Pharmacist Michael

Michael J. Brown, RPh, BCPS, BCPP

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

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

Posted on June 19, 2020June 19, 2020 by Michael Brown

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:

NutraSweet^TMCanderel^TM
Equal^TM

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

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

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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

⁹

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.

¹¹

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.

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

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.

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!

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Michael J. Brown, RPh, BCPS, BCPP

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

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How to Handle a Combative Dementia Patient

Posted on May 25, 2020March 5, 2023 by Michael Brown

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.

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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.

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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.

https://www.dfamerica.org/resources https://www.alz.org/help-support/caregiving

https://www.aplaceformom.com/blog/list-of-alzheimers-resources-3-06-2013/

https://www.alzconnected.org/

https://thecaregiverspace.org/

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.  

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Michael J. Brown, RPh, BCPS, BCPP

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

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

Posted on May 22, 2020June 3, 2020 by Michael Brown

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

⁶

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.

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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.

⁷

⁸

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.

¹⁰

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.

¹¹

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.

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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.

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Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

N-Acetylcysteine for Anxiety, Depression and other Psychiatric conditions

Posted on May 19, 2020March 5, 2023 by Michael Brown

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. UpToDate^TMlists 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.

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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!

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Michael J. Brown, RPh, BCPS, BCPP

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

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.

Gratitude Unlocks the Fullness of Life

Posted on May 12, 2020May 22, 2020 by Michael Brown

The COVID-19 virus has changed our way of living. People are tired of being cooped up in their houses. Most of us are used to being able to socialize, go out to dinner, ship our kids off to school and visit friends and family. During this time, I believe it is important to stop, take a deep breath, and think about the positive things we enjoy daily.

This post is about gratitude. One of the keys to happiness. Any situation can be looked at in different ways. Remember, your glass can be half full or half empty. I am going to share some techniques I use to help change my mindset. These are just a few examples. Find what works best for you. The key is to train your mind to look at the positive aspects of a situation rather than concentrating on the negative. It takes work but it is time well spent.

The Gratitude Journal

It is easy to forget all the great things about our lives. One of the best ways to keep positive thoughts alive in your mind is to create a gratitude journal. This is a very simple process that anyone can do in just a few minutes per day.

I recommend journaling when you first wake up, right before falling asleep, or both. Starting your day off by counting your blessings will allow you to begin your day on a positive note. This doesn’t have to take a lot of time. Just list different things you are grateful for each day.

Journaling just prior to sleeping helps to calm your mind. It can lead to a better night of sleep. Just write down the things that made you happy during the day. What did you do well? List accomplishments. Review your day and jot the positive aspects down on paper.

Take a Break to Appreciate Nature

This has become my number one tool for decreasing anxiety and feeling better about the world we all live in. With everything going on lately, it is very easy to focus on negatives. Please give this a try.

Take a break to go outside and look around at what nature has to offer. Feel the suns warmth on your skin. Listen to birds sing. Actually study a flower or leaf. Pay attention to the details of their beauty.

No matter how your day is going, realizing how spectacular our world is can change your perspective. If you visit nature on a consistent basis, you can actually change how you feel. This is one of the reasons people enjoy hiking so much. The world we live in is truly a beautiful place.

Take pictures of flowers and trees. The photos posted at the beginning of this segment are just a few of the beautiful aspects of nature I have observed this year.

Don’t Forget the Gratitude Quotes

I have made a habit of reading positive quotes daily. This started as a strategy to find content for Instagram posts. I learned that this habit changed my perspective on life. It is another way to place positive information in your mind. These quotes can be found on the internet in seconds. You can also find them at least every other day on my Instagram feed @sunshineNTC.

I often share them with my wife and coworkers. It has helped my mindset. Sometimes it is the simplest things that cause the most impact.

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The Power of Prayer

Do not underestimate the power of prayer. Connecting with your creator on a daily basis can change your life for the better. Take this time to thank God for the life you live and the world you live in. Instead of praying for a better life, consider being thankful for what you have. Your family, friends, job, house and everything you own can bring you joy if you think about things in the right way. If you are not a religious person, this can also be accomplished with meditation.

It is about spending some quiet time to collect your thoughts.

There are many ways to meditate and I plan to write an entire blog post on this subject in the near future. Clearing your mind with meditation has many positive effects on both the mind and body.

Celebrate Thanksgiving Everyday

One of our family’s Thanksgiving traditions is to go around the table and explain to the group what we are thankful for.

What if you did this each night at the dinner table? Start with the youngest and ask them what they enjoyed about their day?

What things made them feel good?

Did they learn anything new?

What are they thankful for?

We like to begin our dinner with a prayer usually spoken by our youngest. This is another way to celebrate the blessing we enjoy every day.

Smile

One of the best things to remember is that smiling makes you happy. This is true even if it is forced. It is also true that smiling at others makes them feel good as well. It is a win-win. You also feel good knowing you made someone else happy even if it were for only a short time.

I like to start each day by looking in the mirror, smiling and telling myself it is going to be a great day. It is quick, easy and it works.

Make it a practice to smile at everyone you walk by. Pay attention to how this makes you feel. I believe you will see a big difference.

Living each day with gratitude is not difficult. It doesn’t take much time. It won’t disrupt your schedule. What it will do is make you feel better about your life. It will increase happiness. The people you associate with will be able to detect a difference in your mood.

If you commit to trying the simple techniques outlined in this post, you will become a more likeable person. You will look forward to each day, have more energy and sleep better. Being grateful is one of the keys to happiness. Give it a try, you will be glad you did.

Thank you for reading my blog post. Please take some time and browse our website. If you have any questions, let us know. Sign up for our newsletter to get up to date information on our company. Meet our ambassadors. Receive discount codes and learn something new.

As always, I hope you and your family have a great week. Stay safe! I will see you all here next week.

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Michael J. Brown, RPh, BCPS, BCPP

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

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Somatic Mindfulness Exercises to Reduce Stress and Anxiety

Posted on April 7, 2020April 7, 2020 by Michael Brown

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Can somatic mindfulness exercises help me?

Are they hard to learn?

What are the benefits?

Mindfulness has become a popular subject for therapists as well as those seeking self-help ideas to treat anxiety disorders and decrease stress and frustration of daily living. The COVID-19 outbreak has increased interest even more.

Mindfulness is the ability to be present in the moment without judgement. Paying attention to the simple things that we often take for granted. It is an amazingly simple idea that can really pay off.

In this post, I am going to explain a few somatic mindfulness exercises you can do to help control anxiety and improve mental health. These are simple to do and, as with most everything else, practice makes perfect. If you work on these regularly, you will find them to be very useful.

A Scan of Your Body – C. A. L. M.

This is something I practice often and I find it to be very beneficial for those times when I feel irritated or overwhelmed. This works best in a quiet place with minimal distractions. C.A.L.M. helps you remember the large zones of the body to focus on.

Before beginning, get comfortable in any position that suits you at the time. If possible, lay down. I find this to be most relaxing but understand it isn’t always convenient. Close your eyes and take a few slow deep breaths.

Chest: The first region of the body to concentrate on is your chest. Pay close attention to your breathing. Notice how your chest rises as you breathe in and falls as you exhale.

Are you breathing fast or slow?

Attempt to regulate the speed of your breathing. Keep it slow and steady. As you regulate your breath, your mind and body are also under your control. You begin to relax. Imagine your stress and anxiety leaving your body with every exhaled breath.

After a few breaths, take a deep breath and tighten all muscles in your chest. Hold this for three seconds concentrating on how it feels to be tense. Finally, allow all your muscles to relax and notice the tension leaving your body with each breath. Continue to breathe slowly and evenly as you allow your body to fully relax.

Arms: Focus on your arms. Using your mind, scan each arm from your shoulders all the way down to each fingertip.

How do your arms feel?

Are they tense, relaxed, warm, cold?

Spend a little time concentrating on just your arms. If you feel any tension, attempt to relax.

After a couple of minutes, squeeze each fist and flex all the muscles in each arm tightly. Finally, release the tension in your arms and relax each hand. Take a few breaths and notice the feeling of calmness. Let your body relax as you slowly breathe in and out.

Legs: Next, focus your mind on your legs from your hips all the way down to your toes.

How do they feel?

Are they weak, shaky, warm or cold?

Are your legs telling you anything about your level of stress or anxiety?

Begin to squeeze your muscles starting at your feet and extending up to your hips. Hold this tension for a few seconds and then release.

Notice how you feel when the tension is released. As you breathe, imagine all the tension from each leg and foot leaving your body.

Mouth: The last area to focus on is your mouth and jaw. Many of us tense muscles around our mouth when we are anxious without realizing it.

What expression is your mouth communicating?

Is this a result of stress or anxiety?

As before, clench the muscles around your mouth and jaw for a few seconds and pay close attention to the feeling. Relax your muscles and with your eyes still closed, smile.

Enjoy the feeling of relaxation as your breathing helps to remove stress from your body.

Continue to breathe is this relaxed state thinking about the areas where you noticed evidence of stress and anxiety or tension. As you breathe, imagine the tension leaving your body with each breath.

This exercise can be a life-changing skill once developed. With practice, you will be able to close your eyes and imagine the stress and tension leaving your body just by breathing.

You can train yourself to identify tension in different areas of your body and remove it using your mind.

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Grounding Exercises

Heel drops: In this exercise you will start by standing. Slowly lift up your heels so you are standing on your toes. Return to your standing position. Do this repeatedly in a slow, rhythmic pattern. Pay attention to how your hips and lower back feel while doing this exercise. Each time you return to a standing position, imagine stress and tension leaving your body.

Bamboo Swaying: In this exercise you will stand and allow your body to slowly sway back and forth like a bamboo in the wind. The rocking motion helps to relieve tension. If you feel little tremors through your body while doing this exercise, do not be alarmed. This is one of the ways your body releases tension.

It is important to take a moment to scan your body after these grounding exercises to see how you feel.

Do you feel more grounded?

More connected to the earth below?

Do you feel less tension or stress?

Other Ways to Practice Mindfulness

In today’s society, most of us are used to doing more than one thing at a time. This can lead to frustration, anxiety, burnout and even depression. Trying to take care of our families, get our work done, prepare meals and keep the house clean can feel overwhelming. One of your goals should be to try to do one thing at a time. This can be learned by taking small steps.

Make a list of what needs to be done starting with the most important tasks. Begin with the first task on the list and try to let go of distractions that come your way. I suggest silencing your cell phone and computer email during this time.

If you find yourself worrying about different things or thinking about something else, take a few deep breaths and imagine those thoughts leaving your mind with your breathing. If you find yourself doing more than one thing at a time, stop, and choose the thing on the top of the list and return to it. This can be difficult at first but will become easier with practice.

Tell your intrusive thoughts to leave your mind. Keep doing this until you get results. There are several exercises that can be done to help you succeed. Start to notice times where you are thinking about one thing only.

How does this feel?

Here are a few things that can be done to practice focusing on one thing only. Try to do these exercises several times each day, especially when you are feeling stressed or overwhelmed.

Watch a fire. This can be in your fireplace or a campfire. Don’t think about anything, just watch.
Watch the raindrops running down a window.
Listen to the ticking of a clock.
Listen to the ocean waves.
Breathe mindfully as explained above.
Watch trees blowing in the wind.

I also like to take a walk outside and observe nature when I get stressed. Concentrating on something as simple as the beauty of a leaf or the bark on a tree can change your mindset.

With practice, somatic mindfulness can become an important tool to fight stress, anxiety, depression and burnout. We started with breathing which I believe to be a very important first step to calm the body. A few months ago I wrote a post on anxiety. This would be a great time to review that article. It has more information on breathing techniques and other ideas to help relieve stress and anxiety. When these exercises aren’t enough, don’t forget about our Anxiety Formula. This is the best-selling product in our store and our customers love it. Take a look at this video recorded by a friend of mine who uses the product.

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We can all live a more productive, enjoyable life if we take some simple steps to take care of our mind and body. You are reading this because you are committed to be a happier and healthier person. Remember what I have been telling you all:

Get plenty of sleep.
Drink eight, 8 ounce glasses of water daily. More if you are sweating (exercise or hot weather).
Eat whole foods – stay far away from fast food, junk food and empty calories.
Exercise – Stay active. Find an exercise you like and do that activity for at least 30 minutes, 5 days per week.
Avoid alcohol and drugs. If you need a reminder why you shouldn’t drink alcohol, read my article on ethanolism.
Think positively and surround yourself with positive people.
Spend as much time with your happiness elements as possible!

That is all for this week. I hope you are all staying safe during this COVID-19 outbreak. PLEASE STAY HOME if you are not an essential worker. This virus has turned out to be worse than we initially thought.

Wash your hands often,

maintain a six-foot distance from others, and

stay isolated until this virus runs its course.

We will get through this.

If you have any questions or comments, please feel free to contact me. I welcome any interaction from my readers. This blog is for you!

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Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

Bipolar Depression Treatment – Seroquel, Latuda, and Others

Posted on March 6, 2020March 6, 2020 by Michael Brown

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

7 Great Health and Psychological Benefits of Bonding with a Pet Dog

Posted on February 1, 2020April 2, 2020 by Michael Brown

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.

Does owning a pet dog make you healthier?

What are the benefits?

Pet Dogs May Decrease Child Anxiety

A study published in Preventing Chronic Disease in 2015 looked at several factors involving pet dogs and children. This was a cross-sectional study with 643 kids over the age of 18 months. The hypothesis was that pet dogs have a positive impact on healthy weight and mental health. The results of this study were:

Difference in BMI – No change
Screen time of 2 hours or less – No change
Change in physical activity – None noted
Change in the probability of childhood anxiety – 12% for those with dogs, 21% for those without dogs.

This study showed that having a dog in the home decreased the incidence of childhood anxiety.¹

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Dogs May Lower Hypertension and Cardiovascular Death Risk

Patients with hypertension are often started on antihypertensive medications to prevent heart disease. Unfortunately, most of these agents work on resting blood pressure but have little effect on physical and mental stress that can lead to hypertension.²

Studies have been performed examining the effect of pet ownership on hypertension in individuals with high-stress occupations. Since dogs are perceived by humans to be non-judgmental, they may be a healthy social support alternative. A study published in Hypertension in 2001, found that pets had a greater effect on sympathetic responses than did treatment with an ACE inhibitor which is a popular antihypertensive medication.⁴

Another study examined 4039 elderly hypertensive patients who responded to a pet-ownership questionnaire. Of these, 3490 owned at least one pet and 871 owned at least one dog. The investigators found those who owned pets were associated with improved survival and a lower risk of fatal cardiovascular incidents compared to those who did not own pets.

Owning a Dog May Increase Socialization

Owning a dog increases the chances of random interactions with other people. Many dog owners walk their pets and often meet other dog-lovers along the way, thus increasing the chances of stopping to have a quick chat. Humans love to talk about their pets, including those currently owned, as well as animals they have cared for in the past. It is well known that increased socialization improves mood. Many friendships have started in dog parks.

As the photo above shows, kids love to hang out with friends that have a dog! They are much more fun than toys!

Dog Ownership Can Add Purpose to Your Life

Owning a dog comes with responsibility. Caring for another living thing can bring purpose to one’s life and give an otherwise lonely person a reason to keep going. Dogs need to be walked, fed, groomed, and loved. They will always give more back in return than they receive. Dogs can be just what the doctor ordered for a lonely individual because it is much harder to give up on yourself and life in general when you have another living thing depending on you for their care.

Dog Ownership for Children may Decrease Incidence of Allergies and Asthma Later in Life

The hygiene hypothesis states that a lack of childhood exposure to various infectious agents, including parasites and bacteria, can increase the chances of developing asthma and allergies later in life.⁵

It is known that (Can f 6), which is an allergen found in canine saliva, is an immunomodulary protein that may promote airway hypersensitivity reactions such as asthma. Therefore, decreasing the sensitivity to this substance may lead to decreased asthma incidence.⁶

Unfortunately, many families avoid owning pets when the parents have allergies to them. This decreases the exposure of their children to the allergens that they are likely to be allergic to later in life based on genetic factors. It is also difficult to measure such an effect due to the vast array of allergens that may lead to asthma.

It is probably true that early exposure to dogs and cats will decrease the likelihood of being allergic to them as adults.

Service Dogs Can Decrease PTSD Symptoms in Military Veterans

There has been an increase in the use of service dogs for military veterans suffering from post-traumatic stress disorder (PTSD). This disorder is prevalent in service members returning from deployment overseas. It is estimated that 6-14% of all Operation Iraqi Freedom and Operation Enduring Freedom veterans who returned from Iraq or Afghanistan are affected by PTSD.⁷

⁸

PTSD also leads to other psychiatric conditions such as substance abuse, suicide and depression.

Although evidence-based PTSD treatment is effective for some, dropout and nonresponse rates may be up to 50%.⁹

¹⁰

¹¹

A study was completed comparing two groups of PTSD veterans. The control group, (Group A), were those waiting to receive a service dog but provided usual care and the treatment group, (Group B), were those receiving usual care and a service dog.

There was a total of 141 patients who completed the study. Sixty-six subjects received usual care while waiting for a service dog, while seventy-five subjects received usual care and were paired with a service dog.

The investigators came to the conclusion that the group paired with the service dogs showed less PTSD symptoms, reduced depression, and increased socialization as compared to those waiting for their service dogs.

Owning a Dog May Increase Exercise

Dogs love to go on walks. It is well-known that getting outside and being exposed to sunlight can decrease the chances of becoming depressed. Dog owners often feel the need to take their dogs on walks. This exercise is beneficial for both the dog and their owner, and may also be more enjoyable because the owner feels like he or she is doing something special for their “companion.” As I have stated many times in the past, any exercise is better than no exercise.

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I don’t believe anyone who has owned a dog is surprised by the many benefits they can provide. Canines are loyal, playful, and always happy to see you. They improve mood and help us get through some of our toughest days. They will never give up on you and provide unconditional love. Dogs help keep us active and may even save our lives. If you haven’t owned a pet dog, you really should give it a try. Visit your local animal shelter and find the perfect friend. They will love you even more than you love them. Life is too short to miss out on the happiness these furry creatures can bestow upon us.

If you have an active child as I do, dogs can help to burn some of their energy. Joshua spends hours chasing and being chased by Ginger in the backyard. The exercise is good for both of them, and gives mom and dad a break! Dogs do take some work and money to care for them, but I believe the investment is well worth it.

I hope you have enjoyed this post. Since our family just brought a dog into our home, I thought it was an appropriate time to write about this.

Any questions regarding this article or any other, can be entered into the comments section below. I will answer all of the questions posted. Thank you for reading and, if you like my posts, tell a friend.

Always remain as happy and healthy as possible.

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Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

Woman in sensory room holding fiber optics

Snoezelen Therapy for Dementia Patients

Posted on January 12, 2020January 15, 2020 by custom

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.

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.

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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

⁶

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.

Daily care routines such as bathing, feeding, and administering medications ⁷
⁸

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

Specially designed rooms or MSEs.¹⁰

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

Decreased agitation and disruptive behavior.
¹¹

¹²

¹³

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

Increased alertness¹⁴

Increased social interaction, reduced apathy, and better mood.¹⁵
¹⁶
¹⁷

Better communication with others.¹⁸

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.

²⁰

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.

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.

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Michael J. Brown, RPh, BCPS, BCPP

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