the sales dollar on promotion, versus 13.4 percent for research and development in 2004. That is almost twice as much money on pushing their drugs on the people than research to make sure it is safe!
This raises the following question: Are they safe? Read the antidepressant black-box warning for yourselves, and you will be alarmed by the side effects listed on the inserts:
- Manic reactions
- Suicidal ideation
- Loss of consciousness
- Feeling drunk
- Alcohol abuse
- Homicidal ideation
Why would any parent subject their children to drugs with such dangerous side effects?
Dr. Edward C. Hamlyn, a founding member of the Royal College of General Practitioners, in 1998 stated, “ADHD is fraud intended to justify starting children on a life of drug addiction.”
The “attention deficit” lies in the responsibility of the parents, not the child. Scripture tells us that the parent is to “train up a child in the way he should go: and when he is old, he will not depart from it" (Proverbs 22:6), "not the other way around." Read original article
Article posted by Bradlee Dean’s Blog | May 23, 2013
Diet soda habit as bad for your teeth as meth addiction
THURSDAY, May 23 (HealthDay News) - Heavy consumption of diet soda can damage teeth as badly as methamphetamine or crack cocaine, a new study contends.
"You look at it side-to-side with 'meth mouth' or 'coke mouth,' it is startling to see the intensity and extent of damage more or less the same," said Dr. Mohamed Bassiouny, a professor of restorative dentistry at the Temple University School of Dentistry in Philadelphia.
Methamphetamine, crack cocaine and soda -- sweetened or not -- are all highly acidic and can cause similar dental problems, Bassiouny said in a study published recently in the journal General Dentistry.
The acid in soda is in the form of citric acid and phosphoric acid, Bassiouny said. Without good dental hygiene, constant exposure can cause erosion and significant oral damage, he said.
In his study, he found that a woman in her 30s who drank 2 liters of diet soda daily for three to five years experienced tooth rot and decay remarkably similar to that suffered by a 29-year-old methamphetamine addict and a 51-year-old habitual crack cocaine user.
The younger man had used methamphetamine for three years, and often downed two or three cans of regular soda a day because the drugs made his mouth so dry. The older man reported an 18-year history of crack abuse.
The woman said concerns about weight gain led her to choose diet soda over regular, and admitted that she had not seen a dentist in many years, according to the study. She also associated sweetened beverages with a higher risk of tooth decay.
Her teeth were soft and discolored, with many destroyed by erosion. She usually sipped the beverage directly from a can or a bottle, and held the soda in her mouth before swallowing, Bassiouny said.
"She also mentioned that when doing so, she habitually leaned on her left side against the arm of the sofa while watching television," he said. The "massive" damage to the left side of her mouth bore this out and resulted in what is called a collapsed bite.
"None of the teeth affected by erosion were salvageable," Bassiouny said. The woman had to have all of her teeth removed and replaced with dentures.
Methamphetamine and crack are known to ravage the mouths of users, and the two drug abusers needed all of their teeth extracted.
Besides exposing teeth to damaging acid, these illegal drugs reduce the amount of saliva in the mouth, providing less opportunity for the acids to wash away. The drugs also cause systemic health problems that affect dental hygiene. Previous studies have linked "meth mouth" with rampant decay.
A group representing soft drink manufacturers said this case study should not be seen as an indictment of diet sodas generally.
"The woman referenced in this article did not receive dental health services for more than 20 years -- two-thirds of her life," the American Beverage Association said in a statement. "To single out diet soda consumption as the unique factor in her tooth decay and erosion -- and to compare it to that from illicit drug use -- is irresponsible.
"The body of available science does not support that beverages are a unique factor in causing tooth decay or erosion," the group said. "However, we do know that brushing and flossing our teeth, along with making regular visits to the dentist, play a very important role in preventing them."
Dr. Eugene Antenucci, spokesman for the Academy of General Dentistry, said he was not surprised by Bassiouny's findings.
"From my experience, the damage that happens to people's mouths from cocaine or methamphetamine are degrees greater than what I see from soda, but I see a lot of damage from soda," said Antenucci, a dentist in Huntington, N.Y.
Damage from excessive soda consumption can cause "very deep brown stains, where it's actually eroded into the tooth, and the teeth are soft and leathery," he said.
Prevention is the best cure, Bassiouny said. How often you drink soda, how much you drink and how long it's in your mouth all are important factors. "You can help prevent it from happening by reducing any of those," he said.
Sugar-free soda is no better than regular soda when it comes to dental decay, Bassiouny added. "Both of them have the same drastic effect if they are consumed in the same frequency, the same amount and the same duration," he said.
Antenucci said people need to keep in mind that they are drinking something that is highly acidic when they pick up a soda.
"Knowing that, you limit it and understand that you need to clean your mouth afterward," he said. "Even simple water will wash away the acidity. And everyone should brush twice a day, if not more often."
Should people give up drinking soda? "You'd be better off if you didn't drink the soda," Antenucci said, "but in my mind there's not a reason for that extreme." View original article
Article by Dennis Thompson, HealthDay Reporter
ER visits soaring from one popular sleeping pill
If you suffer from insomnia, you may be taking a sleeping pill that is sending higher numbers of people to the emergency room. A new U.S. study found the popular prescription sleeping aid that contains the ingredient Zolpidem resulted in a sharp increase in visits to the hospital since 2005.
Adverse events from Ambien up 220 %
The report that comes from researchers from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) found ER visits from Zolpidem containing prescriptions increased from 6,000 in 2005 to more than 19,000 in 2010.
Drugs that contain Zolpidem include Ambien, Ambien CR, Edluar and Zolpimis.
Seventy five percent of the adverse events occurred in people age 45 or older, the report found. Females were especially likely to have a bad reaction to the sleeping pill. The analysis found a 274 percent increase in emergency room visits among women as the result of taking Zolpidem.
The finding is important because the drug is popular. Escalating reports of adverse events prompted the FDA to recommend lowering the dose of the drug in January 2013.
Why the sleeping pill might be causing more problems
According to the report, millions of people take the sleeping aids without any problems, but combining sleeping pills with other drugs potentiates the effect.
In 2010, more than half of visits to the emergency room visits related to the prescription sleep medicine involved other drugs such as pain medicines and anti-anxiety medications.
Drugs combined with Zolpidem that could be dangerous included oxycodone and hydrocodone combinations, benzodiazepines, anticonvulsants, muscle relaxants and antipsychotics, according to the SAMSHA Drug Abuse Warning Network (DAWN) report.
Known side effects of Zolpidem include sleepiness, dizziness, hallucinations, and agitation, sleep-walking and decreased mental alertness while driving.
“Although short-term sleeping medications can help patients, it is exceedingly important that they be carefully used and monitored,” said SAMHSA Administrator Pamela S. Hyde in a press release.
“Physicians and patients need to be aware of the potential adverse reactions associated with any medication, and work closely together to prevent or quickly address any problems that may arise.”
One of the goals of SAMSHA is monitoring prescription related adverse events to promote awareness of how to lower the chances of having a bad reaction.
Hyde said the finding highlights the importance of working with your doctor to identify and quickly address any problems that arise.
All medications have the potential to cause harm, even those that are sold over-the-counter. If you think your sleeping pill might be causing problems, talk with your doctor about a solution. Consumers should be aware that combining Zolpidem with pain medications or anti-anxiety medications could be dangerous. If your doctor prescribes a new medication, schedule a review with your pharmacist for potential interactions.
There were 4,916,328 trips made to the emergency room as the result of taking the sleeping pill Zolpidem, marketed primarily as Ambien, in 2010, the report found. Read original article.
Source - SAMSHA, Article by Kathleen Blanchard RN, EmaxHealth.com
ADHD is Over Diagnosed, Experts Say
Mar. 30, 2012 - What experts and the public have already long suspected is now supported by representative data collected by researchers at Ruhr-Universität Bochum (RUB) and University of Basel: ADHD, attention deficit hyperactivity disorder, is over-diagnosed. The study showed that child and adolescent psychotherapists and psychiatrists tend to give a diagnosis based on heuristics, unclear rules of thumb, rather than adhering to recognized diagnostic criteria. Boys in particular are substantially more often misdiagnosed compared to girls.
Daniel has ADHD, Danielle doesn't
The researchers surveyed altogether 1,000 child and adolescent psychotherapists and psychiatrists across Germany. 473 participated in the study. They received one of four available case vignettes, and were asked to give a diagnoses and a recommendation for therapy. In three out of the four case vignettes, the described symptoms and circumstances did not fulfill ADHD criteria. Only one of the cases fulfilled ADHD criteria based strictly on the valid diagnostic criteria. In addition, the gender of the child was included as a variable resulting in eight different case vignettes. As the result, when comparing two identical cases with a different gender, the difference was clear: Leon has ADHD, Lea doesn't.
Male and conspicuous: the "prototype" makes the difference
Many child and adolescent psychotherapists and psychiatrists seem to proceed heuristically and base their decisions on prototypical symptoms. The prototype is male and shows symptoms such as motoric restlessness, lack of concentration and impulsiveness. In connection with the gender of the patient, these symptoms lead to different diagnoses. A boy with such symptoms, even he does not fulfill the complete set of diagnostic criteria; will receive a diagnosis for ADHD, whereas a girl will not. Also the therapist's gender plays a role in the diagnostic: male therapists give substantially more frequently a diagnosis for ADHD than their female counterparts.
Diagnostic inflation, more medication, higher daily doses
In the past decades the diagnoses ADHD have become almost inflationary. Between 1989 and 2001, the number of diagnoses in German clinical practice increased by 381 percent. The costs for ADHD medication, such as for the performance-enhancer Methylphenidate, have grown 9 times between 1993 and 2003. The German health insurance company, Techniker, reports an increase of 30 percent in Methylphenidate prescriptions for its clients between the ages of 6 and 18. Similarly, the daily dosage has increased by 10 percent on average.
Remarkable lack of research
Considering these statistics, there is a remarkable lack of research in the diagnostic of ADHD. "In spite of the strong public interest, only very few empirical studies have addressed this issue," Prof. Schneider and Dr. Bruchmüller point out. While in the 70s and 80s a "certain upswing" of studies on the frequency and reasons for misdiagnoses could be observed, current research hardly examines the phenomena. The current study shows that in order to avoid a misdiagnosis of ADHD and premature treatment, it is crucial for therapists not to rely on their intuition, instead to strictly adhere to defined, established diagnostic criteria. This is best possible with the help of standardized diagnostic instruments, such as diagnostic interviews. Read source article
Article from Science Daily and reprinted from materials provided by Ruhr-Universitaet-Bochum, via AlphaGalileo
Legal Drugs, Deady Outcomes
Prescription overdoses kill more people than heroin and cocaine. An L.A. Times review of coroners' records finds that drugs prescribed by a small number of doctors caused or contributed to a disproportionate number of deaths.
Terry Smith collapsed face-down in a pool of his own vomit.
Lynn Blunt snored loudly as her lungs slowly filled with fluid.
Summer Ann Burdette was midway through a pear when she stopped breathing.
Larry Carmichael knocked over a lamp as he fell to the floor.
Jennifer Thurber was curled up in bed, pale and still, when her father found her.
Karl Finnila sat down on a curb to rest and never got up.
These six people died of drug overdoses within a span of 18 months. But according to coroners' records, that was not all they had in common. Bottles of prescription medications found at the scene of each death bore the name of the same doctor: Van H. Vu.
After Finnila died, coroner's investigators called Vu to learn about his patient's medical history and why he had given him prescriptions for powerful medications, including the painkiller hydrocodone.
Investigators left half a dozen messages. Vu never called back, coroner's records state.
Over the next four years, 10 more of his patients died of overdoses, the records show. In nine of those cases, painkillers Vu had prescribed for them were found at the scene.
Vu, a pain specialist in Huntington Beach, described himself as a conscientious, caring physician. He declined to comment on individual cases, citing confidentiality laws, but he said he treats many "very, very difficult patients" whose chronic pain is sometimes complicated by substance abuse and depression, anxiety or other mental illness.
"Every single day, I try to do the best I can for every single patient," he said in an interview. "I can't control what they do once they leave my office."
Prescription drug overdoses now claim more lives than heroin and cocaine combined, fueling a doubling of drug-related deaths in the United States over the last decade.
Health and law enforcement officials seeking to curb the epidemic have focused on how OxyContin, Vicodin, Xanax and other potent pain and anxiety medications are obtained illegally, such as through pharmacy robberies or when teenagers raid their parents' medicine cabinets. Authorities have failed to recognize how often people overdose on medications prescribed for them by their doctors.
A Los Angeles Times investigation has found that in nearly half of the accidental deaths from prescription drugs in four Southern California counties, the deceased had a doctor's prescription for at least one drug that caused or contributed to the death.
Reporters identified a total of 3,733 deaths from prescription drugs from 2006 through 2011 in Los Angeles, Orange, Ventura and San Diego counties.
An examination of coroners' records found that:
- In 1,762 of those cases - 47% - drugs for which the deceased had a prescription were the sole cause or a contributing cause of death.
- A small cadre of doctors was associated with a disproportionate number of those fatal overdoses. Seventy-one - 0.1% of all practicing doctors in the four counties - wrote prescriptions for drugs that caused or contributed to 298 deaths. That is 17% of the total linked to doctors' prescriptions.
- Each of those 71 physicians prescribed drugs to three or more patients who died.
- Four of the doctors - including Vu - had 10 or more patients who fatally overdosed.
- Vu had the highest total: 16.
Experts said the findings challenge the prevailing view of what is driving the surge in overdose deaths and should prompt closer scrutiny of doctors and their prescribing practices.
"The data you have is something that's going to shock everybody," said Dr. Jorge F. Carreon, a former member of the Medical Board of California.
Carreon, a South Gate physician whose term on the board ended in July, said he had long suspected that doctors' prescriptions were contributing to the increase in overdoses. The Times' analysis, he said, showed that it was "worse than what I thought."
President Obama's drug czar, R. Gil Kerlikowske, said of the findings: "Do I think this has the potential to change the game in the way it's being looked at and being addressed, both at the state and federal level? Yes, I do."
In its review of prescription drug fatalities, The Times examined cause-of-death findings, toxicology reports and other information in county coroners' files, including lists of prescription medications found at death scenes. Those lists typically identify the prescribing doctor.
The deaths often stemmed from multiple drugs, sometimes prescribed by more than one physician. In some cases, the deceased mixed alcohol or illicit drugs with prescription medications.
Medical experts say that even one overdose death should prompt a doctor to conduct a thorough review of his or her prescribing.
"Personally, it would be a big, big deal," said Dr. Peter Przekop, a pain and addiction specialist at the Betty Ford Center in Rancho Mirage and an assistant professor at Loma Linda University School of Medicine. "I would certainly want to stop using those medications until I knew what was going on."
The 71 doctors with three or more fatal overdoses among their patients are primarily pain specialists, general practitioners and psychiatrists. Almost all work alone, without the peer scrutiny that is standard in hospitals, group practices and HMOs.
Four of them have been convicted of drug offenses in connection with their prescriptions. A fifth is awaiting trial on charges of second-degree murder in the overdose deaths of three patients.
The rest have never faced criminal prosecution over their practice of medicine, and most - including Vu - have spotless records with the Medical Board of California, which licenses and oversees physicians.
Dr. Lynn Webster, president-elect of the American Academy of Pain Medicine, said many physicians lack an appreciation of how easily patients with chronic pain can become addicted to their medications, and how dangerous those drugs can be.
"It leads them down a path that can be very harmful, and that's what physicians have to watch for," said Webster, who practices in Salt Lake City.
He said physicians who prescribe pain medications have a duty to screen patients for risk factors for addiction and then watch them closely to prevent abuse.
In interviews, several of the 71 Southern California doctors with multiple patient deaths described themselves as compassionate caregivers who try to ease the suffering of those in pain.
Vu and others said they follow recommended practices to deter drug abuse, including requiring patients to sign "pain management contracts" in which they agree to take their medications as directed and not obtain more from other doctors.
Some of the 71 doctors said overdose victims caused their own deaths by ignoring instructions on the safe use of medications. Some said family members of the deceased bore responsibility too for failing to intervene. Some also faulted health insurers, saying that reduced payments to physicians have made it difficult to spend the time to monitor patients adequately.
These doctors' 298 patients who died of overdoses ranged in age from 21 to 79. The median age was 48.
Many had histories of mental illness or addiction, including previous overdoses or stints in drug treatment. Others did not start out as high-risk patients. They were middle-aged adults - teachers, nurses and police officers - with bad backs, injured knees and other non-life-threatening conditions.
Lynn Blunt was a 46-year-old mother of four who suffered from degenerative disc disease. Despite the pain, she was careful not to exceed the recommended dosage of her medications, said her husband, Lonnie. She wanted to remain alert enough to care for her two youngest children, girls ages 14 and 11, he said.
The condition eventually crippled Blunt, leaving her dependent on a cane and unable to continue working as a U.S. customs inspector. She saw a series of doctors, eventually ending up at Vu's California Pain Center.
According to coroner's records, Vu prescribed skin patches containing fentanyl, a pain reliever 100 times more powerful than morphine.
On Sept. 7, 2006, coroner's records show, Blunt went to Vu's clinic to receive an epidural injection of an unspecified medication for her pain. A day later, she was found dead in her family's apartment in Downey.
Blunt overdosed on multiple drugs prescribed by Vu and two other doctors, coroner's records show. High levels of fentanyl were found in her system.
Blunt had been looking forward to a planned trip to the East Coast to visit one of her two grown children, her husband said.
"We followed the prescriptions," he said. "Something didn't mix well."
Vu, a native of Vietnam, was 11 when he and his family immigrated to the U.S. as refugees just before the fall of Saigon in 1975. They settled in Seattle.
As a high school student, he volunteered at a clinic for low-income families and was impressed, he said, by the selflessness of physicians serving "people who really needed help."
He earned undergraduate and medical degrees from the University of Washington and served a residency in anesthesiology at USC. He is board-certified in that field and in pain medicine.
"I pretty much achieved the dream come true that America affords," said Vu, 49, who lives with his wife and four children on Christiana Bay in Huntington Beach.
Vu said most of his patients are referred by other doctors, who turn to him as "a last resort" for those who have been battling pain for years. Many patients come to him already dependent on narcotics, he said.
Vu said he conducts routine urine tests to make sure they take their medications as prescribed and do not use illegal drugs. He said he regularly uses a state-run prescription monitoring program to see whether any of his patients are also obtaining drugs from other doctors.
"I am doing the best I can in this very difficult field," he said. "I consider myself to be one of the best. But we have limits."
He said any patient death from an overdose was unacceptable, but added that he has treated thousands of patients successfully with the same drugs.
"Are we willing to trade that?" he asked. "Are we willing to withhold pain medications from everyone?"
Vu said he was unaware of many of his patients' deaths until Times reporters contacted him. He called the information "eye-opening."
"I'm a physician," Vu said. "I feel terrible when somebody loses their life. I'm the one who should be prolonging life, so I'm saddened by that."
Asked whether he could have taken steps to prevent any of the deaths, Vu paused.
"No," he said, finally. "I don't think so."
Larry Carmichael was a problem drinker who got sober through Alcoholics Anonymous. A doting single father, he coached his son's T-ball team and passed on his love of surfing and fishing.
Carmichael worked as a carpet layer until a car accident left him with debilitating back pain, recalled his son, Dan. He went from one doctor to another in search of relief, and eventually became Vu's patient.
By 2007, Carmichael "had a high tolerance and was known to take too many pills for his pain," coroner's records state. Renee Allen, Carmichael's girlfriend, said she encouraged him to see if he could live without the medications, and to find another doctor.
"I'm not going to sit around and watch you die," she recalled telling him.
But Carmichael kept taking pills. In the months before he died, Carmichael twice passed out, his son said.
"He needed real help," Dan said.
On March 7, 2007, Carmichael filled prescriptions from Vu for half a dozen pain and anxiety medications, including morphine, according to coroner's records.
After Carmichael failed to return phone calls for two days, Dan went to his father's apartment in Lake Forest and found him dead. He was 51.
Dan grabbed his father's prescription bottles and smashed them against a wall, sending pills flying around the room, according to a report by a coroner's investigator.
The coroner concluded that Carmichael died of an accidental overdose of morphine.
For decades, prescriptions for narcotic painkillers were limited largely to cancer patients and others with terminal illnesses. The prevailing view was that the risk of addiction outweighed any benefit for the great majority of patients whose conditions were not life-threatening.
Today, narcotic painkillers are among the most popular prescription drugs in the U.S.
The seeds of this turnabout were planted in the late 1980s, when influential physicians argued in medical journals that it was inhumane to ignore suffering in non-cancer patients.
This new perspective coincided with efforts by drug makers to win approval for formulations of narcotics intended to ease moderate pain.
Pharmaceutical companies launched sales campaigns that downplayed the risks of addiction and overdoses and promoted the benefits of pain relief.
In 2001, Congress declared the start of the Decade of Pain Control and Research. Medical boards across the country encouraged physicians to assess and treat pain in all patients. In 2007, California lawmakers expanded the scope of pain relief, making it legal for doctors to prescribe narcotics to addicts, so long as the purpose was to treat pain and not simply feed a habit.
The use of painkillers quadrupled between 1999 and 2010. Doctors write about 300 million prescriptions a year for painkillers. That is enough for every adult American to be medicated around the clock for a month, according to the Centers for Disease Control and Prevention.
Hydrocodone became the most commonly prescribed drug in the U.S., eclipsing the leading antibiotics and cholesterol medications.
Older pain drugs - including morphine, codeine and Dilaudid - found new life outside hospital wards, while new ones such as fentanyl and Opana were brought to market. OxyContin, a chemical cousin of heroin, had sales of more than $1 billion within a few years of its introduction.
Narcotic pain relievers now cause or contribute to nearly 3 out of 4 prescription drug overdoses and about 15,500 deaths each year, according to the CDC. For every death, 32 people are treated in emergency rooms for nonfatal overdoses.
Although the death toll has received considerable attention, the medical board and law enforcement agencies in California have not mined coroners' files, as The Times did, to identify doctors whose patients overdosed on drugs they prescribed.
Nor have officials tried to take advantage of detailed information that pharmacies provide to the state attorney general's office, listing the kinds and quantities of drugs prescribed, by which doctors and for which patients.
The Controlled Substances Utilization Review and Evaluation System was designed to help doctors learn whether any of their patients were seeking drugs from other physicians too.
The system could also be used to identify doctors who write large numbers of prescriptions for commonly abused drugs. The CDC has urged state authorities to use such programs to identify not only doctor-shopping patients but the physicians who cater to them. In California, authorities do neither.
Karl Finnila had a long record of drug arrests by the time he became Vu's patient. He was bipolar, had attempted suicide and had overdosed several times, according to coroner's records and his sister Sally, a tax accountant in Irvine.
Finnila, the oldest son of a Mattel Inc. executive, had been addicted to prescription drugs since he was a teenager, his sister said. He had been in and out of mental hospitals and was unable to hold a job.
He would lose touch with his family. But every so often, Sally would find him, take him to lunch and buy him a new pair of shoes and socks.
On June 29, 2007, Finnila was discharged from a hospital in Orange County, according to Carol Spetzman, a friend and caregiver. He had been treated there for a drug overdose, his sister said.
That same day, he filled prescriptions from Vu for hydrocodone and carisoprodol, a muscle relaxant, at a pharmacy down the hall from the doctor's office, coroner's records show.
Finnila then checked into a sober-living home in Westminster. After dinner, he went for a walk, sat down on a curb and died, coroner's records state.
The cause was "combined effects" of hydrocodone, carisoprodol and seven other medications prescribed by Vu and other doctors. He was 43.
Jennifer Thurber had been coping with pain for much of her life by the time she came under Vu's care.
Thurber's childhood was marred by a painful stomach condition that caused severe indigestion. She had corrective surgery when she was 11, but a car accident seven years later brought the problem back.
She was prescribed various medications for the pain and eventually began abusing them, according to her father, Charles, an Orange County sheriff's deputy.
Thurber obtained drugs through various doctors. On May 21, 2007, she filled prescriptions for morphine and methadone written by Vu.
Two days later, her father climbed the stairs of the family's Fountain Valley home and pushed open the door of her bedroom to ask her to get ready for dinner.
He found his daughter in bed, pale and motionless. Blood trailed from her nose. He laid her on the floor and attempted CPR.
Thurber died of an overdose of multiple drugs prescribed by Vu and two other doctors, coroner's records show.
Morphine and methadone were among the drugs. She was 22.
"That was my birthday," her father recalled, his voice wavering. He said he blames himself for not seeing the signs of drug abuse sooner and for not paying closer attention to her doctors and what they were prescribing.
"At the time," he said, "we thought they were trying to help her." Read original article
Los Angeles Times | written by Scott Glover, Lisa Girion
Dementia Risk from Sleeping Tablets
Sleeping pills taken by more than a million Britons significantly increase the risk of dementia, researchers warn today.
Pensioners who used benzodiazepines – which include temazepam and diazepam – were 50 per cent more likely to succumb to the devastating illness, a Harvard University study found.
Academics believe the side effects of the drugs may be so harmful that doctors should avoid prescribing them.
Around 1.5million Britons are believed to be taking the pills at any one time and more than 10million prescriptions are handed out a year.
The researchers also estimate that up to 8 per cent of the over-65s have used them within the last few years to treat insomnia or anxiety.
But there is growing evidence that they have serious side effects and a number of studies have linked them to falls, memory problems, panic attacks and early death.
Academics from Harvard University in the US and the University of Bordeaux in France discovered that over-65s who had taken the drugs within the last 15 years were 50 per cent more likely to get dementia.
The drugs can only be obtained by a prescription. They work by changing the way messages are transmitted to the brain, which induces a calming effect.
But scientists believe that at the same time they may be interfering with chemicals in the brain known as neurotransmitters, which may be causing dementia.
Professor Tobias Kurth, who works jointly at Harvard University’s School of Public Health and the University of Bordeaux, said: ‘There is a potential that these drugs are really harmful.
‘If it is really true that these drugs are causing dementia that will be huge. But one single study does not necessarily show everything that is going on, so there is no need to panic.
‘These drugs certainly have their benefits and if you prescribe them in a way they should be prescribed they treat very well.’
The study, published today in the British Medical Journal, involved 1,063 men and women over the age of 65 for a period of 20 years in south west France. Initially none of the participants had dementia and no one was taking benzodiazepines.
The researchers followed them up after 15 years and found that 253 had developed dementia. They worked out that out of 100 not taking the drug, 3.2 would be expected to get the illness.
But among 100 patients on these drugs, 4.8 would get dementia - a significantly higher proportion. The patients had taken the pills at least once - over the course of a week or so - at some point in the previous 15 years.
The study concluded: ‘Considering the extent to which benzodiazepines are prescribed and the number of potential adverse effects, indiscriminate widespread use should be cautioned against.’
In the last 20 years the number of prescriptions for benzodiazepines has fallen by 40 per cent, largely due to concerns that patients were becoming addicted.
But they remain one of the most commonly used drugs and there are fears some patients are taking them for far too long.
A spokesman for the Alzheimer’s Society said: ‘This is the not the first time it has been suggested that these drugs could have a negative impact on cognition. With this long-term study adding to the evidence, it emphasises how important it is we properly monitor how treatments for anxiety or sleep problems are used.’
A study last year from Cardiff University found that Britons who had used the pills were 60 per cent more at risk from dementia. The study of 1,160 men aged 45 to 85 found that 9 per cent had taken them at least once over the last two decades.
Earlier this year American researchers found the drugs heightened the risk of early death. Their study showed that even patients taking between four and 18 pills a year were 3.6 times more likely to die prematurely. Those on more than 132 pills a year were 5.3 times more likely to die.
Dementia is one of the biggest burdens facing the NHS. Some experts believe the cost of caring for patients will rise to £35billion annually within the next two decades.
There are currently 800,000 Britons with dementia, including Alzheimer’s disease. read original article
Written by Mail Online by Sophie Borland
Fish Oils Are Supposed to Boost Brainpower. But Do the Facts Really Stack Up?
Elliot is nine years old. A year ago, he was falling behind in his schoolwork, particularly reading – which he found a struggle. He had little interest in studying and would crash on the sofa to watch TV when he got home from school.
But over the past year, a dramatic change has taken place in Elliot. He has soared through the Harry Potter books and now heads to the library after the school bell has sounded.
Elliot has been taking part in a scientific study on more than 100 children from 12 Durham schools. The children were required to take a course of capsules with their meals for the duration of six months.
“His reading jumped 18 months [over the trial period]. He’s just a lot more interested in everything. He’s even developed an interest in classical music,” says Sheila, Elliot’s mother.
Over the course of the year, Elliot's academic problems disappeared.
Mark, 10, who is in the year above Elliot at Timothy Hackworth School in Shildon, Durham, experienced similar changes.
“When I first heard about it, I didn’t think Mark had any problems. He’d only been taking them a few weeks when I started to notice changes. His handwriting became better and his teachers said he was joining in more in class discussions,” says Mark’s mother Christine.
“At home, he started asking loads of questions. It was quite hard work for me.”
The capsules given to children in the trial contained oils high in Omega 3 fats, which are found naturally in oily fish such as mackerel, salmon and sardines and in some plant crops such as rape seed.
Omega 3s and another group called Omega 6s belong to a family of fats known as essential fatty acids. The right balance of these two types of fatty acids is important for the healthy functioning of many parts of the body.
Heart of the matter
Omega 3 fatty acids are known to help prevent heart disease and they can improve the condition of some patients with depression and bipolar disorder. But their effects on brainpower have not been investigated in the same depth.
The Durham trial was conducted by Dr Alex Richardson, a senior research fellow in physiology at Mansfield College, University of Oxford and Madeleine Portwood, a special educational psychologist for Durham Local Education Authority.
The results have not yet been published, but they are expected to show a statistically significant improvement in school performance in the group of children given Omega 3 supplements. This does not mean that every child benefitted from the treatment - many did not. But according to Portwood, about 40% of children showed some clear improvement.
In the dark
The children were selected on the basis that they were not fulfilling their potential at school, but their general ability was normal. They were subjected to regular tests to measure their co-ordination, concentration and academic ability.
The study followed an experimental method called a randomized double-blind controlled trial. Half the children were given capsules of Omega 3 fatty acids, and half given placebos. Neither the children nor those evaluating their progress knew which group was taking which treatment.
Richardson believes that conditions such as dyspraxia - characterized by poor physical co-ordination - dyslexia and attention deficit and hyperactivity disorder (ADHD) form a spectrum of associated conditions with some of the same underlying causes.
“Clinically, there is about 50% overlap between dyspraxia and dyslexia,” says Richardson, “and both show a similar overlap with ADHD.”
The dramatic effects of Omega 3 fatty acids on the children in the Durham trial may hinge on several functions of fatty acids in the brain.
Electrical signals travelling through the brain get passed from one brain cell, or neuron, to the next - much like the baton handed between runners in a relay race. In the changeover, a signal needs to leave one brain cell at a point called the synapse and cross a physical gap before entering the neighboring neuron.
For signals to enter a neuron, they need to pass through the walls that surround them. These walls, known as cell membranes, consist almost entirely of fats. About 20% are essential fatty acids like Omega 3s.
Embedded in brain cell membranes are structures called ion channels that open to allow the flow of electrical signals into the cell or close to prevent the flow. They perform this function by changing their shape.
One theory is that a specific Omega 3 fatty acid called Docosahexaenoic acid (DHA) makes the membrane that holds these channels more elastic, making it easier for ion channels to change shape.
If there is not enough DHA available, the membrane substitutes it with a molecule called DPA (n-6), which cells regard as the next best thing. This substitute is almost identical to DHA, but a tiny difference in the molecular structure of DPA (n-6) makes it vastly less flexible.
The substitution of DHA for a less flexible substitute may make it harder for ion channels to change shape within the fatty membrane, hindering their control over electrical impulses entering the cell.
This substitution may also affect structures called G-proteins that sit on the inside of the cell membrane and are a vital link in the transmission of signals between brain cells. G-proteins help molecules on the outside of the membrane communicate with molecules on the inside.
The substitution of DHA for DPA (n-6) can cause a one thousand-fold reduction in the ability of G-proteins to perform this function, according to Dr Joseph Hibbeln of the National Institute of Alcohol Abuse and Alcoholism (NIAAA) in Bethesda, US.
This effect may be particularly important before birth; when connections are being created in the brain of the developing fetus. It is here in the womb that the replacement of DHA with its less supple alternative may have its most far-reaching effects.
“A good analogy is if you’re building a new [road network] and you don’t have the right type of concrete, you might choose an inferior substitute,” says Hibbeln.
“You might choose to make inadequate roads. But if you have the optimal fatty acid, it’s like having the optimal concrete - you make the right roads in the right places first time round.
“If you get the right type of concrete later, you can rip things up and re-lay the road, but it’s more expensive.”
But even if you’re prepared for the effort and expense, the benefits of repairing intrinsically flawed connections in the brain may be limited. The clearest indication of this came in 2001, in a study led by Dr Richard Weisinger of the University of Melbourne, Australia.
Weisinger’s team showed that laboratory rats deprived of essential fatty acids at specific stages in their development developed high blood pressure that remained elevated for the rest of their lives. The brain’s control over the autonomic nervous system and cardiovascular system was permanently affected.
However, studies such as the Durham trial suggest that all is not lost, and that boosting Omega 3 intake may still confer significant benefits.
The Omega 3 fatty acid used in the Durham trial was Eicosapentaenoic acid (EPA). It may play an equally crucial role in brain function. EPA is found only at very low levels in the cell membranes; it seems to have a functional, rather than a structural role.
“It can improve brain function at the very simplest level, by improving blood flow,” says Richardson.
EPA helps the body manufacture important, hormone-like substances called eicosanoids. Some of these substances help improve blood flow around the body. They also seem to have controlling effects on hormones and the immune system, both of which are known to affect brain function.
Western diets contain very little Omega 3 fatty acid. Hydrogenation, the process used to give foods a long shelf life, removes them. But certain people may break down Omega 3 fatty acids faster than others. Some of the children who showed greatest improvement in the Durham trial might fall into this category.
But there is disagreement over which Omega 3 fatty acid would perform best as a treatment. US researchers such as Hibbeln tend to favor DHA, while British researchers, of which Richardson is one, mostly regard EPA as the best option.
But some quarters of the medical research community are deeply skeptical about the usefulness of so-called complementary therapies - the category of treatment in which fish oil supplements are often lumped.
Professor Richard Olson, a developmental psychologist at the University of Colorado, Boulder and an expert on the treatment of dyslexia, urged caution over a ‘quick fix’ syndrome towards the treatment of learning disorders.
“I haven’t read the research, but I have a slight feeling of unease because in the field of dyslexia particularly, one quick fix after another seems to pop up and then fall by the wayside,” says Olson.
“I hope they’re right. I’m just skeptical of easy answers because there have been various schemes in the past and parents [with dyslexic children] go out and spend a lot of money on them. For many children with dyslexia, improvement can only be achieved with a lot of hard work,” he adds.
Professor Maggie Snowling, a psychologist at the University of York also warned about the use of Omega 3s as a treatment for dyslexia.
“These studies tend to show statistically significant effects, but it’s not clear if there are any clinical effects or real improvements for the children involved.
"[Omega 3s] are not a treatment for dyslexia. They might have some slight benefit on children with attention disorder, and some of them might have dyslexia. But there are a lot of provisos,” says Snowling.
While researchers have yet to fully resolve how the balance of different Omega 3s affects brain function, one point on which they agree is that studies into their effects need to be widened beyond children.
“To my knowledge, there are no studies linking Omega 3s to improvements in cognition or neuropsychological function in otherwise healthy adults,” says Hibbeln.
Does he think this is a promising area for future research? Hibbeln answers plainly: “Yes.”
Source | BBC Home | Original Article
Potential Driving Safety Risk for Seniors Who Take Rx Drugs
Every day, 10,000 Americans turn 65. More than 80 percent of drivers 65 and older regularly take medication-two-thirds take five or more daily. Yet only half have talked with a medical professional about the possible safety issues related to driving.
The AAA Foundation for Traffic Safety warns that the risks of drug interaction and side effects affecting driving ability is a growing problem not only for older drivers but for anyone who has to take medication and needs to drive.
According to Jake Nelson, Director of Traffic Safety Advocacy and Research for AAA, “As we get older, we’re more likely to need to take a greater number of medications, which presents an opportunity for problems to occur.”
Many seniors have no idea that medications they take regularly could pose a risk when driving.
Diovan, for example, is a commonly prescribed blood pressure medication. But using it can potentially lead to the following driving problems: trouble staying within lane markings, delayed reactions, lowered level of vigilance, difficulty recalling intended destination, loss of consciousness at the wheel, difficulty concentrating, larger blind spots, difficulty seeing at night, lack of coordination in controlling vehicle, mistaking accelerator pedal for brake, weaving between lanes, speeding, failure to obey traffic laws, and more.
Certain types of medications, like antidepressants, have been shown to increase crash risk by up to 41 percent. Ingredients like diphenhydramine, commonly found in over-the-counter (OTC) cold and allergy medicines, can have the same effect on driving as being above the legal limit for blood alcohol concentration (BAC).
NEW ONLINE TOOL:
To help seniors, and family members who care about them, learn more about drug side effects and interactions between medications that may impact safety behind the wheel, the AAA Foundation for Traffic Safety has developed a free online tool, Roadwise RX.
Using the Roadwise RX tool, simply enter the different drugs, prescription and OTC, along with vitamins and supplements, you are taking and then take the results to your doctor to see how you can still be able to drive safely.
“Your doctor can help by discussing with you what you take and possibly adjusting the dose of the prescription, changing the timing of the dose so that when you experience symptoms, you’re not driving - such as taking it before going to sleep,” said Nelson. “He may recommend an exercise and nutrition program that may reduce the need to take certain medications, or he may change your medication regimen altogether.”
If it is necessary to continue taking certain medications and you still need to get around, it may be time to consider alternative means of transportation such as riding the bus, taking taxis, shuttle buses, trains or subway, getting a ride from a family member or friend, or walking, where it is safe to do so.
POTENTIALLY IMPAIRING MEDICATIONS:
Roadwise RX lists the most common classes of medications that have the potential to create the greatest amount of risk given an individual and driving. These include tranquilizers, narcotic pain pills, sleep medicines, some antidepressants, cough medicines, antihistamines and decongestants. Among the classes of drugs, Nelson identified the following three as the most high-risk.
Barbiturates - such as Amytal and Soneryl, benzodiazepines such as Valium
Antihistamines - such as Claritin and Benadryl
Analgesics and narcotic pain relievers - such as hydrocodone and codeine
It is important to note that these drugs are potentially impairing medications. Not everyone will experience the same side effects or interactions when taking them, or they may experience them sometimes but not others. “Even if you take medications regularly, how they affect you may change over time,” said Nelson. “You may experience symptoms initially and the effect later subsides.”
WHAT CAN YOU DO:
Nelson offers the following recommendations for anyone concerned about medication use and driving:
The point is not to stop taking medications. It is to monitor yourself, what medications you take, how they make you feel and when the symptoms occur.
Take your list of medications with you to all the doctors you see and discuss the potential risks of each medication and driving. Carry your list on your person, so that if you’re in an accident, first responders will be in a better position to treat you.
Talk with your doctor before you stop taking medications or alter the regimen prescribed for you. Your doctor should decide how much and when and may be able to recommend other things for you to help mitigate the risk of taking certain medications and driving.
In the beginning stages of taking a certain medication or when you’re no longer able to drive, look into alternatives to driving.
Roadwise RX, the only tool of its kind that looks at medications and associated driving hazards, is free to everyone to use. “While older drivers may be at more risk, seniors are among the safest drivers on the road. Safety is dependent on ability, not age,” said Nelson.
Article by Suzanne Kane | September 18, 2012 | Original article
Record 4.02 billion prescriptions in United States in 2011
People in the United States took more prescription drugs than ever last year, with the number of prescriptions increasing from 3.99 billion (with a cost of $308.6 billion) in 2010 to 4.02 billion (with a cost of $319.9 billion) in 2011. Those numbers and others appear in an annual profile of top prescription medicines published in the journal ACS Chemical Neuroscience.
Journal Editor-in-Chief Craig W. Lindsley analyzed data on 2011 drugs with a focus on medications for central nervous system (CNS) disorders. So-called antipsychotic medicines - including those used to treat schizophrenia, bipolar disorder, obsessive-compulsive disorder, Tourette syndrome and some forms of depression - ranked as the fifth most-prescribed class of drugs by sales. Antidepressants, for conditions that include depression and anxiety, ranked No. 7.
Xanax, Celexa and Zoloft were the most-prescribed psychiatric medicines, with other depression and anxiety medications rounding out the top 10. Two antipsychotics were among the 10 drugs that Americans spent the most on, with Abilify in fourth place. Lindsley explains that while antidepressants continued to be the most-prescribed class of CNS drugs in 2011, prescriptions for ADHD medicines increased by 17 percent and multiple sclerosis medications by 22.5 percent in sales from 2010. While expiring patents on major antipsychotics in the next few years will put pressure on drug makers to innovate, the industry should be heartened by the growth of the number of prescriptions and spending.
Article Source - American Chemical Society | Zolft, Xanax, Abilify, Celexa are trademarks and are used only for identification and explanation, without intent to infringe.
Med Mix-Ups Like Jeremy Renner's Can be Dangerous, Even Deadly
When Jeremy Renner mistook a Viagra tablet for a sleeping pill on a recent plane flight, the story made for great late night TV on "Jimmy Kimmel Live!" this week. But a similar medication mistake left Kerry Kennedy so sleepy that she swerved her car into a tractor-trailer. Kennedy, 52, told police that she believed she’d taken a sleeping pill by mistake instead of her thyroid medication.
No one knows exactly how many Americans make pill mix-ups each year. But the results can range from unpleasant to downright dangerous.
“At least twice a quarter we have someone admitted to our hospital who took the wrong medication,” says Laura Haynes, a specialist in clinical pharmacy and medication safety at the Hospital of the University of Pennsylvania.
And those mistakes can be catastrophic, or even deadly, Haynes says. “Some antibiotics can cause significant heart dysrhythmias if they’re taken with a heart medication,” she explains. Or if a person ends up taking too many sedative agents, their body might not want to breathe anymore.”
Recent reports to the Institute for Safe Medical Practices include a woman who was rushed to the emergency room with severe muscle spasms in her face, neck and back. On a trip with her dad, she’d tried to save room by packing his medications in the same package as hers. She ended up taking his anti-psychotic pills instead of her lipid-lowering medication.
Another woman was brought to the hospital when she suddenly developed memory loss and began behaving strangely. Turns out she’d tossed some of her sleeping pills into the same container as her cholesterol-lowering mediation and was taking sleep aids during the day by mistake.
In one of the more scary reports, a pilot mistook a sleeping pill for his blood pressure medication. He soon became confused and sleepy while the plane was in the air. A catastrophe was averted only because of the quick actions of a flight attendant and co-pilot.
“These kinds of mix-ups are pretty common,” says Michael Cohen, a pharmacist and president of ISMP. “I’ve done it myself.”
The biggest problem, Cohen says, is that people are often tempted to put more than one type of medication in a single container – especially when they are traveling. “They don’t want to take five different containers so they put everything into one plastic vial and then they go by appearance.”
Problem is, a lot of medications look similar. And the people with the most prescriptions tend to be older, often needing reading glasses. If you don’t bother to put on your glasses, you might end up taking the wrong pill, Cohen says.
Another error that leads to pill mix-ups is grabbing your meds in the dark. That’s how Cohen ended up taking the wrong pill.
“I took prednisone that had been prescribed for my wife instead of the 80 mg aspirin I take to protect against heart attacks,” he says. “The pills were different colors, but I couldn’t see that because it was dark.”
Sometimes it’s not the patient’s fault, but the pharmacy’s instead, Cohen says. It’s not uncommon for a pharmacy to mix up patients’ prescriptions. So you might end up with your name on the bag, but a different person’s name on the label on the bottle.
“Then the patient goes home and sees his name on the outside of the bag and takes the medication without looking at the name on the container,” Cohen says. “I tell people to check the names on the containers before they leave the pharmacy. Make sure all the drug labels have your name on them. And if you’re refilling a prescription, make sure the pills look the same as last time. If they don’t question the pharmacist.”
Haynes underscores the importance of double checking everything before you pop a pill into your mouth. “The take-home message for me is that reading is so fundamental,” she says. “Be aware of what you’re taking. I’d rather people questioned me than just say, "Oh, she knows what she’s doing."
Read original article
Article by Linda Carroll with Health on Today
Generic-Antidepressant Must Pay Settlement for Being Less Effective
Generics of Wellbutrin have been judged inferior to the name-brand and thus will pay a national settlement. The popular antidepressants alternatives use the same active drug, Bupropion hydrochloride, but uses an inferior release technology, releasing the drug into the system in one quick dump rathar than the more effectively slow chemical release of brand name Wellbtrin. The total number of class members may be as many as 2.24 million people.
$3.2 million have been awarded in attorney fees, $1.3 million in class counsel costs, amidst other fees. The defendants, Teva Pharmaceuticals and Impax Laboratories, were both targeted in the suit. Said the plaintiffs:
“The representative plaintiffs all took defendants’ products to treat their depression but their symptoms instead worsened. Had they known that the differences in defendants’ products rendered them useless as antidepressants, plaintiffs would not have purchased defendants’ medication. Defendants failed to disclose important information to consumers, in violation of California consumer protection laws.
Whether this met the stipulation of Federal rule of Civil Procedure 23(b), so that individual class members would also receive compensation, and not just attorneys, was a “close” call according to the judge. He said the request for statutory damages would not count under Rule 23 (b) because the statutory damages “avoid an individualized calculation of damages. Plaintiffs also proposed a complicated mechanism whereby restitution damages could be calculated for the entire class.”
There have been some complaints against this that only lawyers would have benefited from the settlement. Read Full Article
Article from JD Journal
Drug Company Busted for Antidepressants Aimed at Minors
GlaxoSmithKline Plc agreed to plead guilty to misdemeanor criminal charges and pay $3 billion to settle what government officials on Monday described as the largest case of healthcare fraud in US history.
The agreement, which still needs court approval, would resolve allegations that the British drugmaker broke US laws in the marketing and development of pharmaceuticals.
GSK targeted the antidepressant Paxil to patients under age 18 when it was approved for adults only, and it pushed the drug Wellbutrin for uses it was not approved for, including weight loss and treatment of sexual dysfunction, according to an investigation led by the US Justice Department.
The company went to extreme lengths to promote the drugs, such as distributing a misleading medical journal article and providing doctors with meals and spa treatments that amounted to illegal kickbacks, prosecutors said.
In a third instance, GSK failed to give the US Food and Drug Administration safety data about its diabetes drug Avandia, in violation of US law, prosecutors said.
The misconduct continued for years beginning in the late 1990s and continued, in the case of Avandia's safety data, through 2007. GSK agreed to plead guilty to three misdemeanor criminal counts, one each related to the three drugs.
Guilty pleas in cases of alleged corporate misconduct are exceedingly rare, making GSK's agreement especially unusual.
The agreement to settle the charges "is unprecedented in both size and scope," said James Cole, the No. 2 official at the US Justice Department.
He called the action "historic" and "a clear warning to any company that chooses to break the law."
The settlement includes $1 billion in criminal fines and $2 billion in civil fines.
GSK said in a statement it would pay the fines through existing cash resources. The company announced a $3 billion charge in November related to legal claims.
New era at GSK
Chief Executive Officer Andrew Witty said the misconduct originated "in a different era for the company" and will not be tolerated. "I want to express our regret and reiterate that we have learnt from the mistakes that were made," he said in a written statement.
The GSK settlement surpasses what had been the largest criminal case involving a drugmaker in US history. In 2009, Pfizer Inc agreed to pay $2.3 billion to settle allegations it improperly marketed 13 drugs.
The cases follow a trend of US authorities cracking down on how pharmaceuticals are sold, in part because of the rising cost of providing drugs through government programs.
Part of civil fines address allegations that, from 1994 to 2003, GSK underpaid money owed to Medicaid, the healthcare program for the poor run jointly by states and the federal government. The company had an obligation to tell the government its "best prices" but failed to do so, prosecutors said, and $300 million of the settlement will go to states and other public health authorities.
A portion of the $2 billion in civil fines may go to a group of whistleblowers who contributed to the government's investigation and who are eligible to share in the recovery under the False Claims Act. Cole said the amount has not been determined.
As part of the settlement, GlaxoSmithKline agreed to new restrictions by the US government to prevent the use of kickbacks or other prohibited practices.
The inspector general of the US Department of Health and Human Services will oversee the "Corporate Integrity Agreement" for five years.
The company will not be able to compensate its salesmen based on sales goals for territories. It was also required to change its executive compensation program to allow the company to "claw back" certain pay for those engaged in misconduct.
Witty said GSK's US unit has "fundamentally changed our procedures for compliance, marketing and selling. When necessary, we have removed employees who have engaged in misconduct."
Prosecutors have not brought criminal charges against any individuals in connection with the GSK case, although the settlement expressly leaves open that possibility. Cole declined to comment on the possibility of future charges.
Almost exactly a year ago GSK agreed to pay nearly $41 million to 37 states and the District of Columbia in an unrelated case about substandard manufacturing processes at a Puerto Rico factory.
In 2010, the company took a $2.4 billion charge in connection with Avandia to settle claims from patients.
GSK's shares were positive on the New York Stock Exchange on Monday, up 1.6% to $46.29 at 1400 EDT.
The case is US v. GlaxoSmithKline LLC, US District Court for the District of Massachusetts, No. 12-cr-10206. - Source: Reuters - read full article
British Dogs to Get Antidepressants
London, June 25 : Dogs in Britain would now be given anti-depressant drugs similar to those given to humans after it was found that over six million canines suffer from behavioural problems.
Traditional behaviour by dogs, such as barking at strangers, cowering from fireworks or howling when left alone, is now being reinterpreted, The Sun reported Monday.
Earlier thought to be natural reactions, the responses are now being diagnosed as "hyperactivity", "phobic behaviour" and "separation anxiety".
The analysis, based on responses from over 1,300 dog owners who examined their pets' behaviour over a fortnight, was carried out by leading vet Claire Corridan, honorary secretary of the Companion Animal Behaviour Therapy Study Group - an affiliate of the British Small Animal Veterinary Association.
Vets are warning of similar behavioural problems emerging in cats, rabbits and parrots.
Some other conditions assessed by veterinarians include sleep problems, anxiety, anorexia, "self-mutilation", stress and depression.
The most common dog issue was hyperactivity, with 60 percent of pets exhibiting this behaviour.
The research found that 30 percent of dogs have fears or phobias, while around 22 percent were described as having "obsessive compulsive disorders" - such as excessive paw-licking or tail-chasing. Around 12 percent showed "separation-related problems" when parted from their owner. (IANS) - reprinted from newKerala.com
A Fog of Drugs and War
More than 110,000 active-duty Army troops last year took antidepressants, sedatives and other prescription medications. Some see a link to aberrant behavior.
Article by Kim Murphy | Los Angeles Times
SEATTLE - U.S. Air Force pilot Patrick Burke's day started in the cockpit of a B-1 bomber near the Persian Gulf and proceeded across nine time zones as he ferried the aircraft home to South Dakota.
Every four hours during the 19-hour flight, Burke swallowed a tablet of Dexedrine, the prescribed amphetamine known as "go pills." After landing, he went out for dinner and drinks with a fellow crewman. They were driving back to Ellsworth Air Force Base when Burke began striking his friend in the head.
FOR THE RECORD:
An earlier version of this story said that Bart Billings, a former military psychologist, hosts an annual conference at Camp Pendleton on combat stress. He now holds the conference at other venues.
"Jack Bauer told me this was going to happen - you guys are trying to kidnap me!" he yelled, as if he were a character in the TV show "24."
When the woman giving them a lift pulled the car over, Burke leaped on her and wrestled her to the ground. "Me and my platoon are looking for terrorists," he told her before grabbing her keys, driving away and crashing into a guardrail.
Burke was charged with auto theft, drunk driving and two counts of assault. But in October, a court-martial judge found the young lieutenant not guilty "by reason of lack of mental responsibility" - the almost unprecedented equivalent, at least in modern-day military courts, of an insanity acquittal.
Four military psychiatrists concluded that Burke suffered from "polysubstance-induced delirium" brought on by alcohol, lack of sleep and the 40 milligrams of Dexedrine he was issued by the Air Force.
In a small but growing number of cases across the nation, lawyers are blaming the U.s. military's heavy use of psychotropic drugs for their clients' aberrant behavior and related health problems. Such defenses have rarely gained traction in military or civilian courtrooms, but Burke's case provides the first important indication that military psychiatrists and court-martial judges are not blind to what can happen when troops go to work medicated.
After two long-running wars with escalating levels of combat stress, more than 110,000 active-duty Army troops last year were taking prescribed antidepressants, narcotics, sedatives, antipsychotics and anti-anxiety drugs, according to figures recently disclosed to The Times by the U.S. Army surgeon general. Nearly 8% of the active-duty Army is now on sedatives and more than 6% is on antidepressants - an eightfold increase since 2005.
"We have never medicated our troops to the extent we are doing now.... And I don't believe the current increase in suicides and homicides in the military is a coincidence," said Bart Billings, a former military psychologist who hosts an annual conference on combat stress.
The pharmacy consultant for the Army surgeon general says the military's use of the drugs is comparable to that in the civilian world. "It's not that we're using them more frequently or any differently," said Col. Carol Labadie. "As with any medication, you have to look at weighing the risk versus the benefits of somebody going on a medication."
But the military environment makes regulating the use of prescription drugs a challenge compared with the civilian world, some psychologists say.
Follow-up appointments in the battlefield are often few and far between. Soldiers are sent out on deployment typically with 180 days' worth of medications, allowing them to trade with friends or grab an entire fistful of pills at the end of an anxious day. And soldiers with injuries can easily become dependent on narcotic painkillers.
"The big difference is these are people who have access to loaded weapons, or have responsibility for protecting other individuals who are in harm's way," said Grace Jackson, a former Navy staff psychiatrist who resigned her commission in 2002, in part out of concerns that military psychiatrists even then were handing out too many pills.
For the Army and the Marines, using the drugs has become a wager that whatever problems occur will be isolated and containable, said James Culp, a former Army paratrooper and now a high-profile military defense lawyer. He recently defended an Army private accused of murder, arguing that his mental illness was exacerbated by the antidepressant Zoloft.
"What do you do when 30-80% of the people that you have in the military have gone on three or more deployments, and they are mentally worn out? What do you do when they can't sleep? You make a calculated risk in prescribing these medications," Culp said.
The potential effect on military personnel has special resonance in the wake of several high-profile cases, most notably the one involving Staff Sgt. Robert Bales, accused of murdering 17 civilians in Afghanistan. His attorneys have asked for a list of all medicines the 38-year-old soldier was taking.
"We don't know whether he was or was not on any medicines, which is why [his attorney] has asked to be provided the list of medications," said Richard Adler, a Seattle psychiatrist who is consulting on Bales' defense.
While there was some early, ad hoc use of psychotropic drugs in the Vietnam War, the modern Army psychiatrist's deployment kit is likely to include nine kinds of antidepressants, benzodiazepines for anxiety, four antipsychotics, two kinds of sleep aids, and drugs for attention-deficit hyperactivity disorder, according to a 2007 review in the journal Military Medicine.
Some troops in Afghanistan are prescribed mefloquine, an antimalarial drug that has been increasingly associated with paranoia, thoughts of suicide and violent anger spells that soldiers describe as "mefloquine rage."
"Prior to the Iraq war, soldiers could not go into combat on psychiatric drugs, period. Not very long ago, going back maybe 10 or 12 years, you couldn't even go into the armed services if you used any of these drugs, in particular stimulants," said Peter Breggin, a New York psychiatrist who has written widely about psychiatric drugs and violence.
"But they've changed that.... I'm getting a new kind of call right now, and that's people saying the psychiatrist won't approve their deployment unless they take psychiatric drugs."
Military doctors say most drugs' safety and efficacy is so well-established that it would be a mistake to send battalions into combat without the help of medications that can prevent suicides, help soldiers rest and calm shattered nerves.
Fueling much of the controversy in recent years, though, are reports of a possible link between the popular class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) - drugs such as Prozac, Paxil and Zoloft, which boost serotonin levels in the brain - and an elevated risk of suicide among young people. The drugs carry a warning label for those up to 24 - the very age of most young military recruits.
Last year, one of Culp's clients, Army Pfc. David Lawrence, pleaded guilty at Ft. Carson, Colo., to the murder of a Taliban commander in Afghanistan. He was sentenced to only 121/2 years, later reduced to 10 years, after it was shown that he suffered from schizophrenic episodes that escalated after the death of a good friend, an Army chaplain.
Deeply depressed and hearing a voice he would later describe as "female-sounding and never nice," Lawrence had reportedly feared he would be thrown out of the Army if he told anyone he was hearing voices - a classic symptom of schizophrenia. Instead, he'd merely told doctors he was depressed and thinking of suicide. He was prescribed Zoloft, for depression, and Trazodone, often used as a sleeping aid.
The voices got worse, and Lawrence began seeing hallucinations of the chaplain, minus his head. Eventually, Lawrence walked into the Taliban commander's jail cell and shot him in the face.
"They give him this, and they send him out with a gun," said his father, Brett Lawrence.
Up until the Burke case, there had been few if any recent rulings exonerating military defendants claiming to be incapacitated by medications.
Burke's case may have marked a turning point. Four Army doctors concluded that he wasn't mentally responsible for his actions - a finding none of them would have made had he been merely drunk.
"Three drinks over an entire evening is not enough to black somebody out, but I don't remember 99% of what happened over the rest of that evening," Burke said in an interview. "It was kind of like I was misfiring on the cylinders."
Both the American Psychological Assn. and the American Psychiatric Assn. in a 2010 congressional hearing urged the Army to stay the course on psychotropic drugs.
The real danger, said the psychologists' spokesman, M. David Rudd, dean of the college of social and behavioral science at the University of Utah, is if soldiers are frightened out of access to potentially life-saving medication.
The Army surgeon general's office said no one without specific approval is allowed to go on deployment using psychotropic drugs, including antidepressants and stimulants, until they've been stabilized. Soldiers who need antipsychotic agents are not allowed to go to combat.
But are those precautions enough? Julie Oligschlaeger said her son, Chad, a Marine corporal based at Twentynine Palms, came home from his second tour in Iraq in 2007 complaining of nightmares and hallucinations. He was taking Trazodone, Fluoxetine, Seroquel, Lorazepam, and propranolol, among other medications.
"I didn't realize how many pills he was on until it was too late," said Oligschlaeger. "He sometimes would slur his words, and I would think, 'OK, are you drinking? What is going on?' And he'd say, 'Oh, I'm taking my pills, and I'm taking them when I'm supposed to.' I never thought to look."
In 2008, two months before Chad was scheduled to get out of the Marines, start college, and marry his fiancee, the young corporal was found dead on the floor of his room in the barracks. An autopsy concluded the death was accidental due to multiple-drug toxicity - interactions among too many drugs.
At the memorial service, Oligschlaeger looked her son's commander in the eye and reminded him that Chad had waited in vain for a bed in a combat stress treatment facility. "I asked him, 'Why didn't you have your eyes on your Marine?'" she said. "He didn't answer me. He just stood there with his hands behind his back. And he looked at me." - read original article by LA Times
Article by Kim Murphy | Los Angeles Times
Prescription Meds Can Put on Unwanted Pounds
FRIDAY, March 2 (HealthDay News) -- Medications taken by millions of Americans for mood disorders, high blood pressure, diabetes and other chronic conditions can have an unhealthy side effect: weight gain.
While other choices exist for some types of drugs, adjusting medications is not simply a matter of switching, said Ryan Roux, chief pharmacy officer with the Harris County Hospital District, in Houston.
In the late 1990s, Dr. Lawrence Cheskin conducted early research on prescription medicines and obesity.
"Some medicines make an early, noticeable difference, causing patients to become ravenously hungry, while changes are subtle for others. A few months taking them and you've gained 10 pounds," said Cheskin, now director of the Johns Hopkins Weight Management Center, in Baltimore.
To help increase awareness, Roux and his pharmacist group have compiled a list of "weight-promoting" and "weight-neutral or weight-loss" drugs.
Antidepressants that promote weight gain include Paxil (paroxetine), Zoloft (sertraline), amitriptyline (Elavil) and Remeron (mirtazapine).
Wellbutrin (bupropion) and Prozac (fluoxetine) are considered weight-neutral or weight-loss drugs.
"Generally, older antidepressants are typically more prone to cause weight gain than the newer SSRIs [selective serotonin reuptake inhibitors]," Cheskin said.
Mood-disorder drugs that can add weight include the antipsychotics Clozaril (clozapine), Zyprexa (olanzapine), Risperdal (risperidone) and Seroquel (quetiapine). Lithium, valproic acid (Depakote) and carbamazepine (Tegretol) can also put on the pounds.
Drugs with hormonal effects, such as antipsychotics and steroids, are among the biggest culprits in weight gain, Cheskin said. "They work on the brain, and appetite control is largely a brain function. They make you more hungry," he said.
Both experts agreed that less-than-perfect adherence to prescribed medications is common, regardless of whether they affect a patient's weight.
With antipsychotic meds, Roux said, a challenge is that once people feel better they may stop taking them. When drugs like Zyprexa -- used in schizophrenia and bipolar disorder -- cause weight gain of 20 pounds and upward, that's another barrier to treatment adherence.
Blood pressure medicines that can cause weight gain include Lopressor (metoprolol), Tenormin (atenolol), Inderal (propranolol), Norvasc (amlodipine) and clonidine (Catapres).
Cheskin said dietary changes can help counterbalance the effects of these medications. "I recommend increasing fiber content and water, and lowering calorie density. Spread out calories over several meals, five or six a day, instead of saving it all for dinner."
Corticosteroids such as prednisone and methylprednisolone, are important for treating conditions like rheumatoid arthritis, asthma and some types of cancer, but they're notorious for adding weight.
"With steroids, you're talking about putting on fat stores," Roux said. Extra weight may deposit around the body's trunk, he said, and people often retain salt and fluid.
Rather than giving up on the drug, Cheskin said, "Please talk to your doctor to see if there's an alternative. With steroids, you might be able take them every other day or in smaller doses. But there's no real substitute for steroids if you need steroids."
Diabetes drugs, including oral medications like Actos (pioglitazone) and Amaryl (glimepiride), promote weight gain, as does insulin.
"With insulin, a lot of it is the chicken and the egg," Cheskin said. "People who are obese become diabetic, and people who are diabetic have mechanisms that make them less responsive to dietary changes."
Weight-loss or weight-neutral alternatives exist for oral diabetes meds: Byetta (exenatide), Januvia (sitagliptin), Symlin (pramlintide), Precose (acarbose) and metformin (Biguanides).
Epilepsy drugs prevent seizures. Some, like carbamazepine and Neurontin (gabapentin), can cause weight gain. Possible alternatives are Lamictal (lamotrigine), Topamax (topiramate) and Zonegran (zonisamide).
Roux said women taking birth control pills also may be "big gainers."
Switching to weight-neutral drugs won't work for everyone, Roux cautioned.
"They have different mechanisms of action, and their particular disease state might not be controlled," he said. "First and foremost is the disease state that's causing the biggest hindrance upon their lifestyle. That should be the first order of business."
People should talk to their health care providers if they're troubled by weight gain, Roux said.
"I advocate patients talking with the pharmacist first, so they don't just arbitrarily stop their medication before their next [medical] appointment," Roux said. "It should not be an embarrassment either to a patient or a provider to try to dig in, to get into a person's specific comfort level with their medication."
And, Cheskin added, "with all the attention on the environmental factors causing obesity, people may not be aware that what we're prescribing for you may not help and may push someone in the wrong direction." - read full article
Article written by Lisa Esposito, HealthDay Reporter, Philly.com/Health
Could Ambien Increase Your Risk of Death?
Feb. 28, 2012 - For the millions of Americans who use sleeping pills, a new study suggests the prescription medications may be doing more harm than good.
About 10 percent of Americans take some kind of sleep aid at night. Scripps Health researchers found that people who take any of a range of sleeping pills, or hypnotics, have a four-fold increase in death. Even people who took very low doses – as few as 18 pills a year – had a greater mortality risk. Ambien was the most widely prescribed sleep aid, although other drugs such as Lunesta, Sonata, Restoril, barbituates and sedative antihistamines were also included in the research. The researchers tracked over 10,000 patients from the Geisinger Health System in Pennsylvania who were prescribed sleeping pills for an average of 2.5 years and compared them to people who were matched for age, lifestyle and underlying health problems. Other research has indicated that women are more likely to take sleep aids than men, particularly women between the ages of 40 and 59. The average age for all the participants in the study was 54. The headline is frightening, but it’s not a cause-and-effect study. It's an association. Scientifically, that means just because you take an Ambien doesn’t mean you’re going to die. But people who take the pills have an increased risk because of a number of associated factors: possible mixed drug overdoses; depression; anxiety; impaired motor and cognitive skills (if someone takes a pill by accident and drives); and sleep apnea. A big limitation in the study is that all the data was based on prescriptions, which doesn’t mean the pills were actually taken or whether the prescriptions were even filled. Also, the researchers couldn’t be certain whether the participants who didn’t receive sleeping pill prescriptions were taking over-the-counter antihistamine sleep drugs or non-prescribed hypnotics. While the Scripps study is provocative and flawed, there have been numerous other studies showing an increased risk of mortality from sleep medications. On TODAY Tuesday, the Pharmaceutical Manufacturers Association responded, saying, “Prescription medicines undergo thorough clinical trials regulated by the FDA and are FDA-approved on the basis of their safety and effectiveness. Biopharmaceutical research companies also work closely with the FDA throughout the life of approved medicines, continuing to monitor the medicines for safety issues.” However, it goes to the bigger picture that we are overmedicated as a society. More people are on anti-anxiety medications and sleeping aids than any time in history. A lot of people take sleep aids because we have a conventional wisdom that everyone needs eight hours of sleep at night. When we have insomnia, we panic. Working women, in particular, have no downtime, so it's not surprising that we're self-medicating. My advice to people who take sleep aids is to remember: These things and alcohol or other anti-anxiety medicines don’t mix. That's where a lot of people get into trouble. Everything you put in your mouth can have a downside. Use the sleeping aids sparingly. If you’re using them all the time, think about what you can change in your life so you don’t have to rely on medication. read org. article Article written by Dr. Nancy Snyderman
Chief Medical Editor, NBC
Why Antidepressants Don't Work for Treating Depression
Here's some depressing recent medical news: Antidepressants don't work. What's even more depressing is that the pharmaceutical industry and Food and Drug Administration (FDA) have deliberately deceived us into believing that they DO work. As a physician, this is frightening to me. Depression is among the most common problems seen in primary-care medicine and soon will be the second leading cause of disability in this country.The study I'm talking about was published in The New England Journal of Medicine. It found that drug companies selectively publish studies on antidepressants. They have published nearly all the studies that show benefit -- but almost none of the studies that show these drugs are ineffective.
Feb. 28, 2012 - For the millions of Americans who use sleeping pills, a new study suggests the prescription medications may be doing more harm than good. About 10 percent of Americans take some kind of sleep aid at night. Scripps Health researchers found that people who take any of a range of sleeping pills, or hypnotics, have a four-fold increase in death. Even people who took very low doses – as few as 18 pills a year – had a greater mortality risk.
Ambien was the most widely prescribed sleep aid, although other drugs such as Lunesta, Sonata, Restoril, barbituates and sedative antihistamines were also included in the research.
The researchers tracked over 10,000 patients from the Geisinger Health System in Pennsylvania who were prescribed sleeping pills for an average of 2.5 years and compared them to people who were matched for age, lifestyle and underlying health problems. Other research has indicated that women are more likely to take sleep aids than men, particularly women between the ages of 40 and 59. The average age for all the participants in the study was 54.
The headline is frightening, but it’s not a cause-and-effect study. It's an association. Scientifically, that means just because you take an Ambien doesn’t mean you’re going to die. But people who take the pills have an increased risk because of a number of associated factors: possible mixed drug overdoses; depression; anxiety; impaired motor and cognitive skills (if someone takes a pill by accident and drives); and sleep apnea.
A big limitation in the study is that all the data was based on prescriptions, which doesn’t mean the pills were actually taken or whether the prescriptions were even filled. Also, the researchers couldn’t be certain whether the participants who didn’t receive sleeping pill prescriptions were taking over-the-counter antihistamine sleep drugs or non-prescribed hypnotics. While the Scripps study is provocative and flawed, there have been numerous other studies showing an increased risk of mortality from sleep medications.
On TODAY Tuesday, the Pharmaceutical Manufacturers Association responded, saying, “Prescription medicines undergo thorough clinical trials regulated by the FDA and are FDA-approved on the basis of their safety and effectiveness. Biopharmaceutical research companies also work closely with the FDA throughout the life of approved medicines, continuing to monitor the medicines for safety issues.”
However, it goes to the bigger picture that we are overmedicated as a society. More people are on anti-anxiety medications and sleeping aids than any time in history. A lot of people take sleep aids because we have a conventional wisdom that everyone needs eight hours of sleep at night. When we have insomnia, we panic. Working women, in particular, have no downtime, so it's not surprising that we're self-medicating.
My advice to people who take sleep aids is to remember: These things and alcohol or other anti-anxiety medicines don’t mix. That's where a lot of people get into trouble.
Everything you put in your mouth can have a downside. Use the sleeping aids sparingly. If you’re using them all the time, think about what you can change in your life so you don’t have to rely on medication. read org. article
Article written by Dr. Nancy Snyderman Chief Medical Editor, NBC
That warps our view of antidepressants, leading us to think that they do work. And it has fueled the tremendous growth in the use of psychiatric medications, which are now the second leading class of drugs sold, after cholesterol-lowering drugs.
The problem is even worse than it sounds, because the positive studies hardly showed benefit in the first place. For example, 40 percent of people taking a placebo (sugar pill) got better, while only 60 percent taking the actual drug had improvement in their symptoms. Looking at it another way, 80 percent of people get better with just a placebo.
That leaves us with a big problem -- millions of depressed people with no effective treatments being offered by most conventional practitioners. However, there are treatments available. Functional medicine provides a unique and effective way to treat depression and other psychological problems. Today I will review seven steps you can take to work through your depression without drugs. But before we get to that, let's take a closer look at depression.
What's in a Name?
"Depression" is simply a label we give to people who have a depressed mood most of the time, have lost interest or pleasure in most activities, are fatigued, can't sleep, have no interest in sex, feel hopeless and helpless, can't think clearly, or can't make decisions.
But that label tells us NOTHING about the cause of those symptoms. In fact, there are dozens of causes of depression -- each one needing a different approach to treatment. Depression is not one-size-fits-all, but it is very common.
Women have a 10 to 25 percent risk and men a five to 12 percent risk of developing severe major depression in their lifetime. ) One in ten Americans takes an antidepressant. The use of these drugs has tripled in the last decade, according to a report by the federal government. In 2006, spending on antidepressants soared by 130 percent.
But just because antidepressants are popular doesn't mean they're helpful. Unfortunately, as we now see from this report in The New England Journal of Medicine, they don't work and have significant side effects. Most patients taking antidepressants either don't respond or have only partial response. In fact, success is considered just a 50 percent improvement in half of depressive symptoms. And this minimal result is achieved in less than half the patients taking antidepressants.
That's a pretty dismal record. It's only made worse by the fact that 86 percent of people taking antidepressants have one or more side effects, including sexual dysfunction, fatigue, insomnia, loss of mental abilities, nausea, and weight gain.
No wonder half the people who try antidepressants quit after four months.
Now I want to talk to you about the reasons why doctors and patients have been deceived by the "antidepressant hoax." Despite what we have been brainwashed to believe, depression is not a Prozac deficiency!
How We have Been Deceived by the Antidepressant Hoax
Drug companies are not forced to publish all the results of their studies. They only publish those they want to. The team of researchers that reported their findings in The New England Journal of Medicine took a critical look at all the studies done on antidepressants, both published and unpublished. They dug up some serious dirt ...
The unpublished studies were not easy to find. The researchers had to search the FDA databases, call researchers, and hunt down hidden data under the Freedom of Information Act. What they found was stunning.
After looking at 74 studies involving 12 drugs and over 12,000 people, they discovered that 37 of 38 trials with positive results were published, while only 14 of 36 negative studies were published. Those that showed negative results were, in the words of the researchers, "published in a way that conveyed a positive outcome."
That means the results were twisted to imply the drugs worked when they didn't.
This isn't just a problem with antidepressants. It's a problem with scientific research. Some drug companies even pay or threaten scientists to not publish negative results on their drugs. So much for "evidence-based" medicine! I recently had dinner with a step-uncle who runs a company that designs research for drug companies. He designs the study, hires the researcher from an esteemed institution, directs the study, writes up the study and the scientist just signs his or her name after reviewing it.
Most of the time, we only have the evidence that the drug companies want us to have. Both doctors and patients are deceived into putting billions of dollars into drug companies' pockets, while leaving millions with the same health problems but less money.
The scientific trust is broken. What can we do? Unfortunately, there is no easy answer. But I do think functional medicine, on which my approach of UltraWellness is based, provides a more intelligent way of understanding the research. Rather than using drugs to suppress symptoms, Functional Medicine helps us find the true causes of problems, including depression.
I see this in so many of the patients I have treated over the years. Just as the same things that make us sick also make us fat, the same things that make us sick also make us depressed. Fix the causes of sickness -- and the depression takes care of itself.
Consider a few cases from my practice ...
A 23-year-old had been anxious and depressed most of her life and spent her childhood and adolescence on various cocktails of antidepressants. Turns out, she suffered from food allergies that made her depressed.
Food allergies cause inflammation, and studies now show inflammation in the brains of depressed people. In fact, researchers are studying powerful anti-inflammatory drugs used in autoimmune disease such as Enbrel for the treatment of depression.
After she eliminated her IgG or delayed food allergies, her depression went away, she got off her medication -- and she lost 30 pounds as a side effect!
Here's another story ... A 37-year-old executive woman struggled for more than a decade with treatment-resistant depression (meaning that drugs didn't work), fatigue, and a 40-pound weight gain. We found she had very high levels of mercury. Getting the mercury out of her body left her happy, thin, and full of energy.
Or consider the 49-year-old man with severe lifelong depression who had been on a cocktail of antidepressants and psychiatric medication for years but still lived under a dark cloud every day, without relief. We found he had severe deficiencies of vitamin B12, B6, and folate. After we gave him back those essential brain nutrients, he called me to thank me. Last year was the first year he could remember feeling happy and free of depression.
These are just a few of the dozens of things that can cause depression.
The roots of depression are found in the 7 keys to UltraWellness and the 7 fundamental underlying imbalances that trigger the body to malfunction. Taking antidepressants is not the answer to our looming mental health epidemic. The real cure lies in rebalancing the underlying systems in your body that are at the root of all healthy and illness.
Here are a few things you can do to start treating your depression today.
7 Steps to Treat Depression without Drugs
1. Try an anti-inflammatory elimination diet that gets rid of common food allergens. As I mentioned above, food allergies and the resultant inflammation have been connected with depression and other mood disorders.
2. Check for hypothyroidism. This unrecognized epidemic is a leading cause of depression. Make sure to have thorough thyroid exam if you are depressed.
3. Take vitamin D. Deficiency in this essential vitamin can lead to depression. Supplement with at least 2,000 to 5,000 IU of vitamin D3 a day.
4. Take omega-3 fats. Your brain is made of up this fat, and deficiency can lead to a host of problems. Supplement with 1,000 to 2,000 mg of purified fish oil a day.
5. Take adequate B12 (1,000 micrograms, or mcg, a day), B6 (25 mg) and folic acid (800 mcg). These vitamins are critical for metabolizing homocysteine, which can play a factor in depression.
6. Get checked for mercury. Heavy metal toxicity has been correlated with depression and other mood and neurological problems.
7. Exercise vigorously five times a week for 30 minutes. This increases levels of BDNF, a natural antidepressant in your brain.
Overcoming depression is an important step toward lifelong vibrant health. These are just of few of the easiest and most effective things you can do to treat depression. But there are even more, which you can address by simply working through the 7 Keys to UltraWellness. Read full article.
Article written by Mark Hyman, M.D.
Expectant Mothers on Anti-Depressants Risk Newborns with High Blood Pressure
Thursday, January 12, 2012
Mothers who take anti-depressants during pregnancy are more likely to give birth to children with persistent pulmonary hypertension (high blood pressure in the lungs) finds a study published today on bmj.com.
Persistent pulmonary hypertension is an increase in blood pressure in the lungs leading to shortness of breath and difficulty breathing. It is a rare, but severe disease with strong links to heart failure.
The study, carried out by researchers at the Centre for Pharmacoepidemiology at Karolinska Institutet in Stockholm Sweden, reviewed 1.6 million births in total between 1996 and 2007 in five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. The babies were assessed after 231 days (33 weeks).
A total of 1,618,255 singleton births were included in the study. Approximately 11,000 of the mothers filled out a prescription for anti-depressants in late pregnancy and approximately 17,000 in early pregnancy. Those who did fill out a prescription were generally older mothers who also smoked. A further 54,184 mothers were identified as having previously undergone psychiatric diagnosis but were not currently taking any medication.
Factors taken into account during the study included persistent pulmonary hypertension, maternal smoking, BMI (in early pregnancy), year of birth, gestational age at birth, birth weight and maternal diseases including epilepsy, malignancies, arthritis, bowel disease, lupus and pre-eclampsia.
The uses of several drugs were analysed which included fluoxetine, fluvoxamine, citalopram, paroxetine, sertraline, fluvoxamine and escitalopram. Although, research found that fluvoxamine had rarely been used and that none of the children with persistent pulmonary hypertension were exposed to this drug.
The results found that out of 11,014 mothers who used anti-depressants in late pregnancy just 33 babies (0.2%) were born with persistent pulmonary hypertension and out of 17,053 mothers who used anti-depressant drugs in early pregnancy, just 32 babies (less than 0.2%) were diagnosed with persistent pulmonary hypertension. A total of 114 babies whose mothers had previously been diagnosed with a mental illness were found to be suffering from the disease.
For mothers using anti-depressants, factors such as being born small for gestational age, or by C-section did not influence the likelihood of having a child with persistent pulmonary hypertension.
While the authors acknowledge that the risk of developing pulmonary persistent hypertension is low (around three cases per 1000 women which more than doubles if anti-depressants are taken in late pregnancy) they still advise caution when treating pregnant women with SSRIs.
In an accompanying editorial, researchers from the Motherisk Program Hospital for Sick Children in Toronto and the School of Pharmacy at the University of Oslo support the view that mothers who take SSRIs in late pregnancy are more likely to give birth to children with persistent pulmonary hypertension. Read full article.
Research: Helle Kieler, Karolinska Institutet, Centre for Pharmacoepidemiology, T2, Karolinska University Hospital, Stockholm, Sweden
Article by BMJ - Helping doctors make better decisions.
GPs Need More Awareness About Benzodiazepines
GPs generally tend to view benzodiazepines as relatively innocuous and can be unaware of their high level of abuse and street use, the founding Professor of General Practice at University College Cork has warned.
Speaking ahead of the ‘Benzodiazepines: An Integrated Response’ conference, Prof Colin Bradley told Irish Medical Times that while GPs were aware on one level of the dangers of the drug, others were not quite aware of their prevalence.
“A lot of GPs would think that while not entirely desirable, benzodiazepines are not that dangerous,” he commented.
The conference, a community outreach drug awareness project open to the public, takes place at the Best Western Montenotte Hotel (Garden Suite) in Cork City, next Wednesday (November 9) from 6.30pm to 9pm. It is a collaboration between Cork City Partnership and Cork Local Drugs Task Force (CLDTF).
Prof Bradley said the low level of risk perception was perpetuated because some GPs had some patients on benzodiazepines for some time without it seemingly doing them any great harm. It was also difficult for GPs to identify the minority for whom the drug might be doing harm, he added.
Prof Bradley, who was on the Commission on Benzodiazepine Prescribing and the Cardiovascular Strategy Review Group, will review its 2001 recommendations and guidelines to GPs, highlighting the lack of any apparent progress on reducing benzodiazepine use and abuse 10 years later.
According to Prof Bradley, some 10 per cent of medical cardholders were on benzodiazepines in 2001, and 10 years on not much has changed in terms of the volume of benzodiazepines prescribed. This, he said, could be attributed to the fact that GPs have few therapeutic options owing to the way the health service has been reconfigured, with access to specialist services only available through consultants.
Furthermore, more appropriate treatments - for example, for patients with mild to moderate symptoms - such as counselling, mental health and psychology services were already oversubscribed by patients with more severe conditions.
There was a need for a follow-on engagement with GPs in order to maintain awareness and the ICGP, which will address the same issue at its Winter Meeting on November 26, has started reviewing the issue, said Prof Bradley.
Dr Terry Lynch, the author of Beyond Prozac who has just published Selfhood: A Key to the Recovery of Emotional Wellbeing, Mental Health and the Prevention of Mental Health Problems, will be guest speaker at the conference. View article.
By Lloyd Mudiwa / Irish Medical Times
Painkillers Over-the-Counter Pain Relievers May Block Some Antidepressants
People with depression encounter a lot of pharmaceutical frustration. For largely unknown reasons, roughly one in three patients receive no benefit from any antidepressant. A recent study, however, suggests that something as simple as over-the-counter painkillers could play a role. Ibuprofen, aspirin and other anti-inflammatory drugs may disrupt the action of selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant.
Antidepressants alter brain chemistry. SSRIs increase the amount of the neurotransmitter serotonin in the space between brain cells. Neuroscientist Jennifer L. Warner-Schmidt of the Rockefeller University and her colleagues noticed that certain proteins in the brain that interact with SSRIs had the potential to be influenced by anti-inflammatory drugs such as pain relievers.
The team embarked on a series of experiments in rodents to explore this idea. In one test, researchers measured how long it takes a mouse to overcome its fear of a new, open space and move toward food placed in the center. Mice that had been given the SSRI Citalopram for two weeks approached the food more than twice as quickly as unmedicated mice. But mice given ibuprofen with the SSRI for two weeks headed for the food nearly as slowly as unmedicated mice, Warner-Schmidt and her colleagues report in the Proceedings of the National Academy of Sciences USA.
The researchers also examined information from a previous study of patients with treatment-resistant depression. The study evaluated how the participants responded to a 12-week course of Citalopram and noted other medication use. Patients who had taken an anti-inflammatory drug or acetaminophen during their SSRI treatment were significantly less likely to experience relief from their symptoms than patients who had not.
The researchers are planning studies to figure out how exactly the pain medications interfere with the SSRIs and to determine how big a dose of painkillers is detrimental. But the evidence so far “is clinically important,” Warner-Schmidt says. “It’s a piece of information that doctors should keep in mind when looking at an individual who is not responding to an SSRI.” - view article
Article by Aimee Cunningham Scientific American
Drug Deaths Now Outnumber Traffic Fatalities in U.S., data show
September 17, 2011 - Fueling the surge are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol.
Propelled by an increase in prescription narcotic overdoses, drug deaths now outnumber traffic fatalities in the United States, a Times analysis of government data has found.
Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide, according to preliminary data from the U.S. Centers for Disease Control and Prevention.
While most major causes of preventable death are declining, drugs are an exception. The death toll has doubled in the last decade, now claiming a life every 14 minutes. By contrast, traffic accidents have been dropping for decades because of huge investments in auto safety.
Public health experts have used the comparison to draw attention to the nation's growing prescription drug problem, which they characterize as an epidemic. This is the first time that drugs have accounted for more fatalities than traffic accidents since the government started tracking drug-induced deaths in 1979.
Fueling the surge in deaths are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol. Among the most commonly abused are OxyContin, Vicodin, Xanax and Soma. One relative newcomer to the scene is Fentanyl, a painkiller that comes in the form of patches and lollipops and is 100 times more powerful than morphine.
Such drugs now cause more deaths than heroin and cocaine combined.
"The problem is right here under our noses in our medicine cabinets," said Laz Salinas, a sheriff's commander in Santa Barbara, which has seen a dramatic rise in prescription drug deaths in recent years.
Overdose victims range in age and circumstance from teenagers who pop pills to get a heroin-like high to middle-aged working men and women who take medications prescribed for strained backs and bum knees and become addicted.
A review of hundreds of autopsy reports in Southern California reveals one tragic demise after another: A 19-year-old Army recruit, who had just passed his military physical, took a handful of Xanax and painkillers while partying with friends. A groom, anxious over his upcoming wedding, overdosed on a cocktail of prescription drugs. A teenage honors student overdosed on painkillers her father left in his medicine cabinet from a surgery years earlier. A toddler was orphaned after both parents overdosed on prescription drugs months apart. A grandmother suffering from chronic back pain apparently forgot she'd already taken her daily regimen of pills and ended up double dosing.
Many died after failed attempts at rehab - or after using one too many times while contemplating quitting. That's apparently what happened to a San Diego woman found dead with a Fentanyl patch on her body, one of five she'd applied in the 24 hours before her death. Next to her on the couch was a notebook with information about rehab.
The seeds of the problem were planted more than a decade ago by well-meaning efforts by doctors to mitigate suffering, as well as aggressive sales campaigns by pharmaceutical manufacturers. In hindsight, the liberalized prescription of pain drugs "may in fact be the cause of the epidemic we're now facing," said Linda Rosenstock, dean of the UCLA School of Public Health.
In some ways, prescription drugs are more dangerous than illicit ones because users don't have their guard up, said Los Angeles County Sheriff's Sgt. Steve Opferman, head of a county task force on prescription drug-related crimes. "People feel they are safer with prescription drugs because you get them from a pharmacy and they are prescribed by a doctor," Opferman said. "Younger people believe they are safer because they see their parents taking them. It doesn't have the same stigma as using street narcotics."
Lori Smith said she believes that's what her son might have been thinking the night he died six months shy of his 16th birthday. Nolan Smith, of Aliso Viejo, loved to surf, sail and fish with his brother and father. He suffered from migraines and anxiety but showed no signs of drug abuse, his mother said.
The night before he died in January 2009, Nolan called his mother at work, asking for a ride to the girls basketball game at Aliso Niguel High School. Lori told him she couldn't get away.
When Nolan didn't come home that evening, his parents called police and his friends. His body was found the next morning on a stranger's front porch.
A toxicology test turned up Zoloft, which had been prescribed for anxiety, and a host of other drugs that had not been prescribed, including two additional anti-anxiety drugs, as well as morphine and marijuana.
All investigators could give the family were theories.
"They said they will have parties where the kids will throw a bunch of pills in a bowl and the kids take them without knowing what they are," Lori said. "We called all of his friends, but no one would say they were with him. But he must have been with someone. You just don't do that by yourself."
The triumph of public health policies that have improved traffic safety over the years through the use of seat belts, air bags and other measures stands in stark contrast to the nation's record on prescription drugs. Even though more people are driving more miles, traffic fatalities have dropped by more than a third since the early 1970s to 36,284 in 2009. Drug-induced deaths had equaled or surpassed traffic fatalities in California, 22 other states and the District of Columbia even before the 2009 figures revealed the shift at the national level, according to the Times analysis.
The Centers for Disease Control collects data on all causes of death each year and analyzes them to identify health problems. Drug-induced deaths are mostly accidental overdoses but also include suicides and fatal diseases caused by drugs.
The CDC's 2009 statistics are the agency's most current. They are considered preliminary because they reflect 96% of death certificates filed. The remaining are deaths for which the causes were not immediately clear.
Drug fatalities more than doubled among teens and young adults between 2000 and 2008, years for which more detailed data are available. Deaths more than tripled among people aged 50 to 69, the Times analysis found. In terms of sheer numbers, the death toll is highest among people in their 40s.
Overdose deaths involving prescription painkillers, including OxyContin and Vicodin, and anti-anxiety drugs such as Valium and Xanax more than tripled between 2000 and 2008.
The rise in deaths corresponds with doctors prescribing more painkillers and anti-anxiety medications. The number of prescriptions for the strongest pain pills filled at California pharmacies, for instance, increased more than 43% since 2007 - and the doses grew by even more, nearly 50%, according to a review of prescribing data collected by the state.
Those prescriptions provide relief to pain sufferers but also fuel a thriving black market. Prescription drugs are traded on Internet chat rooms that buzz with offers of "vikes," "percs" and "oxys" for $10 to $80 a pill. They are sold on street corners along with heroin, marijuana and crack. An addiction to prescription drugs can be costly; a heavy OxyContin habit can run twice as much as a heroin addiction, authorities say.
On a recent weekday morning, Los Angeles County undercover sheriff's deputies posing as drug buyers easily purchased enough pills to fill a medicine cabinet on a sidewalk a few blocks south of Los Angeles City Hall.
The most commonly abused prescription drug, hydrocodone, also is the most widely prescribed drug in America, according to the U.S. Drug Enforcement Agency. Better known as Vicodin, the pain reliever is prescribed more often than the top cholesterol drug and the top antibiotic.
"We have an insatiable appetite for this drug - insatiable," Joseph T. Rannazzisi, a top DEA administrator, told a group of pharmacists at a regulatory meeting in Sacramento.
In April, the White House Office of National Drug Control Policy announced initiatives aimed at stanching prescription drug abuse. The plans include a series of drug take-back days, modeled after similar programs involving weapons, in which consumers are encouraged to turn leftover prescription drugs in to authorities. Another initiative would develop voluntary courses to train physicians on how to safely prescribe pain drugs, a curriculum that is not widely taught in medical schools.
Initial attempts to reverse the trend in drug deaths - such as state-run prescription drug-monitoring programs aimed at thwarting "doctor-shopping" addicts - don't appear to be having much effect, experts say.
"What's really scary is we don't know a lot about how to reduce prescription deaths," said Amy S.B. Bohnert, a researcher at the University of Michigan Medical School who is studying ways to lower the risk of prescription drugs.
"It's a wonderful medical advancement that we can treat pain," Bohnert said. "But we haven't figured out the safety belt yet." View original article
Article written by Lisa Girion, Scott Glover and Doug Smith, Los Angeles Times
When Medicine Makes You Sick
The prescription drug you've been on for years can have sudden, scary side effects.
Los Angeles civil attorney Lisa Herbert (not her real name), 61, was shopping at Trader Joe's one evening in June 2009 when she suddenly became disoriented. For an hour she wandered the aisles in a haze, filling her cart with chocolate cupcakes and frozen tamales. At home she talked incessantly, yelled at her roommate, and-convinced she had found an ingenious way to clean the apartment-yanked a fire extinguisher off the wall and sprayed the kitchen and bathroom with a thick white foam.
By morning Herbert's mental clarity had returned, along with a deep embarrassment and confusion over what had caused such bizarre behavior. The answer - which her ever-vigilant doctor immediately suspected - was drug toxicity, a gradual buildup of prescription medication in her bloodstream.
Herbert, who has multiple sclerosis, had been taking baclofen for the past six years to control muscle spasms in her legs. She had taken the same dose all that time with no ill effects, but three months before her disorienting episode, she had begun a strict, low-carb diet and had proudly shed 15 pounds. Because she was thinner yet still taking the same dose of baclofen, the drug had built up to toxic levels.
Drug toxicity is a common and significant health problem, yet it often goes undetected by both patients and doctors, who don't suspect it as the cause of such symptoms as mental disorientation, dizziness, blurred vision, memory loss, fainting, and falls. Although drug toxicity may result when a medication dose is too high, it can also happen because a person's ability to metabolize a drug changes over time or, in the case of Herbert, because she simply didn't need as much of the drug at her lower weight.
Older people are at high risk for drug toxicity, but younger people can suffer symptoms as well. Drug toxicity is "a major public-health issue even for people in their 40s and 50s," says Mukaila A. Raji, M.D., chief of geriatric medicine at the University of Texas Medical Branch in Galveston. "Most drugs are eliminated from the body through the kidneys and liver, but starting around the fourth decade we start accumulating fat and lose muscle mass, accompanied by a progressive decline in the ability of our kidneys and liver to process and clear medications. All of this makes us more prone to drug toxicity." According to findings from the Baltimore Longitudinal Study of Aging, age-related loss of kidney function often starts even earlier, in your 30s, and gets worse with each passing decade.
Despite the well-established connection between aging and drug toxicity, physicians sometimes fail to equate patients' symptoms with an adverse drug reaction, attributing them instead to a new medical condition. "As doctors, we see a lot of patients who come in with a general 'I don't feel well' complaint, or maybe they're confused and dehydrated, and we attribute it to a viral illness, when it's caused at least in part by the medication they're taking," says medical toxicologist Kennon Heard, M.D., an associate professor at the University of Colorado School of Medicine in Denver.
Physicians' prescribing habits may also be partly to blame. "There is a tendency for physicians to prescribe a medication for every symptom, and not every symptom requires a medication," says Raji. The more medications a patient takes, the more likely one of them will build up to toxic levels, experts say.
Finally, patients often see multiple doctors who do not communicate with one another and so end up prescribing similar drugs - which, when combined, can reach toxic levels. Electronic medical records will help close the communications gap, experts say. Computerized Clinical Decision Support Systems - used by many hospitals to generate patient-specific recommendations for care - will also help. A 2005 Journal of the American Medical Association study of the systems' effectiveness showed improvements in diagnosis, drug dosing, and drug prescribing.
To avoid drug toxicity, patients should be proactive by keeping a careful record of which drugs they're taking - including over-the-counter medications - and bringing that list to every doctor visit.
They can also insist that their doctors consider drug toxicity when a new symptom arises. "Many doctors don't specifically test for drug toxicity," explains Raji, "and a simple CBC [or blood chemistry panel] won't detect it." Certain blood tests can monitor the levels and effects of several drugs, including levothyroxine (Synthroid), warfarin (Coumadin), some antibiotics, and digoxin (Lanoxin). But even so, says Raji, "the blood range of digoxin that's listed as 'normal' in medical textbooks is based on tests done on young people." In general, say medical experts, the best way to determine if drug toxicity has occurred is to eliminate or reduce the dose of a suspected medication when safe to do so - as Lisa Herbert's doctor did.
Patients should also read the safety inserts that come with their medication - before taking it. After recovering from what she calls her "cognitive flip-out," Herbert finally read her baclofen insert, discovering in the fine print the drug's rare but possible adverse effects: seizures, confusion, even hallucinations. Had she read the insert earlier, she realized, she might have saved herself and her roommate a good deal of anguish - not to mention a day's work in cleaning up one very messy apartment.
Drugs With the Highest Potential for Harm
Three classes of medications - anticoagulants (warfarin, aspirin, clopidogrel), antidiabetic agents (insulin, metformin, glyburide, glipizide, chlorpropamide), and narrow therapeutic agents (digoxin, phenytoin, lithium, theophylline, valproic acid) - account for almost half of all emergency-room visits for adverse drug events in older patients. Read original article.
Other medications that are problematic for seniors:
- BelladonNa alkaloids
Article by: Mary A. Fischer | from: AARP The Magazine | Sept./Oct. 2010 issue
New FDA Warning for Clacks (Citalopram)
On August 25, 2011 the FDA warned that Celexa (Citalopram) should not be used at dosages higher than 40mg per day. Studies have shown that high doses can cause abnormal changes in the electrical activity of the heart, which can be fatal. Patients with existing heart conditions, or those prone to low potassium or magnesium levels are at an even higher risk factor.
In July 2011 a study in the British Medical Journal (BMJ) stated that all Selective Serotonin Reuptake Inhibitors (SSRIs) are more likely to cause death and issues such as heart attack, stroke, falls and seizures in older populations.
The FDA also warned that mixing antidepressants with migraine drugs can trigger a life-threatening condition called Serotonin Syndrome.
SSRIs have been shown to alter neurobehavioral development in the fetus and have been linked to an increased risk of autism.
Although antidepressants are the most popular prescription medication in the United States, most patients are not aware of the risks. Celexa was created in 1989 and went generic in 2003 after the patent expired. It has taken 22 years for the FDA to obtain enough evidence to issue the latest warning. This is another example of how a potentially unsafe medication is approved and yet the dangers are not realized for years. Written by Alesandra Rain, Point of Return, August 30. 2011
Can Medicines Make Me Fat?
If you want the short answer, then yes - medicines can make you fat. But only a few of them. However, it's safe to blame your bulging waistline on your never-ending migraine, depression or pain medications.
Dr Sushila Kataria, Senior Consultant in the Dept of Internal Medicine at Medanta Medicity, New Delhi helps us identify these weight gain culprits, and tells us how we can deal with the dilemma of needing medication, yet fearing what it might do to our body weight. 'Medicines which can cause weight gain are steroids, anti-psychotic drugs, anti-depressants, anti-seizure drugs, anti-migraine drugs. Diabetes medicines like insulin and some oral tablets can also cause weight gain. Other than these, not all the medicines should be blamed for weight gain,' says the doctor. Read on to understand how this affects you...
Here's a list of drugs which can lead to weight gain:
Allergy Drugs: They contain diphenhydramine which gives you instant drowsiness. Something like what most cough medicines would do, leaving you less active. You should ask your doctor and go for another antihistamine such as zyrtec which doesn't have drowsiness affect.
Antidepressant Drugs: Some antidepressant drugs might give a kick to your mood increasing your urge to eat. Best is to seek a psychiatrist help and go for antidepressants that don't lead to weight gain, such as Zyban and Wellbutrin.
Birth Control Pills: Birth control pills can easily lead to piling of pounds because they tend to cause bloating and retention. Go for a low-estrogen pill or progestin pill.
Sleeping Pills: Over-the-counter available sleeping pills such as diphen-hydramine, sominex or Tylenol Simply Sleep can be a major cause why you are gaining weight. Discuss this at length with your doctor and only take the medications prescribed by him.
Migraine Medicines: These can cause weight gain as they make you want to eat more. Oleanzipine and sodium valproat can lead to weight gain. Stay away from migraine medicines such as depakene and depakote and talk to your doctor regarding migraine medicines which are weight loss or weight neutral ones.
Steroids: Many over-the-counter available steroids can make you feel ravenously hungry. Steroids are actually good appetite boosters. They improve your appetite, so you eat more thus leading to weight gain. They also cause water retention and bloating problems. Ask your doctor specifically to prescribe you NSAIDs. However, if because of extreme pain you doctor still recommends you steroids like prednisone and all, then make sure your eating right and exercising too. View whole article…
Article written by Mansi Kohli, Health Me Up
Antidepressant Tied to Dangerous Heart Rhythm, FDA Says
(Health Day News) -- High doses of the popular antidepressant Celexa can cause potentially fatal abnormal heart rhythms and should no longer be prescribed to patients, the U.S. Food and Drug Administration said Wednesday.
Doses of Celexa (Citalopram hydrobromide) greater than 40 milligrams a day can cause changes in the electrical activity of the heart, which can lead to abnormal heart rhythms, including a potentially deadly arrhythmia known as Torsade de Pointes, according to the agency.
Patients at high risk for changes in the electrical activity of the heart include those with pre-existing heart conditions (including congestive heart failure) and those prone to low levels of potassium and magnesium in the blood, the FDA said.
Even though studies have not found that doses higher than 40 mg a day offer any benefits to patients with depression, Celexa's drug labeling previously stated that some patients may require a dose of 60 mg a day, the agency noted.
The label has been revised to include the new dosage limit as well as information about the potential for abnormal heart electrical activity and rhythms.
Celexa belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), which also include widely used medications such as Paxil, Prozac and Zoloft. Article written copy written by Health Day - view article
Heat Spikes Death Rates from Drugs
With relentless heat enveloping much of the nation, no one, it seems is spared. That includes a group at especially high risk of harm from high temperatures: drug users, both therapeutic and recreational, particularly those who take stimulants like cocaine, methamphetamine and Ritalin or antidepressants and other psychiatric medications.
One study found that for every week that the temperature exceeds 75 degrees Fahrenheit, New York City will experience two extra cocaine-related deaths. And, as the temperature climbs, the number of deaths leaps proportionally. A week like this with temperatures in the 90's and possibly 100's might tally 4-7 extra cocaine deaths in New York City alone.
“High doses of stimulants can produce extremely high body temperatures,” says Zheng-Xiong Xi, a researcher at the National Institute on Drug Abuse. And extremely high body temperatures can kill.
While cocaine doesn't literally fry your brain, the higher the temperature climbs, the more likely it is that high doses of stimulants like coke, together with the heat, will injure brain cells and the greater the risk is for overdose death.
Two factors combine here. First, stimulants themselves raise body temperature, which is not what you want during a heat wave. They also interfere with the body's ability to regulate temperature to cool itself down. The high body temperatures that result are one way that stimulant overdose kills- extra heat makes matters worse.
Secondly, chemical reactions that injure or kill brain cells can occur when high doses of these drugs are taken. These may be more toxic when the temperature is higher. High doses of stimulants cause excess release of dopamine and glutamate- if these levels get high enough, the resulting chemical reactions can be deadly to cells. That process may increase overdose risk as well as contributing to long-term harm in those who survive.
Ecstasy (MDMA) is another drug that can be deadly when mixed with high temperatures- just like its chemical cousin, methamphetamine, Ecstasy can kill by overheating the body even in normal temperatures.
The legal recreational drugs aren't any better: even a stimulant as mild as caffeine raises body temperature and alcohol does the same.
But these problems aren't only limited to recreational drug use. Although therapeutic use of stimulants typically involves much lower doses of medication, these drugs can nonetheless seriously affect body temperature as well.
ADHD medications like Ritalin (methylphenidate), Desoxyn (methamphetamine) and Adderall (mixed amphetamines) have the same effects as their illegal variants- and are especially risky for children during heat waves.
Other medications that increase risk for heat stroke include antidepressants (all classes) and antipsychotics (newer medications like Risperdal, Zyprexa, Seroquel and Abilify may have higher risks than older drugs like Thorazine or Haldol).
So, if you are taking any of these substances for any reason, be sure to cool yourself off by limiting your time outdoors, drinking lots of water and minimizing the amount of strenuous activity that you do. Keep careful watch over the children and elderly who take medications and be prepared to seek help if someone becomes disoriented or difficult to rouse. Do not stop prescribed medications without medical advice- just stay as cool as possible! Read article
Article by MAIA SZALAVITZ Time Healthland on Friday, July 22, 2011
1 Billion Settlement in Paxil Birth Defect Cases
As more and more information is being revealed about the utter lack of disclosure, providing false data from clinical trails and paying physicians to write false science reports on their drugs, the FDA is considering bring criminal charges against executives in these companies. Let's hope this happens.
I was stunned about two months ago when the Mayo Clinic Issued a statement indicating they supported the use of psychiatric drugs during pregnancy amid all the information that is being revealed about the birth defects being caused by these drugs.
What pregnant women need to understand is you can treat depression during pregnancy safely with acupuncture. If you are experiencing Postpartum Depression you should call one of the compounding pharmacies that are treating women with bioidentical hormones for this hormone driven condition. The links for the compounding pharmacies I recommend are listed in my links.
Understanding the effect that hormone imbalance has on women's health and the more than 35 symptoms that have been identified as being associated with the imbalance of hormones has come about as the baby boomers have sought out help for the symptoms associated with menopause. This have brought a new understanding to a time in a women's life which in past generations lead to the misdiagnosis of mental illnesses and institutionalization of women in this age group. Thanks to those of us who have championed this wakening it's now time to bring this awareness to pregnancy which is the time in a women's life where the hormone changes that occur allow us to grow life in our wombs.
One must understand that it takes a great deal to change the thinking of a medical community. We as women are still not being recognized for the uniqueness in our endocrine systems and the need for doctors to treat the individual symptoms we each experience when our hormones are imbalanced.
There are physician who are leading these most essential changes in thinking who can be found through the referrals that you will receive from the compounding pharmacies that are spread throughout the country.
I am not certain how it is my psychiatrist back in 1981 knew about the birth defects that were being caused by these drugs and some how that understanding got lost along the way.
There is this notion that somehow it's better to go through a pregnancy taking psychiatric drugs that can lead to birth defects of your baby and even death than to be educated on the safest ways to deal with depression during pregnancy and following pregnancy.
I am an advocate of baseline hormone levels to be used as a first line diagnostic tool by every physician in this country and bring awareness for reform in the mental health community in treating trauma which puts women at risk of experiencing Postpartum
There are many similar symptoms for many conditions. It's time we started looking at the symptoms caused by hormones imbalances and those that are the pioneers of bring forth a new understanding of the symptoms of trauma.
Medicine in evolutionary and it's time for change in the perception of Postpartum that will prevent the untimely deaths of young women and their babies. Article by:SHEILA SULLIVAN on AUGUST 26, 2010Read full article
Are You Taking Too Many Meds? - CNN News
Editor's note: Americans have been led to believe -- by their doctors, by advertisers and by the pharmaceutical industry -- that there is a pill to cure just about anything that ails them. This week, the networks of CNN go deep into the politics and the pills.
(CNN) -- For Alesandra Rain, it all started with sleeplessness. In 1993 she was having marital troubles and her business wasn't doing well. Anxiety kept her up at night, so her general practitioner prescribed sleeping pills.
"It worked fabulously. I felt very relaxed and I would sleep better," Rain remembers. "I thought this was certainly the right prescription for me."
Then a few weeks later, another symptom developed.
"It was so unusual. I started having bronchitis and lung infections," she recalls. She went to a pulmonologist who prescribed an antibiotic.
Another complication soon followed.
"My heart started skipping beats, so I was referred to a cardiologist," explains Rain, who says other than a series of surgeries after a car accident, she had been completely healthy until this point in her life. The cardiologist ran a few tests and prescribed medication to treat arrhythmias.
It didn't end there.
Eventually she developed seizures. At this point, she was already taking at least six different prescriptions from three separate specialists. She went to see a neurologist who prescribed an anti-seizure medication on top of that.
"My whole day became pills and doctors and shots," she says.
Rain's insomnia returned as things continued to spiral out of control. Despite all the testing and prescriptions, she says no one could figure out the problem. She was put on temporary disability. Depression followed.
"When I finally got to a shrink of course I was depressed, because no one could figure out what was wrong with me! It never occurred to me that it might be the pills themselves."
Too many drugs, too little communication
At her worst, Rain was under the care of a general practitioner, pulmonologist, cardiologist, pain management specialist and a psychiatrist. She was spending more than $900 a month, taking 12 different types of medication, amounting to about a thousand pills a month.
"That's what I call prescription multiplication," says Michael Wincor, an associate professor of clinical pharmacy, psychiatry and the behavioral sciences at the University of Southern California.
He says it is not uncommon for patients to receive multiple prescriptions from different specialists, each focusing on a specific symptom. Wincor says it can be potentially dangerous for the patient, especially if the various physicians aren't communicating with one another.
"A patient could have adverse effects and think the medical condition is getting worse, when in fact it is a side effect of several different medications which are all interacting in a negative way," Wincor says. "When you're on more than 20 drugs all at the same time, you'd want to question whether or not that's really necessary."
According to the Kaiser Family Foundation, prescription drug usage in the United States is continuing to rise. A recent report finds the number of prescriptions filled each year increased by 39% between 1999 and 2009, and the amount of money spent was $234 billion in 2008. The average American fills 12 prescriptions each year.
"Many side effects from drug interactions (not all) are exacerbations of known side effects of the single drugs that are made worse by the two drugs together," says Dr. Russ Altman, a professor of bioengineering, genetics and medicine at Stanford University.
He co-authored a study in the journal Clinical Pharmacology and Therapeutics that found a widely prescribed antidepressant used in conjunction with a common cholesterol-lowering medication caused unexpected increases in blood sugar levels.
Altman says most drugs are tested and approved independently, and it can be difficult to predict the side effects of drug combinations.
"It is very hard to find these in advance of release of the drug, because sometimes these effects will only manifest in the context of large numbers of patients," he explains.
"I don't think people really understand the nature of medication; the (drugs) will, by definition, have some toxic, collateral side effects," says Dr. Douglas Bremner, a professor of psychiatry and behavioral sciences at Emory University. His 2008 book "Before You Take that Pill" warned patients of the risks and benefits of some commonly prescribed drugs.
Bremner says medications clearly do a lot of good and are needed in many situations, but warns that when a patient is on too many at once, there are serious questions about whether the therapeutic benefits outweigh the collateral. "When you end up on 12 prescription medications you need to seriously look at what the situation is," he says. "At that point, there's no way of knowing what's causing what anymore."
"I don't want to do this anymore"
Wincor recommends patients fulfill all their prescriptions at one pharmacy, especially if they are receiving treatment from multiple practitioners.
"Often the pharmacist is the best point person because they're the last stop before the prescription hits the hand of the patient and are ready to be taken."
He says the most important thing is to have one person who is keeping track of the various drugs and how they could interact.
If you can't have a single overall manager of treatment, experts suggest keeping a list of all your prescriptions and showing the list to any physician introducing a new medication.
Altman says, when possible, introducing new medications one at a time can help you recognize side effects and interactions earlier. You can potentially trace them to the most recent drug added, he says.
Bremner also advises patients to check out websites like Medication.com and Askapatient.com and read the experiences others have had with the medication you have just been prescribed. "Patients should become more educated about the effects and not just blindly take what is given to them."
Alesandra Rain says she reached her tipping point in 2003.
"I opened my medicine cabinet and saw it lined with prescription pill bottles," she remembers. "I looked at myself in the mirror. My skin was gray, I was hunched over in pain, my eyes were swollen and I had no quality of life. I thought, 'I don't want to do this anymore.' "
She decided to quit taking all her prescriptions cold turkey -- something neither she nor other experts recommend for any patient. "You can't go cold turkey off that many pills without doing some damage," Rain says. She eventually enrolled in a drug rehab facility that helps victims of substance abuse.
Today, Rain runs a company called Point of Return, which educates patients about the effects of prescription medications and helps them outline an "exit strategy" for safely tapering off highly addictive varieties of prescription drugs.
"I spent 10 years on the pills before I realized there was no exit strategy. It was always more drugs, never less." says Rain, who later learned the cause of her initial insomnia was a B-12 vitamin deficiency. She is now taking one daily multivitamin. "My life became nothing but a bag of pills, and I just thought there has to be a different way." Written by Sabriya Rice, CNN Medical Producer
May 31, 2011 10:22 a.m. EDT - View article.
My Favorite Mistake: Stevie Nicks
The biggest mistake I ever made was giving in to my friends and going to see a psychiatrist. It was in the mid-1980s, and I had just gotten out of Betty Ford. I was feeling buoyant and saved and fantastic. But everyone said, “We’re sure you’re going to start using again. You should go to a psychiatrist.” Finally, I said, “All right!” and went. What this man said was: “In order to keep you off cocaine we should put you on the drug that we’re using a lot these days called Klonopin.” Stupidly, I said, “All right.” And the next eight years of my life were destroyed.
Klonopin is in the Valium family, but Valium is fuzzy and Klonopin is insidious because it’s so subtle that you can hardly tell you took it. I got through 1986 and 1987. Thank God I’d already written the words for my record The Other Side of the Mirror. But what started happening was that if I didn't’t take it, my hands started to shake. I felt like I had a neurological disease or Parkinson’s. I started not being able to get to Lindsey Buckingham’s house on time, and I would get there and everybody was drinking, so I’d have a glass of wine. Don’t mix tranquilizers and wine. Then I’d sing horrific parts on his songs, and he would take the parts off. I was hardly on Tango of the Night, which I happen to love.
The next six years were terrible. Looking back on it, I think this therapist was basically a groupie. He loved hearing stories of rock and roll and he started upping my dose. He watched me go from a beautiful, 125-pound, newly sober woman who had the world at her feet to a 170-pound woman who had the lights go out in her eyes.
Finally, in 1993, I’d had enough. I said, “Take me to a hospital.” I went in for 47 days, and it made Betty Ford look like a cakewalk. My hair turned gray and my skin molted. I could hardly walk. You can detox off heroin in 12 days. Coke is just a mental detox. But tranquilizers-they are dangerous. I was terrified to leave, and I came away knowing that that would never happen to me again.
I learned so much in that hospital. I wrote the whole time I was there, stuff that I consider to be some of my best writing ever. I learned that I could have fun and laugh and cry with amazing people and not be on drugs. I learned that I could live my life and still be beautiful and fun and still go to parties and not even have to have a glass of wine. I never went to therapy again after that-why would I? More…
by: Kirstin Burns | from: Newsweek
The Benzodiazepine Withdrawal Syndrome and Its Management
SUMMARY: The literature on benzodiazepine dependence and withdrawal is reviewed with an emphasis on social and psychological considerations. The problems of when to prescribe, identifying withdrawal symptoms, effective communication with the patient, the structure of withdrawal programmes, and the use of drugs, psychological approaches and other services are discussed.
The problems of benzodiazepine dependence and withdrawal have recently assumed a higher profile. There has been a renewal of interest in the popular press with advice to patients which can be interpreted as encouragement to sue their doctors for prescribing benzodiazepines. Recently a timely editorial in the Journal outlined a rational approach to benzodiazepine withdrawal. This review highlights the complex nature of the withdrawal syndrome and offers further guidelines on withdrawal to the general practitioner, with particular emphasis on social and psychological issues.
Identifying benzodiazepine withdrawal symptoms
Several reviews conclude that a significant proportion of, but by no means all, patients receiving therapeutic doses of benzodiazepines develop symptoms when withdrawing that indicate physical dependence. Many studies have used selected samples of patients who have had previous difficulty withdrawing. Ashton, for example, lists perceptual distortions, paresthesia and difficulty walking as occurring in all her subjects. Other reported symptoms include feelings of unreality or depersonalization, pain, visual disturbances, depression, paranoid thoughts and feelings of persecution, gastrointestinal symptoms and increased sensitivity to light, noise, taste and smell. A double-blind placebo controlled study, also using a selected sample, found all subjects experienced anxiety, tension, agitation, restlessness and sleep disturbance.
However, studies with less selected samples yielded a similar constellation of symptoms. For example, 'Iyrer and colleagues found insomnia to be the most commonly experienced withdrawal symptom (57.5% of sample), along with extreme dysphoria, impaired perception of movement, muscle pain and headache. Onyett and Turpin found sleep disturbance and headache were most frequently reported. More exceptionally, fits, confusional states and psychosis have occurred following sudden withdrawal.
Although the existence of the withdrawal syndrome is difficult to dispute, its definition and explanation are not simple. Smith and Wesson separate three categories of symptomatology: a 'sedative-hypnotice constellation which is found with high dosage and has a fairly rapid onset after withdrawal; a 'low dose' constellation beginning soon after withdrawal and improving after weeks or months; and 'symptom re-emergence' entailing a resurgence of the anxiety symptoms which continue unabated over time. The picture is further complicated by reports of 'rebound anxiety' in which the original symptoms of anxiety return, but temporarily and with greater intensity." However, the syndrome involves more than a return to a previous level of anxiety, as shown by withdrawal symptoms that are untypical of anxiety, the occurrence of the syndrome being unrelated to the patient's psychiatric history, and the patient returning to pre-withdrawal levels of anxiety a short time after withdrawal is complete. More…
Misery of the tranquilliser addicts forced to go cold turkey by GPs
Helen lay shaking and sobbing in the drug addiction detox unit. The 61-year-old businesswoman was racked with such excruciating pain she wasn’t sure she could survive it.
What’s so shocking is that unlike the other patients at the unit, who were struggling with heroin or cocaine addictions, the only drugs Helen had ever taken were the tranquilizers prescribed by her GP for depression and anxiety.
‘Seven years ago, my doctor gave me Valium, which I thought would just get me through a rough patch,’ recalls Helen, who is married with a daughter. ‘I had no idea they were addictive.’
Two years ago, she began to suffer from chronic dizziness - her GP sent her for brain scans and heart tests but these proved inconclusive, so Helen did her own research, and discovered that her symptoms matched the symptoms of the long-term side-effects of common tranquilizers.
‘When I went back to my GP, he said my symptoms had nothing to do with drugs and asked me why I wanted to come off them,’ says Helen.
Even when she did finally get herself into a detox unit, the drugs were withdrawn at a much faster rate than officially recommended, causing her such terrible side-effects she’s had to go back on to the drugs.
Helen is one of an estimated 1.3 million Britons addicted to prescription tranquilizers, also known as benzodiazepines.
These drugs include diazepam (known previously as Valium), Xanax, Ativan, Serax and Librium. They are commonly prescribed as a treatment for severe anxiety and insomnia - last year ten million prescriptions for benzodiazepines were issued in England alone.
They work by boosting the action of a naturally occurring brain chemical called GABA (gamma-aminobutyric acid). GABA tells brain cells to slow down and stop firing, and has a calming effect on the brain, muscles and heart rate, helping to ease the insomnia that often accompanies anxiety.
But the drugs use the same addictive pathways in the brain as illegal drugs such as heroin. Patients often need progressively higher doses as the body becomes accustomed to the drug - these higher doses can cause side-effects including paranoia, fatigue, dizziness, memory problems and dulled emotions.
Because of the high risk of addiction, the UK’s Committee for Safety of Medicines issued guidelines back in 1988 advising GPs that the drugs should be prescribed for no more than two to four weeks.
Despite this, there are huge numbers of patients who’ve been left on the pills long term, even for decades, say campaigners.
The concern now, however, is that over the past year GPs have performed a drastic U-turn and, without warning, are rapidly reducing patients’ drug doses in a short space of time to get them off the drugs.
Campaigners believe this has been prompted by a Department of Health review looking into the number of prescriptions GPs are issuing for benzodiazepines.
But going ‘cold turkey’ in this way can cause severe withdrawal effects, including excruciating pain in the muscles and joints, insomnia, and even suicidal thoughts.
Barry Haslam, the chairman of Oldham TRANX, a support group for patients addicted to benzodiazepines, says the charity is taking calls from people all over the country about being suddenly and abruptly withdrawn from their tranquilizers.
Apart from the crippling side-effects, he points out that, ‘most patients are just left to go on with it on their own.
‘And even if they are offered help it’s usually a referral to a detox unit for illegal drug users, and that is just not appropriate because they bring patients off the drugs in too short a space of time.’
Official advice for health professionals (NHS Clinical Knowledge Summaries) suggests reducing a patient’s dose of benzodiazepines by five to ten per cent every one to two weeks. Once a lower dose is reached, the reduction should be slowed.
It acknowledges that it may take a year or longer for patients to come off the drugs and stresses a patient must be stable, and willing to come off their tablets - and that the withdrawal plan should be tailored to their individual needs.
Campaigners say it’s the latter point that is crucial; patients should be allowed to proceed at their own pace and have their personal situations taken into account.
Dr Trevor Turner, a consultant psychiatrist at the East London Foundation Trust, says: ‘GPs are caught in the middle between trying to be humane prescribers - after all, some of these patients really do need this medication to function - and following clinical guidelines.
If patients do want to come off their medication they should be offered alternative therapies such as cognitive behavioral therapy, relaxation classes and maybe alternative medication such as anti-depressants.’
One of those affected by the new change of heart about benzodiazepines is Steven James. The 26-year-old writer was shocked when he received a terse phone call from his GP practice six months ago telling him he must quit his prescription tranquilizers.
‘My old doctor retired and a new doctor rang out of the blue last summer and said my pills were addictive and were only a short-term treatment,’ recalls Steven, who lives in Cardiff.
‘I was horrified as this had never been mentioned to me before.
Steven was 14 when he was first prescribed diazepam for panic attacks.
‘I was on a repeat prescription, and if I felt stressed or anxious my GP would put it up a bit more each time. No one ever mentioned I shouldn't be on them long term.’
But Steven’s new doctor was adamant he must come off the drugs, and reduced his prescription by 2mg a fortnight from his daily 45mg a day. He is now taking 20mg, but although this reduction rate was in line with official advice, Steven has found it hard to function and he suffers from headaches, lack of concentration and panic attacks.
‘The effects are horrendous,’ he says.
In some ways, however, he’s been more fortunate than patients such as Helen, whose prescription was reduced at a much more brutal rate.
Initially undeterred by her GP’s reluctance to take her off the drugs, Helen had started to follow The Ashton Manual, an online guide to coming off benzos written by Professor Heather Ashton, an expert in benzodiazepines.
‘I gradually reduced my dosage down from 15mg a day to 1.5mg over ten months, but I was in excruciating pain,’ she says.
‘In desperation, I called my GP who said I would have to have my dosage increased to 20mg a day to stabilise my condition - which was higher than when I started out.’
So Helen rang her local drug and alcohol misuse service, who suggested she go to a residential NHS Detox Unit, and made a referral.
‘The problem is that the staff reduced my dosage far too rapidly - from 16.5mg to 8mg in two weeks, which is the speed used for illegal drugs. I was in a terrible state, crying and shaking. After a four week break, I was re-admitted and my dosage was reduced to zero.’
Eight weeks later, the pain was so bad that Helen had to go back on diazepam and is back up to 15mg.
‘I don’t want to stay on the pills - they suppress all your emotions and make you feel like you’re in a parallel universe,’ she says. ‘I will come off them eventually, but it has to be at my own pace and I need support to be able to do this.’
The solution, ultimately, is for psychiatrists, GPs and patient groups to sit down ‘and thrash out a good set of guidelines on monitoring and assessing patients’, says Dr Martin Johnson, a GP and trustee of the Patients’ Association.
A Department of Health spokesman says: ‘GPs should be prescribing benzodiazepines and managing withdrawal from these drugs based on their clinical judgment of their patients’ needs and in line with the guidance available to them.’
However, patients such as Steven and Helen say they can’t come off these drugs alone.
‘All I’m asking for is a GP or psychiatrist to be willing to help me,’ says Steven. ‘And that means more than just stopping the prescription.’ View Article
Treatment-resistant depression (TRD) may be related to inadequate dosing of antidepressants or antidepressant tolerance. Alternatively, there are reasons to believe that antidepressant treatment itself may contribute to a chronic depressive syndrome. This study reports a case of antidepressant discontinuation in a TRD patient, a 67-year-old white man with onset of major depressive illness at the age of 45. He was homozygous for the short form of the serotonin transporter. He was treated off and on until the age of 59 and had been on an antidepressant continuously until the age of 67. Over the previous 2 years he had been depressed without any relief by medication or 2 electroconvulsive treatments. His medications at the time of evaluation included Paroxetine 10 mg daily, Venlafaxine 75 mg daily and Clonazepam 3 mg daily. His 17-item Hamilton depression score was 22. Over the subsequent 6 months, he was started on Bupropion and then tapered off all antidepressants, including the Bupropion. His Hamilton depression score dropped to 18. The patient was not satisfied with his progress and sought another opinion to restart antidepressants. One year later, on Duloxetine 60 mg daily, he continued to complain of unremitting depression.
A possible prodepressant effect of antidepressants has been previously proposed. Fava was the first to suggest that an antidepressant-related neurobiochemical mechanism of increasing vulnerability to depression might play a role in worsening the long-term outcome of the illness. Understanding of potential mechanisms of this phenomenon can be gleaned from observations regarding the short form of the serotonin transporter (5HTTR). Patients with the short form of the 5HTTR and prolonged antidepressant exposure, may be particularly vulnerable to antidepressant-related worsening. In other words, prolonged exposure to antidepressants can induce neuroplastic changes that result in the genesis of antidepressant-induced dysphoric symptoms. The investigators propose the term 'tardive dysphoria' to describe such a phenomenon and describe diagnostic criteria for it. Tapering or discontinuing the antidepressant might reverse the dysphoric state. Antidepressant discontinuation may not provide immediate relief. In fact, it is likely that transient symptoms of withdrawal will occur in the initial 2-4 weeks following antidepressant discontinuation or tapering. However, after a prolonged period of antidepressant abstinence, one may see a gradual return to the patient's baseline.
Article Source Psychotherapy and Psychosomatics
Families on the Brink: Elders Confused on Too Many Medications
Intervening Can Keep Elders Safe
91-year-old Maynard Merel takes ten different types of pills every day. Ask him to tell you what each pill does for him, and the chances are he'll tell you he has no idea.
Although he suffers from high cholesterol, high blood pressure, and underactive thyroid, and chronic asthma, he can't remember which pill combats which ailment, or the proper dosage he needs.
During a doctor's visit, his geriatrician reminded him that he only needed to take one thyroid pill a day. Maynard Merel was taking ten.
"We have to straighten out all of these – too many medications," said Merel's geriatrician, Dr. Barbara Paris, director of geriatrics at Mamimonides Medical Center.
Francis Merel, Maynard's wife, agreed."I think he is a mess," said Francis. "He's been taking too much of the drug. He is just lethargic."
Merel is one of many seniors at risk of dying from polypharmacy, the term for when a patient takes too many potentially unnecessary medications.
"There are a lot of patients who see multiple specialists, and nobody is coordinating their care," said Paris. "And they get into dangerous situations where the right hand doesn't know what the left is doing."
Nearly one-third of Americans ages 57 to 85 take at least five prescription drugs -- people with chronic illnesses may take more than 20. Sixty-eight percent of Americans are also taking over-the-counter medicines or supplements, according to a 2008 article published in the Journal of the American Medical Association. These combinations may lead to dangerous and often unmonitored interactions.
"There are over 100K deaths per year related to polypharmacy and medication misuse and adverse reactions, which brings it to one of the leading causes of death in this country," said Paris.
Seniors can experience polypharmacy not only when they are prescribed numerous medications, but also when they start taking the medications of other family members as well.
While Paris put Merel on a new plan, which reduced three of his medications, she discovered he was taking his wife's prescription anti-depressant medication.
"One night he said 'I don't want dinner, I'm going to lie down,' and it just seemed to me to be a kind of depression," said Francis Merel. "He isn't as hotsy totsy as he used to be. ... It's not his style."
Maynard Merel needed help to manage his care. But, like many seniors, Maynard said he felt that asking for help would compromise his sense of independence. And many times, adult children find it hard to determine whether they should step in, in the belief that changes in their parent's behavior are just the natural signs of aging.
Family members can watch for signs of polypharmacy at home, according to ABC's chief health and medical editor, Dr. Richard Besser. These signs can include weight loss, depression, or lack of interest in normal activities.
Also, there are forms an elderly patient can fill out, which will allow family members to discuss the care of their loved ones with the doctor.
"You may find that your parent's doctor won't talk to you because you are not approved due to privacy laws," said Besser.
Filling out HIPPA (Health Insurance Portability and Accountability Act) release forms beforehand can assure you'll be included in conversations about your loved one's care, Besser said.
WRITTEN BY GITIKA AHUJA AND LARA SALAHI - ABC News Health
Most of us who live stressed out lives have taken recourse to Psychiatric drugs, some times. But their effectiveness remains doubtful.
Most of us who live stressed out lives have taken recourse to Psychiatric drugs, some times. But their effectiveness remains doubtful. Many a times the medical practitioners are encouraged in prescribing these drugs, in league with Pharmaceuticals and Drugs companies with commissions and other quid pro quo.
I was Chairman and Managing Director of India's largest Drugs and Pharmaceuticals Company , IDPL in 1985 and 1986 , with five units producing a wide range of bulk drugs, formulations, chemicals and surgical instruments , employing nearly 13,000 personnel .As a result of price control regime , the Indian government did succeed in keeping the prices of the life saving drugs cheap , also forcing multinationals to produce bulk drugs in India. IDPL trained a large number of Pharma industry experts , ( Dr Reddy of Reddy Laboratories was one of them) researchers, marketers and technicians .India now produces drugs amounting to 12 o 15 billion dollars and is a major exporter.
During my tenure with IDPL, I became aware of the nexus between the doctors and drug companies. How private companies keep politicians on their rolls to plead their case and other such practices. IDPL was always at a disadvantage, with the controlling ministry not supporting us .Many bureaucrats were gifted shares in private companies, whose cause they promoted.
It was clear that drugs mostly treat the symptoms and not cure the disease. But some medicines like anti-biotics are necessary in curing infections. But have been abused and over prescribed.
I am reproducing below an article edited by Gary G. Kohls, MD, with his permission, on the subject noted above. Three years ago I was forced to take Xanax and other Psychiatric drugs with indifferent results .Finally I was able to kick off the drugs with daily breathing exercises , one can learn from TV being done by Guru Ram Dev , who has done more for the health of Indians than many health ministers put together. - Article written by MWC News - Media with Conscience More...
So Young and So Many Pills
More than 25% of Kids and Teens in the U.S. Take Prescriptions on a Regular Basis
Gage Martindale, who is 8 years old, has been taking a blood-pressure drug since he was a toddler. "I want to be healthy, and I don't want things in my heart to go wrong," he says.
And, of course, his mom is always there to check Gage's blood pressure regularly with a home monitor, and to make sure the second-grader doesn't skip a dose of his once-a-day enalapril.
These days, the medicine cabinet is truly a family affair. More than a quarter of U.S. kids and teens are taking a medication on a chronic basis, according to Medco Health Solutions Inc., the biggest U.S. pharmacy-benefit manager with around 65 million members. Nearly 7% are on two or more such drugs, based on the company's database figures for 2009.
Doctors and parents warn that prescribing medications to children can be problematic. There is limited research available about many drugs' effects in kids. And health-care providers and families need to be vigilant to assess the medicines' impact, both intended and not. Although the effects of some medications, like cholesterol-lowering statins, have been extensively researched in adults, the consequences of using such drugs for the bulk of a patient's lifespan are little understood.
Many medications kids take on a regular basis are well known, including treatments for asthma and attention-deficit hyperactivity disorder.
But children and teens are also taking a wide variety of other medications once considered only to be for adults, from statins to diabetes pills and sleep drugs, according to figures provided to The Wall Street Journal by IMS Health, a research firm. Prescriptions for antihypertensives in people age 19 and younger could hit 5.5 million this year if the trend though September continues, according to IMS. That would be up 17% from 2007, the earliest year available.
Researchers attribute the wide usage in part to doctors and parents becoming more aware of drugs as an option for kids. Unhealthy diets and lack of exercise among children, which lead to too much weight gain and obesity, also fuel the use of some treatments, such as those for hypertension. And some conditions are likely caught and treated earlier as screening and diagnosis efforts improve.
Gage, who isn't overweight, has been on hypertension drugs since he had surgery to fix a heart defect as a toddler, says his mother, Stefanie Martindale, a Conway, Ark., marketing-company manager.
Most medications that could be prescribed to children on a chronic basis haven't been tested specifically in kids, says Danny Benjamin, a Duke University pediatrics professor. And older drugs rarely get examined, since pharmaceutical firms have little incentive to test medicines once they are no longer under patent protection.
Still, a growing number of studies have been done under a Food and Drug Administration program that rewards drug companies for testing medications in children. In more than a third of these studies, there have been surprising side effects, or results that suggested a smaller or larger dose was needed than had been expected, Dr. Benjamin says. Those findings underscore that children's reactions to medicines can be very different than those of adults. Long-term effects of drugs in kids are almost never known, since pediatric studies, like those in adults, tend to be relatively short.
"We know we're making errors in dosing and safety," says Dr. Benjamin, who is leading a new National Institutes of Health initiative to study drugs in children. He suggests that parents should do as much research as they can to understand the evidence for the medicine, confirm the diagnosis, and identify side effects. Among the places to check: drug labels and other resources on the FDA's website, published research at www.pubmed.gov, and clinical guidelines from groups like the American Academy of Pediatrics.
When a child psychiatrist diagnosed their then 8-year-old daughter with bipolar disorder four years ago, Ken and Joy Lewis, of Chapel Hill, N.C., sought a second opinion from another child psychiatrist.
They also worked with a psychologist. Dr. Lewis, who leads a company that does early-stage drug studies, reads all the available research on each medication suggested for the girl, now 12, who has taken antipsychotics and other psychiatric medications including Risperdal and Haldol.
"If your child has a chronic problem, then you have to invest the time as a parent," he says.
Parents and doctors also say non drug alternatives should be explored where possible. Tom Wells, a professor of pediatrics at the University of Arkansas for Medical Sciences who sees patients at Arkansas Children's Hospital in Little Rock, frequently pushes diet and exercise changes before drugs for hypertensive kids. "Obesity is really the biggest cause I see for high blood pressure in adolescents," he says. But only about 10% of families adhere to his diet and exercise recommendations, he says. More...
Article written by Anna Wilde Mathews, Wall Street Journal Health
1 in 2 Seniors on Antidepressants Face Drug Interactions
WASHINGTON - More than half of older Americans taking an antidepressant for the first time were already taking another drug that could interact with it and cause side-effects, researchers reported on Friday.
And a quarter of patients who suffered side-effects stopped taking antidepressants altogether, the study by a team at Thomson Reuters, the University of Southern California, Sanofi Aventis and elsewhere found.
"We found a concerning degree of potentially harmful drug combinations being prescribed to seniors," Tami Mark of Thomson Reuters, parent company of Reuters, said in a statement.
Other studies have found that older adults are often taking dangerous combinations of prescription drugs, but doctors are not getting the message, the researchers reported in the American Journal for Geriatric Psychiatry.
The research team used a Thomson Reuters database of claims for Medicare, the federal health insurance plan for people over 65.
They found more than 39,000 patients who started antidepressants between 2001 and 2006. "Twelve commonly reported antidepressant side effects were identified in the month after drug initiation," Mark's team wrote.
More than 25 percent of the patients were prescribed antidepressants and another drug that could cause a major interaction. Another 36 percent had potential moderate interactions.
"The most common side effect was insomnia, somnolence, and drowsiness, which occurred in 1,028 (2.6 percent) patients. The next most common side effect was dizziness, which was documented in 416 (1.1 percent) patients," the researchers wrote.
The side-effects meant patients often dropped the drug they were taking. Only 45 percent of those with documented side-effects refilled the prescription for the same antidepressant and a quarter quit taking antidepressants altogether.
Many adults are at risk of this problem, the researchers noted - other studies show that 25 percent of older adults with chronic illnesses such as arthritis or heart disease also have depression, and they have also been shown to be helped by antidepressants.
"Older adults often need to be on many medications, some of which may contribute to depression and/or interact with antidepressants. Finally, older adults metabolize medications slowly and are more sensitive to side effects than younger patients," the researchers concluded.
Reprinted from Thomson Reuters 2010.
In a report released today by the National Highway Traffic Safety Administration (NHTSA), over a five-year period from 2005 to 2009, an increasing number of U.S. drivers involved in fatal car accidents have tested positive for drug use, which can include legally prescribed medications, over-the-counter drugs and illicit substances.
Of the 21,798 U.S. drivers killed in 2009 who were tested for drugs, approximately 18 percent of drivers showed evidence of drugs in their system at time of death, compared with 13 percent in 2005.
Drugs tested for by the agency include narcotics, depressants, stimulants, inhalants, hallucinogens, cannabinoids, phencyclidines (PCPs), anabolic steroids and other medications that can affect a driver's ability to operate a motor vehicle. Side effects that affect an individual's ability to drive include hallucinations, dizziness, hyperactivity, confusion, loss of muscle coordination, drowsiness, blurred vision and seizures.
"Every driver on the road has a personal responsibility to operate his or her vehicle with full and uncompromised attention on the driving task," said NHTSA administrator David Strickland in a press release. "Today's report provides a warning signal that too many Americans are driving after having taken drugs, not realizing the potential for putting themselves and others on the highway at risk."
While it may seem obvious that drugs such as amphetamines, sleeping pills and tranquilizers may impair driving abilities, many medications used to treat anxiety, depression, the flu and even seasonal allergies can create a driving hazard.
"There tends to be a response that my doctor prescribed this, which is true, but that doesn't mean you're OK to be driving," said Catherine Evans, chief of vehicular crime for the Harris County District Attorney's office in Houston, Texas.
A 2001 study from the University of Minnesota found that driving under the influence of certain antihistamines such as Benadryl can impair driving abilities to a greater extent than alcohol. Often drivers are left unaware of their impairment, extreme drowsiness or delayed reflexes.
Other potentially-hazardous medications include narcotics such as Vicodin, morphine and Demerol, tranquilizers and anti-anxiety medications such as Halcion, Valium and Xanax, muscle relaxants and sleeping pills such as Soma and Unisom, amphetamines such as Adderall, Vyvanse and Xyrem, and certain diet pills and appetite suppressants.
This is the NHTSA's first study involving drug-related driving deaths. The analysis only included drug test results from two-thirds of driver fatalities from 2009, and it is unknown as to whether drugs were the cause of the accidents or merely a coincidence. -Reprinted form drug watch nov 30, 2010
Dr. Marcus Thygeson once wrote his patients countless prescriptions for heartburn drugs such as Prevacid, Prilosec and Nexium -- the "little purple pills" of TV ads.
But several months ago, when his own doctor advised him to start taking the pills, he refused. "It was all I could do to get out of the office without a prescription," he said.
The Twin Cities gastroenterologist has come to see the popular pills as a symbol of the excesses of modern medicine -- a powerful medication "handed out like water" in his words, amid mounting evidence that it may do many people more harm than good.
"It's a drug we've become very cavalier about," says Thygeson, president of the Center for Healthcare Innovation at Allina Hospitals & Clinics.
"Now it's like front-line therapy if you so much as belch."
The heartburn drugs, known as proton-pump inhibitors (PPIs), are designed to reduce the body's ability to pump acid into the stomach.
Today, they are among the nation's best-selling medications, with more than 119 million prescriptions written last year, in addition to over-the-counter sales. Experts have called them a godsend for ailments like acid reflux, a major cause of heartburn.
Yet there's a growing consensus that millions of people are taking the pills needlessly, or far longer than necessary, wasting billions of dollars and in some cases triggering significant side effects.
Some skeptics even dare to ask why so many Americans are taking pills, which can cost up to $200 a month, to control digestive problems that can be tied to their own bad habits, particularly at the dinner table.
"I'm not blaming patients -- it's the path of least resistance," said Dr. Greg Plotnikoff, an internist at Abbott Northwestern's Penny George Institute for Health and Healing in Minneapolis. Fixing the underlying problem, he said, may require losing weight, avoiding certain foods or other lifestyle changes. A pill can seem like an easy alternative.
"When I was a resident, I was told it was a quick and easy answer to everything, and it had no side effects, and insurance was willing to pay for it," Plotnikoff said.
In the past few years, though, scientists have raised concerns about long-term side effects, such as bone fractures and pneumonia. One study in 2009 even found that the drugs, when stopped abruptly, can cause the very symptoms they were designed to prevent.
The drug manufacturers and some leading experts have disputed those findings. But insurers and doctors alike are starting to have second thoughts.
"When you put a patient on a PPI, you're essentially setting them up to be on it for a lifetime," said Thygeson. "I think we need to back away from those drugs."
In recent years, several studies have suggested that many people are taking the drug for no apparent reason. In one Michigan hospital, researchers reviewed patient charts in 2005 and concluded that 60 percent were started on acid-suppressing drugs with no valid explanation.
In May, an editorial in the Archives of Internal Medicine claimed that 53 to 69 percent of the prescriptions for acid suppressors are "for inappropriate indications."
Dr. David Peura, an industry consultant and former president of the American Gastroenterological Association, readily admits that the drugs are overused. But he said that's partly because doctors are reluctant to take patients off medicine if it seems to be working. "One of the first rules in medicine is, don't poke a skunk," said Peura, a retired academic and researcher in Virginia. "That's why I think a lot of people are probably on the medicine who probably don't need it."- BY MAURA LERNER | STAR TRIBUNE (MINNEAPOLIS) More...
Eminem: "I had to Learn to Write and Rap Again"
How bad was Eminem's descent into prescription drug addiction? It not only nearly robbed him of his life, it scrambled his brain so badly that he literally had to learn how to rap again, he revealed to the New York Post.
On the eve of his historic two-night stand at Yankee Stadium with Jay-Z; and his two VMA wins; the paper spoke to Slim Shady, 37, about his tumble into drug addiction and the long, hard road to redemption on his hit album Recovery.
"I had to learn to write and rap again, and I had to do it sober and 100 percent clean," Em said, explaining the more mature, focused nature of his rhymes on Recovery. "That didn't feel good at first ... I mean it in the literal sense. I actually had to learn how to say my lyrics again; how to phrase them, make them flow, how to use force so they sounded like I meant them. Rapping wasn't like riding a bike. It was [as much] physical as mental. I was relearning basic motor skills. I couldn't control my hand shakes. I'd get in the [recording] booth and tried to rap, and none of it was clever, none was witty and I wasn't saying it right."
The rapper recalled taking his first Vicodin when he was 24 or 25, back before he could afford anything he wanted. "It was easy in the beginning," he said. "I didn't have the money to get really involved in drugs. I'd do them when somebody offered them to me. As my career took off and the crowds got larger and life got faster, I reached out for that sh-- more and more. I used it as a crutch to calm my nerves. Especially the sleeping pills."
But as his addiction deepened, the drugs began affecting his art, stifling his creativity, shutting off his brain and making him so lazy he preferred watching TV to making new tracks. He said that while listening to albums such as 2004's Encore, he can hear how high he was in the music. "I think the drug use was obvious," he said.
While late partner Proof tried to get him off the pills, Em said even hearing deep concern from his childhood best friend wasn't enough to get him to come clean. "He'd say what was on his mind," Marshall said of Proof. "But as close as he was, it didn't matter. I wasn't ready to listen. There wasn't a person who could tell me I had a problem.
What came next was a nearly four-year hiatus during which the rapper first went to rehab, but then relapsed and settled into a drug funk that he was only beginning to come out of when he released last year's album Relapse. In retrospect, he realized that there were some problems with the record.
"I wasn't disappointed when I put it out. When I felt that was later, when I was reassessing my work; trying to figure out why my songs didn't sound like they used to sound," he said. "The further I got away from Relapse, I was able to hear the problems with all the accents I was using to slip in and out of characters, and how the serial killing didn't work. The joke was over; I ran it into the ground."
He realized the problem was an obvious lack of "personal honesty" on the tracks, a situation he rectified on Recovery with such hit tracks as “Not Afraid” and the Rihanna collabo "Love The Way You Lie." Once his head finally cleared, Em said, he was a new man, which might explain why he ditched plans to make Relapse 2 and start over with Recovery..
"When I got clean and sober, it was like I was a kid again," he said. "Everything was new. Not to sound corny, I felt like I was born again. I had to learn my writing skills. I was relearning how to rap. I didn't know if my MC skills were intact. But everything was fun and suddenly I started feeling happy. I hadn't felt happy for a long time." - Article by Gill KaufmanMore...
Taking antipsychotic drugs, especially newer “atypical” antipsychotics, appears to increase a user’s risk for developing potentially life-threatening blood clots.
In a new study from the U.K., antipsychotic drug use was associated with about a 30% increase in risk for deep vein blood clots or pulmonary embolism.
The risk was highest for new users of the drugs and for patients prescribed atypical antipsychotics, which include Seroquel (quetiapine), Risperdal (risperidone), and Zyprexa (olanzapine).
Compared to patients who did not take antipsychotic drugs, users of atypical antipsychotics were 73% more likely to develop the dangerous blood clots. Seroquel use was associated with a nearly threefold adjusted increase in risk among the study population.
The risk to individual patients remained quite small and the findings need to be confirmed by other researchers, study researcher Julia Hippisley-Cox, MD, of the University of Nottingham, tells WebMD. - Article By Salynn Boyles WebMD Health News, September 22, 2010 More...
Doctors will admit that medications have side effects. Unfortunately, very often we don't realize the degree of side effects until the offending drugs have been on the market for many years.
Even then, there are times when the degree of negative side effects does not become apparent for another few years.
That appears to be the case with many antidepressants. Drugs known as SSRIs (selective serotonin reuptake inhibitors) have now proven to have additional side effects other than the usual depletion of vitamins, suicide, weak bones and liver failure and sometimes even bizarre behavior.
Dr. Robert Rowen wrote of a Canadian study involving patients 65 and older.
"A Canadian team analyzed data on nearly 19,000 people 65 years old or older," he explained. Then they compared their health records to about 190,000 controls. The research team found that, overall, taking SSRIs raised the risk of cataracts by about 15 percent. That's about 22,000 cases of additional cataracts each year in the U.S. alone."
He suggested that while 15 percent alone didn't seem all that large, the results were somewhat shocking when broken down into cases per specific drug. For example, Paxil (paroxetine) elevated cataract risk by 23 percent; Effexor (venlafaxine also an SNRI) brought the odds up to 33 percent; and Luvox (fluvoxamine) increased the risk by a huge 39 percent. Rowen explained that these drugs forcibly induce greater serotonin levels in and around cells that use the neurotransmitter. Those cells in your eye's lens have serotonin receptors. Excess serotonin can induce opacity in the lens, according to Rowen.
Depression is a terrible disorder that alternative physicians feel may possibly be exacerbated by lack of proper nutrition as well as various deficiencies such as the "B" family of vitamins and vitamin D. There are unbelievable numbers of Americans who have tremendous deficiencies in vitamin D. Doctors will also check for heavy metals. They recommend high quality, mercury-free fish oil or other forms of omega 3s, magnesium, B-complex, the amino L-theanine, and extra B1 and SAMe seem to be helpful according to many alternative physicians. They also suggest avoiding sugars and caffeine. There are other remedies in their arsenal that can only be taken under the supervision of a physician and that's better than attempting to treat depression without medical or psychological help.
Regarding the problems with cataracts, I once wrote about a formula that Rowen recommends for cataracts. It involves several substances and his formula is listed on his website. I would suggest that anyone interested in seeking more information on the cataract remedy, speak with his/her ophthalmologist to have the doctor oversee the application of the drops.
In speaking of other contributions to cataracts, Rowen closes with this suggestion: "... if you are taking hormones foreign to your body, please know that there are estrogen receptors in your lens that might trigger cataracts as well. In women who had taken hormone replacement therapy (HRT), the risk for cataracts increased by 14 percent. For current hormone users, the increase in risk soars even higher to 18 percent when compared with women who never used HRT. What's more, the longer you take HRT, the higher your risk for cataracts."
Under no circumstances should a patient stop taking medications without the supervision of a physician. If a drug is working, risk vs. benefits should come into play. - Article by Dee Woods, The Reporter More...
Don't Go Cold Turkey
- Reducing your reliance on antidepressants requires patience and a doctor's involvement.
When the weight of her husband's cancer and the stress of her corporate job became too heavy to bear, Karen Huber did as many of her friends had done and started taking an antidepressant.
What she didn't realize was how difficult it would be to stop.
After a year of taking 10 milligrams of Lexapro daily, on top of 50 mg of Trazodone that she had been taking for a decade to help her sleep, Huber tried to quit cold turkey. The withdrawal symptoms were insufferable: anger and frustration so overwhelming she "could have chewed through a brick."
When Huber tried quitting again in March, she attacked it with a three-pronged strategy: She split her pills in half every couple of weeks, took nutritional supplements to mitigate her irritability, and ultimately checked into a detox center for three weeks. It took more than two months, but it worked.
"If I had known how hard antidepressants are to get off of, I would have tried to avoid them," said Huber, 54, of Little Rock, Ark.
Antidepressant usage doubled between 1996 and 2005, to 10 percent of the U.S. population, according to a study published last year in the Archives of General Psychiatry. That boom means masses of patients who face the challenges of stopping.
Though antidepressants are the most commonly prescribed medications in the U.S., there are no official published guidelines for when and how to come off them, said Dr. Michael Banov, a psychiatrist and author of the new book "Taking Antidepressants" (Sunrise River Press, $16.95).
Generally, patients should stay on antidepressants for at least nine to 12 months to reduce the likelihood of a depression relapse, Banov said. But beyond that, it's up to patients to work with their doctors on whether and how to wean themselves off the drugs. Sometimes the process is unpleasant.
About 20 percent of people who try to quit suffer what the drug companies coined "antidepressant discontinuation syndrome," which can cause symptoms including depression, anxiety, irritability, dizziness, nausea, light-headedness and electric shocks known as "brain zaps."
Symptoms can be more severe the longer you have taken antidepressants, the higher the dosage and the more sensitive your body happens to be, Banov said. They also depend on the drug. Paxil and Effexor are associated with some of the worst withdrawal symptoms because they clear out of your system quickly, leaving little time for your body to adjust to the sudden drop in the neurotransmitter serotonin. Prozac, meanwhile, takes a long time to leave your body, diffusing the withdrawal effects.
Though drug companies warn of potential withdrawal symptoms in their literature, physicians don't always alert their patients when they prescribe the meds, and many people start taking antidepressants not knowing it's so hard to stop.
"It made me angry. I felt like I hadn't been told," said Katherine Perry, 40, an English professor in Cumming, Ga., who became uncomfortably irritable and anxious when she tried to wean herself off Paxil and Wellbutrin on separate occasions.
A cruel catch to discontinuing antidepressants is that it can be hard to tell if the symptoms are from withdrawal or a return of depression, so you have to wait it out, Banov said. If it's withdrawal, the symptoms should begin to clear up in one to two weeks, though sometimes it takes six to eight. If it's depression, they'll get worse.
The key to managing withdrawal is to taper the dosage gradually. But some people need more help, especially when they're trying to come off several prescription drugs.
Wendy Honeycutt was put on antidepressants after the suicides of her mother and brother. It proved a "doorway to disaster," she said, as the side effects later prompted her to take sleeping pills and anti-anxiety medication. At the peak, she was taking seven prescription drugs.
When she decided to clear her body because she felt like "a toxic mess," the Texas woman went into a debilitating withdrawal that left her sleepless, anxious, shaking, sweating and emotionally numb, with electrical zaps feeling like "red-hot pokers in my head." She was incapacitated for two months and sick for three years.
It wasn't until Honeycutt found Point of Return, a nonprofit based in Malibu, Calif., that helps people come off their prescription meds, that she began to improve. In addition to offering tapering schedules, information on how drugs interact with each other and emotional support, the organization swears by a schedule of nutritional supplements to temper withdrawal, including omega-3 fatty acids to support brain function and glutathione to enhance the immune system.
Honeycutt, 44, a pastor who now volunteers at Point of Return, said she has been medication-free for three years.
Of course, some people need to be on antidepressants and shouldn't quit. Long-term untreated depression is bad for your brain and body, causing parts of the hippocampus to shrink and hurting the immune system, Banov said. The goal is to be depression-free, not medication-free, he said.
But for Huber, who used the Point of Return program for the six weeks she tapered her dosage, life is better without them - though not necessarily easier. The Lexapro had protected her like a "hard shell," keeping her from being weepy all the time, especially after her husband died last summer.
"Since I've been off them, I cry much easier, I'm much more tender," Huber said. "But that's OK. That's part of the grief process." - Article by Alexia Elejalde-Ruiz, Chicago Tribune, August, 29, 2010 More...
Point of Return in the News
Stand Up to Cancer 2012 | POR Medical Advisor Dr. Habib Sadeghi
Interview with Fox News Chanel | POR Co-founder Rain, Dr. Sadeghi
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Interview with CNN National News | POR co-Founder Alesandra Rain
Interview with Geraldo at Large, Fox News Chanel | POR co-Founder Alesandra Rain
Views and opinions expressed on this page and in related articles do not necessarily reflect the views of POINT OF RETURN, Inc. They are provided strictly for informational purposes only.
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In withdrawal from antidepressants, sleeping pills or anxiety medications, these jolts of electricity can worsen and become debilitating, although there is no current evidence that the zaps present any danger to the individual. So what causes brain zaps? MORE...
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