YOUR HEART HEALTH IS GOING DOWNHILL, BUT YOU’LL FEEL BETTER ABOUT IT. Actually, according to some recent very large studies, only about 2% better over placebo… The bottom line is that anytime we alter physiology with a foreign compound there is a price to be paid. While a drug may focus on a single enzyme, because of our lack of understanding of the complexities of the human body, there may be other things that the blocked enzyme does that we’re not aware of until that drug hits the market in large numbers. Yes, you’ve heard it said that, in taking a new drug, you become part of a large clinical trial that has really bad reporting of outcomes. Look at Vioxx causing heart attacks and strokes (because of the unfamiliar effect of COX-2 enzyme effects on a compound called prostacyclin). We know know that SSRIs are associated with bone loss because of serotonin’s effect on bone. This study finds that SSRIs interfere with heart rate variability, a strong predictor of cardiovascular health. All this in the face of really very poor performance of SSRIs on depression (again…over placebo only 2% improvement long term).
Anxiety
Serotonin, SSRIs and Depression; The Myth Behind the Marketing
If you go into your PCP’s office and mention that you’ve been feeling down there’s a good chance you’re going to get a prescription for a SSRI.
SSRI stands for Selective Serotonin Re-uptake Inhibitor. This is a class of drugs that slows the brain cell’s ability to pick up the hormone serotonin that your brain cell just used to send a message to the neighboring brain cell. To put it in simpler terms, SSRIs keep serotonin in play longer, increasing the likelihood that a message is going to be relayed.
The typical concept that is used in explaining the use of SSRIs is that you have a chemical imbalance in your brain (serotonin) and this drug will fix it.
Sounds pretty straightforward and seems to make sense. It also gives many people hope that there is a drug to fix how he or she is feeling. There is something WRONG and it can be FIXED.
But what if this entire concept was MADE UP?
Couldn’t be possible, right?
There’s no way a concept like a drug that can fix a chemical imbalance in the brain and help with depression could become as well-founded in medicine and society as drinking water to cure thirsty.
You know where I’m going with this although this point you’re probably about as skeptical as you’ve ever been. This information was all brought up in an editorial in the BMJ by Dr. David Healy, a professor of psychiatry in Wales. The full text of this editorial can be found on his website by clicking here.
Let’s review some things that we already know first:
- SSRIs have been shown to be pretty much worthless in the medical research beyond placebo (especially when ALL the studies are taken in account—not just the positive ones).
- The placebo effect is very, very powerful and deals with the brain. Which is ironic since depression and anxiety are “brain” problems.
- While a small few do benefit, the vast majority of patients in my office who are on this class of drugs don’t notice all that much of an improvement in mood with use beyond 3 months. Most give me a sheepish shrug and a grunt of “maybe” when I ask if they seem to help.
With these three things in mind, it’s time to clarify a few more myths and identify the timeline of SSRI development, marketing and use.
Serotonin levels and depression
Early clinical studies attempted to demonstrate that people with depression had lower levels of serotonin. This was never able to be proved. To make this a little bit more confusing, the SSRIs have never been shown to actually increase serotonin levels (except theoretically in the synaptic cleft between brain cells). Contrast this with compounds like tryptophan and 5-HTP, which give the body the building blocks to make more serotonin if needed.
There has been no evidence that the strength of the SSRI’s effect on blocking serotonin reuptake was related to the better outcomes (in other words, stronger SSRIs did not have a greater effect on depression).
Just to make matters worse, the original clinical trials pitting SSRIs up against the tricylic antidepressants like Elavil and Amitriptyline had them failing miserably.
Finding a use for the SSRIs
The SSRIs were developed in the late 1980s, but originally had no indication. In other words, the drug companies had a neat new drug but no idea what to do with it. The original thoughts were to use it for controlling blood pressure of maybe weight loss, but these ideas were quickly scrapped.
But concern was rising with the risk of dependence from the use of tranquilizers, creating a potential market for the SSRIs. However, the general public had been trained to expect an immediate response from their anxiety and diabetes drugs and the SSRIs didn’t fit this expectation.
So the drug companies needed to retrain the public and doctors by reframing how we thought about depression.
It’s amazing what gobs of money can accomplish.
So the drug companies created the idea of a chemical imbalance linked to serotonin levels. Luckily, the white horse was already on its way in.
So where does that leave us?
All of this does not mean that serotonin was a worthless concept. But it does likely mean that the use of drugs that affect serotonin reuptake are not the answer. Don’t expect this message to be adopted anytime quick, though. This is still one of the most successful classes of drugs on the market and there are enough prescriptions written in the Westernized world to treat every adult. Many of these prescriptions are being used because patients could not get off of them.
The long list of side effects that are experienced with withdrawal are sometimes used to convince patients that they NEED to be on the drugs. What a way for the drug companies to create their own market.
The real long-term answer to psychological disorders lies with brain health. Making sure that the cells of your brain have the energy they need to function at their best. Making sure that the cells are healthy enough so that they can communicate with each other when needed as well as NOT communicate with each other when needed.
Tools for this should include:
- Exercise
- Stress management techniques (yoga, biofeedback, meditation)
- Counseling—you NEED a good therapist on your team to help you learn long-term coping strategies
- A brain-healthy lifestyle (you can check out my Depression eBook by clicking here)
- Positive outlook—waking up each day at looking for the positives, always focusing on these rather than the negatives
- Brain-healthy supplements like vitamin D, magnesium and fish oils
I’m not saying that there is no need for drugs that affect the psychological aspects, but these drugs should be used short-term while you get the motivation and education to rise above your current mental state.
Some may still need drugs long-term, but these drugs, like any other drugs, should not be the ONLY tool in your toolbox. Rather, they should be just one of many (like those on the list above) of the tools you use to help your brain.
Have a Skinny Friend? Maybe You Should Borrow Some of This
Obesity and weight loss are complicated issues. It’s no longer about calories in versus calories out.
In a prior article I wrote about the contributions of environmental chemicals to obesity and diabetes. And this contribution is not a small one. You can read more about this relationship by clicking here.
Certainly the quality of the foods you eat, the calories and the amount of calories that you burn play a role. You can’t sit on the couch and eat 4,000 calories a day and not expect to gain weight. But what about the other extreme? What if you watch your calories, watch the quality of your calories as well as exercise consistently using both aerobic and resistance training and still cannot get to your ideal weight?
That is the frustrating situation you may find yourself in, ultimately throwing up your hands and giving up. And unfortunately, I can’t provide you with a direct, immediate answer. The answer to maintaining an ideal weight is not an easy one. It certainly requires attention to diet and exercise.
The harder factors to account for and change are the environmental ones I mentioned earlier. I know that in our household we have moved to stainless steel pitchers for our tea, glass and stainless steel for our water bottles, glass for our cups, natural / fragrance free dish soaps, laundry soaps and cleaners as well as getting any other chemicals that we can identify out of our lives. Not an easy task and we have to make some sacrifices as a family.
Talk about confusing. I cannot tell you how many patients are unaware that drinking out of plastic water bottles can make them fat. But what if the story got even MORE confusing?
Just what you wanted to hear. But that’s exactly what this particular study does. There has already been some hints from medical research that the bacteria in your gut can play a role in body fat. Stress, artificial sweeteners and antibiotics have all been shown to disrupt the delicate balance of the bacteria in your gut towards obesity and diabetes.
The researchers in this study took it quite a bit further. They took the bacteria in the gut of mice fed a high fat diet and transplanted this bacteria into mice who had basically had their guts wiped clean of bacteria so it was a clean slate. Here’s what happened to the mice given the high fat diet bacteria:
- There were disruptions in exploratory, cognitive, and stereotypical behavior (there were actual behavioral changes in the mice).
- There were disruptions in markers of intestinal barrier function (aka leaky gut).
- The was increased circulating endotoxin (more toxins from the bacteria in the gut).
- There was increased lymphocyte expression of ionized calcium-binding adapter molecule 1, toll-like receptor 2, and toll-like receptor 4 (basically, the white blood cells were gearing up for a fight with something).
- There was increased inflammation in the brain as well as alterations in the blood flow within the brain.
All of these changes from something as simple as changing the bacteria in the gut. Some would say this is just a mouse study and has no relevance. That argument is a little weak when you look at the human studies previously mentioned that have found relationships between bacteria in the gut and obesity. Then when you consider the reports of weight gain in patients who has undergone fecal transplants for C. diff infections this study becomes even more important.
The take home message is that the bacteria in your gut plays a strong role in your weight. The stress you experience, the foods you eat, your exercise and the drugs you take in (from anti-inflammatories and steroids down to antibiotics) all have an influence on your gut bacterial populations. Think on that when you decide to adopt a behavior that is known to negatively affect the bacteria in the gut.
Anxiety, Antibiotics And Gut Flora
IS YOUR ANXIETY / STRESS CAUSED BY ANTIBIOTICS?
It would not be the first time that I’ve posted about just how important the bacteria in our gut is. I just hope that you understand just how critically important the presence of friendly bacteria in our gut is. This is exponentially more important as newborns, infants, toddlers and young adults. The negative consequences of not having the right balance of bacteria are too numerous to mention, but this article points out one you may not think of. Given the fact that the gut actually produces a large chunk of the body’s neurotransmitters (it is frequently referred to at the “second brain”) it is understandable that altered gut flora has been linked to weight gain and now anxiety. Although this is a mouse study, it would do us well to pay attention to the results.
Second Hand Smoke and Your Child’s Mental Health
WILL THIS GET YOU TO QUIT SMOKING?
We all know that smoking is bad for us, and yet this alone is not enough to make us quit. Somehow, we all think we will escape the near certainty that smoking will cause a slow, painful, medically-ridden premature death. Statistically, it is much like playing video games instead of working because you are sure that this Lotto drawing is yours.. But that’s you. What about those you care about? What if smoking was destroying THEIR mental health, leading to depression, aggression, anxiety and ADHD? Is this enough? We all want our children to be happy and well adjusted and lead a wonderful life. If you know that smoking is destroying the chances of this (and this study suggests that it does), is THIS enough to get you to quit?
Valerian – (04-23-03)
Valerian.
If I can get patients to get past the smell of this herb, most of them find it very effective at helping them sleep. Once again, American Family Physician gives a nice, unbiased review.
Valerian – April 15, 2003 – American Family Physician
Psychotropic Practice Patterns for Youth–A 10-Year Perspective
Psychotropic Practice Patterns for Youth–A 10-Year Perspective.
The idea that utilization of psychotropic meds for youth is closing in on adult levels that drops my jaw. Are our children that disturbed? And, even if they were (which I strongly doubt…) would anyone out there like to bet their right arm against the fact that these drugs in no way interfere with proper neurological development? Remember that the brain is plastic–it is constantly regenerating itself. The old adage that killing off brain cells in college never to be replaced is not true. Those new cells being produced are being bathed in meds that we have no true long term studies (unless you consider 3 years long in the life of a child) showing their safety.
Psychotropic Practice Patterns for Youth: A 10-Year Perspective – Click here for more information.
Exercise, Memory, Depression and Your Brain; Great News!
The list of things you can do to protect your brain and improve brain function is quite long, but there is one things that is always at the top.
Exercise.
There is absolutely, positively no doubt that exercise is incredibly important for your brain. And this is regardless of what you are worried about or what you are dealing with. Parkinson’s, Alzheimer’s, depression, anxiety, chronic migraine headaches, seizures, multiple sclerosis…
Sadly, this tool is brought into play far too seldom. The second you walk into your neurologist’s door, the first question he or she should be asking is how is your exercise routine going. All too frequently medications are the only item of discussion.
How exactly exercise helps the brain is yet to be figured out, but it’s likely working by several mechanisms:
- Improved blood flow to the brain. More blood flow means more nutrients and healthier brain cells.
- Release of the hormone irisin through exercise.
- Muscles use glucose. More muscle means better glycemic control and lowered risk of diabetes. Prediabetes and diabetes destroy the brain.
And probably several more ways that I can’t think of right now. This particular article adds to the list. In it, researchers looked at the effect of the hormone adiponectin on the brains of mice.
Adiponectin is a hormone produced by the fat cells in the abdomen. This hormone is essentially an anti-diabetes hormone. As I mentioned, since diabetes is so bad for the brain, it might make sense that adiponectin would have positive effects on the cells of the brain.
But the specifics are what were so surprising:
- Adiponectin can cross the blood–brain barrier. Higher levels in the brain increased the number of brain cells and decreased depression-like behaviors.
- A deficiency of adiponectin, however, cut short the beneficial effects of exercise in increasing the number of brain cells in the hippocampus (the region affected by Alzheimer’s dementia).
Because researchers were using mice, they were able to modify the hormone levels. But, in your own brain, these same effects can be achieved through a combination of living an anti-diabetic lifestyle and exercise.
The anti-diabetic lifestyle will increase the levels of adiponectin being released by your fat cells. The higher levels of adiponectin will give you the best possible effects of exercise on your brain. Specifically, according the this study, the hippocampal region of your brain will benefit. This is the region that is heavily involved with memory.
So, if you are a migraine sufferrer, it is not exercise alone that is going to protect your brain and your memory. Exercise needs to be coupled with an anti-diabetic diet to have the full effect on protecting your brain.
Want to avoid Alzheimer’s dementia? Same story.
Depression? Anxiety? Same story.
Get the point? You cannot change or improve one aspect of your lifestyle without making changes in other areas as well. Anything less will not give you the full benefit.