Psilocybin for Depression and Anxiety

Can the psychoactive substance found in “magic mushrooms” be used to treat depression?

Psilocybin is a hallucinogenic drug present in some species of mushrooms. This compound was utilized in the 1960’s for various psychiatric conditions before being classified as a schedule I substance by the FDA in 1970. 

Schedule I substances have no current acceptable medical use and have a high potential for abuse. 

Some examples of Schedule I substances are heroin, LSD, and PCP.

Recently, some cities have decriminalized psilocybin. The first to do so was Denver, Colorado, in May of 2019.  

The first state to legalize psilocybin is Oregon, where I live. Measure 109 passed in November of 2020. This measure allows the Oregon Health Authority (OHA) to develop a program to enable licensed providers to administer mushrooms and fungi containing psilocybin to individuals over 21.

This measure opens the door for psilocybin to be used for psychiatric conditions where traditional treatment has failed.

What is Psilocybin?

Psilocybin is a psychedelic substance that alters consciousness through interaction with serotonin (5HT2A) receptors.

The question is whether this substance has any benefit for these conditions. To answer this question, I looked at the available studies.

 

Psilocybin Treatment for Anxiety and Depression in Cancer Patients

Cancer patients commonly suffer from significant anxiety and depression. It is estimated that 30-40% of these patients are affected by these disorders when hospitalized.

Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies.1

Anxiety and depression are associated with a variety of symptoms that lead to poor outcomes.  Some of these include:

2

3

 

4

  • Increased suicide rates.
  • Increased disability
  • Poor medication compliance.
  • Increased health care utilization.
  • Decreased quality of life.
  • Increased pain.
  • Decreased social functioning.
  • Decreased survival rates.

Although this is a significant problem, no FDA-approved pharmacotherapies are approved for psychological distress related to cancer. Antidepressant agents take time to take effect, side effects compromise treatment adherence, many treatments are ineffective, and relapse rates are significant.5

 

6

A double-blind, placebo-controlled, crossover trial involving 29 patients with cancer-related anxiety and depression was published in the Journal of Psychopharmacology in December of 2016.7

This study was designed to determine the efficacy of a single psilocybin dosing session compared to an active control (niacin 250mg) in treating cancer patients with anxiety and depression.  

The investigators concluded that moderate-dose psilocybin (along with psychotherapy) produced rapid and sustained anxiolytic and anti-depressant effects.  These effects lasted anywhere from 7 weeks to 8 months. These patients exhibited decreased cancer-related existential distress, increased spiritual well-being, quality of life, and improved attitudes towards death.

There were no serious adverse effects reported during this study in either group.

Psilocybin in Unipolar Depression

An open-label study of 12 patients with moderate-to-severe, unipolar depression was published in Lancer Psychiatry in July of 2016. This was a feasibility trial involving six men and six women.8

These patients received two oral doses of psilocybin (10mg and 25mg) seven days apart. The figure below represents the Schedule of study interventions for this trial.

This study’s main objective was to create an optimized protocol for psilocybin administration and gain information about its efficacy in treating unipolar depression.

No severe adverse effects occurred during this study, and the psilocybin was well-tolerated. The side effects that did appear were:

  • Anxiety (mostly mild)
  • Confusion or thought disorder
  • Nausea
  • Headache

No prolonged psychosis was observed in any of the subjects.

Depression severity was measured using the Quick Inventory of Depressive Symptomatology (QIDS) score. Scoring is as follows:

>21 – Very severe depression

16-20 – Severe depression

11-15 – Moderate depression

6-10 – mild depression

5 or below – No depression

<=9 – Indicates remission of depression

 

All scoring was completed at the intervals shown on the graph below. The time period reflects time passed after the high-dose session. The figure below shows the results over time. These results were also confirmed using the Beck’s Depression Inventory Scale.

Every patient had a reduction in depression severity one week after the high-dose session. Week 2 showed the most significant results. Eight of the twelve patients (67%) achieved complete remission at week one, and five of these (42%) were still in remission at three months.

Although this was a study with a small sample size and no control group, it is promising that many of these treatment-resistant patients achieved remission of their depression. More studies are needed to confirm what was gleaned from this study, but it appears that psilocybin can be safely administered to patients who are appropriately screened and receive adequate support.

Anxiety and depression are prevalent in today’s society. Many of our traditional antidepressant medications take weeks to work and are often ineffective. Psilocybin shows promise in the management of those with treatment-resistant anxiety and depression.

Psilocybin is also associated with only minor side effects. It does not typically cause compulsive drug-seeking behaviors and is relatively non-toxic.  

In addition to the studies mentioned above, psilocybin has also had positive effects on smoking cessation.9

It has also been shown to significantly decrease alcohol consumption in alcoholic patients.10

More studies need to be conducted to determine the optimal dose and frequency of psilocybin administration in treating psychiatric disorders. One thing is certain; we desperately need more treatments for anxiety and depression.  

If you have any comments regarding this post or any other, please feel free to contact me through the link in the author box below.

As always, have a happy week 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.

Gaslighting in Relationships, Is it Happening to you?

Are you being gaslighted in your relationship?
What is gaslighting?
How do you stop it?

Gaslighting describes a form of manipulation. In gaslighting, the manipulator convinces their victim that the victim’s thinking or thoughts are distorted. They proceed by convincing the victim that their (the manipulators) views are correct. This may lead to the victim questioning their sanity. The victim may start to question their thoughts, memories and experiences.

This term was born as a result of Patrick Hamilton’s stage play Gas Light in 1938. This play became a movie starring Ingrid Bergman and Joseph Cotton in 1944. In Gas Light, the husband slowly dims the lights in their home, powered by gas. When his wife asks about the dim lights, the husband insists that the lights haven’t changed, and she is making a mistake in believing so.

Is this a big deal?

Why worry about such a trivial thing?

The truth is gaslighting can have an impact on our emotional, psychological, and even physical health. How can we detect gaslighting and stop it from affecting us in a negative way?

The Signs of Gaslighting

The following are signs that may suggest that you are the victim of gaslighting.  

  • You often wonder if you are too sensitive.
  • You find yourself apologizing often.
  • You feel like something is wrong but can’t identify it.
  • You feel isolated from your friends and family.
  • You have a hard time making your own decisions.
  • You feel hopeless.
  • You are unable to experience pleasure from activities you enjoyed in the past.
  • You make excuses for your partner’s behavior.
  • You always think it is your fault when things go wrong.
  • You are becoming increasingly anxious.
  • You don’t feel like yourself anymore.
  • Your confidence has diminished.
  • You question the responses you give to your partner.

Although many of these signs are also present in depressive and anxiety disorders, the difference is that gaslighting involves another person. If you experience these symptoms with a specific individual, you may be the victim of gaslighting.

How to Fight Gaslighting

The first step to fighting gaslighting is recognizing that it is occurring. If you have any of the symptoms listed above ask yourself if they happen around everyone or just a particular person. As I have pointed out in previous posts, if you believe you are suffering from anxiety or depression and you feel like it is affecting your ability to live a meaningful, happy life, you should seek professional help.

Remember, mental disorders are no different than any other medical issue, they just affect a different organ. Never feel distressed about seeking medical attention for any reason. You deserve to be happy!

It may also be important to seek professional help if you are being gaslighted, especially if it involves someone who is hard to escape from such as a live-in partner. Many times, getting the advice of a third-party who can see the situation objectively is critical.

I also want to point out that many individuals with narcissistic personality disorder use gaslighting to manipulate their victims. You can read my blog post on narcissism by clicking here.

Gaslighting can lead to emotional, psychological, and physical unrest. It may also be one sign of an abusive relationship. Always remember that toxic people should be avoided at all costs.   

This post is meant to be a brief description of gaslighting.  There is much more to learn about this tactic.  If you want a more in-depth view, I suggest reading “The Gaslight Effect:  How to Spot and Survive the Hidden Manipulation Others Use to Control Your Life.” by Dr. Robin Stern. 

My suggestion is to work on your personal development daily. Here are some ideas:

  • Remind yourself that you deserve to be happy.
  • Read at least a few pages in a positive motivational book daily.
  • Start and end your day by being thankful for what you have.
  • Consider starting a gratification journal.
  • Exercise and eat healthy, whole foods.
  • Spend as much time as possible with your happiness elements.

If you make a commitment to spend some time on yourself each day, it will pay off.

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

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.

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

 

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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

Behaviors:

  • 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:

https://www.eatingrecoverycenter.com/

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.

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

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

5

6

 

as well as attempts,7

8

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:

 

800-273-8255

 

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.

Ideas for Limiting Screen Time for Tweens

Do your children spend too much time on electronic devices?  

Are they tuned out of everything besides their phones, tablets, and Television?

What can you do to stop this?

What effects may too much screen time have on your kids?

My wife and I have struggled with this issue for many years. If you let your children spend too much time on their devices, you feel like they aren’t interacting enough with the outside world. They are also at risk of viewing inappropriate information and even can become victims of predators

If you limit their screen time too much, they have a tendency to drive you crazy. Although electronics should not be used for “babysitting,” most of us have become dependent on them for a little reprieve at times. This post is designed to give you some ideas on how to limit screen time effectively.

What are Tweens?

Tween is short for tweenager. A tween is a child between 9 and 12 years of age. These kids are in a transition period between small children and teenagers. Many challenges occur during this period, including:

  • Puberty may start resulting in body changes and mood swings.
  • Peer pressure to engage in dangerous activities often occurs during this time. 
  • Tweens are often coerced into using illegal drugs or having sex. 
  • The increased workload at school occurs. Homework can take many hours per week to complete.
  • Tweens become more concerned with their appearance and social standing.

These kids are also very fond of their electronic devices. 

I am sure you are aware that they begin using them at earlier ages as time progresses. If left unchecked, these kids will likely spend most of their time staring at a screen.

Harmful Effects of Too Much Screen Time

There is much debate as to the effects of too much screen time on our developing children. It is beyond the scope of this post to go into all of the studies regarding this topic. My philosophy is anything that interferes with basic human needs can be detrimental. 

These basic needs include:

  • Social interaction.
  • Adequate sleep.
  • A healthy, well-balanced diet.
  • Exercise.

It is clear that too much screen time can have a negative effect on all of these. In addition, other problems can arise based on what the child is watching on the screen. 

My opinion is that screen time should be limited to keep our kids from missing out on the basic needs listed above. 

I am writing this post to help parents with this daunting task.

Ideas to Limit Screen Time

I have researched this topic and will list what I believe to be the best techniques to limit screen time. Please remember that these are not the only options, but ones that I believe are the best.  

Identify time periods where electronic devices are not allowed

The first step in limiting screen time is to identify “blackout periods.” These can be whatever you, as a parent, decide. Some examples are.

Meal periods – I believe meals should be family time. We have a rule in our house prohibiting electronic use during dinner. 

This should be a time to discuss what happened during the day. Remember to role model this behavior. If you are talking on the phone or texting during dinner, it is hard to convince your children not to do the same.  

Before Sleeping – You have probably heard that using electronic devices just prior to sleep decreases sleep quality.1

My suggestion is to take the devices away from your children at least one hour before bedtime. There are several reasons for this.

  • Evening exposure to LED-backlit screens has been shown to decrease melatonin levels and decrease daytime alertness and cognitive performance.2
  • Having a phone or tablet close by while sleeping increases the risk of nocturnal awakening. Phones may ring at night, and tablets may produce sounds due to various apps.
  • The fact that the device is available to the child may result in them waking up earlier to begin using it.

Family time – Holidays and special occasions should be a time to interact with family and friends. This may also include vacation time. Make specific rules around screen time during these periods and stick to them.  

Encourage Exercise and Outdoor Activities

One way to limit screen time is to send the kids outside to play. My family invested in a full-size trampoline to help with this. You could also have them help in the garden or play sports with them. This also helps with exercise.   

Playdates with other kids is also an option. 

Anything that gets them moving works. 

Use Electronic Devices as Rewards

If your children believe they can use their electronics whenever they choose, it can be difficult to limit screen time. 

Change the rules and only allow screen time after homework, chores, and physical activities are completed. 

Remember, you are in charge, not them. 

They may squawk at first, but they will survive.

Not only will this result in less screen time, but it will also incentivize your children to get their work done.

Consider Third Party Programs to Help

There are programs available at reasonable prices to help parents keep their children safe on-line. One such product is bark. This program can:

  • Monitor texts, email, YouTube, and 30+ apps and platforms
  • Get alerts for issues like cyberbullying, on-line predators, suicidal ideation, and more
  • Manage screen time
  • Filter which websites your kids can visit
  • Keep up with kids with location check-ins

Another product is Net Nannytm This program also manages screen time and can block inappropriate content from reaching your children.

I am not affiliated with these companies in any way but believe their products are useful. You can find these and other products by doing a simple Google search.

Kids love electronics. I remember how excited my brother and I were when we opened our first video game console back in the dark ages. Pong was a game where each person had a flat paddle and moved it up and down the screen, trying to hit the moving square.  

Video games are much more sophisticated these days. 

They are designed to keep players engaged for hours. I am sure if these were available when I was younger, I would have been hooked as well.

As parents, we must protect our kids from all threats. Too much screen time can rob our children from some of their basic needs. It is essential to model the behavior we want our kids to display. I spend a lot of time on my phone, but it is almost entirely work-related. Even though this is the case, what my kids see is me on my phone most of the time. It is difficult to make them stop doing something that you are doing yourself.

Try to spend time with your kids doing things that don’t involve screens.  

  • Play board or card games.
  • Take a hike in the woods.
  • Visit the beach.
  • Play sports with them.
  • Bake goodies with them.
  • Read a book to them.

There are many activities that can be done without electronics.  

Finally, if you are worried about what your children are being exposed to or want some help managing their screen time, consider purchasing a program like bark or Net Nannytm. These can

filter out damaging content and alert you when your kids are doing inappropriate activities on-line.  

Electronics are not going away any time soon. These are just a few ideas to help your children grow up happy and healthy. If you have any comments about this or any other post, please send me an email.

Until next week, be happy, healthy, and 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.

Malignant Narcissistic Personality Disorder

Although malignant narcissistic personality disorder (MNPD) is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), it is used by many clinicians to describe a subtype of narcissistic personality disorder (NPD).

Campbell’s Psychiatric Dictionary states that MNPD combines characteristics of Narcissistic Personality Disorder (NPD), Antisocial Personality Disorder (APD), aggression, sadism and paranoia.

Let’s take a look at these separately.

What is Narcissistic Personality Disorder (NPD)?

A person with a narcissistic personality disorder is one who has a desire for admiration and has an over-inflated sense of worth, knowledge, power, or identity. They must possess at least five of the following characteristics.

  • Has feelings of entitlement.
  • Seeks admiration.
  • Has an exaggerated sense of self-importance.
  • Appears outwardly arrogant.
  • Is preoccupied with beauty, success, power, or brilliance.
  • Lacks empathy. Is unable to identify with the feelings of others.
  • Exploits others for personal gain.
  • Wishes to only associate with others who are successful.
  • Is envious of others and may believe others are envious of him/her.

NPD patients depend on positive feedback from others. If they don’t receive admiration, these individuals may become angry, anxious, or depressed.

It is common for those with NPD to be controlling. They often detach emotionally from others and have minimal or no concern regarding the impact of their behavior.

The opinions and views of others are ignored if they differ from their own. They do not respond well to change and are insecure and vulnerable. These people tend to have a difficult time managing their emotions and responding to stress.

It can be challenging to diagnose this condition because of the difference in presentation between individuals. Some may be shy and avoid contact with people, while others are grandiose and outgoing.

The critical thing to remember is these people have little self-esteem and have problems regulating their emotions.

Antisocial Personality Disorder (APD)

People with Antisocial personality disorder have little to no empathy. They often abuse others both physically and emotionally. Diagnosis of APD is made after at least three of the following are present:

  • Inability to follow through on commitments or obligations.
  • Use of deceit, seduction or charm to achieve goals
  • Inability to conform to cultural norms or lawful, ethical behavior.
  • Lack of remorse for others suffering.
  • Persistent or frequent anger or aggressive behavior.
  • Seeks immediate gratification and is impulsive.
  • Engages in risky, dangerous, and self-damaging activities.

 

Aggression

Aggression is not a condition but a behavior. It generally occurs in response to anger. Aggression is a hostile or violent behavior or attitude directed toward another person. Many factors may contribute to aggression, including mental health, family structure, relationships, environment, and family structure.

Sadism

Sadism is the tendency to derive pleasure from inflicting pain, suffering, or humiliation on others. This pleasure is often sexual in nature.

How is NPD Treated?

The first-line treatment of all personality disorders is psychotherapy. For MNPD, cognitive therapy is the starting point. The recommendation is to offer group-based cognitive and behavioral interventions to target impulsivity, antisocial behaviors, and interpersonal weaknesses.

The use of medication is reserved for specific behaviors related to cluster B personality disorders:

Anticonvulsants/mood stabilizers – These may be used for impulsive and violent behavior, although there is limited data to support their use.

Lithium 1200 mg/day (target level = 0.6-1.5 mEq/L)

Phenytoin 300 mg/day

Divalproex 750 mg/day

Carbamazepine 450 mg/day

Stimulants such as methylphenidate have been used for inattention, impulsivity, and irritability. There is a high risk of abuse, so these medications are rarely used.

SSRI’s can be useful for aggression, hostility, and impulsivity.

Sertraline – 25-50 mg/day titrated slowly to 150-200 mg/day.

Fluoxetine – 20 mg/day slowly titrated to 60-80 mg/day.

Benzodiazepines should only be used in crisis situations due to abuse potential and an increased risk of suicide in these individuals.

Malignant narcissistic personality disorder is a condition brought about by emotional dysregulation. They have a fragile ego and must receive positive feedback from others. These individuals can be dangerous when things don’t go their way. Many have little regard for the feelings of others and often are controlling. They often exploit others for their own personal gain.

Unfortunately, most of these people will not seek treatment because they believe the problem stems from others. They have an exaggerated sense of self-worth and prefer to be surrounded by influential people. They are shallow when evaluating others and often put too much emphasis on looks.

Personality disorders are the most difficult psychiatric conditions to treat because they are the result of coping mechanisms created over many years. The only hope is to retrain these individuals to react to their environment in a healthy way. Group therapy is often the best method of achieving this.

Medications can be helpful for specific symptoms, but I have observed little success of medications used for personality disorders.

If you are in a relationship with a narcissist, be sure to protect yourself. These individuals can be dangerous and may get gratification from hurting you. Follow your instincts. If you feel threatened, get out of the relationship.

Remember, people with mental illnesses are no different than those with heart disease, diabetes, or cancer. They have a disorder that affects the brain. As a society, it is our responsibility to take care of them. If we don’t, we will all suffer the consequences.

If you have any questions, please send me an email. This is a difficult but important subject. Be healthy, be happy, and most importantly, be 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.

Is Aspartame Sweetener Bad for You

What is aspartame?

Is it bad for you?

My favorite soft drink is Diet Coke. Diet Coke is sweetened by a substance called aspartame. I have been trying to improve every aspect of my life regarding health choices. One thing I plan to change is what I choose to drink. 

Not surprisingly, water is going to be my main drink going forward. Water can be flavored using fruit for a different taste. Stay tuned for a future blog post on different ways to enjoy the healthiest drink on the planet!  

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.

What is Aspartame?

Aspartame is an artificial sweetener marketed under the following names:

  • NutraSweetTMCanderelTM
  • EqualTM

This substance is found in over 6,000 food items and is consumed by millions of Americans daily.1

 

2

 

3

Aspartame is found in many diet soft drinks, chewing gum, and vitamin supplements. It is not a good sweetener for baking because it breaks down and loses most of its sweetness when heated.  

Aspartame is a dipeptide of two natural amino acids, L-aspartic acid, and L-phenylalanine. After ingested, aspartame is broken down into-

  • Aspartic acid
  • Phenylalanine
  • Methanol4
  • Formaldehyde5
  • Formic acid

Aspartame and your Health

Aspartame has been a subject of controversy for years. Many believe that this sweetener is hazardous to one’s health. We will take a look at some of the available studies.

Effects on the Brain

The metabolism of aspartame mentioned above may lead to the following effects on the brain.

  • Phenylalanine acts as a regulator of neurotransmission.6

  • Aspartic acid is an excitatory neurotransmitter 7

Studies have shown a decrease in the production of dopamine and serotonin following aspartame ingestion. 

This is believed to be caused by an increase in aspartic acid and phenylalanine.

8

 

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We know that aspartame also increases the permeability of the blood-brain-barrier altering concentrations of some substances such as dopamine in the brain. This change in dopamine concentration may lead to the pathogenesis of some mental disorders.10

Other researchers have concluded that these adverse effects of aspartame only occur at very high concentrations not generally achieved by typical aspartame consumption.

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A study published in April of 2014 tested the effects of high-aspartame meals (25 mg/kg/day) vs. low-aspartame meals (10 mg/kg/day) on spatial orientation, working memory, mood (irritability), depression and headaches.

This study was double-blind, and the subjects served as their own controls. They received either the high-aspartame diet or low-aspartame diet followed by a two-week washout period. During this washout period, they consumed their regular diet. After the washout period, they received the other aspartame diet (high or low).  

The treatment periods were eight days in length.

The results are shown in Table 1 below.

 

 

This study found that subjects showed weaker spatial orientation and an increased frequency of irritability and depression when consuming the high-aspartame diet 12

Another study by Walton et al. in 1993 also found high aspartame diets caused more irritability and depression. This study was not completed due to adverse reactions experienced by the study subjects.13

 

Aspartame and Cardiometabolic Health

An analysis of 7 trials (1003 subjects) was published in 2017. These subjects were obese, overweight, or hypertensive. This study found that artificial sweeteners, including aspartame, may be associated with increased body mass index (BMI) and cardiometabolic risk.14

More experimental studies are needed to compare different sweeteners with regard to BMI and cardiometabolic effects. At the current time, research does not support a benefit of artificial sweeteners for weight management.

 

 

 

Other Health Concerns Regarding Aspartame

Aspartame has been a controversial substance for many years. Here are some of the other risks reported with its use.

  • Lupus
  • Cancer
  • Multiple Sclerosis
  • Alzheimer’s Disease
  • Dizziness
  • Seizures
  • ADHD
  • Erectile Dysfunction (ED)

Some people have also reported headaches after ingesting aspartame. 

My recommendation for anyone suffering from headaches is to keep a journal. Keep track of what you eat and drink daily. When you have a headache, write down the time and severity in the journal.

Determine if patterns exist.

Are certain foods a possible trigger? 

If you are taking medications for psychosis or suffer from phenylketonuria, you should avoid aspartame.  

Please see my blog post on low glycemic sweeteners by clicking here. 

My research shows the most likely adverse effects resulting from aspartame consumption are weaker spatial orientation and an increased frequency of irritability and depression. These only seem to be a concern when consuming higher amounts of aspartame.  

Although aspartame has been blamed for many other negative health effects, the available research doesn’t support this.

I look at aspartame as a risk vs. benefit situation. 

Since there are other sweeteners available, I am going to limit my intake of aspartame. My goal will be to consume black coffee, water (flavored and plain), and AXIO.

I don’t feel the risk of consuming aspartame is currently worth the benefit.

As always, if you have any questions or comments, please let me know.

Have a great week, and be happy and 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.

 

 

How to Handle a Combative Dementia Patient

There are many challenges involved in caring for a patient with dementia. At times these patients may become combative. This is a regular aspect of the disease and may happen even in patients who were not aggressive earlier in their lives. 

How do you deal with combative dementia patients? 

I work as a pharmacist in a geriatric psychiatric unit. We care for these patients when caregivers are unable to. Our goal is to stabilize them and return them into the community.  

This post will give you pointers on what to do when faced with aggression from a dementia patient. 

Be Prepared and Keep Calm

It is essential to be prepared for unusual behaviors from dementia patients. Due to damage occurring in the brain, these patients often display unexpected behaviors.  

Be calm when they become aggressive and speak to them in a soft, comforting tone. Always remember that this is part of the disease process and not a personal attack against you. 

Although your instincts may lead you to retaliate when dealing with an aggressive dementia patient, this can make the situation worse. Try to learn from each situation and keep yourself and the patient safe. 

Try to Identify Possible Causes of the Aggression

There are some basic things to rule out when patients begin to act out. Be sure basic needs are met. These include: 

 Pain – uncontrolled pain can cause individuals to lash out. They often are not able to communicate. It is vital to look for non-verbal signs of distress, including: 

  • Facial grimacing. 
  • Moaning. 
  • Guarding certain areas or withdrawing from touch. 
  • Writhing or constant movement. 
  • Increase in blood pressure or respiratory rate. 

 

 Constipation-this can make anyone uncomfortable, including dementia patients. Be sure they follow a toileting schedule and pay attention to the frequency of bowel movements. 

 

Urinary tract infections– These can be a cause of pain and discomfort and are more common in elderly patients. Monitor the patient for smelly, cloudy, or discolored urine. If these signs appear and the patient is acting differently, they should be seen by a medical professional for an evaluation. 

Try to keep the patient comfortable. Maintain a reasonable room temperature and create a good place for the patient to relax.  

 

Sleep – We all can become grumpy if we don’t get enough sleep.  Follow the basic sleep hygiene guidelines listed below. 

 

  • Follow a sleep schedule. Try to get the patient to sleep at the same time each night. 
  • Avoid letting the patient take long naps during the day. 
  • Do not give the patient large amounts of fluid close to bedtime. This can increase nighttime awakening. 
  • Be sure the room where the patient sleeps is dark, quiet, cool, and comfortable.  

It is important to note that sleeping pills other than melatonin are not appropriate for dementia patients. Drugs such as diphenhydramine (BenadrylTM) and other sedating antihistamines make dementia worse. Read my blog post on anticholinergics and dementia for more information. 

 

 

Calm the Environment

Excessive noise and activity can agitate patients.  

The nurses on our unit are quick to ask staff to quiet down when it becomes noisy or hectic.

Keep music soft, and try to have people speak quietly.

If too many people are around the patient, ask some of them to relocate temporarily. If the patient is starting to act out, try moving them to a different room.

Keep track of what works and doesn’t.

Every patient is different. 

 

Redirect

Many times you can calm a dementia patient by merely redirecting them. Read them a story, show them pictures or watch a TV show with them. Avoid activities that demand too much thought or concentration. Most dementia patients will become frustrated if they are asked to participate in activities that are too difficult for them to perform. Find activities that the person enjoys. Redirection is one of the best tools available to you. 

Smile and be Kind

Sometimes a simple smile can do wonders—all of us like people to smile at us.

A gentle touch can also help.

Avoid startling the patient. Approach them from the front so they can easily see you coming.

Show them you care.   

Give Them Time Alone

If nothing seems to be working, consider giving the patient some time alone.

Be sure the patient is safe and keep an eye on them.

They may just need to cool down.

Some alone time in a quiet place may be what is necessary.  

Take Care of Yourself First

If you are taking care of a dementia patient, you will likely be under a lot of stress.

The most important thing for you to do is keep healthy, both physically and mentally.

You will not be an effective caregiver if you get burned out or become sick yourself.  

If you need a break, find help!  

Taking care of these patients often causes one to be up in the middle of the night. Try to find a family member or friend to help when needed.

We all need a break at times. 

Know Your Limits

In some cases, you may be unable to care for the patient yourself.

If the situation becomes unsafe for either you or them, it is time to consider placement into a memory care facility.

This is not a sign of failure on your part. We all have our limits. Memory care facilities are staffed with individuals who know how to care for your loved one. They take care of these patients every day.

Caregivers in these facilities are trained to recognize behaviors that require medication.

Remember, your health and well-being are important too. 

I have spent the last four years working on a unit that cares for geriatric patients with psychiatric issues. Many of these patients have dementia. There are several forms of this disease, but all of these patients become dependent on others for their care eventually.   

Working with these patients has been one of the most rewarding aspects of my pharmacy career. Being involved in the final chapter of a patient’s life has a special meaning to me. 

I hope this post has helped if you are caring for a loved one with dementia. I want you always to remember that there is help out there for you if you are struggling.  

Safety is always the most important goal.   

I have listed some resources below if you need help.  

You can always contact me with questions at [email protected].

If I don’t know the answer to your question, I will find it for you. 

 

 

Have a great week, and stay safe. Be sure to read our other blog posts to help you live a happy, healthy life, and please sign up for our newsletter below.   

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.

Alternatives to ADHD Meds – Dietary Supplements

Are you looking for alternatives to traditional stimulant medications to treat your child’s ADHD?

Is there a more natural way to treat ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopment disorder that is associated with the following symptoms. There are two broad groups.

Inattention that negatively impacts social, occupational, and or academic functioning.

Symptoms in this category include:

  • Forgetfulness
  • Distractibility
  • Inability to listen
  • Frequently loses items
  • Trouble organizing
  • Difficulty in maintaining attention
  • Not able to follow instructions or finish tasks
  • Avoids activities that require attention
  • Fails to focus on details or makes careless mistakes on schoolwork

Hyperactivity and impulsivity

symptoms include:

  • Excessive talking
  • Impulsive (doesn’t wait turn and blurts out answers)
  • Runs and climbs when not appropriate to do so
  • Cannot remain seated
  • Fidgets or squirms in seat
  • Constantly on the go
  • Unable to engage in quiet activities

ADHD was estimated to affect 9.4% of children in the US, according to a national parent survey in 2016. 

Of these children, 77% were receiving treatment. This treatment was as follows:

  • 30% treated with medication alone.
  • 15% received only behavioral treatment.
  • 32% received both medication and behavioral treatment.

NSCH 2016: Redesigned as an online and mail survey, estimate includes children 2-17 years of age. 1

Is there a reasonable alternative to stimulants for these children?

Polyunsaturated Fatty Acids (PUFAs)

Omega-3 fatty acids must be obtained through our diet. The following foods are high in this substance:

  • Fish (salmon, trout, sardines, halibut, herring, albacore tuna)
  • Walnuts
  • Flaxseed oil
  • Canola oil

Other foods that contain omega-3 fatty acids are:

  • Clams
  • Shrimp
  • Catfish
  • Cod
  • Spinach

The Western diet consists of a higher quantity of omega-6 fatty acids. Foods that contain omega-6 are poultry, eggs, cereals, nuts, whole-grain bread, and durum wheat.  

Why is this important in ADHD?

One meta-analysis that contained ten trials, including 699 children with ADHD found that PUFA supplementation produced a small but significant improvement compared to a placebo group.2

A significant relationship was also shown between the eicosapentaenoic acid (EPA) dose within the omega-3 supplements, and the efficacy obtained.3

The mechanism of action of the omega-3 in the treatment of ADHD is likely due to its effect on serotonin and dopamine neurotransmission.4

There have been other systemic reviews that have raised questions about the use of omega-3 supplementation in the treatment of ADHD.5

 

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The methods in these reviews were different, which may have led to altered results.

I believe an omega-3 supplement is worth a try. The possible benefits seem to outweigh the risks involved.

Melatonin

Melatonin is a hormone produced by our bodies to regulate circadian rhythm. Adults and children have used melatonin as a sleep aid. 

As a pharmacist, it is the first-line medication for sleep that I recommend. Melatonin has very few side effects and is non-addictive.  

We know that sleep problems are common in children with ADHD. We also know that a lack of sleep can cause symptoms such as hyperarousal, disinhibition, and executive function problems that mimic ADHD symptoms.

The two studies I located showed melatonin was effective for sleep but had no effect on ADHD symptoms.

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Iron

A meta-analysis published in 2012 found that children and adolescents with ADHD had lower serum ferritin levels than healthy controls.

9

A small randomized, placebo-controlled study showed children with ADHD, and low serum ferritin levels demonstrated significant improvement when receiving ferrous sulfate (80 mg/day) compared to placebo.

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More studies with a larger sample size are needed before iron can be recommended as a standard treatment of ADHD.

Pycnogenol

Pycnogenol is an extract obtained from the bark of the French maritime pine. Pycnogenol was the subject of the very first post I made to this blog. You can read this post by clicking here!  

Case reports have shown Pycnogenol can improve ADHD symptoms either alone or in combination with psychostimulants.  

A four week randomized, placebo-controlled trial of 61 children found Pycnogenol significantly improved ADHD symptoms according to the Child Attention Problems (CAP) teacher rating scale.

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A significant improvement was not found using Connor’s Parent and Teacher Ratings, but trends were similar to CAP.

This study also found lower catecholamine levels in the urine of the pycnogenol subjects suggesting a possible effect on catecholamine formation or metabolism.

More studies are needed to determine the safety and efficacy of Pycnogenol in the treatment of ADHD.

Parents are often reluctant to put their children on medications to treat ADHD. At times, this leads to the use of nutritional supplements that are ineffective in the treatment of this disorder.While researching this topic, I discovered supplements such as St. John’s Wort, carnitine, and Gingko Biloba either were ineffective or had minimal evidence to support their use in the treatment of ADHD.

These substances may also produce unwanted side effects.

Zinc can be useful when a deficiency exists, but this is rare in the United States. There have been studies in Israel, Turkey, and Poland demonstrating lower zinc levels in children diagnosed with ADHD. 

Correcting this deficiency of zinc can improve ADHD symptoms.

Magnesium supplementation has been tried, but no randomized, placebo-controlled trials are available to support its use.

Iron supplementation has shown to be effective in one small study. 

Pycnogenol has also shown positive results although more studies are needed to confirm its benefits in the treatment of ADHD.

The most robust evidence available at this time is for omega-3 fatty acid supplementation in the treatment of ADHD and melatonin for sleep-onset insomnia.

The Omega-3 fatty acids are still not as effective as traditional ADHD medications, but they may be beneficial in those with mild symptoms. 

Melatonin is always my first recommendation for patients of all ages for insomnia.

Please feel free to send me an email if you have any questions regarding this post or any other subject regarding medications, diet, fitness, or happiness.  

Don’t forget to sign up for our newsletter below. This monthly newsletter will give you information on our company, influencers, exclusive coupon codes, and much more.

Have a great week, and please stay safe out there!

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.

 

 

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

 

5  

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

12

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.

 

 

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