Obese man with heartburn

How to Fix Acid Reflux After Gastric Sleeve Surgery

obese man with heartburn

Acid reflux, also known as gastroesophageal reflux disease (GERD), is a common concern arising after gastric sleeve surgery. This surgical weight loss procedure, also called sleeve gastrectomy, involves reducing the stomach size to promote weight loss by limiting the amount of food consumed. 

While this surgery has numerous benefits for individuals struggling with obesity and related health issues, it can lead to changes in the anatomy of the stomach that may contribute to acid reflux. Managing acid reflux after gastric sleeve surgery is essential to ensure the procedure’s success and maintain overall health and quality of life. 

This post will explore strategies and lifestyle modifications to help individuals address and alleviate acid reflux post-gastric sleeve surgery.

Symptoms of GERD in Gastric Sleeve Patients

Here are common symptoms of GERD that may occur after a gastric sleeve procedure:

  1. Heartburn: This is the most common symptom of GERD. It typically presents as a burning sensation in the chest, often after meals or when lying down. Persistent heartburn can sometimes be severe and may be mistaken for a heart-related issue.
  2. Regurgitation is the sensation of stomach contents, including acid, flowing back into the mouth or throat. It can cause a sour or bitter taste in the mouth.
  3. Difficulty Swallowing: Also known as dysphagia, this symptom may arise if the narrowing of the stomach after gastric sleeve surgery causes food to move more slowly through the digestive tract.
  4. Chest Pain: GERD-related chest pain may be similar to heartburn but can also be mistaken for heart-related pain. It’s important to distinguish between the two, as a medical professional should always evaluate chest pain.
  5. Sore Throat: Repeated throat exposure to stomach acid can cause irritation and lead to a persistent sore throat or hoarseness.
  6. Chronic Cough: A cough that persists for an extended period, especially when it’s worse at night or in the early morning, can be a symptom of GERD. The reflux of stomach contents can irritate the airways and trigger a cough.
  7. Asthma Symptoms: Some individuals with GERD, including those who have had gastric sleeve surgery, may experience exacerbated asthma symptoms or new-onset asthma due to acid reflux irritating the airways.
  8. Laryngitis: Inflammation of the voice box (laryngitis) can result from stomach acid reaching the upper respiratory tract.
lady with GERD

Understanding the Mechanism of Acid Reflux Post-Gastric Sleeve Surgery

Gastric sleeve surgery involves the removal of a significant portion of the stomach, leaving a smaller, banana-shaped stomach pouch. This alteration in stomach anatomy can impact the normal functions of digestion and lead to changes in how stomach contents, including stomach acid, are handled. 

One of the primary factors contributing to acid reflux after gastric sleeve surgery is the reduction in stomach size. With a smaller stomach, there is less space to hold food, and the stomach can become full more quickly. This can cause increased pressure on the lower esophageal sphincter (LES), the muscle that separates the stomach from the esophagus. 

When the pressure on the LES increases, it may become less effective at preventing stomach contents from flowing back into the esophagus, leading to acid reflux.

Dietician meeting with patient

Treatment Options of Heartburn Symptoms After Gastric Bypass Surgery

1. Medication Management

One of the first steps in addressing acid reflux after gastric sleeve surgery is through medication management. Consulting with a healthcare professional, such as a gastroenterologist or the bariatric surgeon who performed the gastric sleeve surgery, is crucial to determine the most appropriate medications to control acid reflux symptoms. Common medications prescribed for acid reflux include proton pump inhibitors (PPIs) and H2 blockers.

2. Dietary Modifications

Making strategic changes to your diet can significantly help alleviate acid reflux symptoms. It’s essential to avoid foods that are known to trigger acid reflux, such as acidic, spicy, or fatty foods. These can irritate the stomach lining and exacerbate reflux. Instead, focus on a balanced diet with lean proteins, whole grains, fruits, and vegetables. Smaller, more frequent meals can help prevent the smaller stomach pouch overload, reducing the pressure on the LES.

3. Hydration Habits

Proper hydration is essential, but adjusting your drinking habits to minimize the risk of acid reflux is important. Drinking large amounts of liquid with meals can increase the pressure on the LES and contribute to reflux. To avoid this, sip fluids between meals rather than during meals. This practice ensures that you stay hydrated without compromising digestion.

4. Elevate Your Head

Elevating the head of your bed can be particularly helpful, especially when dealing with nighttime acid reflux. When you sleep with your upper body slightly elevated, gravity can prevent stomach contents from flowing back into the esophagus. This position can significantly reduce the occurrence and severity of nighttime acid reflux.

5. Lifestyle Changes

Several lifestyle modifications can positively impact acid reflux symptoms after gastric sleeve surgery. Smoking is a known contributor to acid reflux, and quitting smoking can significantly alleviate symptoms. Limiting alcohol and caffeine intake can also help reduce the risk of reflux. Additionally, if you’re overweight, losing weight through 

a healthy diet and regular exercise can alleviate pressure on the stomach and improve reflux symptoms.

6. Stress Management

Stress is often overlooked as a potential contributor to acid reflux. However, stress can exacerbate the symptoms of GERD. Incorporating stress-reducing techniques into your daily routine, such as meditation, yoga, deep breathing exercises, or mindfulness practices, can positively impact your mental well-being and digestive health.

7. Regular Follow-Up

Gastric sleeve surgery has long-term effects on your digestive system and overall health. Follow-up appointments enable your healthcare provider to monitor your health over the years, detect potential issues early, and recommend additional screenings or tests as needed. If GERD symptoms are present, your provider can discuss dietary habits, potential prescription medications, and other treatment options available to help alleviate the problem. 

lady under the covers who can't sleep

What Can Happen if GERD is Left Untreated:

Untreated gastroesophageal reflux disease (GERD) can lead to a range of complications that can affect your quality of life and overall health. It’s essential to manage GERD to prevent these potential issues. Here are some of the complications that can arise if GERD is left untreated:

  1. Esophagitis: Chronic exposure to stomach acid can cause inflammation and damage to the lining of the esophagus, a condition known as esophagitis. This can lead to discomfort, pain, and difficulty swallowing.
  2. Strictures: Repeated inflammation and scarring of the esophagus can lead to the formation of strictures, which are narrowed areas in the esophagus. Strictures can make swallowing even more challenging and may require medical intervention to widen the esophagus.
  3. Barrett’s Esophagus: Chronic acid reflux can sometimes lead to changes in the cells lining the lower esophagus. This condition is known as Barrett’s esophagus and is a risk factor for esophageal cancer.
  4. Esophageal Ulcers: Stomach acid can cause ulcers in the esophagus, leading to pain, bleeding, and potential complications if left untreated.
  5. Respiratory Issues: GERD can trigger or exacerbate respiratory issues, such as asthma or chronic cough, as stomach acid can reach the upper respiratory tract and irritate the airways.
  6. Dental Problems: Stomach acid in the mouth due to regurgitation can lead to dental issues, including enamel erosion, bad breath, and an increased risk of cavities.
  7. Chest Pain: Chronic GERD symptoms, if not properly evaluated, can be mistaken for heart-related chest pain (angina). It’s crucial to differentiate between GERD-related symptoms and cardiac issues.
  8. Sleep Disturbances: Nighttime GERD symptoms can disrupt sleep, leading to poor sleep quality, daytime fatigue, and reduced overall well-being.
  9. Weight Loss and Malnutrition: Severe GERD symptoms, such as difficulty swallowing or chronic vomiting, can result in weight loss and potential nutritional deficiencies.
  10. Esophageal Cancer: Although the risk is relatively low, long-term untreated GERD, especially when combined with other risk factors such as smoking, obesity, or Barrett’s esophagus, can increase the risk of developing esophageal cancer.
pharmacist Michael

Acid reflux after gastric sleeve surgery is a common concern that requires attention and proactive management. The changes in stomach anatomy following the surgery can contribute to developing or exacerbating acid reflux symptoms. By working closely with healthcare professionals, implementing dietary modifications, adjusting hydration habits, elevating the head during sleep, making lifestyle changes, managing stress, and staying committed to regular follow-up appointments, individuals can effectively address acid reflux and enjoy the many benefits of their gastric sleeve surgery, including long-term weight loss and improved health. It’s crucial to remember that each individual’s situation is unique, so personalized advice from a healthcare provider is essential to determine the most appropriate strategies for managing acid reflux post-gastric sleeve surgery.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

young lady with a nasal sleep apnea mask

Can Stress Cause Sleep Apnea?

young lady with a nasal sleep apnea mask

Sleep is a fundamental physiological process that is crucial in maintaining overall health and well-being. The quality of sleep has a significant impact on various bodily functions, cognitive processes, and emotional stability. Sleep disorders are known to disrupt this delicate balance, and sleep apnea stands out as one of the most prevalent and concerning disorders. 

Poor sleep increases the risk of cardiovascular disease, weight gain, dementia, type II diabetes, and many other medical conditions. Sleep deprivation can worsen any mental disorder, including anxiety, depression, and bipolar disorder. 

Sleep apnea is characterized by repeated interruptions in breathing during sleep, leading to fragmented sleep patterns and potential health complications. While the primary cause of sleep apnea is often attributed to anatomical factors such as airway obstruction, there is a growing body of research suggesting that stress might also contribute to the development and exacerbation of sleep apnea. 

This post delves into the complex relationship between stress and sleep apnea, exploring the potential mechanisms underlying their connection and the implications for clinical management.


Stress and Sleep Apnea: A Two-Way Interaction

The Physiology of Stress:

Stress is a universal human experience, a natural response to various challenges and demands in life. Whether facing a looming deadline, a public speaking engagement, or a sudden danger, the body’s stress response is a complex cascade of physiological reactions that prepare us to deal with the situation. 

The Stress Response Pathway:

The hypothalamic-pituitary-adrenal (HPA) axis is at the stress response’s heart. This intricate system involves coordinating the hypothalamus, pituitary gland, and adrenal glands to release stress hormones. When confronted with a stressor, the hypothalamus signals the pituitary gland to release adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol, often called the “stress hormone.”

Immediate Physiological Changes:

In the face of stress, the body initiates a fight-or-flight response, preparing to confront the stressor or flee from it. This leads to a series of rapid physiological changes:

  1. Increased Heart Rate and Blood Pressure: The sympathetic nervous system is activated, causing the heart rate and blood pressure to rise. This prepares the body to deliver oxygen and nutrients to muscles and organs to respond to the impending challenge.
  2. Dilated Airways: The airways in the lungs widen, allowing for increased oxygen intake. This supports the body’s heightened demand for oxygen during stress.
  3. Redirected Blood Flow: Blood flow is redirected from non-essential functions, such as digestion, to essential functions like the brain and muscles. This enhances physical and cognitive capabilities.
  4. Release of Glucose: The liver releases stored glucose into the bloodstream, providing a quick source of energy to fuel the body’s response.
  5. Heightened Sensory Perception: The senses become more acute, enabling the individual to detect potential threats more effectively.


Man stressed out covering his face

Long-Term Effects and Chronic Stress:

While the stress response is essential for survival, chronic stress can harm overall health. Prolonged activation of the stress response can lead to a range of health issues, including:

  1. Cardiovascular Impact: Elevated heart rate and blood pressure over time can increase the risk of heart disease, hypertension, and stroke.
  2. Suppressed Immune System: Chronic stress can suppress the immune system’s functioning, making the body more susceptible to infections and illnesses.
  3. Mental Health Concerns: Persistent stress is linked to the development of mental health disorders such as anxiety and depression.
  4. Digestive Disorders: The diversion of blood flow away from the digestive system can lead to gastrointestinal problems, including irritable bowel syndrome.
  5. Cognitive Impairment: Prolonged exposure to stress hormones can affect memory, concentration, and cognitive function.

Sleep Apnea: An Overview:

Sleep apnea is a common and potentially serious sleep disorder characterized by recurring pauses in breathing or shallow breaths during sleep. These breathing interruptions can last for a few seconds to minutes and may occur multiple times during the night. As a result, sleep apnea disrupts the normal sleep cycle, leading to poor sleep quality and a range of potential health complications. 

Types of Sleep Apnea:

  1. Obstructive Sleep Apnea (OSA): This is the most prevalent form of sleep apnea. It occurs when the muscles at the back of the throat relax excessively, leading to the temporary collapse of the upper airway. As a result, airflow is obstructed, and breathing temporarily stops until the brain signals the body to awaken slightly and resume breathing. Individuals with OSA often experience loud snoring, gasping, or choking sounds during sleep.
  2. Central Sleep Apnea (CSA): This type is less common and is primarily characterized by the brain’s failure to transmit proper signals to the muscles responsible for breathing. Unlike OSA, CSA is not usually associated with physical airway obstruction. It often results in abrupt awakenings, shortness of breath, or difficulty staying asleep.
  3. Complex Sleep Apnea Syndrome (Mixed or Treatment-Emergent Sleep Apnea): Treatment-emergent central sleep apnea occurs when an individual initially has OSA but develops central sleep apnea after receiving treatment with continuous positive airway pressure (CPAP) therapy.

Common Symptoms of Sleep Apnea:

Sleep apnea symptoms can vary in severity and may include:

  1. Loud Snoring: Especially common in OSA, loud and chronic snoring can disrupt sleep for both the individual and their partner.
  2. Pauses in Breathing: Witnessed by a bed partner or recorded during sleep studies, these breathing interruptions are a hallmark of sleep apnea.
  3. Excessive Daytime Sleepiness: Due to fragmented sleep, individuals with sleep apnea often feel excessively tired during the day, leading to difficulties concentrating, staying awake, and performing daily tasks.
  4. Morning Headaches: Recurring headaches upon waking may result from the decreased oxygen levels associated with sleep apnea.
  5. Irritability and Mood Changes: Sleep disruptions can affect mood, leading to increased irritability, mood swings, and even depression.
  6. Insomnia or Restless Sleep: Individuals may have trouble falling asleep or experience restless tossing and turning during the night.
  7. Awakening with a Choking Sensation: A sudden awakening accompanied by choking or gasping for air can indicate sleep apnea.

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lady falls asleep in front of laptop

The Stress-Sleep Apnea Connection:

  1. Bi-directional Relationship: Research suggests that the relationship between stress and sleep apnea is complex and bi-directional. Chronic stress can potentially contribute to the development and exacerbation of sleep apnea. On the other hand, the fragmented and poor-quality sleep caused by sleep apnea can also exacerbate stress levels, creating a vicious cycle.
  2. Impact on Airway Function: Stress-induced changes in muscle tone and respiratory control mechanisms can influence the risk of sleep apnea. Chronic stress may lead to increased muscle tension, including those responsible for airway stability, potentially narrowing the airway and increasing the likelihood of breathing interruptions.
  3. Neuroendocrine Pathways:The release of stress hormones, particularly cortisol, has been linked to alterations in the neural control of breathing. Cortisol affects the respiratory centers in the brainstem, potentially disrupting the normal regulation of breathing patterns during sleep.
  4. Inflammation and Immune Response: Chronic stress can contribute to chronic low-grade inflammation in the body. Inflammation is believed to play a role in the pathophysiology of sleep apnea by promoting airway inflammation and compromising the integrity of the upper airway muscles, thereby increasing the risk of airway collapse.

Clinical Implications and Management Strategies:

  1. Screening and Assessment: Given the potential interplay between stress and sleep apnea, healthcare professionals should consider both factors when evaluating patients. Comprehensive assessments should consider anatomical factors, the patient’s stress levels, and psychological well-being. Different treatment options should be considered, and a sleep specialist may be consulted in severe cases.
  2. Stress Management: Incorporating stress management techniques into treating sleep apnea could be beneficial. Techniques such as cognitive-behavioral therapy, mindfulness, and relaxation exercises may help reduce stress levels and improve sleep quality. Patients should be questioned about symptoms of anxiety, panic disorder, and other psychological symptoms. 
  3. Collaborative Approach: A holistic approach that involves collaboration between sleep specialists, psychologists, and other healthcare professionals can provide a more comprehensive treatment strategy for individuals with sleep apnea and elevated stress levels. Weight loss strategies and lifestyle changes, including substance abuse treatment, should be explored.  

The intricate relationship between stress and sleep apnea underscores the need for a multidimensional approach to understanding and managing these conditions. While sleep apnea’s primary cause is often attributed to anatomical factors, it is becoming increasingly evident that chronic stress can also contribute to its development and exacerbation. The bi-directional nature of this relationship highlights the importance of addressing both anxiety and sleep apnea in clinical practice. Untreated sleep apnea can lead to multiple health issues. Those who think they may suffer from sleep apnea should consult their healthcare provider. Future research is warranted to elucidate the underlying mechanisms further and develop more effective integrated interventions that consider the complex interplay between stress and sleep apnea. Ultimately, a comprehensive approach that recognizes the synergistic impact of stress and sleep apnea on health outcomes can lead to improved patient care and overall well-being.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Mouth pain while sleeping due to teeth grinding

Home Remedies for Teeth Grinding

Mouth pain while sleeping due to teeth grinding

Have you ever wondered what the cause of bruxism or teeth grinding is? 

Why is it important to pay attention to bruxism? 

What can happen if you don’t take the appropriate steps to keep your teeth strong and healthy? 

The following are some common reasons a person may be experiencing sleep bruxism and awake bruxism.

  • Stress and anxiety
  • Caffeine Intake
  • Smoking 
  • Heavy Alcohol Consumption
  • Obstructive Sleep Apnea
  • Depression 

Depending on your daily habits, making lifestyle changes can not only improve your everyday life by reducing psychological stress, but can also improve your overall health and reduce bruxism. 

At first glance, these changes may seem unrelated, but stress manifests in different ways. Consuming alcohol, caffeine, and nicotine can take a toll on our bodies in many ways. Sleep disorders, if left untreated, can cause many issues as well. 

Girl at Dentist

Oral Hygiene is Critical

Let’s explore what can happen if you ignore your oral health. There are several dental problems associated with bruxism that result in long-term damage:

  • Painful teeth
  • worn tooth enamel
  • flattened biting surfaces
  • damaged fillings and crowns
  • Chipped or cracked teeth

Other possible side effects have to do with muscle tension. This would include facial pain, sore jaw muscles, ear pain, and neck pain.

Headaches and fatigue are also associated with bruxism.

Other Contributing Factors Leading to Bruxism

In addition to the lifestyle choices that can lead to bruxism, other factors can lead to teeth grinding.

As mentioned previously, a person’s stress level is a primary factor; how much stress you internalize within your given personality type can increase your risk.

If you have a competitive or hyperactive personality, this can increase your chances of bruxism during sleep as well as during the day.

It’s also important to consider how medications may affect you.

Though it may be an uncommon side effect, some psychiatric medications and certain antidepressants can cause bruxism.

Bruxism can also be a trait that is passed down through families.

Lastly, other medical conditions are associated with bruxism, such as Parkinson’s disease, dementia, sleep apnea, and attention-deficit hyperactivity disorder.

Natural Remedies for Bruxism

There are severe cases requiring conventional treatments from a healthcare provider, but the good news is that several natural remedies can be effective in preventing further damage, assisting with stress management, and improving sleep quality. 

One such treatment is to wear a night guard. Often you can wear the night guard on the lower teeth only. In addition, you can get custom-made mouthguards from your local dentist. This will prevent further damage to your teeth during the night.

Additional home remedies to add to your daily routine include placing a warm compress on your jaw, such as a heating pad or a hot towel, to help relax the muscles. 

There are also relaxation techniques, such as opening your mouth as wide as you can and touching your tongue to your front teeth, which will help to relax your jaw. 

Massage therapy is still another way to lessen sore muscles. When massaging facial muscles, it helps to use essential oils.

Meditating, yoga, and deep breathing are alternative therapies that also reduce stress.

A healthy plate of food

Eat Healthy Whole Foods

Lastly, good nutrition is essential. Drinking herbal tea to help relax your mind and body will allow you to get better sleep.

Turmeric milk is always a good option. Turmeric has anti-inflammatory properties, reducing the pain from your sore muscles.

Vitamin C benefits the adrenal glands. It can be found in many fruits and vegetables, such as citrus fruits, peppers, papaya, guava, strawberries, and many more.

You can also opt for supplements. Vitamin B-rich foods such as potatoes, vegetables in the cabbage family, fish, chicken, and seafood decrease psychological stress and help fight depression.

Magnesium-rich foods like boiled spinach, black-eyed peas, avocados, bananas, yogurt, fish, dark chocolate, and flaxseed aid in relaxation and help regulate mood.

Whatever remedy you choose, the first step is taking time for yourself and being mindful of how you are helping your body to be healthy and resilient.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

man with trigeminal neuralgia pain

Home Remedies for Trigeminal Neuralgia

man with trigeminal neuralgia pain

Do you suffer from trigeminal neuralgia (TN)?


Are you looking for a home remedy to help with the symptoms?


Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerves in the face. These nerves, also called the 5th cranial nerves, are composed of three branches. The three branches V1(ophthalmic), V2(maxillary), and V3(mandibular) are responsible for transmitting nerve impulses from the face to the brain. They also assist with motor functions such as chewing. Trigeminal neuralgia, also known as Fothergill’s disease, usually occurs in those fifty years of age and older and is more common in females.

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

lady with ice pack on side of face

Trigeminal Neuralgia Symptoms

  • Electric shock-like feeling on one side of the face.
  • Pain may be caused by applying makeup, brushing teeth, chewing, or touching the face.
  • Painful attacks may become more frequent and worsen over time.
  • Pain attacks may last from seconds to a few minutes.
  • Pain that doesn’t respond to traditional pain medication.
  • Light sensitivity.
  • Spontaneous facial pain.
dentist working on patients mouth

Causes of Trigeminal Neuralgia

We are not certain as to what causes trigeminal neuralgia. We think it is the result of trigeminal nerve compression. Blood vessels can press against the nerve and if the nerve is damaged, pain may occur. Other possible causes are:

  • Facial trauma.
  • dental procedures.
  • Tumors or cysts.
  • Malformed blood vessels.
Blue medication capsules

Trigeminal Neuralgia Treatment

Medications: Traditional painkillers such as acetaminophen and ibuprofen are generally ineffective against trigeminal neuralgia. Prescription medications are often utilized, specifically anticonvulsants. These include:

Carbamazepine (Tegretol)

Phenytoin (Dilantin)

Gabapentin (Neurontin)

Topiramate (Topamax)

Side Effects of Anticonvulsants: The main side effects of these types of medications are drowsiness, dizziness, nausea, and fatigue. Please consult your physician or pharmacist for more specific information.

Surgical Treatment: There are several surgical options available to treat trigeminal neuralgia.

Microvascular Decompression Surgery (MVD): This procedure works by inserting a cushion between the vessel and part of the trigeminal nerve. An incision is made behind the ear and a small portion of the skull is removed. This procedure helps approximately 80% of sufferers and is thought to be the longest-acting treatment. Risks of MVD include:

  • Hearing loss
  • Facial numbness
  • Bleeding
  • Infection
  • Paralysis
  • Leaking of CSP

Rhizotomy: This is an outpatient procedure and is also effective in about 80% of patients. The patient is placed under general anesthesia and a hollow needle is placed through the cheek. The affected nerves are treated with heat (electrical current) or chemicals (glycerin or glycerol). This procedure takes about 30 minutes and pain relief is immediate.

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Prevention:  If you know things that cause trigeminal neuralgia flare-ups, avoid them. Examples include windy weather, spicy foods, and rubbing certain areas of the face. Keep a food diary to determine if particular foods can cause pain. Some common culprits are bananas, caffeine, and citrus fruits. Hot and cold liquids can also cause flare-ups. If this happens, using a straw might help.

Medical History and Neurological Exam:  One of the best ways to help trigeminal neuralgia pain is to remove the underlying cause. To discover the source of the electric shock-like pain, a medical history should be obtained. Other disease processes such as diabetes can lead to nerve pain and make the symptoms of trigeminal neuralgia worse. A complete neurological exam can help to differentiate trigeminal neuralgia from other types of neuropathic pain conditions. 

Electrical Stimulation: Transcutaneous Electrical Nerve Stimulation (TENS) and Transcranial Magnetic Stimulation (rTMS) are treatment options that use electrical current to block pain signals transmitted by damaged nerves. These options are non-invasive, well-tolerated, and can be a good option for trigeminal pain management.

Topical Pain Relievers:  Topical agents have the advantage of working locally. This typically leads to fewer side effects. There are several creams, ointments, patches, and rubs that can be used to treat painful episodes. In the hospital where I practice, we use lidocaine ointment and patches, Diclofenac gel, and menthol creams for pain relief.

Nutritional Supplements: Several natural products can help relieve nerve pain. When selecting a pain management strategy, side effects are important. I believe natural supplements should be tried before prescription medications because the side effects of anticonvulsants are usually more severe and can negatively affect the quality of life.

Turmeric: Turmeric contains curcumin which has been shown to help with pain and inflammation. This includes nerve pain. Curcumin may promote the regeneration of nerves after nerve injuries. Curcumin has also been shown to inhibit nerve pain transmission.1

Another study showed that curcumin can promote nerve regeneration after nerve fibers are damaged.2

pharmacist Michael

Trigeminal neuralgia is a painful condition that can interfere with daily activities and diminish the quality of life. The intense pain of trigeminal neuralgia can be treated with anticonvulsant medication, topical pain relievers, and turmeric. There are also outpatient and inpatient surgical procedures available. Electrical stimulation is a less intrusive option and may also be effective. Always remember to consider natural remedies such as acupuncture as well. 


I believe it is always prudent to try natural remedies and nutritional supplements before prescription medications and surgical procedures whenever possible. The side effects of medications and the surgical risks can be extensive. 


If you think you may be suffering from trigeminal neuralgia, it is a good idea to visit a neurologist. Review your treatment options and pick the one that best fits your situation. If you have any questions about this topic or any other health and wellness issue, please feel free to contact me using the author box below. I am always willing to help.


Thank you for reading this blog post and enjoy a happy, healthy life.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


9 Useful Tools For Anxiety Relief

We have all experienced anxiety during our lives.  Most of us are able to cope with stress and anxiety but it can become problematic and may even cause other more serious medical issues.  In this post, I am going to give you 9 ways to obtain anxiety relief without drugs.  Most of these techniques can be learned quickly and some you may already know.

1. Take A Walk

One of the quickest and easiest ways to reduce stress and anxiety is to remove yourself from the current situation.  I like to take a quick walk outside when possible.  Just breathing fresh air can really help.  Take some time to appreciate nature.  Pick up a leaf and notice how remarkable nature can be.  Walk to a river or stream and just watch and listen to the running water.  Taking a walk not only helps with anxiety but can also improve blood flow to your brain and help you think more clearly.

2. Exercise

Exercise is one of the best weapons against stress and anxiety.  It is so important that it is one of my five pillars of health.  We all know the many benefits of exercise.  If you find yourself experiencing stress and anxiety, make time for physical activity.  It is important that you pick a form of exercise you enjoy.  If you don’t like the activity, you probably won’t stick to it.  I recommend setting aside at least 30 minutes a day, five days a week for exercise.

3. Be Sure to Get Plenty of Sleep

Sleep is also one of my five pillars of health.  I have found that if I don’t get enough sleep, I become more easily stressed and my anxiety level increases.  Most of us need at least seven to eight hours of sleep per night.  This will vary depending on the individual.  When we are under stress, our bodies need more sleep.  Be sure to practice good sleep hygiene as well.

4. Watch What You Eat

5. Avoid or Limit Alcohol

Drinking  alcohol can make anxiety and stress much worse.  It can decrease sleep quality and using it to relax can backfire.  Click here for a more in depth discussion on why you should avoid drinking alcohol.

6. Just Breathe

The quickest and easiest way to reduce anxiety is to concentrate on your breathing.  I like to use square breathing.  Breathe in for 3 seconds, hold your breath for 3 seconds, breath out for 3 seconds, hold your breath for 3 seconds, and repeat as many times as necessary.  This takes your mind away from whatever it is that is causing the stress. 

7. Stay Positive

I believe positivity can improve almost anything.  Always remember that things can always be worse.  Think of what you are grateful for and consider keeping a gratitude journal.  Writing these things down can improve happiness and reduce anxiety. 

8. Be Careful With Caffeine

Coffee and caffeinated beverages can keep you alert, but too much caffeine may make stress and anxiety worse.  Know your limits.  Be sure to stop drinking caffeine several hours before going to sleep.  

9. Consider Natural Supplements

Our Anxiety Formula is specifically designed to help reduce the symptoms caused by stress and anxiety.  Order yours today by clicking on this link.

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Three Specific Types of Eating Disorders, Signs, Symptoms, Risk Factors, and Treatment

Do you or someone you know have an eating disorder?

What are the most common types of eating disorders?

What are the treatments available for eating disorders?


This post will concentrate on the three most prominent eating disorders.  These include

  • Anorexia nervosa (AN)
  • Bulimia nervosa (BN)
  • Binge eating disorder (BED


We will explore these disorders one at a time.  The most important thing to remember is that getting professional help is crucial if you suffer from any of these conditions.  All of these disorders can progress to death if not treated.

Anorexia Nervosa (AN)

Anorexia is probably the most well-known eating disorder.  Although estimates vary based on the study, it is estimated that the lifetime prevalence rate of AN is 0.8%.1



It is important to note that eating disorders are often underreported in the literature because many with these conditions do not seek treatment.

Patients with anorexia have significantly low body weight in relation to age, sex, and physical health.  These individuals have an intense fear of gaining weight and becoming fat.  They also underestimate the seriousness of their low body weight and have a distorted view of their body shape.  There are two types of anorexia.

  • Restricting type – The patient has not regularly engaged in binge eating or purging in the last three months.
  • Binge eating/purging type – The patient has regularly engaged in binge eating or purging in the last three months.

Signs and Symptoms of Anorexia

The signs and symptoms of anorexia can be split into three specific categories, as follows:3

Psychiatric symptoms:

  • Preoccupation with food, cooking, and nutrition
  • Fear of weight gain
  • Restlessness
  • Social isolation and withdrawal
  • Ritualistic behaviors
  • Irritability

Many of these patients also suffer from other psychiatric disorders such as depression, anxiety, or obsessive-compulsive disorder.

Eating Behaviors:

  • Water loading.
  • Vegan and vegetarian diet.
  • Skipping meals.
  • Calorie restriction.
  • Cutting food into small pieces.

Physical Signs:

  • Underweight, emaciated
  • Constipation, abdominal pain
  • Lethargy
  • Dry skin, brittle nails
  • Yellowish skin
  • Electrolyte imbalances
  • Hypoglycemia
  • Infertility, premature births
  • Bradycardia, hypotension, cardiac arrhythmias
  • Osteoporosis

Risk Factors for Developing Anorexia

Genetic factors – Some studies suggest genetics may be a factor in the development of anorexia.

  • Diabetes
  • Emotional Stress – There is a link between emotional stressors such as the death of a loved one or divorce of parents and the development of AN.
  • Parental pressure regarding achievement and appearance.
  • Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
  • Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
  • Age – Peak onset is early to mid-adolescence.
  • Gender – Lifetime prevalence in females is 0.9% and only 0.3% in females.4

Treatment of Anorexia Nervosa

Treating anorexia should be accomplished using a team approach.  Physicians, nurses, dietitians, therapists, and other health professionals with experience treating eating disorders should be employed. 

A dietician should provide nutritional rehabilitation to avoid refeeding syndrome.  This is done by slowly increasing the patient’s weight. 

The most effective treatment for anorexia in adolescents and young adults is family-based psychotherapy. 

The use of medications in the treatment of AN is controversial and should not be started until the patient has gained sufficient weight in most cases.   These may include:

  • Multivitamins
  • Agents for constipation, abdominal pain and bloating.
  • Calcium supplements for osteopenia.

Medications used to treat co-existing conditions such as depression, OCD, and anxiety may also be initiated when it is safe to do so. 

In severe cases, hospitalization may be necessary to correct dehydration, electrolyte imbalances, cardiac arrhythmias,  or severe malnutrition.

One final comment about AN.  Many people are unaware that this disorder has a high mortality rate.  In fact, a meta-review of all-cause and suicide mortality in mental disorders came to the following conclusion:

 Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa.5

Bulimia Nervosa (BN)

Bulemia Nervosa (BN) is an emotional disorder that involves an obsessive desire to lose weight.  BN is characterized by extreme overeating followed by depression and inappropriate compensatory behaviors to prevent weight gain, such as:

  • Excessive exercise.
  • Misuse of laxatives, diuretics, or enemas.
  • Self-induced vomiting or purging.

The severity of BN can be categorized according to the frequency of these inappropriate behaviors:

  • Mild – Average of 1-3 episodes weekly.
  • Moderate – Average of 4-7 episodes weekly.
  • Severe – Average of 8-13 episodes weekly.
  • Extreme – Average of more than 13 episodes weekly.

Signs and Symptoms of Bulimia

As with anorexia, the signs and symptoms of BN can be split into categories.

Psychiatric Symptoms:

  • Substance use disorders
  • Anxiety disorders
  • Impulsivity
  • Depression
  • Mood fluctuations


  • Preoccupation with food and eating
  • Laxative or diuretic abuse
  • Compulsive exercise
  • Poor self-image
  • Self-induced vomiting or purging

These patients often lose control over food intake.  They eat large quantities of high-calorie foods such as cake and ice cream, often attempting to combat dysphoric mood states.  Binging helps with anxiety and dysphoria in the short term but makes them feel guilty.  Patients with BN often conceal their binging, plan it, and eat until they are uncomfortable.

Physical Signs:

  • Normal to slightly overweight
  • Loss of tooth enamel from purging
  • Increase in dental cavities
  • Lethargy
  • Electrolyte imbalances
  • Amenorrhea
  • Hypotension, bradycardia, prolonged QTc interval
  • Osteopenia, osteoporosis

Risk Factors for Developing Bulimia

  • There is a strong genetic predisposition, according to studies.
  • Physical and sexual abuse victims are more prone to BN.
  • Emotional stress.
  • Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
  • Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
  • Those who are impulsive.
  • Those who have inadequate stress coping skills.
  • Gender: Incidence is reported to be 2.6% in females and 0.5% in males.

The peak age of onset for bulimia is 16-20 years. 

The mortality rate is about 1%. 

Early detection is a critical factor in recovery. 

Treatment of Bulimia Nervosa

As with anorexia, the treatment of bulimia should involve a multidisciplinary team of professionals. 

Psychotherapy has the best efficacy for this disorder.  This process can take 4 to 5 months to complete.

SSRI’s such as fluoxetine are also used to reduce binge-purge episodes. 

Dietitians can be instrumental in creating nutritional plans for these patients as adequate meals can decrease food craving.

Some organizations can help get bulimia patients the help they need.  Two great options are:


Overeaters Anonymous:  www.oa.org

Bulimia.com to help locate support groups: www.bulimia.com

Binge Eating Disorder (BED)

Binge eating disorder (BED) is a condition in which the patient eats a more considerable amount of food than most people would in a similar time period.  Unlike bulimia, these individuals do not regularly employ compensatory measures such as purging to counter the binge eating.  They often eat rapidly until they are uncomfortable.  Binge eaters often eat even when they are not hungry and eat alone due to embarrassment.  They often feel depressed or guilty after eating.

To be diagnosed with BED, binge eating must occur at least once per week for at least three months. 


The severity of BED can be classified as follows:

Mild – Average of 1-3 episodes weekly.

Moderate – Average of 4-7 episodes weekly.

Severe – Average of 8-13 episodes weekly.

Extreme – 14 or more episodes per week.

Signs and Symptoms of Binge Eating Disorder

The signs and symptoms of BED are as follows:

  • Slightly overweight to obese.
  • High level of emotional stress.
  • High incidence of GERD.
  • Presence of stretch marks due to weight changes.
  • Gallbladder disease.
  • Poor impulse control.
  • Feelings of guilt.
  • Comorbid anxiety or depressive disorders.
  • Cardiovascular disease.
  • Hyperlipidemia
  • Hyperglycemia – prone to diabetes.

Risk Factors for Developing Binge Eating Disorder

There seems to be a genetic component with BED.  Family and twin studies have shown a 57% heritability. 

Females have a higher incidence (3%) than males (2%). 

The age of onset peaks at 18-20 years of age, but this disorder may occur later in life. 

Many of these patients have a history of “yo-yo” dieting.  They have large fluctuations in body weight over time. 

There is a strong correlation between binge eating and obesity.  About 50% of obese individuals report binge eating as one of their problems.

Treatment of Binge Eating Disorder

As with the above eating disorders, a multidisciplinary team of professionals should be employed in the treatment of BED.  Psychotherapy has the most significant effect on BED, but drugs may be added.  Some examples of adjunctive medications include:

  • Lisdexamphetamine is the only medication FDA approved for BED. It has been shown to decrease binge eating days, binge eating cessation, and global improvement compared to placebo.6
  • Topiramte
  • Zonisamide
  • SSRI’s (fluoxetine, sertraline, citalopram, fluvoxamine, escitalopram)
  • Orlistat
  • Bupropion/naltrexone

Eating disorders can cause endless problems for patients who suffer from them and the families involved.  Our society has caused our young citizens to believe that they need to look a certain way to be popular or successful. Social media has amplified this lie!  The truth is, we all have a special gift to give, and it has very little to do with our weight or body shape.   

I urge every person reading this to begin to love yourself as you are.  Determine your “gift” and take steps to develop it to share this gift with those who will benefit.

Our body shape is something that we are born with.  We can’t all have the body type of the stars.  The best thing you can do for yourself is:

  • Eat whole, healthy foods.
  • Drink plenty of water.
  • Exercise 5 days per week for at least 30 minutes.
  • Get enough sleep.

If you think you may have an eating disorder, GET HELP!

There are many sources of help available.  Here is one example:


I hope you have learned something from this post.  Remember, eating disorders are serious and can be deadly if not treated.

Have a great week, and stay safe out there.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Acupuncture for Back Pain

Acupuncture is a significant element of Chinese medicine.  It has been traditionally used to treat pain and has also been used for stress management and wellness.  Acupuncture is used to balance the flow of energy known as chi or qi (chee).  This energy may flow through meridians that are pathways in the body.  It is believed that this energy can be re-balanced by inserting very thin needles through the skin at specific points along these meridians.

Although acupuncture can be used for many types of pain and other conditions, this post will concentrate on its use for lower back pain. 

Lower Back Pain (LBP)

Lower back pain (LBP) affects as many as 70% of adults in industrialized countries during some point in their life.1

 This causes an economic burden on both society and individuals.  It is estimated that at least $100 billion is spent due to lower back pain yearly.2



There are many treatments for LBP, but no single remedy appears to be superior.4

For this reason, many LBP sufferers turn to alternative treatments, including acupuncture, to relieve pain and discomfort.5

Is acupuncture effective for LBP?  An overview of systemic reviews looked at this question in 2015.6

A total of 16 studies were included in this review.  These studies were of variable quality. The researchers came to the following conclusions:

  • For acute LBP, acupuncture does not appear to be more effective than sham acupuncture in improving function, and inconsistent evidence that acupuncture is more effective at relieving pain than sham acupuncture.
  • For chronic LBP, there is consistent evidence that acupuncture provides short-term clinical benefits on pain relief and functional improvement compared to no treatment or when added to prevailing interventions.
  • It appears that acupuncture causes significant pain relief but no impact on the functional limitation on chronic LBP when compared to sham acupuncture.

To summarize this overview of the systemic reviews available, acupuncture can provide short-term clinically relevant improvement in pain and functionality in treating lower back pain when combined with conventional therapy.

Low Back Pain in Pregnant Women

Many studies have examined back pain in pregnant women.  Rates of LBP in these women range from 25% TO 90%, with most studies estimating that 50% of pregnant women will experience it.7

One-third of these women will suffer from severe pain.  This decreases their quality of life.  Eighty percent of women suffering from LBP say it affects their daily routine, and 10% cannot work.8

 The most common risk factors associated with lower back pain in women include a history of pelvic trauma, chronic LBP, and lower back pain during a previous pregnancy.9

 Regular exercise prior to pregnancy may reduce the chances of developing LBP during pregnancy.

A study published in 2018 examined the effectiveness of acupuncture in the treatment of back pain in pregnancy.  Fifty-six pregnant women at a gestational age between 14 and 37 weeks who complained of lower back pain were included in the study.  The subjects received up to six sessions.  This study found a statistically significant reduction in lower back pain as early as the second acupuncture treatment.  Improvement gradually improved with the number of sessions completed.  No serious adverse effects related to the acupuncture were reported.10

Side Effects of Acupuncture

Acupuncture, like other treatments, can cause side effects.  The most common adverse effects include bleeding, soreness, or bruising at the site of needle insertion. Other, less common risks include:

  • Dizziness
  • Fainting
  • Internal bleeding
  • Convulsions
  • Hepatitis B
  • Dermatitis
  • Nerve damage


With the use of disposable needles, hepatitis B, and other infections are rare.  It is important to note that the side effects of acupuncture are uncommon.  Most people will tolerate acupuncture sessions with no adverse effects.

Acupuncture can be used for a variety of conditions, including:

  • Chemotherapy-induced and postoperative nausea and vomiting.
  • Dental pain.
  • Tension headaches and migraines.
  • Labor pain.
  • Lower back pain.
  • Neck pain.
  • Menstrual cramps.


This treatment is a popular alternative to traditional medications.  Acupuncture can be an effective treatment for lower back pain in pregnant individuals and others who suffer from LBP. This treatment seems to work best for short term relief of back pain when combined with traditional therapy.  As with most alternative therapies, more research is needed to determine best practices when utilizing acupuncture for back pain.


I have recently met a local acupuncturist and plan to get treatment in the next couple of weeks.  I will let you all know how that goes.  Luckily, the Protandim Tri-Synergizer product has eliminated my back pain.  I am always searching for other treatments to help me live a healthier, happier life.


If you have any questions or comments, please feel free to reach out to me.  Have a great week, and stay safe!  


I decided to try acupuncture for myself on October 29th.  This was simply a wonderful experience.  My goal was to improve circulation in my hands and feet.  I don’t do well with cold weather and in Oregon, the cold season is here.  

After a few minutes of standard medical questions, my time had come.  I laid on the warmest, most comfortable bed you can imagine.  It was beyond relaxing.

Hannah was awesome.  I could barely feel the needles, and she was very friendly.  She enjoys answering questions and it was clear she enjoyed her profession.  I told her I wished I had tried this earlier in my life.  It really improved my mood for the rest of the day.

The atmosphere, conversation, and warmth were amazing.  If you haven’t tried acupuncture, I strongly recommend it!  I will be going back for more sessions.

Take a look at the ad below.  If you need any of these services and live in the Portland area, this is a great place to visit.  These professionals are friendly and truly love helping people become healthy.



Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Ketamine Infusion Therapy for Depression and Suicidal Ideation

Can ketamine infusion therapy work for depression?


What are the advantages?

Ketamine is a medication that has been traditionally used to induce and maintain anesthesia. This drug is often used off-label for conditions such as pain relief, conscious sedation, and depression.

Ketamine has addictive properties and is a popular drug of abuse. The drug is available as white powder, liquid, and tablets and is known as “K”, “Vitamin K”, and “Special K” on the street. Ketamine can cause hallucinations, out-of-body experiences and temporary paralysis. The user may be awake but unable to move or even talk. These effects have led to ketamine being referred to as a “date rape drug.”

In March 2020, SpavatoTM (Esketamine) nasal spray was approved for adults with treatment-resistant depression. This is an important milestone in paving the way for this drug to be used more commonly in depressed and suicidal patients who have tried other treatments without benefit.

Ketamine is not just another antidepressant. It begins to work right away. Other treatments for depression take weeks to work. 

The popular selective serotonin reuptake inhibitors (SSRI’s) must be slowly titrated to the effective dose due to side effects. We must be sure the patient can tolerate the drug and wait weeks to determine effectiveness. 

The same is true for other antidepressants currently available.

This post will describe the use of ketamine infusion therapy for the treatment of depression.  


Suicide rates have increased over the past two decades and are one of the top three causes of mortality worldwide for those between the ages of 15-44.1 

This has occurred despite efforts to reduce suicide.2

We know that approximately 90% of those who commit suicide suffer from a treatable mood disorder.3

Our current treatment options for those with suicidal ideation consist mostly of hospitalization, psychotherapy, and pharmacotherapy.  

Although dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), and treatment with clozapine and lithium have been shown to decrease suicide deaths,4




as well as attempts,7


They take time to work and have not shown effectiveness acutely. This leads us to a search for an antidepressant that can take effect quickly. 


Is ketamine a solution? 

Ketamine for Suicidal Ideation and Mood Disorders

There have been studies showing that ketamine infusions are effective in treating suicidal ideation and depression in the acute setting. A meta-analysis published in the American Journal of Psychiatry in February 2018 came to the following conclusions:9

  • Ketamine significantly reduced suicidal ideation. This occurred within one day and continued for one week after the treatment.
  • The change in the severity of depressive symptoms was strongly correlated with the decrease in suicidal ideation.
  • Ketamine’s effect on suicidality is only partially due to its antidepressant effects.
  • 54.9% of patients had no suicidal ideation 24 hours after a single ketamine infusion, and 60% remained free of suicidal thoughts one week after the infusion.

Are you thinking of Getting a Ketamine Infusion?

If you are considering utilizing ketamine infusions to treat depression or suicidal thoughts, here is what to expect:

  1. You may receive the infusions as an outpatient or inpatient. Several facilities offer ketamine infusions as an outpatient procedure.
  2. You may be asked to fill out a questionnaire to determine your depression level before the procedure.
  3. You will need to arrange for transportation as you will be unable to drive after the infusion.
  4. The following conditions may exclude you from receiving the ketamine infusion:
    • History of schizophrenia, bipolar disorder, or schizoaffective disorder.
    • Dementia.
    • Delirium within the last seven days.
    • Uncontrolled hypertension.
    • Pregnancy.
    • Certain heart conditions.
    • Positive urine drug screen showing substances of abuse or a previous history of substance abuse.
    • An allergy or previous adverse reaction to ketamine.

It is important to note that various facilities will have different protocols. Check with your facility of choice to get their specific guidelines. Here is a few typical guidelines used:

  1. The ketamine infusion will likely last about 40 minutes.  
  2. Vital signs (heart rate, blood pressure, oxygen blood levels, etc) will be monitored during the infusion.
  3. As with any medication, you may experience side effects. Some of these include:
    • Confusion
    • Delirium
    • Dream-like state
    • Excitement
    • Hallucinations
    • Irrational behavior
    • Vivid Imagery
    • Change in heart rate
    • Change in blood pressure
    • Seizure-like movements
    • Rash
    • Nausea and vomiting
    • Double vision
    • Others

Ketamine infusions will normally be given on a pre-determined schedule. A typical schedule may be:

  1. Twice a week for 2-3 weeks (not less than three days apart)
  2. After 2-3 weeks, the infusions should be weekly to every three weeks with a goal to extend the infusions to an interval if possible. This will vary based on patient response.
  3. Ketamine infusions should be tapered when discontinued.
  4. Ketamine infusions range from $400-$800 per infusion, and there may also be an initial consultation fee. These prices are for outpatient procedures. It is important to note that most health insurance plans do not cover these infusions. Inpatient treatment can cost substantially more.

I am a huge proponent of using ketamine infusions for treatment-resistant depression. I have spent many years caring for psychiatric patients, and some do not respond to conventional therapies.  


Depression is a devastating mood disorder that can rob an individual of a fulfilling life. It can ruin careers, relationships, and even result in death.


If you have any thoughts of ending your life or are depressed, GET HELP. Call someone! There are many resources available to help you. You can get better. We can help! 


The Suicide Hotline can be reached at:




With the recent approval of SpavatoTM, my hope is that some of the stigma associated with ketamine will dissipate. Many drugs we use every day have the potential of being abused. The fact is ketamine can help some of our most vulnerable people.


As a society, we have the responsibility to care for our sick individuals. This includes those with mental disorders. Anyone can become depressed!  I pray that we will embrace the potential of ketamine infusions. After other treatments have failed, those who need ketamine should have access to it. 

Insurance companies should pay for it!


It is more costly to hospitalize someone for weeks while our traditional treatments take effect. One of ketamine’s most important benefits is that it begins to work right away. This can be the difference between life and death!

Ketamine is a subject I have wanted to write about for some time. We are unable to use ketamine infusions in our facility due to a perceived danger.  It is possible to refer those patients who might benefit from ketamine to an alternative facility. I plan to continue to lobby for its use within our facility. I believe we owe it to our patients.

If you have any questions about ketamine or any other medication, health issue, or nutraceutical, please contact me.

I am happy to help whenever I can.  That is why I started Sunshine Nutraceuticals in the first place.

Have a great week, everyone, and stay safe!!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

N-Acetylcysteine for Anxiety, Depression and other Psychiatric conditions

N-acetylcysteine (NAC) is an over-the-counter supplement that may be used for several conditions. This molecule is a derivative of cysteine, which is an amino acid. In the hospital setting, it is used by the intravenous route for the treatment of acetaminophen overdose.1

NAC is also used in chronic obstructive pulmonary disease to break up mucous. It may also be beneficial in the prevention of contrast-induced nephropathy.2

During the last several years, there has been an interest in using acetylcysteine for other ailments. 

This post will focus on the use of NAC for depression, anxiety, bipolar disorder, schizophrenia  and the treatment of addiction.


Acetylcysteine has been studied for its ability to treat several types of addiction. A study conducted on 116 cannabis dependent adolescents and young adults found that those treated with 2.4 grams per day of NAC had a significantly higher incidence of negative urine cannabinoid tests as compared to the placebo group.3

This was a double-blind, randomized controlled trial lasting eight weeks. The NAC group also showed a more considerable decrease in self-reported days of cannabis use than the placebo group, but this was not statistically significant. 

There is a possibility that NAC could increase cannabinoid elimination. This would increase the probability of the NAC group having a negative urine test. 

More studies are needed to investigate the effects of NAC of cannabinoid metabolism.

Several controlled studies have shown NAC to be beneficial for treating cocaine addiction. The most extensive study showed positive effects only in a small subset of subjects that were abstinent at the beginning of the trial.

The studies for using NAC in other types of addiction, including gambling, were inconclusive.


The treatments currently available for anxiety disorder have limited effectiveness. Several studies suggest oxidative stress has a role in the development of anxiety. These findings have led to studies on the use of antioxidants in the treatment of anxiety.4



There has been a case study of a 17-year-old male with generalized anxiety disorder and social phobia who had failed cognitive behavioral therapy and several antidepressants but responded well to NAC. 

Unfortunately, more studies are needed before NAC can be recommended as a treatment for anxiety.

Bipolar Disorder

Bipolar disorder is a mood disorder characterized by periods of depression alternating with periods of mania.

Symptoms of depression include:

  • Feeling sad or hopeless.
  • Loss of interest in pleasurable activities.
  • Sleep disturbances – too much or too little sleep.
  • Inappropriate guilt.
  • Unexplained weight changes.
  • Isolation.
  • Loss of energy or fatigue.
  • Restlessness or lethargy.

Manic symptoms are as follows:

  • Racing thoughts.
  • Distractibility.
  • Euphoria and increased self-confidence.
  • Increased activity and agitation.
  • Participation in risky behaviors.
  • Poor decision making.
  • Unusual talkativeness.

Bipolar disorder can be severe and may also present with psychotic features. Acetylcysteine has been shown to improve depressive symptoms in patients with bipolar disorder significantly.6

Unfortunately, this study was not able to show any significant difference in the frequency of new episodes of either depression or mania in the NAC group compared to the placebo group. More research is necessary to determine the role NAC may have in the treatment of bipolar disorder.


A randomized-controlled trial of 252 patients with major depressive disorder (MDD) showed NAC improved symptoms more effectively than placebo when added to the patient’s usual treatment regimen for a twelve-week period.7

There is also a case series of two patients who showed successful and sustained improvement of depressive symptoms when NAC was added to their antidepressant regimen.8

Other studies of NAC in the treatment of other disorders have found an improvement in mood and well-being.9

The current evidence suggests NAC may be a valuable treatment option either alone, or in combination with other agents for the treatment of mood disorders.




There have been positive results obtained when utilizing acetylcysteine for the treatment of schizophrenia.

One such study showed patients receiving NAC improved with regards to schizophrenia symptoms and akathesia.10

Other studies have also supported the use of NAC as a viable addition to schizophrenia treatment regimens.11


Although these results are promising, more studies with larger sample sizes are necessary to determine the true utility of NAC in the treatment of schizophrenia.

Mechanism of Action

The proposed mechanisms of action of NAC are too complicated for the scope of this post. This substance is thought to work as an antioxidant and anti-inflammatory. It is also thought to affect several neurotransmitters and mitochondrial function within cells.  


Adverse Effects of Acetylcysteine

Acetylcysteine is generally well-tolerated. UpToDateTM lists the following adverse reactions to oral acetylcysteine:

  • Chest tightness
  • Hypotension
  • Rash (with or without fever)
  • Urticarial
  • Nausea and Vomiting
  • Hypersensitivity reaction
  • Bronchospasm
  • Bronchitis

Less than 1%, post-marketing and/or case reports (important or life-threatening only):

  • Angioedema
  • Pruritis
  • Tachycardia


Pregnancy and Breast-Feeding

Since acetylcysteine crosses the placenta, it should only be used in pregnancy when the benefits outweigh the risk. This may occur in the case of acetaminophen overdose. 

It is not known whether NAC is excreted into breast milk.  Based on pharmacokinetic data, acetylcysteine should be cleared from the body thirty hours after administration. 

If NAC is consumed while breast feeding, breast milk should be pumped and discarded for thirty hours after ingestion.

NAC should not be used in pregnant women for depression, anxiety, bipolar disorder or the treatment of addiction.

Drug Interactions

There are no known drug interactions.

I became interested in N-Acetylcysteine after speaking to a child psychiatrist at the hospital where I practice. She had ordered it for one of her patients, and I was curious as to her reasoning for its use. She believed in NAC’s ability to improve several psychiatric symptoms in children with minimal risk. She sent me an article which detailed much of what I have covered in this post.

NAC has also been studied for use in Alzheimer’s disease, ADHD, autism, epilepsy, neuropathy, traumatic brain injury (TBI), and several impulse control disorders. It is essential to mention that more studies need to be done in all of these conditions before a recommendation can be made to use NAC.

  I do believe it is worth trying NAC in patients who present with the disease states covered in this post. There is minimal risk, and the benefits could be significant. This is especially true in conditions such as anxiety disorder, where our treatment options are scarce and often ineffective.

Please feel free to contact me if you have any questions regarding acetylcysteine or any other medication or supplement. I would be happy to get an answer for you ASAP.

As always, have a great week, stay healthy, and stay safe!



Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Turmeric, Diet, and Boswellia for Arthritis

I decided to write a post on arthritis because this is a condition I live with every day. Some days are better than others. I have done plenty of research on arthritis with the hope of improving my quality of life and I will share with you what I have learned about medications, foods, and natural supplements. I hope you never have to deal with this on a personal level but if you do, perhaps what I have learned over the last few years will help relieve some of your pain.  

              This figure represents alterations that occur in the joints during the onset of Oseteoarthritis1

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.


Osteoarthritis (OA) is the most common joint disorder in the United States.2


It is also known as degenerative joint disease or “wear and tear” arthritis. This most often occurs in the joints of the hands, knees and hips. Osteoarthritis affects 32.5 million adults in the United States.3


OA is characterized by joint stiffness, swelling, pain and loss of mobility resulting from the breakdown of articular cartilage and synovial inflammation.


Here are a few facts about OA:


88% of OA patients are 45 or older and 43% are 65 or older. 62% are women and 78% are non-Hispanic Caucasians.4


OA patients experience more pain and have more activity limitations than other people in their age group. They are also more prone to fatigue and disability.5


One-third of those with arthritis over the age of 45 suffer from anxiety or depression. 

Approximately one million knee and hip replacement surgeries are completed each year due to OA.6


By 2040, approximately 11.4% of all adults will have some activity limitations as a result of arthritis.7


Risk Factors



Like most other ailments, osteoarthritis is initially treated by modifying risk factors. Losing weight, eating healthier foods and exercise are all excellent strategies. It may also help to optimize your workspace, especially if you sit for long periods of time. When these fail, medications may be necessary to relieve pain and inflammation. Most of the medications listed should only be used when symptoms are present since none of these agents have been shown to modify disease progression.


Topical NSAIDs – This class is the starting point, especially when few joints are affected. These work well in arthritis occurring in the hands and knees. They have similar efficacy to oral NSAIDs and have a better safety profile.9


The drug most utilized in this class is diclofenac gel (Voltarentm.) This medication is only available by prescription.


Oral NSAIDs – The next step is to utilize oral NSAIDs. Medications in this class include ibuprofen (Motrintm), naproxen (Alevetm), piroxicam (Feldenetm), and others. 

Caution must be exercised as these agents can cause GI bleeding, kidney disease and cardiovascular complications.  COX-2 inhibitors, such as celecoxib (Celebrextm) may also be used.


Duloxetine (Cymbaltatm) – This is an antidepressant medication known as an SNRI (serotonin-norepinephrine reuptake inhibitor.)  These drugs increase the amount of serotonin and norepinephrine available in the brain. My physiatrist (pain specialist) informed me that 90% of his patients responded to duloxetine. It works very well for both nociceptive and neuropathic pain.


Glucocorticoid (Steroid) intra-articular injections – Steroid injections are sometimes utilized for OA of the knee. These have a short duration of action (approximately four weeks) and may have adverse effects on the hyaline cartilage.10



Opiates – Due to the recent changes in opiate use guidelines, these drugs should generally not be used for arthritis. Opiates have many side effects, including increased risk of falls, sedation, nausea and dizziness. They are also habit-forming and may cause hyperalgesia leading to an increased sensitivity to pain. 

Effect of Vitamins and Diet

Arthritis is associated with inflammation, so foods known to decrease inflammation should help relieve pain due to this disease. My recommendation is to stick with the Mediterranean diet as much as possible. This diet has the most evidence to support various health-related benefits.  


Many of the foods that help with inflammation are part of the Mediterranean diet. Some examples of these include broccoli, tomatoes, whole grains, nuts, blueberries, avocados and many others. You can learn more about this diet by reading my post at the link below.

 Mediterranean vs Ornish Diet


Nightshades – Some people with arthritis believe eating plants from the nightshade family worsen arthritis pain. Nightshades contain solanine, which is a neurotoxin at high doses. Some examples of nightshade foods include white potatoes, eggplant, tomatoes and bell peppers. There is no scientific evidence to support the notion that eating plants from this family makes arthritis symptoms worse. If, however, you notice a negative change when eating these foods, you should avoid them. 

Natural Supplements

Turmeric – The only two nutritional supplements recommended by UpToDatetm at the current time are curcumin, the active ingredient in turmeric, and Boswellia serrata.  Curcumin has been used in Ayurvedic medicine for thousands of years for arthritis, respiratory infections, GI problems and even cancer treatment.   

A review of the efficacy of curcumin in the treatment of osteoarthritis was published in The Journal of Evidenced-Based Complementary & Alternative Medicine in 2017. The conclusion was that curcumin-containing products demonstrated statistically significant improvements in osteoarthritis compared to placebo in four out of five studies.11




Boswellia serrata – A randomized, double-blind placebo-controlled study of 30 patients with osteoarthritis was published in 2003. The investigators found a statistically significant improvement in knee pain, knee flexion and increased walking distance in patients receiving Boswellia extract compared with placebo. Swelling in the knee joints was also improved. There were no changes that could be seen on x-rays. The Boswellia extract was well tolerated, with the exception of minor GI symptoms. 15

Vitamin K2 – There is some evidence suggesting vitamin K may be important in preventing arthritis. A longitudinal study compared patients with vitamin K deficiency to those who had adequate levels. The vitamin K deficient group had a 56% higher risk of developing knee osteoarthritis than the control group. 16

Vitamin K2 supplementation may also reduce inflammation in rheumatoid arthritis by lowering CRP levels.17


Ashwagandha is frequently used to treat both osteoarthritis and rheumatoid arthritis in Ayurvedic medicine.  Several anti-inflammatory pathways may be affected by withanolides, the active ingredients in ashwagandha.18

Arthritis and the Weather

We have all known people who believe they can predict the weather based on their arthritis pain. Scientists have been searching for a link between the weather and arthritis pain for years. Unfortunately, no definitive results have been obtained.


Colder weather may cause people to be less active and this may lead to stiffer joints. Lower barometric pressure may cause the nerve endings in joints where cartilage is worn away due to arthritis to be more sensitive, resulting in increased pain.


Finally, these changes in barometric pressure could cause expansion and contraction of scar tissue, muscles, and tendons leading to increased pain in these areas. Even though there hasn’t been any scientific proof, my arthritis pain is worse during the winter months. As long as I don’t try to lift heavy items, or cause increased strain on my back, I have very little pain during the summer months.

Arthritis is a painful disease affecting millions of people in the United States alone. It is a common cause of disability and has been linked to anxiety and depression. This condition not only causes pain but can limit physical activity as well. I have experience with this disease myself. 


I suffered for years before finally visiting a pain specialist.  Presently, my pain is under control most of the time as I have learned several things over the years that have helped. I try to get up to walk around often, I sit in comfortable chairs, and when my pain flares up, I take a turmeric supplement. 


If the pain gets worse, I take naproxen but try to limit its use. I watch what I eat and have found that if I sleep too long the pain is worse. I have also learned some exercises that relieve the pain.  


My pain seems to be worse in the winter months which may lead to our family relocating to a warmer climate in the future. Although science has not found a direct link between the weather and arthritis pain, I can feel a difference based on the temperature. When it is cold, my pain is worse!


If you have any questions regarding this subject, I would be happy to answer them. Stay safe, stay healthy and follow your dreams!




Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.