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Depression, Drugs and Interaction Dangers

Posted By Administration, Thursday, January 13, 2011
Updated: Friday, April 18, 2014

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by Ali Meschi, PhD, CNC

Complexity and the roots of depression have always been a major and complex health issue.  Depression contains other health issues such as behavioral, psychological, social, cultural, religious and the spiritual aspects of ones life.  Because of the complexity aspects of depression, it should always be treated with one and the “Whole Person” ideology in mind.

The depression epidemic has gotten worse since the September 11th tragedy and all that followed.  The stress of the tragedy has put a lot of old wounds of mind back in the front seat, dominating the daily activity in every aspect of everyone’s life, not only in the United States, but also throughout the world.

Dr. Jane Mak, a Neuropsychologist and clinical psychologist has stated that many of her past patients including children, have been back for visits to seek resolution to their flared up old wounds.

Today, four out of every six Americans are having difficulty concentrating on their jobs.  Three out of 4 patients take some form of supplements totally unsupervised.  Many take the supplements with or without their physician’s knowledge and sometimes in combination with prescription drug/s, presenting safety issues.

Despite the various aches and pains, irritability, difficulty concentrating, fatigue, digestive problems, anxiety, guilt and much more, Depression is not a disease by medical evidence.  Depression is not more than a “trapped inward feeling”, with no two people experiencing exactly the same symptoms.

Depression may have underlying factors such as Thyroid Disease, Cardiovascular or Endocrine System problems, deficiency and or imbalances of certain nutrients, digestion, food sensitivities, artificial lighting, inactivity, numerous toxic environment chemicals found in the household.  Heavy metal poisoning, adrenal, ovarian or testical problems, immune deregulation, anemia, blood sugar fluctuations, prolonged physical illness and many more symptoms can cause Depression.

True “healing” cannot be achieved by simply “relieving” the pain and symptoms.  Studies have shown that if the cause and effect relationship between depression and functional decline is not understood properly, depression can become a killer disease.

Contrary to today’s only approach of treatment, stopping the pain, we must hear the message (the symptom) and understand the message (the symptom) that the body is trying to tell us.  The message is simple, something is wrong somewhere.  I recommend we stop shooting the messenger (pain) and start being a good listener to our body’s warning signs.  My simple message to you, do not self-treat!

 


I often see patients who have decided to self-prescribe medications or supplements for various problems, depression included. Not only do they mask the real problem, not listening to their body and its symptoms, they run the risk of having dangerous drug interactions.  If you are currently on any medication or supplements, please take the time to read the following Drug/s Interaction Dangers.  It could save your life.

Food(s) / Supplement(s) / Drug(s) Interaction Dangers

Add-on Interactions:

“Add-on” interactions are the most common type and can be the most dangerous, even fatal.  These occur between drugs that have similar effects, either depressant + depressant or stimulant + stimulant.

Depressants include: alcohol, antianxiety agents, tranquilizers, anticonvulsants, antihistamines, certain high blood pressure drugs, muscle relaxants, narcotics and the popular pain reliever propoxyphene (e.g., Darvon).

Stimulants include: antidepressants (MAO inhibitor type drugs and tricyclics family drugs), appetite suppressants, some asthma drugs, caffeine, nasal decongestants, methylphenidate (Ritalin) and pemoline (Cylert).  You should always ask your doctor and/or pharmacist about these types of interactions before you take any medication.

Amine-containing foods + MAO inhibitors:

MAO inhibitors are used in some cases of clinical depression.  This can be a life threatening combination that may result in a dangerous rise in blood pressure, with severe headache, fever, visual disturbances, and confusion, possibly followed by brain hemorrhage/stroke.

Caution: Avoid amine-containing foods, even for several weeks after stopping MAO-inhibitor type antidepressant drugs.

Amine-Containing foods include: avocados, baked potatoes, bananas, bean pods, beer, bologna, caviar, cheese, chicken liver, canned figs, instant soup mixes, meat tenderizers, nuts, pepperoni, pickled herring, raspberries, salami, sauerkraut, summer sausage, sour cream, soy sauce, wines, yogurt, yeast and other aged or fermented foods.

MAOI’s include: isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate)

Tricyclics include: amitriptyline (Elavil, Enddep), desipramine (Norpramin, Pertofrane), imipramine (Janimine, Tofranil), nortriptyline (Aventryl, Pamelor), Doxepin (Adapin).

Both types of antidepressant drugs MAOIs and Tricyclics require close monitoring to determine proper dosage.  The drugs must be taken for at least three weeks before mood improves.  And the side effects associated with these two families (Gambini’s and Kapone’s) can be severe and debilitating.

Trycyclics can induce dry mouth, constipation, weight gain, blurred vision, heart attacks, stroke, high or low blood pressure, heart block, seizure, hallucinations, delusions, confusion, disorientation, in coordination, tingling, abnormal involuntary movements, anxiety, insomnia, nightmares, dizziness, ocular pressure, rashes, bone marrow depression, elevation or lowering of blood sugar, edema, hair loss and more.

MAOI’s can provoke the same side effects plus an increased risk of hypertension and hepatitis.
 

Tags:  depression  side effects 

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Is Your Medication Robbing You of Nutrients?

Posted By Administration, Friday, August 20, 2010
Updated: Friday, April 18, 2014

by Hyla Cass, MD 3308079338_c8c107bc7f_b   

 

A little known but potentially life-saving fact is that common medications deplete vital nutrients essential to your health. Here's a practical guide to avoid drug-induced nutrient depletion, and even replace your medications with natural supplements.

 

We have been called a pill-popping society, and statistics bear this out. Nearly 50 percent of American adults take at least one prescription drug, and 20 percent take three or more. In a survey(1), more than half of those over 65 and 30 percent of people 45 to 65 used at least three prescription drugs in a one-month period. With our increasing reliance on medications comes nutrient depletion, a problem we can't ignore. Every medication, including over-the-counter drugs, will drain the body of specific nutrients. On top of this, most Americans are already suffering from nutrient depletion. In fact, many of the conditions we see in everyday practice may actually be related to this deficiency.

The good news is that with the right supplements, you can avoid depletion side effects, and even better, you may be able to control and prevent chronic diseases, such as diabetes, cardiovascular disease and osteoporosis.

 


A Common Scenario

I have seen case after case of patients who have experienced nutrient loss from taking prescribed medications. Too often, neither the patients nor their doctors were aware that the cause of symptoms was the medications themselves.

For example, a 57-year-old retired schoolteacher, Kathy, was being treated by her internist with three medications: the thiazide diuretic, Diuril, for high blood pressure; Fosamax for osteoporosis; and the beta-blocker, Tenormin, for heart palpitations.

She was referred to me, an integrative psychiatrist, because she suffered from fatigue, anxiety, depression and insomnia. I couldn't find an obvious psychological explanation for these symptoms, except perhaps for the stress of her physical illnesses.

The likeliest cause of her symptoms was the drugs themselves. So, rather than adding an antidepressant, an anti-anxiety pill or sleeping agent, I checked the known nutrient depletions associated with these medications. Lab results confirmed that Kathy was deficient in three essential minerals: magnesium, potassium and zinc.

Any one of her three medications could deplete potassium and magnesium, causing arrhythmias, hypertension, fatigue and depression. The diuretic also could be depleting zinc. Her internist agreed that he would continue to oversee her medications while I supervised her nutritional regimen.

Daily doses of magnesium, zinc and potassium, in addition to a high-potency multivitamin, resolved Kathy's "psychiatric" symptoms. Once her mineral levels were restored, her energy and mood were back to normal. She was not only spared the burden of an additional medication, but was able to lower the doses of the three she was taking.

I see cases similar to Kathy's more frequently than I'd like. Physicians will often tell these patients that their symptoms are "part of the illness" or "just signs that they're getting older." They then prescribe an additional drug or two for the side effects, further compounding the problem.

To understand the role of medications in nutrient depletion, we must first understand the variety of nutrient-depleting mechanisms in pharmacy.

Many drugs, such as the stimulants Ritalin (methylphenidate) and Adderall, are prescribed for attention deficit disorder. These can reduce appetite. This, in turn, decreases the intake of beneficial nutrients. Some antidepressants also tend to have this appetite-reducing effect.

On the flip side, a drug can reduce nutritional status by increasing the desire for unhealthy foods, such as refined carbohydrates. Many of the neuroleptics (antipsychotic drugs) and some antidepressants cause insulin resistance or metabolic syndrome, with resulting blood sugar swings. Patients then crave simple carbohydrates, such as sugar, bread and pasta. Steroid drugs, including those given by an inhaler, can create similar issues as well.

Certain medications reduce the absorption of nutrients. In passing through the gastrointestinal tract, drugs often bind to specific nutrients before they're absorbed into the bloodstream. The antibiotic, tetracycline, for example, can block absorption by binding with minerals such as calcium, magnesium, iron and zinc in the GI tract.

Weight loss drugs and cholesterol lowering medicines similarly bind to fats, preventing them from being absorbed. Drugs that treat acid reflux or heartburn raise the pH environment of the upper GI tract, which reduces absorption of needed vitamins and minerals. This is especially problematic among the elderly, who often are already low in stomach acid.

Nutrients are essential to the metabolic activities of every cell in the body. They're used up in the process and need to be replaced by new nutrients in food or supplements. Some drugs deplete nutrients by speeding up this metabolic rate. These drugs include antibiotics (including penicillin and gentamicin) and steroids, such as prednisone and the gout medication, colchicine.

Other drugs block the nutrients' effects or production at the cellular level. In addition to the intended effect on enzymes or receptors, medications can influence enzymes or receptors that help process essential nutrients. For example, widely prescribed statin drugs block the activity of HMG-CoA, an enzyme that's required to manufacture cholesterol in the body. This action also depletes the body of coenzyme Q10, which requires HMG-CoA for its production. This has a serious negative impact on muscle and heart health.

Drugs also can increase the loss of nutrients through the urinary system. Any drug that does this can drain the body's levels of water-soluble nutrients, including B vitamins and minerals, such as magnesium and potassium. The major offenders are medications to treat hypertension, particularly the diuretics that reduce blood pressure by increasing the volume of water flushed out of the body.

Drug-induced nutrient depletion is far more common than we think. In evaluating patients' symptoms, doctors must assess whether symptoms are due to the illness, to side effects of the drugs or to drug-induced nutrient depletion. Considering the inadequate nutrition of most people, we must remember that the illness itself may be due, in part, to nutrient deficiency. To cover all bases, it is easiest to provide baseline coverage: a daily high potency multivitamin mineral formula, CoQ10 (200 mg), omega-3 fatty acids (2 grams) and additional vitamin D and probiotics, especially if you've taken antibiotics.

The bottom line: As physicians, we must look more deeply and determine underlying causes to determine whether drugs are harming patients, and what we can do to reverse these effects. As a consumer, be aware of these drug-nutrient depletions, and do what you can to avoid taking medications whenever you can, using natural products instead.

1. Centers for Disease Control and Statistics. Health United States 2006. Accessed via www.cdc.gov/nchs/data/hus/hus06.pdf#093.

Tags:  side effects 

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Medication Side Effects and How to Prevent Them

Posted By Administration, Thursday, July 22, 2010
Updated: Friday, April 18, 2014

227906487_17d94931a3_oby Joel Lopez, MD, CNS

Medications are essential for certain acute conditions. There are people who take medications for chronic symptoms, however. It’s all fine and well until side effects happen. That’s why, a person’s biochemical individuality should always be taken into account when a person has to take medications long-term. A regular review of your medications should be in order, taking into account that there’s less metabolism or excretion of medications as we age.

Fortunately, there are genomic tests available that could tell you instantly and reliably on the kind of pharmacological substances which are most suitable for you. It furthermore advises you which dose grants you optimized therapeutic success.

One such lab is called Genosense in Vienna, Austria. They have a genomic test called Pharmacosensor. This test examines carefully selected polymorphisms which lead to structural changes in proteins that strongly influence the speed of metabolism in a series of pharmacological substances and also account for the accelerated or reduced transformation of harmless precursors of given medication into highly efficient substances.

If a person is unable to do this test, then at least they should be aware of possible nutritional deficiencies their medications could cause and make sure to replenish them.

One such class of medications are the antacid or ulcer medications. Nutrient deficiencies in Vitamins B12, folic acid, Calcium, Iron and Zinc could occur with the following potential health problems: anemia,depression, birth defects, increased cardiovascular risk, cervical dysplasia, heart disease, cancer risk, osteoporosis, muscle weakness, hearing loss, tooth decay, hair loss, brittle nails, loss of sense of taste or smell, and sexual dysfunction.

Another class of meds are the cholesterol-lowering agents called “statins”. They deplete the body of Coenzyme Q10. When this happens, various cardiovascular problems, a weakened immune system and low energy could occur.

Anticonvulsants could deplete the body of Vitamins D, B1, B2, B3, B6, B12, C, Magnesium, Selenium and Zinc. Potential health issues could include osteoporosis, muscle weakness, hearing loss, tooth decay, heart and blood pressure irregularities, cervical dysplasia, anemia, hair loss, depression, dermatitis, fatigue, reduced antioxidant protection, poor wound healing and skeletal problems.

My purpose is not to alarm people who take these medications but to make them aware that an integrative approach to any medical condition yields better results. It’s a good thing that we can now check for nutritional deficiencies. One such functional test is done through Spectracell. It checks for 33 nutrient deficiencies. I love this test because it takes the guesswork out of supplementation. Better yet, most PPO’s and Medicare cover for this test.

Tags:  side effects 

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Black Cohosh May Reduce Side Effects of Clomid/Clomiphene

Posted By Administration, Thursday, April 15, 2010
Updated: Friday, April 18, 2014

 

 

by Fiona McCulloch, ND

Clomid is one of the most commonly used pharmaceuticals in the treatment of fertility concerns today.  It is often the first therapy used.  Clomid (also known as clomiphene) binds to estrogen receptors, inhibiting the action of estrogen (which is produced by developing follicles) on the hypothalamus in the brain.   As a result, the pituitary gland perceives estrogen levels to be low (when they actually are not), and it responds by producing increased levels of both LH and FSH.  This causes increased follicle production by the ovaries, and stimulation of ovulation.pregnancy with clomid therapy

As effective as this therapy can be at inducing ovulation, studies have indicated fertility specific side effects of clomiphene, many of which are caused by its antagonism to estrogen. The major fertility related side effects are: 1) thinning of the endometrial lining and 2) reduction of cervical mucous required for entry of sperm into the uterus.

One of the isomer forms of clomiphene has a slow excretion rate from the body (it can take more than 6 weeks to be excreted).  If clomiphene therapy is used for longer than two months, side effects can be more pronounced, resulting in greater thinning of the endometrial lining which is needed for healthy implantation. In women over 40, endometrial lining thins naturally, and perhaps this is why clomiphene is often not an effective treatment in this group of patients.

For many women, the ovulation induction produced by this medication can be the answer to ovulation difficulties however therapy often must be stopped after a short period due to side effects over time. Estrogen therapy has been studied in conjunction with Clomid presumably to offset the anti-estrogenic effects of the medication, with mixed results.  Some studies have found giving additional estrogen to women to be helpful, and others have found it to be of no benefit.

Recently, two studies have been completed on combining black cohosh (also known as Cimicifuga racemosa) with clomiphene in patients seeking treatment for infertility.  Cimicifuga is a botanical therapy, often used in womens health to treat menopausal conditions such as hot flashes.  Estrogenic effects of black cohosh remain highly debated, with early studies indicating that it  directly affects estrogen receptors, and more recent studies showing that the effect of the plant may occur from an entirely different mechanism.  Without yet knowing the exact mechanisms through which black cohosh works, several convincing studies have indicated it to be beneficial in the clinical treatment of hormonal disorders.  A recent study has indicated that black cohosh may reduce proliferative effects of estrogens on tissues, which is in line with the effect of many phytoestrogens, however the mechanism for this remains to be elucidated.

In the first study conducted in 2008, black cohosh was found to significantly increase estradiol and LH concentrations in patients taking clomiphene therapy.   Endometrial thickness, serum progesterone and clinical pregnancy rate in patients were significantly higher in the black cohosh group as compared to control.

The second study was completed in 2009. In this study of patients taking clomiphene, black cohosh given in the follicular phase was compared to estrogen therapy, presumably in order to determine which could reduce side effects more effectively. The black cohosh group needed significantly fewer days for healthy follicular development, had a thicker endometrial lining and had higher estradiol concentration at the time of HGG ovulation trigger when compared to the estrogen replacement therapy group.  Clinical pregnancy rate was 14.0% in the estrogen replacement group versus 21.1% in the black cohosh group. Although this did not reach clinical significance, it appears that the black cohosh group did display many benefits overall when compared to the estrogen replacement group. When results from the previous study are also considered, it appears that this therapy may warrant serious consideration and further study for those undergoing clomiphene treatment.

More studies will need to be conducted in order to determine the mechanisms of this herbal medicine’s benefits for patients undergoing modern assisted reproductive technology therapies.

References:

Homburg, I.  Clomiphene citrate—end of an era? a mini-review.  Human Reproduction 2005 20(8):2043-2051

Insler, V MB, BCh; Zakut, H MD; Serr, D M MB, ChB. Cycle Pattern and Pregnancy Rate Following Combined Clomiphene-Estrogen Therapy. April 73 (4) 4

Massai et al.  Clomiphene citrate affects cervical mucus and endometrial morphology independently of the changes in plasma hormonal levels induced by multiple follicular recruitment.  Fertil Steril. 1993 Jun;59(6):1179-86

Osmers et al. Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms. Obstetrics & Gynecology:  May 2005 – Volume 105 – Issue 5, Part 1 – pp 1074-1083

Sandro Gerli, Hossein Gholami, Antonio Manna, Antonio Scotto Di Frega, Costantino Vitiello, Vittorio Unfer, Use of ethinyl estradiol to reverse the antiestrogenic effects of clomiphene citrate in patients undergoing intrauterine insemination: a comparative, randomized study, Fertility and Sterility, Volume 73, Issue 1, January 2000, Pages 85-89

Shahin AY, Ismail AM, Shaaban OM. Supplementation of clomiphene citrate cycles with Cimicifuga racemosa or ethinyl oestradiol–a randomized trial. Reprod Biomed Online. 2009 Oct;19(4):501-7.

Shahin, Ahmed Y.1; Ismail, Alaa M.1; Zahran, Kamal M.1; Makhlouf, Ahmad M.1 Adding phytoestrogens to clomiphene induction in unexplained infertility patients – a randomized trial. Reproductive BioMedicine Online, Volume 16, Number 4, April 2008 , pp. 580-588(9)

Tags:  black cohosh  clomid  clomiphene  side effects 

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