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.

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.

Anxiety

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

 

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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.

Depression

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.

 

 

Schizophrenia

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

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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

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.

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

Overview

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

                    8

Medications

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

12

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14

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

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.

 

 

Crohn’s Disease Dietary Restrictions and Natural Remedies

Crohn’s disease is an inflammatory bowel disease (IBD) resulting in chronic inflammation of the gastrointestinal tract.  IBD encompasses Crohn’s disease and ulcerative colitis.   Crohn’s disease is associated with distinct granulomas and inflammation which may also affect lymph nodes.1

Ulcerative colitis is a milder disease that is characterized by continuous inflammation affecting the colon.  Both of these conditions lead to extensive epithelial damage.

Inflammatory bowel disease may cause a variety of symptoms including:

  • Loss of appetite
  • Fever
  • Weight loss
  • Diarrhea which may contain blood
  • Abdominal pain and cramping
  • Anemia due to blood loss
  • Urgency to defecate

I thought I would write a post on ways to combat this disease other than the traditional medication therapy. 

Remember, if you suffer from IBD, it is important to visit your physician on a regular basis.  Since bleeding and GI blockages are possible, tests may need to be performed by a professional to keep you as healthy as possible. 

You may require medication depending on how severe your symptoms are.  This disease may also cause a decrease in the absorption of vital vitamins and nutrients the body needs for proper functioning. 

The recommendations in this article should only be considered in combination with the advice of a physician.  I am a strong advocate of yearly check-ups.  Preventative medicine is vital to health.

What Foods Cause Crohn's Disease Flare-ups

Although there is no particular diet that has been scientifically proven to prevent inflammatory bowel disease, there are some trigger foods that may cause flare-ups.  My advice is to keep a food journal and this should help you determine which foods tend to cause problems.  If you find a certain food or food group appearing often before flare-ups, you may consider eliminating that item from your diet.  Some of the possible “problem items” include:

  • Corn, including popcorn
  • Dairy products – if lactose intolerant- consider supplementing with lactase or eliminating
  • Foods that cause increased gas production in the gut (onions, broccoli, cabbage, beans, legumes, lentils, etc.)
  • High fiber foods (chia seeds, avocado, pasta, chickpeas, quinoa, oats, almonds etc.)
  • Fried foods
  • Nuts and seeds, including peanut butter
  • Some raw fruits
  • Coffee and tea
  • Chocolate
  • Fats (butter, mayonnaise, cooking oils)
  • Alcoholic beverages
  • Red meat
  • Pork
  • Spicy foods

As you can see, there are many foods on this list, and others may also cause irritation and flare-ups.  This is why a food journal is essential.  It is worth the effort!

Another strategy is to try an elimination diet.  The way this works is you start by eliminating many foods and if your symptoms improve, you begin to add foods back one at a time.  This can help identify which foods should be avoided in the future. 

There are several elimination diets available today.  The Whole30 is a diet my family and I tried last October.  I have written about this in a separate post if you are interested in the specifics.  I highly recommend trying it.

I was also able to locate a specific diet and cookbook on Amazon written by Patty Catsos, MS, RD, LD.  I have not tried this diet yet, and don’t suffer from IBS, but this book has great reviews.  I do not have any association with this product but will list the link below for your convenience.

https://www.amazon.com/IBS-Elimination-Diet-Cookbook-Low-FODMAP/dp/0451497724

FODMAPs

Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) are short-chained carbohydrates.  These make their way to the end of the intestinal tract where large amounts of bacteria reside.  The bacteria break these substances down causing the release of gas which may lead to digestive issues in some individuals.  These FODMAPs also draw liquid into the intestines which can lead to diarrhea.  Most individuals with IBS are sensitive to FODMAPs and these substances can lead the flare-ups.  Examples of FODMAPs include:

Lactose – Milk sugar contained in dairy products.

Galactans – Legumes have large quantities of these.

Fructose – This is the sugar contained in fruits and vegetables.  You also find this in many packaged products.

Fructans – These are found in many grains including wheat, spelt, barley and rye.

Polyols – These are sugar alcohols and are also used in processed foods as a sweetener.  Examples include sorbitol, mannitol, xylitol and maltitol.

These substances are resistant to digestion and are passed through the intestinal tract unchanged.  FODMAPs cause an increased hydrogen concentration in the intestines of those with IBS.  They also influence the quantity of methane gas and may cause gastrointestinal symptoms in IBS patients.2

Curcumin for IBS

One of the most effective and popular herbal medicines available is turmeric.  This herb contains curcumin which has many beneficial properties.  Curcumin is known to have a wide range of effects on the gastrointestinal system.  This substance has been shown to inhibit the growth of H. pylori in both mice and on agar plates.3

Curcumin is thought to kill bacteria by inhibiting cell division.4

A study by Niamsa and Sittiwet in 2009, demonstrated the antimicrobial activity of curcumin several commonly encountered pathogenic Gram-negative and Gram-positive bacteria.5

Curcumin has also been shown to regulate the gut microbiota.  This is important because inflammatory bowel disease is partially defined by an altered, pathogenic microbiome.6

 

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One of the changes that occur in the gut is the increase in adherent invasive E. Coli (AIEC) which can promote gut inflammation.9

 

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Curcumin has also been shown to inhibit signaling that initiates the inflammatory process in the intestinal tract.11

A study published in 2006 found the addition of curcumin, 1 gram after breakfast and 1 gram after dinner, plus sulfasalazine or mesalamine was more effective than placebo combined with one of these two medications.  The mesalamine group had a 4.65% relapse rate (2/43), whereas the placebo group had a relapse rate of 20.51% (8/39).  A six month follow-up found eight more patients relapsed in the curcumin group and six additional patients relapsed in the placebo group.12

For additional information on curcumin, please refer to my blog post on turmeric below.

Plantago Ovata

Plantago ovata, also known as Desert Indian wheat or psyllim husk has been used as a medicinal plant.  Psyllium is often used as a bulk forming laxative to support normal bowel movements.  Psyllium is marketed as Metamucil.   We also have this product available in capsule form in the Sunshine Store.  There have been studies showing psyllium to be useful in the treatment of UC.13

Probiotics in Inflammatory Bowel Disease

Probiotics would seem to be helpful in IBD.  Ingesting “good” bacterial should fend off some of the “bad” gas-producing bacteria.  At the present time, the studies show that probiotic supplementation is a promising adjuvant treatment in ulcerative colitis.  It is best to use a combination Probiotic such as Probiotic-40 available below.   There is not enough clinical evidence to support the use of probiotics for Crohn’s disease at the present time.14

Inflammatory bowel disease can be a debilitating illness and may be dangerous in some cases.  This condition may lead to a decrease in the absorption of critical nutrients and can also lead to bleeding and/or intestinal obstructions.  I suggest visiting your physician on a regular basis, keeping a food journal, and consider adding nutritional supplements to your medication regimen.  Your physician can tell you if you are deficient in vitamin B-12 or other necessary vitamins or minerals.  I strongly recommend a turmeric supplement.  This is one of the healthiest natural herbs available today.  Psyllium may also be beneficial but caution should be observed as large fiber loads can increase IBS symptoms in some individuals.  Be sure to check with your physician before starting this or any other supplement. 

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.

 

 

L-Arginine and Cardiovascular Disease, IVF, PCOS, and More..

What is L-Arginine

L-Arginine is an amino acid made naturally by our bodies and is used in protein biosynthesis.  It is also found in foods such as fish, poultry, red meat, and dairy products. L-Arginine is vital to overall health.  It is associated with the Krebs Cycle and is a part of the urea cycle where it carries nitrogenous waste.   This amino acid also causes vasodilation by its conversion to nitric oxide (NO).1

It is important in maintaining the acid-base balance of the body as the urea cycle is a significant consumer of bicarbonate.

We have recently added this supplement to our product line mostly to be used by athletes.  I will cover this, as well as some uses of L-Arginine in this post. 

L-Arginine and in vitro fertilization (IVF)

In vitro fertilization has become increasingly popular for couples who struggle to become pregnant.  This is often attempted during the later child-bearing years after the woman has failed to become pregnant.  There is some research to suggest L-Arginine can increase the number of oocytes collected in women attempting IVF.  This, however, has yet to be shown to improve the viable pregnancy rate.2

L-Arginine and Polycystic Ovary Syndrome (PCOS)

A small study of eight patients with polycystic ovary syndrome was published in December of 2009.  This study showed that a combination of L-arginine 1600 mg daily combined with N-acetylcysteine 1200 mg daily for a period of six months resulted in moderate improvement of menstrual function and decreased insulin resistance.3

L-Theanine Effects on Cardiovascular Disease and Exercise

L-Arginine may lessen angina symptoms and improve exercise and quality of life in angina patients according to a study published in 2002.4

Another randomized, double-blind cross-over study published in September of 2000, found that, although L-arginine supplementation did not affect exercise-induced changes in QT interval, QT dispersion, or the magnitude of ST segment depression, it significantly improved exercise tolerance.  This is most likely the result of improved peripheral vasomotion.5

Many studies have found L-arginine to be effective and decreasing both systolic and diastolic blood pressure.  This has been shown in healthy individuals, those with pulmonary hypertension, as well as patients with type 2 diabetes.6

 

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L-arginine also appears to have an additive vasodilation effect when combined with angiotensin converting enzyme (ACE) inhibitors and nitrate vasodilators when used for the treatment of hypertension.10

 

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Intermittent claudication associated with peripheral arterial disease symptoms have also been shown to improve with the administration of oral or intravenous L-arginine for short term periods (up to eight weeks). 15

 

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Although this is promising, walking speed, walking distance, or absolute claudication distance does not seem to improve with long-term (up to six months) administration of L-arginine. 18

 

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L-Arginine and Erectile Dysfunction (ED)

L-arginine has shown some promise in the treatment of erectile dysfunction.  A double-blind, placebo-controlled study of 50 men with organic ED showed significant improvement in sexual function in 9/29 (31%) of the treatment group but only 2/17 (11.8%) of the placebo group.  The nine patients in the treatment group that showed improvement all had initially low NOx but this level doubled by the end of the study.20

L-arginine seems to be effective in men with mixed-type impotence when combined with Pycogenol at 1.7 grams daily or when combined with both Pycogenol and aspartic acid when dosed at 0.69 grams daily.21

 

22

L-Arginine and Statins

The combination of L-arginine and atorvastatin (Lipitor) has been shown to have a significant positive effect on the progression of atherosclerosis.  A study utilizing rabbits found this combination to achieve a 21% decrease in the total area of lesions and a 44% reduction in the area of abdominal lesions compared to the control group.23

A two-arm, randomized, double-blind study on 33 hypertriglyceridemic patients reported that L-arginine alone had no effect on serum lipids compared to placebo. When combined with simvastatin, however, led to a significantly larger reduction in triglycerides compared to placebo plus simvastatin.  This study also found L-arginine attenuated simvastatin-induced increases in aspartate transaminase and fibrinogen.24

L-Arginine and Body Building

L-arginine is popular with body builders because it helps in the synthesis of proteins.  As muscle mass increases, L-arginine helps signal muscle cells and encourages growth hormone release and the metabolism of fat.  This leads to a more defined, stronger, well-defined physique.  L-arginine can also improve endurance and muscle conditioning due to its vasodilation effects.  This increases blood flow to muscle during workout periods.

L-Arginine Drug Interactions

ACE inhibitors, Angiotensin Receptor Blockers (ARBs) and other antihypertensive agents The combination of L-arginine and ACE inhibitors may lead to increased vasodilation and a larger decrease in blood pressure.  When combined, the risk of hypotension exists. Examples include benazepril, captopril, Ramipril, losartan, valsartan, diltiazem, amlodipine, and many more.

Anticoagulants and Antiplatelet DrugsL-arginine may decrease platelet aggregation in humans.  Caution should be exercised when combining L-arginine with medications that increase bleeding risk.  Some examples are warfarin, apixaban, rivaroxaban, enoxaparin, clopidigrel, ticlodipine and others.

Isoproterenol and NitratesL-arginine may lead to increased vasodilation when combined with vasodilators leading to hypotension and dizziness.

Sildenafil (Viagra) – Although not reported in humans, combining L-Arginine with sildenafil may lead to increased vasodilation and dizziness as well.

Potassium-sparing diuretics – There have been some reports of L-arginine causing hyperkalemia in some patients.  Combining L-arginine with these medications may increase the risk of hyperkalemia.  Examples of these medications include amiloride, spironolactone, and triamterene.

Adverse Effects of L-Arginine

L-Arginine is generally well tolerated.  The most common side effects reported for this supplement are:

  • Abdominal pain
  • Bloating
  • Diarrhea
  • Nausea
  • Gout
  • Allergic reactions
  • Exacerbation of airway inflammation in asthmatic patients

L-arginine is an amino acid which helps in the synthesis of proteins.  It also leads to vasodilation and, in doing so, can be beneficial for relieving chest pain.  When combined with a statin, L-arginine leads to a decrease in atherosclerosis which may help prevent heart attacks.  It has also been shown to decrease both systolic and diastolic blood pressures.  Due to its vasodilation properties, L-arginine may help with the symptoms of erectile dysfunction. It may also help with some of the symptoms of polycystic ovary syndrome when combined with N-acetylcysteine.

We recently added L-arginine as a dietary supplement to our product line with the thought of making it available to body builders.  It can increase exercise tolerance and help create a sculpted, muscular body.  As it turns out, many other uses are possible with this substance. 

L-arginine is relatively safe and well tolerated as it is an amino acid found in the human body.  As with any other medication or supplement, allergic reactions are always a possibility.  These reactions are often due to fillers and other substances used to produce the dosage form rather than the active chemical.  Gastrointestinal side effects are always a possibility as well.

If you have any questions about L-arginine or any other medication or supplement, please feel free to send me an email.  I have spent over half of my life working with medications and supplements.   As I have expressed in the past, if I do not know the answer to your question, I will find it.  Have a great week and live a happy, healthy life.  Get plenty of exercise, drink adequate amounts of water, and eat whole foods.  You are worth it.

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.

 

 

Bipolar Depression Treatment – Seroquel, Latuda, and Others

The first line medication treatments for bipolar depression are explored along with signs and symptoms of mania and depression.

Abnormal Condition of Dry or Scaly Skin in Older Individuals

What can be done to prevent dry skin as you age?

The skin is the largest organ of the body. It serves as a barrier and protects us from bacteria. 

Skin also helps to regulate body temperature and allows us to respond to heat, cold, and touch. There are three layers that compose the skin.

  • Epidermis – This is the outer layer that serves as a barrier. The epidermis keeps pathogens from entering the body and regulated water being released from the body.
  • Dermis – The layer below the epidermis is called the dermis. This layer contains blood vessels, nerve endings, sweat glands, and hair follicles.
  • Hypodermis – This layer contains fat and connective tissue, and provides cushioning and insulation to the body.

Dermatologists are specialized physicians who diagnose and treat various conditions of the skin. This post will explore dry skin, its causes, treatments, and effects on the aging population.

Effects of Age on the Skin

As we age, our skin becomes thinner. The number of blood vessels, nerve endings, and the amount of connective tissue also decrease. These changes lead to a reduced ability to retain moisture, control body temperature, and sense the environment.

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Pruritis, or itching, is the most common complaint involving the skin in older individuals. Short-term itching, less than six weeks, may protect us, but pruritis lasting more than six weeks can be bothersome. Pruritis can effect the quality of life and, in some cases, patients would rather live a shorter life without symptoms than live longer with pruritis.

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Dry skin (xerosis) is more common in older individuals and those living in colder climates. Heating homes in the winter months leads to decreased humidity that can dry the skin.

Prevention of Dry, Itchy Skin

The best treatment for most anything is prevention. 

Dry, itchy skin is no exception. 

The first step is to monitor the health of the skin regularly. This can be done by scanning the body for problem areas. A physician may also perform skin monitoring during a routine physical exam. 

Some causes of dry skin include:

  • Cold, dry air during the winter months
  • Skin damage from the sun
  • Use of soaps and detergents that damage the skin
  • Excessive immersion in water (taking long baths)
  • Some diseases such as lymphoma, malnutrition, hypothyroidism, eczema, and others
  • Direct exposure to fan heaters

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    One of the best ways to prevent dry to skin is to eat an adequate amount of protein, vitamins, and fatty acids.

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Best Foods to Eat for Healthy Skin

What should you eat to help keep your skin healthy? In general, fresh fruits and vegetables are a good choice because of the vitamins and antioxidants. Below are some great suggestions.

  1. Salmon – Fatty fish, such as salmon, contain omega-3 fatty acids which reduce inflammation and keep the skin moisturized.

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  1. Bell Peppers – Bell peppers are an excellent source of beta-carotene, especially the red and yellow variety. Green bell peppers are picked before they turn color and do not contain as much beta-carotene, which is converted to vitamin A in the body. Bell peppers are also high in vitamin C, which helps keeps the skin healthy by helping form collagen.

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3. Broccoli –

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Probably my favorite vegetable, broccoli, contains many vitamins and minerals necessary for good skin health, including:

  • Vitamin A
  • Vitamin C
  • Zinc

Broccoli, as well as cabbage, cauliflower, and kale, also contains sulforaphane. This substance may protect the skin from the sun’s damage, thus decreasing photoaging.

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  1. Avocados – Packed with healthy fats, this guacamole ingredient can improve skin health by moisturizing and improving flexibility.

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Avocados also contain vitamins C and E, which act as antioxidants. One symptom of vitamin C deficiency is dry, scaly skin. Vitamin C also is needed to make collagen that helps keep skin healthy and strong.

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  1. Tomatoes – Another favorite of mine, tomatoes contain vitamin C, lycopene, and beta-carotene. 

These substances can protect skin from the sun and help prevent wrinkles.

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  1. Soy – Isoflavones are contained in soy. These have been shown to improve skin elasticity and decrease fine wrinkles in at least one study.

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Isoflavones can also protect the skin from the sun’s harmful rays.  

  1. Sweet potatoes – We started eating more sweet potatoes when consuming the Whole30 diet. These are an excellent beta-carotene source that can protect the skin from the sun. Sweet potatoes are a better option than white or yellow potatoes. Give them a try.
  1. Green leafy vegetables – spinach, kale, and collard greens contain vitamins A, C and E. They are also a good source of protein and spinach contains selenium which can protect the skin from UV rays.
  1. Eggs – These are a good source of protein, selenium, zinc, vitamin A and vitamin C.  

10. Healthy oils –  Extra virgin olive oil and fish oil can help with keeping the skin moist and pliable.

Dietary supplements may be necessary if you cannot get enough nutrients from the foods you eat. 

Some of these can be found in the Sunshine Store. The supplements listed below are the same as those contained in the foods above.  

  • Fish Oil
  • Vitamin A
  • Vitamin C
  • Vitamin E
  • Zinc
  • Selenium

Topical Agents for Dry Skin

Daily use of moisturizers that hydrate the skin is important. Some examples of ingredients that can help are:

 

Topical Urea – This is a molecule produced by our body that is naturally found in the skin. It is generated from the metabolism of proteins and other compounds. 

Urea is excreted in the urine and through sweating.

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Urea is one of the best moisturizing agents available to dermatologists today. It has been used safely for over a century and can be utilized for several skin conditions. Urea has different effects on the skin, depending on the concentration employed. At lower concentrations (~10% or less), it acts as a moisturizer, while at concentrations greater than 10%, it has an emollient/keratolytic action. Urea can also enhance the penetration of other molecules through the skin and is used in combination therapies.

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Other skin moisturizers available include glycerin, lactic acid, and petrolatum.

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Other Ways to Help Dry Skin

  • Avoid traditional soaps – regular soap can alkalinize the skin damaging the moisture barrier. Synthetic cleansers such as Dove, Olay, and Cetaphil are preferred.
  • Avoid excessive washing – This can worsen dry skin, especially if very hot water is used. 
  • Avoid aggressive scrubbing and use luke-warm water.
  • Use a Humidifier – Increasing humidity can help decrease skin drying, especially in the winter months.

 

 As we age, our bodies go through many transformations. Energy levels decrease, our kidneys and liver don’t work as well, and we have a higher percentage of body fat. Our skin also changes and becomes thinner, less pliable, and dry. If we don’t care for our skin, it can crack, leading to pain and possible infection.  

 

One of the best things you can do for your body at any age is to eat fresh, whole foods. If you eat a healthy, balanced diet, you are likely to help your skin stay strong and healthy. Always stay hydrated, exercise, and use high-quality moisturizing lotions. 

 

If you live in the northern part of the country where it is cold in the winter, consider using a humidifier to help decrease the effects of dry air on your skin.  

 

Avoid excessive bathing, especially with very hot water, as this may dry your skin. Stick with high-quality synthetic cleansers, and be sure to monitor your skin for dry, scaly areas. If you find problems with your skin, see your doctor. There are medicated creams and lotions available to help relieve the various skin conditions you may be suffering from.

Skin integrity is vital to our overall health. If you have any questions regarding this topic, or any other health or fitness related subject, feel free to contact us. If you have ideas for future blog posts, let me know. My goal is to keep you entertained and informed. Have a great day; be happy, healthy, and keep smiling.

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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.

 

 

Female Pattern Hair Loss, PCOS Alopecia Treatment, What Works?

Female pattern hair loss (FPHL), also called female androgenic alopecia is a diffuse, non-scarring loss of hair.  The hair loss is most apparent in the frontal, central, and parietal scalp regions.  This condition is most common in adult females and its incidence increases with age.  Unfortunately, this disease shows variable responses to treatment.

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Not surprisingly, FPHL can lead to low self-esteem, poor body image, depression, and a lower over-all quality of life.

We know that the hair follicle changes in alopecia are similar for men and women, but the presentation and response to therapy is different. 

FPHL normally occurs during the reproductive years.  The second peak occurs at menopause (50-60 years of age).  A study conducted in 2001 found a 3% incidence of FPHL among 1008 Caucasian women in their 30’s.  This prevalence increased slowly with age and was 32% in the ninth decade of life.  The combined prevalence was 19%.

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Minoxidil

The first line of treatment for FPHL is Minoxidil (Rogaine).  Many are familiar with Rogaine as it has been approved for use in men’s hair-loss since 2006.

We are not completely sure how minoxidil works but it is thought to promote the growth phase of the hair follicle, shorten the resting phase, and enlarge miniaturized follicles.

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 In 2014, 5% minoxidil was approved for FPHL.  Before this, only 2% minoxidil solution was approved for use in women.  Studies have shown that once daily application of a 5% foam is as effective as twice daily application of a 2% solution.  This is important because once daily application is more convenient for the patient. 

There are side effects associated with the use of minoxidil.  During the Rogaine clinical trials conducted by Johnson and Johnson, the following side effects were reported in at least 2% of the study participants.

  • Weight Gain
  • Headache
  • Itching
  • Nasal and upper respiratory tract infections        4

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One of the common concerns among women using hair growth products is the worry of hair growing in the wrong places.  Hypertrichosis has been reported with both strengths of minoxidil but is significantly less with the 5% foam.

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It is recommended that minoxidil be applied at least 2-4 hours prior to bedtime with hands thoroughly washed after application to limit unwanted hair growth on the face.

Although I do own stock in Johnson and Johnson, I currently am not paid for promoting their products.  I have included the link to the Rogaine site below as a convenience to my readers.  Both 2% solution and 5% unscented foam are available at:

https://www.rogaine.com/products/womens-hair-regrowth-solutions#women

Other Treatment Options

If Minoxidil is ineffective, other medications may be tried.  It is important to note that although these secondary treatments may be tried, no conclusive evidence supporting their effectiveness is available.  In fact, a Cochrane Review including 47 trials with 5290 subjects, found only minoxidil to be effective for FPHL.

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Although evidence is lacking, these systemic treatments are still utilized in some situations.  They will be briefly discussed here.

Spironolactone

Spironolactone is an aldosterone antagonist.  It works by blocking androgen receptors and has some inhibition of androgen synthesis.

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It is usually the initial second-line agent employed for FPHL because it is often used in women for other indications such as acne, hirsutism, and polycystic ovarian syndrome.  This gives providers more confidence in regards to side effects and tolerability.  Spironolactone has limited positive data available for its use in FPHL.  One open-label study treated patients with either spironolactone or cyproterone.  The average duration of treatment in this study was 16 months.  There was not difference between the groups.  Forty-four percent of the patients experienced regrowth of hair, forty-four percent showed no change, and twelve percent had continued hair loss.

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Finasteride

Finasteride is often used to treat baldness in men.  It works by inhibiting the conversion of testosterone to dihydrotestosterone.  This medication is usually well tolerated in females and because of the limited options for women who fail minoxidil, it may be another option.

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Flutamide

Flutamide has a few studies supporting its usefulness in FPHL.  In one prospective cohort study of 101 premenopausal women, flutamide was associated with an average of 15% improvement of hair thickness at six months and 28% at two years.

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Another case study found flutamide reversed hair loss in a patient who had failed treatment with a combination of spironolactone and topical minoxidil.

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Flutamide is associated with side effects such as decreased libido, GI distress and rarely liver failure.  The threat of liver failure has limited flutamide’s use in FPML.

Low-Level Laser Light Therapy (LLLT)

Photobiomodulation therapy, or low-level laser light therapy has also been used to treat FPHL.  A study published in 2014 in The American Journal of Clinical Dermatology found a clinically significant difference in terminal hair density between an FDA approved low-level laser product (Lasercomb) and a sham device.  This was a randomized, double-blind sham device controlled study of 128 male and 141 female subjects. 

The patients who used the Lasercomb also reported an improvement in hair thickness and an overall improvement of their hair loss condition as compared to the sham treated patients. 

There were no serious adverse effects reported with the use of the Lasercomb.  This device may be a good alternative for hair-loss patients who either do not respond to medications or have adverse effects or contraindications to available treatments.

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More information on the Ultima 9 Classic LaserComb can be found at:

https://hairmax.com/products/ultima-9-classic-lasercomb?variant=30328901664886&currency=USD&gclid=Cj0KCQiApt_xBRDxARIsAAMUMu_CUgG6KDzv5d4DMnuOrpiGeL5NHVb0edgODpcXETrwB8E1rGCknE8aArzhEALw_wcB

Surgery

When all other treatments fail, hair transplantation surgery is an option.  Unfortunately, this is not always effective as transplant failure is possible.  This procedure is also costly and time-consuming for the patient.  There may also be an increased amount of hair loss early on and pain and infection is also a risk.

 

PCOS Alopecia Treatment

Polycystic ovarian syndrome (PCOS) alopecia is caused by an increase in male hormones.  Treatments for this are the same as those listed above.  In addition, birth control pills may be used to help decrease androgen levels.  Oral contraceptives not only help with hair loss but also can be effective for the treatment of other PCOS symptoms such as acne and irregular menstruation.  

There is evidence that weight loss in women with PCOS can also decrease androgen levels.  Even a loss of five to ten percent of body weight can have a significant effect on PCOS symptoms.14

Female pattern hair loss is an unfortunate ailment that increases in prevalence with age.  This condition leads to poor self-esteem, a distorted body image, and may even lead to depression.  Unfortunately, the treatments available for this disorder are scarce.  The only scientifically proven method is topical minoxidil, or Rogaine.  Other treatments have been used with some success but are not well supported by the clinical literature. 

Please leave any questions or comments below.  Thanks for reading, and have a great day!

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.

 

 

The 2019 Novel Coronavirus – What You Need to Know

Coronaviruses are a group of viruses that can be transmitted between animals and humans.

These viruses can cause mild ailments such as the common cold as well as more severe infections requiring hospitalization.

The latest outbreak initiated in China has already killed 427 people worldwide, as reported by NBC News on February 4th, 2020. This is alarming since this virus has only recently been identified as 2019-nCoV on January 7th, 2020.

How is this virus spread?

What can you do to protect yourself?

How Does This Virus Spread?

Since this is a new virus, we can only speculate on how it is transmitted.  It can be assumed that its spread is similar to other coronaviruses.  These viruses are normally spread by close physical contact (usually six feet or less). 

Droplet transmission is the most likely culprit. 

When an infected patient coughs or sneezes, droplets may be inhaled by others or land in their mouths or noses.  It may also be transmitted by touching a surface contaminated with these droplets and then touching the mouth, eyes, or nose, but this is not currently confirmed.

There is no vaccine against this virus at the current time.

Coronavirus Symptoms

The symptoms of the new 2019-nCoV virus are as follows

  • Fever over 100.4 degrees
  • Muscle aches
  • Breathing problems
  • Malaise
  • Cough

Some people with this virus will show no symptoms but may still spread the virus to others.  Some patients may have severe symptoms such as pneumonia, hypoxia, and even death.

The risk of death is higher in those who are immunocompromised, prone to pneumonia, elderly or frail.

Coronavirus Treatment

There is currently no treatment for this virus other than supportive measures.  Viruses are difficult to treat with medications.  A hospital stay may be necessary to keep the patient comfortable and prevent the condition from deteriorating.  In severe cases, being treated in the ICU to support breathing may be necessary. 

The FDA has approved the use of hydroxychoroquine (Plaquenil) on 3/30/2020 for the treatment of COVID-19.  This drug helps dry secretions in the lungs.  One of the main causes of death from this virus is respiratory failure.

Prevention of Coronavirus

The best way to prevent this infection is to stay away from others who have it, wash your hands often, and clean work surfaces used by others frequently.  Since it is not possible to know who has the virus, the recommendation is to stay six feet away from everyone.  It is also mandated that people in the USA stay home unless they must shop for food or are in critical positions and must go to work.  The social distancing guidelines are in effect until April 30, 2020.

If you are not familiar with the correct hand-washing technique, please refer to:

 https://www.cdc.gov/handwashing/

  • Hand washing is extremely important for optimal health.
  • If you don’t need to travel to China, don’t. 
  • Avoid touching your eyes, nose, or mouth with unwashed hands.
  • Cough or sneeze into a tissue and promptly throw the tissue in the trash.

If you are living with someone who you think may be infected with coronavirus, do the following:

  • Stay in a separate room and use a different bathroom if possible
  • Clean all surfaces the infected person may have had contact with well!
  • Wear disposable gloves, a disposable gown, and a face mask when caring for them, be sure to wash your hands thoroughly after providing care.
  • Have the infected person wear a mask if possible. If this causes breathing problems, others in the same room as the patient should wear a mask.
  • Keep all surfaces very clean, especially ones the patient comes into contact with.

What if I Get Infected?

If you believe you have contracted this virus, see your doctor.  This is especially important if you have a high fever or trouble breathing.  Do not go to highly populated areas as this may cause the disease to spread.  Stay home from work.  If you are severely ill, go straight to the emergency room. 

The hospital or doctor will test you to confirm you are infected with 2019-nCoV.

It is important to stay away from elderly patients, those who are immuno-compromised, small children and anyone who is susceptible to pneumonia if you suspect you may have this virus. 

Protecting yourself against the coronavirus is much the same as avoiding other illnesses.

Stay away from other infected individuals.

Wash your hands often.

Do not travel to destinations where the disease is prevalent.

Wear protective clothing (masks, gowns, gloves) when caring for others with the condition, and keep yourself in good physical condition.

This virus is more dangerous in those with pre-existing respiratory problems, those who are immunocompromised, and the elderly and frail.

If you have any questions, feel free to contact me.

UPDATE

 As of 03/30/2020, there have been over 143,000 deaths attributed to this virus in the USA.  This has turned out to be much worse than originally thought.  The best resource I have been able to find for updated information can be found at the link below.

https://coronavirus.jhu.edu/

Stay safe, and always remember to be happy and healthy.  Please follow the guidelines issued by the government regarding this virus.  Many lives depend on it!

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.

 

 
Woman in sensory room holding fiber optics

Snoezelen Therapy for Dementia Patients

Woman in sensory room holding fiber optics

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.

The world population is ageing and, because of this, the incidence of dementia has risen.  According to the World Health Organization, approximately 50 million people have dementia worldwide, and 10 million new cases are diagnosed every year.  The incidence of dementia is expected to reach 131 million people by 2050.1

  Dementia has a tremendous impact on both the patient, and the family.    Patients with dementia are unable to remember things, have a difficult time solving problems, and can become easily frustrated.  Their sleep-wake cycle may become reversed and, at times, they may even become violent to the ones they love.  Dementia occurs in older people but is not a normal part of the ageing process.

Dementia patients may reach a point where they need to be hospitalized due to behaviors which are not able to be controlled by their caregivers.  Some of these behaviors include agitation, depression, aggression, and apathy.

I have been working on a unit which cares for dementia patients for three years.  During this time, I have learned a great deal about this condition as well as common and not so common treatments.  I have written other blog posts relating to dementia but this post will concentrate on the use of Snoezelen therapy for these patients.

A Snoezelen room is a controlled multisensory environment (MSE).  Equipment in these rooms cause a variety of stimulation including tactile, auditory, olfactory and visual.  Snoezelen rooms should provide a calm and comfortable environment for the patients.  These rooms can be used for patients with autism, brain injuries, developmental disabilities as well as dementia.  MSE’s are not inexpensive to set up.  Associated costs could run from $10,000 to $30,000 and even more if complex, high-end equipment is used.

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Assessing Unmet Needs

The Unmet Needs Model suggests negative behaviors in dementia may result from the inability to communicate one’s needs to caregivers.  There are ways in which we can attempt to learn what these unmet needs are by trial and error.  In the hospital setting, we often talk about the following possibilities that may make the patient uncomfortable.

  • Pain – This one is difficult to assess. There are pain signs such as grimacing.  The patient may also be suffering from a urinary tract infection, or other ailment.
  • Constipation – Keep track of bowel movements. Constipation can be uncomfortable, and is usually easy to treat.
  • Hunger – Offer food. Attempt to learn the patient’s food preferences by speaking to those close to the patient.
  • Thirst – Offer fluids.
  • General Comfort – How the patient is sitting, temperature, clothing, etc.

If these don’t help, the patient may be suffering from boredom.  This is where the Snoezelen room can help.  Always remember, dementia patients are people like us who have a disease and it is important to view them as such.  What works for one patient, may not be effective for another.  Get to know what the patient prefers and keep track of successful interventions.  Always start with the basic needs described above.  If the patient is in pain or uncomfortable due to being constipated, a Snoezelen room experience will likely have little effect on behavior.

Benefits of Multisensory Environments in Dementia Care

Later stage dementia patients are usually unable to seek out enriching and meaningful activities on their own.  In fact, left to their own devises, they would quickly decline.  Most of the time, they are completely dependent on others for their care.  Older people are also less able to perceive sights, sounds, tastes, and smells which increases their risk of sensory deprivation.3

This can have a negative impact on health and wellbeing.4

Some believe that sensory experiences are able to trigger positive memories.  This may promote a feeling of pleasure for the patient.  Think about this in your own life.  I believe we’ve all experienced being taken back in time when we’ve smelled something that triggers a positive time in our lives, or heard a song that takes us back to a happy time.5

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The goal of the multisensory environment is to positively effect the dementia patient using sensory channels that are still intact. 

The three main avenues by which a multisensory experience can be achieved are.

  1. Daily care routines such as bathing, feeding, and administering medications 7

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  1. Sensory enhancements of the patients living environment. This may include special units in long-term care facilities which provide staff specially trained to care for dementia patients, special activities geared towards these residents and involvement of the family.9

  1. Specially designed rooms or MSEs.10

Studies have shown that MSEs can be beneficial for dementia patients.  Some of these benefits include.

  1. Decreased agitation and disruptive behavior.

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I would like to point out that some of the medications utilized to combat aggressive and disruptive behavior can cause agitation.  

  1. Increased alertness14

  1. Increased social interaction, reduced apathy, and better mood.15

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  1. Better communication with others.18

  1. Improved functional performance19

These positive attributes of MSEs leads to a more relaxed, engaged patient who gets along better with his or her peers. 

Research also shows caregivers who utilize MSEs for their dementia patients have better job satisfaction and a better relationship with their patients.

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This leads to improved patient care and reduced caregiver burnout.

Obstacles to Adding a Snoezelen Room to a Facility

Many facilities do not have the financial resources or space to implement a Snoezelen room.  As mentioned earlier in the post, these spaces can get expensive.  The institutions who have these rooms often under-utilize them.  Another problem is deciding how to design such a space.  There is much debate on exactly what to put into these rooms and research is still being conducted in this area. 

Anti-suicide regulations can also hinder certain facilities from adding a Snoezelen room.  This is especially true of psychiatric facilities where dementia patients may end up due to negative behaviors.

Perspectives of an Expert

I have the pleasure of sharing an office with an occupational therapist.  Kendra Munroe, OTR/L works with our patients daily and was the person who designed our sensory room.  Our main piece of equipment is a Vecta which was purchased from TFH Special needs Toys.  This company specializes in sensory-focused equipment and toys which promote learning and living skills.

The Vecta Full Mobile Sensory Station can turn any room into a relaxing, distracting and empowering multi-sensory room. 

According to Kendra, the sensory room “provides a safe and contained spot where the patients can explore”.  She explains that you want to have different things available to engage their senses.  Some examples include music that is tailored to the specific patients tastes, as well as things they can see or touch.  Kendra also believes it is important to include things related to nature. 

We provide weighted blankets by Salt of the Earth as well as quilts, stuffed animals, robotic pets, and a weighted baby doll to provide a realistic sensory experience.

Munroe stated that certain things are often neglected in sensory rooms, specifically regarding the geriatric population.  She mentioned things that provide proprioceptive and vestibular input in particular. “This is why we put a glider in,” Kendra explains.  We purchased a specific glider that locks in place when the patient attempts to stand.  The Thera-Glide safety glider decreases fall-risk and rocks back and forth which is soothing to the patient.

Kendra does point out that there may be dangers involved with sensory rooms.  She emphasizes that we must be trauma-informed with any of our treatment.  We must be aware that small, enclosed spaces may bother some patients.  We also need to be sure there are no objects or equipment available that the patient may throw due to confusion. 

Dementia patients should never be left alone in a sensory room.  They may become confused because the room is unfamiliar to them.  They may damage the equipment, or injure themselves.

Munroe ended by saying that we really didn’t have many guidelines available to us when setting up our sensory room.  We tried to provide a mixture of adult and pediatric sensory experiences that we believed would be most beneficial to our patient population.

Michael Brown pictured with Final Thought written

I am a big supporter of sensory rooms.  My thought is we should utilize all other treatment modalities prior to resorting to medications for dementia patients.  All drugs come with side effects and currently there are no medications indicated for the behavioral and psychological symptoms of dementia. 

Always try to meet the basic needs of the patient before moving on to other therapies.  Assess for pain, hunger, thirst, constipation and comfort. 

As a society, we have a responsibility to care for our ailing population.  This includes the mentally ill.  Unfortunately, none of us are immune from this debilitation condition.  We can all learn about it, and try to limit our risk of developing dementia.  I will continue to write about this subject as I believe it is very important.

If you have any questions regarding Snoezelen rooms or dementia in general please reach out to me.  I have access to some of the best professionals in this area. 

Please take a look at the Sunshine Store for all of your vitamin and nutritional needs.

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.