Category: Mental Health

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Snoezelen Therapy for Dementia Patients

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

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

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

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

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

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

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Assessing Unmet Needs

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

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

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

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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

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

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

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

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

  1. Specially designed rooms or MSEs.10

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

  1. Decreased agitation and disruptive behavior.

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

  1. Increased alertness14

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

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  1. Better communication with others.18

  1. Improved functional performance19

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

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

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This leads to improved patient care and reduced caregiver burnout.

Obstacles to Adding a Snoezelen Room to a Facility

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

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

Perspectives of an Expert

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

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

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

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

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

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

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

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

Michael Brown pictured with Final Thought written

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

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

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

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

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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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Blissfulness – My Secrets To Happiness

Posted on by sunshineneutraceuticals

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 there a secret to happiness?

Why am I always sad?

What can I do to improve my mood?

Is there hope for a happy tomorrow?

We all want to be happy. There is no emotion more sought after than happiness. It is surprising to me that, although we all want it, most of us do not take the time to research ways to obtain happiness. What if I told you it isn’t that hard to achieve? I am going to ask you to read this post, commit to trying some of the simple exercises outlined, and spend some time each day working on your happiness.   

 

I made happiness one of my New Year’s resolutions a few years back. I bought some books, read them, and tried to make Mike a happier person. It was well worth the effort. It has been life-changing for me.   

My goal is to make all of my readers happier and healthier. I hope you enjoy what you are about to learn. 

Practice Mindfulness

Start to be more conscious of your surroundings. Enjoy the beauty of nature and pay attention to the pleasant colors and smells you encounter during the day. Smile as you realize how blessed you are to be part of this gorgeous planet. Be aware of your surroundings without judging. 

 

Spend more time concentrating on the positive aspects of your day. Take a few minutes each day to focus on your breathing. Use this time to relax and relieve any stress you may be feeling. Be aware of your senses by watching a bird in flight, feeling the warmth of the sun on your face, tasting and appreciating fresh water.

 

Being mindful helps put things in perspective. It may help change the way you think. Make it a priority to practice this several times daily. Set the alarm on your phone to remind you. This is the first step to the new you! 

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Re-Frame Perceived "Negative" Circumstances and Smile

Have you heard the quote 

 

“If it won’t matter in five years, don’t spend more than five minutes being upset about it”?

 

This little tidbit can save you from countless hours of frustration and decreased mood. There are many things beyond our control. I used to get very upset about traffic and, to be honest, still do at times. I have tried to start using this time in a positive way. 

 

You can, too, by listening to your favorite song or downloading some books to listen to. Always remember, things could be a lot worse. If you can turn negative situations into positive ones, happiness will be more plentiful in your life. 

 

If you have no control over what is happening to you, try to find a positive spin to it. This can take practice, but it can improve your level of happiness.  

 

Force yourself to smile in times of sadness. This helps in two different ways. First, your brain perceives you as being happy when you are smiling. Secondly, people who are around you will tend to smile back. This helps reinforce a positive mood. Try it, smiling works! 

Eat Whole Foods

The main thing I learned while on the Whole30 diet was that if you eat only whole foods, you will feel much better. Your diet has more to do with how you feel than you might think as it can affect your entire body in many ways. If you read my post on the Gut-Brain Axis, you already know how important this is. 

 

I am not advocating staying on a restricted diet such as the Whole30 forever, but try to consume more whole foods and less processed foods. Stay away from fast food, drink a lot of water, and try to get several servings of fruits and vegetables each day. A little planning goes a long way. 

  

You really are what you eat in more ways than one. If you want to know how much better you can feel, try the Whole30 diet. It is not easy but will give you an appreciation of how better eating choices can improve various aspects of your life. I highly recommend the Whole30 experience! 

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Happiness Elements

I have written about happiness elements several times. We are all different. What makes me happy likely will not make you as happy.

 

I am going to give you a simple exercise. Take some time to think about the five things that make you the happiest. These can be people, places, activities, etc. Do not list material things on this list.

 

After you have identified your five happiness elements, devise a strategy to spend more time experiencing them. This one small activity can boost your mood. The more time you spend with the elements that make you happy, the better! This seems simple, but many of us don’t take advantage of it.

 

Most of us are happy spending time with the people and pets we love. Dogs, especially, will give you unconditional love. They can make a difference in your mood. I believe strongly in this process as it has helped me in my quest for happiness. 

Surround Yourself with Positive, Happy People

If you can avoid hanging out with pessimistic, negative people, do it. The negativity will rub off on you.

 

We have all worked with this type of person. Everything is terrible, complaints never stop, and they wear you down.

 

If you do have to work with this personality type, remind them that their life isn’t that bad. Better yet, if they are that unhappy, maybe they should be doing something else. Life is too short to be miserable.

 

Perhaps you can be the catalyst that makes them change for the better.

 

It is known that optimists are happier than pessimists. It is possible to change your mindset to become more optimistic. Optimists also live longer. Always try to find the positive aspects of a situation.

 

When you start feeling pessimistic, practice the mindfulness techniques described above. It takes some work, but you can make yourself happier! 

Start A Gratitude Journal

One of the best perks of working on a psychiatry unit is getting tips from therapists. These professionals are always able to come up with a solution to any problem you might be facing. I was recently reminded of the benefits of a gratitude journal. Just thinking about the things you are grateful for can change your mood.

 

Each night before bed, write a few things in your journal that you are thankful for. This is also a good thing to discuss at the dinner table. Go around the table and have each person talk about something they were grateful for that day. Concentrating on the positive aspects of your life is a great mood booster.   

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Money Only Takes You So Far

Studies show that money only increases happiness until you reach about $75,000 per year. This is likely because once basic needs are met, material things only make people happy for a brief period.

 

Many individuals who win the lottery fall back to their baseline happiness level within five years.

 

Most people believe being rich will make them happy but the studies do not support this notion. Think about how you felt when you bought a new car. It feels great at first, but over time, it is just a car. Read this sentence carefully;

  

 Money does not make you happy! 

 

There is an exception to this. If you give money to an organization you believe in, this can make you happy. More money only increases happiness after a point if you give it away!

 

Do not be fooled by the marketing of the large companies brainwashing you into thinking you need “stuff” to make you happy. Possessions lead to clutter, which increases anxiety! 

Help Those less Fortunate

Early in my career, I worked as a nuclear pharmacist. Our boss liked to hire delivery drivers that were retired. One of these drivers was born with no legs so he used ones made of wood and got around the best he could.

 

One summer day after work, I was walking to my car and saw this driver laying on the ground trying to change a flat tire on his car. His hair was all messed up, and his face was sweaty and dirty. Even though I was in a hurry, I had to help. I changed the tire for him. He was delighted with the help and thanked me many times.

 

I remember how that small act of kindness made me feel great. There is something about helping others that makes me happy. 

 

I think this is the main reason I enjoy working in healthcare. Not a day goes by that I don’t feel like I helped someone less fortunate than I. You don’t have to work in a hospital to do this. Make it a point to help someone daily. Something small like giving them directions, buying them a cup of coffee, or just asking how their day is going can make a wonderful difference in both your lives.   

Find a Job You Love

We spend a lot of time working and if you hate your job, being happy is going to be difficult. Remember, money only takes you so far on the happiness scale.

 

I love being a pharmacist. It is mentally challenging, and I help people daily. I work with psychiatric patients who have a difficult life. Many have dementia and assisting this population makes me feel good. 

 

My wife loves to stay at home with our kids. She enjoys taking them to ballet, basketball, horseback riding, and whatever activities they choose to be involved in. She is much more social than I am and likes to visit with the other parents. She would not do well with my job, and I would not do well with hers. We are two different people who enjoy various activities.

 

Even if the pay isn’t as good, find a job that makes you feel good. If you think you need more money, revisit the section on money above! 

Love Yourself

We were all put on this earth for a reason.  Look in the mirror each morning, and appreciate what you have to offer.  Self-esteem is a big part of happiness.  Others like to be around positive, confidant people.  Tell yourself that today is going to be a great day and do everything you can to make that happen.  Remember, optimism is one of the keys to happiness.  You are an awesome person and deserve to be happy.  Keep telling yourself this.   

 

Exercise and Stay in Shape

Keep yourself physically fit. Find an exercise routine you enjoy and stay active. You may enjoy playing tennis or racquetball, swimming, weight lifting, running, or basketball.

 

Exercise will release endorphins, which will improve mood. Staying in shape also enhances your view of yourself. If you are unhappy with your body, you are unlikely to be happy in general. You don’t have to look like a supermodel, but being in shape makes you feel better and improves overall health.

 

If you pick a form of exercise you enjoy, you are more likely to stick with it.   

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Unplug!

This is something I need to work on. If you can spend less time on electronic devices, and more time interacting with people in the old–fashioned way, you will likely be happier. Schedule some time each day to turn your cell phone, iPad, or tablet off and interact with your family and friends. Write a letter, read a book, exercise, take a walk. The world will still be there when you turn your phone back on. Many of us have become addicted to our electronics.   

Read My Anxiety Post

The last thing I am going to ask you to do is read my post on anxiety. Pay close attention to the section on thinking errors. This is one of the fastest, easiest ways to improve mood. Thinking errors will cause your mood to deteriorate. Once you learn how to detect thinking errors and practice dealing with them, you can train your mind to think differently. Follow the instructions in the anxiety post to train your brain to squash thinking errors. 

Michael Brown pictured with Final Thought written

Happiness is one of my favorite topics. I have spent many hours reading about it, talking about it, and trying different techniques to improve my mood. For me, spending some time alone, visiting the beach, and going to concerts are some of my happiness elements. Visiting the beach with my wife is my favorite.

 

I also enjoy spending time with my family, writing, playing music, and cooking. Helping people gives my life purpose. Caring for the poor and vulnerable is what I believe I was put on the earth to do.

 

I want to warn you that if you feel depressed often, don’t have energy, have problems sleeping or sleep too much, cry more than usual, or think about hurting yourself, you need to visit your physician.

 

Although this post is meant to help people live a happy life, depression is real and, at times, needs to be treated by a professional.

 

If you think you might be depressed, get help. Mood disorders are no different than any other disease. There are people who specialize in helping those who suffer from depression. 

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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Probiotics Gut-Brain Axis and Psychiatry

Posted on by sunshineneutraceuticals

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 it possible to treat mental health disorders by altering bacteria in the gut?

 

What is the Gut-Brain Axis?

 

Can the drugs we use to treat psychiatric disorders make patients worse by altering the bacteria living in the gut?

 

There have been many articles and studies published recently discussing the possible connection between the microflora of the gut and the progression of neuropsychiatric disorders. The bacteria in the gut are affected by many factors, including age, diet, exercise, health, and genetics. Medications can also alter gut bacteria. This post will explore the possible effects of the gut microbiome on various psychiatric disorders. 

 

The Gut-Brain Axis

The Gut-Brain Axis is a network of nerves, hormones, and immunological factors connecting the central nervous system (CNS) to the Gastrointestinal (GI) tract. It appears that the gut flora are involved in this system. An imbalance in the function and composition of these intestinal bacteria is associated with many disease states. 1

The microbes in the gut contain genes that perform metabolic functions. The metabolites resulting from these reactions can produce local effects in the GI environment or gut wall. These microbial metabolites may also be absorbed into the systemic circulation and exert their effects on other organs, including the brain.

It is now known that there is bidirectional communication between the gut and the brain. This communication network is known as the gut-brain axis. 2

Altered microflora of the gut has been associated with depression, other mood disorders, and neurodegenerative diseases. 3

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It is known that patients with GI diseases often suffer from mental health issues. 6

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We also know that approximately one-third of patients with irritable bowel syndrome (IBS) have depression. 10

In patients with functional gastrointestinal disorders (FGIDs), 36.5% have comorbid psychiatric disorders. The most common of these are general anxiety disorder and panic. 11

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Effects of Medications on Gut Bacteria

Psychiatric medications are known to disrupt the microbiome of the gut. 12

Second-generation antipsychotics, such as olanzapine, change the balance of intestinal bacteria leading to obesity.

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may inhibit Staphylococcus and Enterococcus growth. 13

 

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The Belgian Flemish Gut Flora Project found both benzodiazepines and antidepressants affected microbiology. 16

The classes of non-antibiotic drugs that have the highest antimicrobial activity are antidepressants, antipsychotics, and benzodiazepines. 17

 

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The drugs we use to treat these psychiatric disorders may be making the conditions worse by altering the composition of the gut flora.

It may be possible to treat psychiatric disorders with living microorganisms. The goal would be to re-establish the healthy flora in the gut resulting in an improved gut-brain axis relationship. This is a difficult subject to study because once ingested; the living organisms are subjected to many negative environmental factors, including digestive enzymes, competitive microorganisms, and pH changes. Despite this difficulty, studies have been done, resulting in positive outcomes. 

Gut-Brain Axis and Autism Spectrum Disorders

Autism spectrum disorders are developmental disorders that affect communication and behavior. This is known as a spectrum disorder because there is a wide variety of symptoms involved. Patients with autism have a difficult time communicating, may not respond to their name, and often do not find enjoyment in activities others enjoy. They may also display repetitive, stereotyped behaviors.

The exact cause of autism is not known, but children with ASD often suffer from GI symptoms that correlate with the severity of their disorder. Several studies have reported altered gut bacteria in patients with autism.    

A treatment protocol using a fecal transplant was administered to 18 children with ASD (ages 7–16 years). The protocol started with two weeks of antibiotics, followed by a bowel cleanse. The children were then given an extended fecal microbiota transplant (FMT) using a high initial dose followed by daily maintenance doses for 7-8 weeks. 

At the end of treatment, there was an 80% reduction of GI symptoms, as measured by the Gastrointestinal Symptom Rating Scale. This included a significant decrease in abdominal pain, indigestion, diarrhea, and constipation. These improvements were still evident eight weeks after treatment. The behavioral symptoms also improved significantly and also remained eight weeks post-treatment. This procedure seemed to be effective for both ASD symptoms as well as GI symptoms and continued long after treatment was completed. 21

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Gut-Brain Axis and Bipolar Disorder

One study showed that patients with bipolar mania were twice as likely to have taken a recent course of antibiotics. 22

It has been suggested that treating bipolar patients with probiotics could help reduce hospitalizations. A small study found treating acutely manic patients with probiotics led to a decrease in the readmission rate. Dr. Faith Dickerson randomized 66 patients to receive a probiotic capsule or placebo for six months after hospitalization for mania. The probiotic, or placebo, were given in addition to the regular medication regimens. Of these 66 patients, 24 or 73% required rehospitalization, while only eight (24%) of the probiotic group was hospitalized. The probiotic patients who were admitted also had a shorter hospital stay than those treated with a placebo.

The probiotics used in this study were Bifidobacterium lactis (bb-12), and Lactobacillus rhamnosus (LGG). These strains are also found in breast milk. 23 

 

 

Gut-Brain Axis and Major Depressive Disorder (MDD)

It has been shown that mice raised in a sterile environment (germ-free mice) have an exaggerated response to stress. This can be reversed by inoculating these mice with feces in their early development. 24

 

This suggests that gut microbial stimulation helps to shape healthy brain development during the early stages of life. 25

 

A review published in 2017 in the Annals of General Psychiatry concluded that treatment with probiotics might improve MDD symptoms. The mechanism is likely a combination of serotonin availability as well as decreased inflammation. More comprehensive studies need to be completed to determine the utility of such a treatment in depression. At the present time, there is likely no harm in supplementing antidepressant medications with probiotics. 26

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Psychobiotics

Psychobiotics are substances that alter the bacteria of the gut. These may be live bacteria (probiotics) or prebiotics. Prebiotics are compounds that change bacterial composition or activity when fermented in the digestive tract. 27

In a study of 55 healthy volunteers, subjects received either fermented milk containing Lactobacillus casei Shirota, or a placebo for three weeks. The study subjects falling into the bottom third of mood scores showed significant improvement as compared to the placebo group. There were no overall changes in mood in this study, which may suggest Lactobacillus has a ceiling effect. In other words, people who are already relatively happy may not have an increase in mood after ingesting the probiotic. 28

It is important to note that not all studies have shown benefits regarding probiotics. A recent review found little evidence of positive outcomes from these substances. 29

 

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Michael Brown pictured with Final Thought written

The Gut-Brain Axis is a fascinating topic that deserves much more research. I believe we can all benefit from eating a healthy diet, exercise, and possibly probiotic supplementation.

The evidence suggests that gut bacteria are vital in helping to develop the brain at a very early stage of human development. It is also evident that many of the medications we use to treat mood disorders such as depression, anxiety, and bipolar disorder, have an effect on the microbiome of the gut.

In the future, we may be able to either successfully treat these disorders with specific bacterial agents, or supplement the healthy flora destroyed by the medications we employ to treat these maladies.

I do know that I benefitted from eating a whole food diet during my Whole30 experience. My mood improved; I slept better and was more alert and happier in general. I can’t be sure this has anything to do with the microbiome in my gut, but it is certainly possible. I hope you have learned something from this post. If you have any questions, please feel free to reach out to me.

 

In the next post, I plan to write about happiness. This is something I have been looking forward to. I want to share my secrets for staying happy and improving your mood. I think you will all enjoy it.

 

Have a great day, and stay healthy!

 

 

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Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

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

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
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Electroconvulsive Shock Therapy Indications, History, Side Effects and More

Posted on by sunshineneutraceuticals

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.

Electroconvulsive therapy (ECT) is a medical treatment performed under anesthesia most commonly used for patients with treatment-resistant depression and catatonia. A generalized tonic-clonic seizure is induced utilizing a small electrical current applied to the head. This seizure lasts from 30-60 seconds. 

ECT is the most rapid and effective treatment available for geriatric patients with psychosis, depression, or bipolar disorder, according to research studies.1

Many believe ECT to be the most effective treatment for depression for all patients. 

This procedure has been a topic of controversy ever since Ken Kesey released “One Flew Over the Cuckoo’s Nest” in 1962. This book was made into a movie in 1975 starring Jack Nicholson and depicted ECT and lobotomies as a method of torture utilized in psychiatric hospitals. This did not sit well with the counterculture movement.

ECT is one of the safest procedures performed under general anesthesia, with only two to four deaths per 100,000 treatments. This is likely because ECT is a short procedure.

History of ECT

The first convulsive therapy was performed in Budapest in 1934 using pentylenetetrazole (Metrazol). Metrazol was used as a circulatory and respiratory stimulant but caused seizures in high doses. It was useful for depression as a convulsant, but side effects and uncontrolled seizures limited its use. 2

Ladislas Meduna gave an IM dose of camphor to a patient who had been in a catatonic stupor for four years in 1934. It is reported that two days after his fifth injection on February 10, 1934, the patient got out of bed, requested breakfast, got dressed, and began to talk. 3

A psychiatry professor, Dr. Ugo Cerletti, induced convulsions by applying electricity directly to the brain at the University of Rome in 1938. Dr. Cerletti achieved success with this method in patients with schizophrenia. 4

In 1938, Cerelli gave the first public presentation on ECT at the Medical Academy of Rome. By 1943, ECT was being used in America. Initially, it was used for schizophrenia, but over time ECT was utilized to treat most psychiatric disorders. After several years, ECT became a common treatment for depression with psychotic features as well as severe mania.

Antidepressants first began to appear in 1958 when an anti-tuberculosis drug, iproniazid (Marsilid), started to be used off-label for depression. This drug was eventually removed from the market due to safety concerns.

 In 1959 imipramine (Tofranil) was approved by the FDA for major depressive disorder (MDD). This was the first tricyclic antidepressant (TCA).

Although the psychiatric community had high hopes following the invention of the TCA’s, these drugs were not 100% effective, and they were associated with side effects. The use of ECT decreased by 46% between 1975-1980, but ECT began to increase in popularity during the 1980s. In the United States in 1980, 2.4% of all hospitalized psychiatric patients received ECT treatment. 5

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ECT Safety

As discussed in the introduction, ECT is a safe procedure. Recent studies have suggested depression is associated with a loss of gray and white matter in different parts of the brain. This neurodegeneration is more prevalent in patients with a more extended history of depression, untreated depression, and a larger number of depressive episodes. This suggests rapid treatment of depression as achieved with ECT can reduce the risk of neuropathologic changes. 6

Postmortem studies of ECT patients who had the procedure done with modern techniques do not show brain damage resulting from the ECT itself. 7

ECT for Behavioral and Psychological Symptoms of Dementia (BPSD)

BPSD is a reality for most dementia patients and their families. This is a common reason for hospital admissions. Symptoms of BPSD include agitation, aggression, disinhibition, apathy, depression, sleep and appetite changes. 

There are no medications approved for dementia besides the anticholinesterase inhibitors and memantine. These drugs slow the progression of dementia but usually have little effect on BPSD. We use antipsychotics to treat these behaviors. Antipsychotic agents all have significant side effects associated with them and an FDA boxed warning for increased mortality risk in elderly patients.

A retrospective chart review of sixty elderly dementia patients with BPSD receiving ECT for agitation was published on September 23, 2019. They found ECT to be safe in their population and very effective in reducing agitation and decreasing the psychotropic pill burden as well. There are other hurdles one must consider when utilizing ECT for dementia patients. The largest is that of consent. Most dementia patients are not able to agree with an ECT procedure.

 

ECT for Catatonia

Catatonia is a condition in which the patient has a significant decrease in their reaction to the environment. Catatonic patients are often mute, appear to be in a stupor, and may demonstrate negativism or motor rigidity. 

The initial treatment for catatonia is benzodiazepines. Many catatonic patients initially respond to IV lorazepam. The conversion to oral lorazepam dosing can sometimes lead to rebound catatonia in which the IV form may need to be reintroduced, or the oral dose increased. 

If the patient does not respond to a benzodiazepine in 2 to 3 days, or if the symptoms are particularly malicious, ECT is the best treatment option. Electroconvulsive therapy works synergistically with benzodiazepines and is beneficial in up to 80% of patients. 8

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ECT in Clozapine-Resistant Schizophrenia (CRS)

Clozapine remains the drug of choice for treatment-resistant schizophrenia. Because schizophrenia is a chronic debilitating disease, it is crucial to find effective treatment methods. Clozapine is superior to other antipsychotics with regards to improved social functioning, symptom improvement, and reduction of hospitalization and mortality. Unfortunately, clozapine does not work for every patient. In 2018, Wang et al. evaluated the safety and efficacy of using ECT in addition to clozapine in the treatment of CRS. This meta-analysis showed adding ECT to clozapine was superior to monotherapy. The main adverse effects suffered in these trials were memory impairment (24.2%) and headache (14.5%). These side effects were mostly mild and short-lived. 9

ECT VS. Antidepressant Medications

The FDA performed a systematic review and Meta-Analysis of randomized, controlled trials examining the effectiveness of ECT in 2011. They came to the following conclusions with regard to ECT and antidepressant medication.

  • Immediately to one-month post-ECT, there is conflicting evidence that ECT is more effective than antidepressant medications.
  • One-month post-ECT, conclusive evidence shows ECT to be more effective than antidepressant medication. 

 

ECT Delirium

There have been cases of delirium reported after ECT treatments. After medical causes are ruled out, delirium may be effectively managed by changing to unilateral ultra-brief pulse ECT with a greater interval between treatment sessions. 10

Lithium is one of our best treatments for bipolar disorder. It is often used for treatment-resistant major depressive disorder (MDD.) There are times when it is beneficial to use Lithium and ECT together as the combination of the two seems to be more effective than either treatment alone. A study published in August of 2019 found that patients treated with lithium and ECT during an inpatient stay had an 11.7 fold higher risk of delirium than those being treated with ECT alone. 11

Lithium should only be used in conjunction with ECT for severe cases or when the risk of suicide is high to prevent delirium.

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ECT and Cognitive Function in Major Depression

A paper published in the Journal of Affective Disorders in 2019, discussed a prospective study following twenty-seven depressed patients before, and two years after ECT. The purpose was to measure remission rates as well as any cognitive changes that may be caused by ECT treatment. 

They found improved neurocognitive function two years after ECT regardless of remission status. The remission rate reached 62.9% at two years. The relapse rate was low; 22% relapsed before the six-week follow-up, and 7.4% between six months and two years after ECT. 12

Although the ECT methods were not uniform in this study, and the sample size was small, the results suggest ECT is beneficial in the treatment of depression without negatively affecting cognitive function.

ECT and Age

A study was done to compare various aspects of ECT on three different age groups:

Young (18-45 years)

Middle (46-64 years)

Old (>=65 years)

A total of 402 patients were evaluated the day before ECT and one-week after. 

One week after ECT, the middle and old age groups showed a significant improvement in the Mini-Mental State Examination (MMSE) score when compared to baseline. Rates of response were not statistically different in the three groups. There was also no difference in premature drop-out rates.

This study concluded ECT was a viable treatment for elderly patients with treatment-resistant depression. Rates of response were near 70%, and no life-threatening adverse events occurred. 13

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ECT Contraindications

 

  • Elevated intracranial pressure.
  • Recent myocardial infarction.
  • Heart Failure.
  • Severe Hypertension.
  • Pheochromocytoma.
  • Risk of bleeding.
  • Unruptured aneurysm.
  • Recent stroke.

Side Effects of ECT

  • Memory loss
  • Confusion
  • Nausea
  • Headache
  • Muscle Pain
  • Complications from Anesthesia
Michael Brown pictured with Final Thought written

Electroconvulsive therapy can be a life-changing procedure for many patients. For those who do not experience relief from antidepressant medications, ECT can be their last hope. It is also useful in treatment-resistant catatonia, dementia with BPSD, and clozapine-resistant schizophrenia. 

This procedure has undergone many improvements over the years. No longer do patients have to worry about broken bones caused by seizures. Today, psychiatrists utilize neuromuscular blocking agents which confine seizure activity to the brain. 

The studies support the use of ECT. I have personally viewed several treatments during my Pharmacy Directorship at a private psychiatric hospital in the late 1990s. The procedure is quick, mild, and most adverse reactions are the result of anesthesia. More importantly, ECT is an effective treatment for a vulnerable segment of our population.

As a society, it is our responsibility to take care of our mentally ill population. We should not have these patients living in tents on the side of the road in our major cities. Psychiatric patients are people like us who have a brain disorder. Remember, this can happen to anyone. Electroconvulsive therapy is not a punishment for bad behavior. It is an effective treatment for several debilitating conditions that are resistant to other, less invasive therapies.

If you have any questions or concerns, feel free to contact me. I will answer every message received.

Always strive to live a happy, healthy life.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

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

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
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Ethanolism – Why You Shouldn’t Drink Alcohol

Posted on by sunshineneutraceuticals

I enjoy a few drinks with friends.

I deserve a drink to calm down after a hard day at work.

Everybody drinks, right?

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

I started Sunshine Nutraceuticals in July of 2019. My goal has always been to help my readers live a happy, healthy, healing lifestyle.

I know a lot, if not most, of my readers, drink alcohol.

Ethanolism – Why You Shouldn’t Drink Alcohol is not about judgment. It is not about right or wrong. This post is meant to give my readers the facts about alcohol. The first fact, and likely the most important is this:

Ethanol is a neurotoxin

 What this means is when you drink alcohol, you are consuming poison.

Is it worth it?

Like most of you reading this, I used to drink alcohol. When my second youngest child was born, I decided to stop. Not because I had to, but because I wanted to be more productive and was sick and tired of wasting money on alcohol. I wanted my kids to grow up in a home without alcohol.

My life today without ethanol is much better. I am in good shape, I think more clearly, my anxiety level has decreased, and I am saving money. 

I have seen hundreds of patients admitted to the hospital because of alcohol intoxication. The nurses in ICU will tell you these are some of the most challenging patients to manage. Alcohol withdrawal is no joke. It can kill you!

I have watched people die of liver failure due to ethanol. This is not a good way to go. Remember, your liver is the primary organ responsible for removing toxins from your body. Imagine living your final days with a body full of byproducts. We have dialysis to help with kidney disease, but if your liver fails, there isn’t much that can be done.

If you want to be healthy, ethanol will not help you achieve the goal.   

Sobering Statistics

It is estimated that 88,000 people die from alcohol-related causes each year.  1

This ranks third as the most preventable cause of death in the United States behind tobacco,  poor diet and physical inactivity. 2

In 2014, thirty-one percent of all driving fatalities (9,967 deaths), were attributed to alcohol impairment. 3

In 2017, 26.4 percent of people over eighteen years of age reported binge drinking and 6.7 percent reported heavy alcohol use in the past month:

Binge drinking: a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. 4

Heavy alcohol use: Binge drinking on 5 or more days in the past month.

Alcohol Use Disorder (AUD) in the United States: According to the 2017 National Survey on Drug Use and Health (NSDUH), 14.1 million adults ages 18 years and older have AUD. 5

Alcohol Use Disorder (AUD): AUD is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe, and recovery is possible regardless of severity. The fourth edition of the Diagnostic and Statistical Manual (DSM–IV), published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM–5, integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder, or AUD, with mild, moderate, and severe subclassifications. 6

Over ten percent of children in the United States live with a parent with alcohol problems, according to a study published in 2012. 7

Drinking alcohol increases the risk of contracting the following types of cancers:

  • Mouth
  • Esophageal
  • Pharynx
  • Larynx
  • Liver
  • Breast 

8

Why Do People Drink Ethanol?

We will now explore the reasons people drink alcohol. Again, no judgment here. I am merely pointing out why you might drink.

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Alcohol Gives Me Confidence and Helps With Socialization at Parties.

What alcohol does is dull your sense of apprehension along with other mental capabilities. Our bodies have a method to combat fear, known as the “fight or flight” response. This is the body’s way of protecting us from dangerous situations. Alcohol has a depressant effect on the brain and suppresses this response.

When our “fight or flight” system is diminished or absent, it makes us vulnerable to dangerous situations. If there is a danger, we are less likely to notice and certainly not as able to respond to it. What do we call people who are drunk? Hammered, wasted, tanked, tipsy, plastered. These words describe someone who can quickly be taken advantage of or hurt. This world is full of individuals that can’t wait to take advantage of someone in a vulnerable state. 

As far as confidence goes, I would much rather spend time with a shy person than someone who is drunk and talks nonstop. Drinking to gain confidence can easily backfire, turning the person into a fool. You are much more likely to develop strong friendships if you appear as you are rather than who you are when drunk. 

Intoxicated people also have diminished impulse control. I explain this to my students in the following way:

Suppose someone has just made you very angry. You don’t like this person and think about punching them in the face. 

Most of us would not punch them. We know there are consequences to such actions. This is an example of impulse control. We stop ourselves from doing something that will undoubtedly have negative consequences. Alcohol removes some of this control. Remember, alcohol deadens all senses, good and bad. 

Why do you suppose there are so many fights in bars? 

Alcohol does not give you any special powers, and it takes away your body’s inherent protective mechanisms.

Another thing to consider is the fact that you have to get home from that party! 

Do you have a designated driver? 

How many times have you driven when you have had too many drinks?

I don’t have to tell you what happens if you get pulled over by the police on the way home.

The least you will lose is a night of freedom and a big pile of money. You could also lose your job or even your career in some cases.

Is it really worth it?

Drinking Alcohol Relaxes Me, and I Deserve That After a Rough Day at Work!

Does alcohol relax us? 

What is it doing? 

The truth is alcohol doesn’t remove stress at all. It merely enables us to ignore our body’s innate warning system. If we are genuinely “stressed,” maybe we are trying to accomplish too much. Our body is telling us to slow down.

In fact, alcohol is very good at causing stress. 

What happens when the alcohol wears off? 

We feel anxious. Most of us want more. 

Wanting more causes stress that is only relieved when we continue to drink. The next drink does induce some relaxation, but this is only due to decreasing the withdrawal symptoms caused by alcohol leaving our body.

What will happen is the more you drink, the more stress you will invite into your life. Secondly, any problems you were attempting to forget will still be there when the alcohol wears off.

Finally, if you end up drinking too much to relax, your next day will likely be worse.

Alcohol helps Me Sleep

Not a chance. It might make you think you are sleeping better, but the sleep quality is reduced. 

Ethanol is a typical “over-the-counter” sleep aid. It increases the quality and quantity of NREM sleep during the first half of the night in non-alcoholics, but REM sleep is disrupted later. The REM stage is where we dream and is considered a restful period as our muscle tone is decreased. Do not use alcohol as a sleep aid! There are many other products that work much better with fewer side effects.

Sleep quality in alcoholics is even worse. During drinking periods as well as abstinence, altered sleep architecture leads to profound insomnia and daytime sleepiness. 9 

Alcohol and Dementia Risk

As a Clinical Pharmacy Specialist in Psychiatry, I see the consequences of substance abuse often. This is one of the subjects I am most interested in and will be writing about regularly — the unit where I currently practice has geriatric psychiatric patients. 

A large percentage of these have dementia. There are four basic types of dementia. Alzheimer’s disease, Lewy body dementia, vascular dementia and frontal-temporal lobe dementia.  

We know that chronic alcohol use can lead to dementia. 

Vascular dementia occurs as a result of a stroke. Long-term ethanol use increases blood pressure, increasing stroke risk. Alcohol consumption also increases the risk of developing type II diabetes, obesity, and atrial fibrillation. All of these increase the risk of stroke.

Alcohol abuse has also been associated with Alzheimer’s dementia:

“Research from the University of Illinois at Chicago has found that some of the genes affected by alcohol and inflammation are also implicated in processes that clear amyloid beta — the protein that forms globs of plaques in the brain and which contributes to neuronal damage and the cognitive impairment associated with Alzheimer’s disease.” 10 

Alcohol is bad for the brain. I want nothing to do with any avoidable habit that may lead to dementia.

What Alcohol is Doing to Your Body

Ethanol has an effect on every organ in the body. 

Take a look at this short youtube video on how drinking negatively affects the body:

https://www.youtube.com/watch?v=V2Aj-iJ6p38

 

Life Without Ethanol

Here are a few positive benefits of an ethanol-free life. Some of these have already been described earlier but will be repeated for emphasis.

  • Fewer calories consumed, which may lead to weight loss: It is no secret that alcoholic drinks contain empty calories. Drinking too much can derail any diet plan.
  • Better sleep quality: As mentioned above, ethanol disrupts REM sleep. This often leads to daytime sleepiness. If you combine this with a hangover, it leads to an awful day! 
  • More money to do the things you enjoy: Drinking is expensive, especially if you go to a bar. I once worked with a psychiatrist who told his patients to take half of the money they spent on their addictive substance (alcohol in this case), and spend it on something they enjoyed.
  • Improved interpersonal communication with family, friends, and colleagues: Nobody wants to be around someone who drinks too much. 

 

Michael Brown pictured with Final Thought written

Alcoholism is a significant problem in the United States. This disease leads to lost productivity, broken families, increased medical costs, and unnecessary pain and suffering. People have lost jobs, been involved in accidents, and gone through a painful divorce because of alcohol abuse.

Many drink booze to “have fun.” Is this making the situation more fun? Maybe you are having a good time because you are surrounded by people you like? Why not try to live without alcohol and see how you feel?

Ethanol does not make you sleep better. It changes your sleep patterns and robs your brain of restful REM sleep.

Think about the positives and negatives of drinking alcohol. If you think about it, drinking poison doesn’t make sense. Take it from someone who has eliminated it. You will feel better!

 It is possible to stop drinking. If you have a problem with alcohol, the most critical thing you can do is get help. Being healthy feels much better than being addicted to ethanol. Click on the following link for more information.

https://www.alcoholrehabguide.org/treatment/

This one-click may be the beginning of the healthiest thing you can do for your body! 

Don’t be shy.

You are in control of your life. 

You are responsible for your happiness, and only you can decide what goes into your body.

Eat right, exercise, get plenty of sleep, and do the things that make you happy!!

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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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Several Vitamin D3 5000 IU Benefits And Why You Should Take This Supplement

Posted on by sunshineneutraceuticals

Do you need to take a vitamin D supplement?

Many of us are deficient in vitamin D. The only way to be sure is to have a blood test performed. The test used is the 25-hydroxy vitamin D test. Our hospital lab lists the normal blood level to be 30.0-100.0 ng/ml. The Vitamin D council lists the ideal level between 40-80 ng/ml. I recommend supplementation in patients who have a level less than 30 ng/ml.

 

What’s the big deal? I live where there isn’t much sun! Why do I need Vitamin D?

It turns out that vitamin D performs many important functions in our body. As more research is completed, we are finding this vitamin helps with physical and mental health.

Vitamin D is one of the four fat-soluble vitamins (A,D,E and K). This vitamin is not found in many foods but is added to milk, tofu, and orange juice. Shitake mushrooms are also a good source of vitamin D.

Our bodies synthesize vitamin D when the skin is exposed to ultraviolet light from the sun. If we aren’t getting enough sunlight and eating enough foods rich in vitamin D, we are likely deficient in this vitamin.

 The other way to get this vitamin is to take a supplement. All supplements are not created equal. The Sunshine Nutraceutical Vitamin D supplement is made in the USA in an FDA inspected facility. Our supplement contains 5,000 IU of vitamin D3 in a soft gel capsule.

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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.

Being Deficient In Vitamin D Comes With A Cost. Here Are Several Problems You May Face:

Osteoporosis

Osteoporosis occurs when the body loses too much bone tissue or is unable to replace bone loss efficiently. This causes the bones to become weak and are more easily broken. People with this condition may break a bone simply by bumping into something or sneezing. 

The first sign that you have osteoporosis is usually when you break a bone. People with reduced bone density do not feel any different. The chances of a person with osteoporosis breaking a bone is 50% for women and 25% for men during their lifetime

 1

You have a higher risk of breaking a bone if you:

  • Are a smoker.
  • Have a low body weight.
  • Are female.
  • Have broken a bone previously.
  • Drink three or more alcoholic beverages daily.
  • Have gone through menopause.
  • Are over fifty years old.
  • Have low calcium and vitamin D intake 2

    The most important mineral in your bones is calcium. Vitamin D helps the bones absorb calcium. If you don’t get enough vitamin D, calcium cannot be absorbed for use by the bones. More calcium in the bones increases density which decreases the chance of a bone fracture

     3

    The incidence of broken bones increases during the winter months. Some researchers believe this is due to lower levels of vitamin D

     4

    A study published on August 1st, 2019 examined the effect of vitamin D levels on fractures in 287 elderly women with at least one previous bone fracture. This study concluded that vitamin D deficiency was associated with an increase in fracture severity as well as bone loss.

     5

General Anxiety Disorder

People with Generalized Anxiety Disorder (GAD) spend a great deal of time worrying excessively about many different things.

 

They may be convinced the world is coming to an end or always worry about money, health issues, family members, or their jobs.

 

This disorder can be debilitating if it becomes severe. People with this disorder may be afraid to leave their houses.

 

A study published in 2019 looked at the effects of vitamin D on GAD. Thirty patients with GAD and vitamin D deficiency were split into two groups of 15 patients each. One group received standard of care (SOC) only, while the treatment group received SOC plus 50,000 IU vitamin D weekly for three months.

 

The Generalized Anxiety Disorder 7-Item (GAD-7) scale was used in both groups to measure changes in anxiety levels. The vitamin D group had significant increases in serotonin levels, and their GAD-7 scores also improved. The group receiving SOC only showed no changes in GAD-7 scores or serotonin levels. 

 6

Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of impulsivity, inattention, and or hyperactivity that interferes with occupational, social, or academic functioning. This disorder may begin in infancy and may continue throughout adulthood.

 

The effect of vitamin D on ADHD was studied using fifty ADHD patients and fifty non-ADHD controls. The Conners’ Parent Rating Scale (CPRS) was used to assess ADHD symptoms, and serum 25-hydroxyvitamin D levels were measured using an ELISA kit. 

 

Vitamin D levels were assessed using the following scale:

 

Serum 25OHD less than 10 (severe deficiency)

                                10-29 (mild deficiency)

                                 >30 (sufficient vitamin D level)

 

Patients with ADHD had significantly lower serum levels of vitamin D (16.57 +/- 9.09 ng/ml) compared to the control group (22.01 +/- 12.67 ng/ml).

 

A severe vitamin D deficiency was 3.36 times more likely to be found in the ADHD group. 

 

This study supports the monitoring of vitamin D levels in patients with ADHD.

 7

Tuberculosis

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. This disease mainly affects the lungs but may also affect the kidneys, brain, or spine. It is spread by tiny droplets in the air produced when an infected patient coughs or sneezes. This disease can be life-threatening. 

 

A nested case-control study was conducted looking at the effect of vitamin D on decreasing the progression of tuberculosis (TB).

 

Vitamin D has shown to have some impact on immunity. Vitamin D deficiency may also increase the risk of TB due to its effect on diabetes. Diabetes is a known risk factor for TB, and vitamin D is known to decrease diabetes risk.

 

In this meta-analysis, it was determined that low vitamin D levels were associated with the progression of TB. This effect was found to be dose-dependent. This raises the possibility of using vitamin D supplementation in high-risk populations to help decrease TB risk.

 8

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Alzheimer’s Dementia

A prospective cohort study of 498 older women was conducted in 2012 to determine the effect of vitamin D on dementia. All subjects received baseline cognitive testing utilizing the Pfeiffer Short Portable Mental State Questionnaire. Only those scoring above 8 (normal cognitive function) were included in the study. 

 

After a seven-year period, the Mini-Mental Status Exam (MMSE) and Grober and Buschke test were conducted to screen for dementia. 

It was determined that the subjects with dementia had a lower average vitamin D intake than those without. (50 vs 59 ug/wk).

 

The subjects in the highest vitamin D intake quintile had a lower incidence of dementia than those in the remaining four quintiles combined (4.1% vs. 17%). 

This study did depend on accurate reporting of vitamin D intake by the subjects tested. About half of the subjects were lost to follow-up during the study period.

 

 9

 

Another small randomized controlled study was conducted in 2015 to determine the effect of vitamin D supplementation on the treatment and prevention of Alzheimer’s disease. Subjects were 60 years of age or older with an MMSE score of less than 24. 

 

Two groups were randomized. The active group had a baseline vitamin D level of 8.2 ug/ml. This group received 4,000 IU vitamin D supplementation daily. The control group had a baseline vitamin D level of 9.3 ug/ml and received no vitamin D supplementation.

 

The MMSE was administered every three months. No difference was found between the two groups after three months, but a significant difference occurred after six months (24 vs. 22). Although the sample size was small, a positive effect of vitamin D supplementation was observed.

 10

If you are interested in reading about Lewy Body Dementia follow this link.

 

Depression

I became interested in vitamin D due to its effects on depression. I see a large number of depressed patients and have noticed many have a sub-therapeutic vitamin D level. 

 

People who are depressed feel unhappy most of the time. They may lose interest in things they have enjoyed in the past. Depression can cause the person may sleep too much or too little. They may have a difficult time concentrating and isolate. Depressed patients may have a change in appetite and may have low self-esteem.

 

Researchers believe vitamin D may increase the amount of serotonin in the brain.

 11

 

Increasing serotonin and other monoamines are the mechanisms of action of many antidepressants available today. 

 

Even though there seems to be a link between vitamin D and depression, conflicting evidence still exists.

 12

 

There have been many studies conducted, but it remains unclear whether vitamin D helps treat depression or whether vitamin D levels are just lower in depressed patients. 

 

A study conducted in the Netherlands in 2014 showed low vitamin D levels were associated with the severity and presence of depression. This study followed 1102 depressed patients aged 18-65 years and 790 patients who were not currently depressed but had been in the past.

 13

 

A study in Finland in 2015 found higher serum concentrations of vitamin D were associated with a lower incidence of depression. The investigators believe higher vitamin D levels protect individuals from becoming depressed.

 14

 

I am a firm believer in utilizing vitamin D supplements for those who are depressed. My recommendation is to take 5000 IU daily. Vitamin D levels can be obtained during your yearly health check-up. 

 

Although I am not depressed, I take vitamin D daily to prevent depression. I live in Oregon and don’t get much sun, especially during the winter months. My vitamin D levels have been low in the past. 

 

Can I Take Too Much Vitamin D?

Yes, because vitamin D is a fat-soluble vitamin, it can accumulate. Hypercalcemia, an increased level of calcium in the blood, is the major consequence of taking too much vitamin D. Hypercalcemia can cause nausea, vomiting, frequent urination and weakness. It may also lead to the formation of kidney stones. A person would need to take a very high dose of vitamin D over a long period to become toxic.

Vitamin D is a critical substance used by our bodies in many ways. I have highlighted many uses of this vital vitamin in this post.

 

I have noticed in my practice that a large percentage of depressed patients have a low vitamin D level.  I believe keeping your level therapeutic is a good step in feeling better and helping your body function as efficiently as possible.

I always recommend vitamin D supplementation in any patient with a level less than 30 ng/ml.  It is an easy preventative measure.

If you have any questions or need further information, please feel free to contact me. As always, I want to thank you for reading my blog. If you have any subjects you would like to learn about; please let me know. 

 

We can all live a happy, healthy, healing life! 

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Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

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

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
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Steroid Induced Psychosis

Posted on by sunshineneutraceuticals

Will taking prednisone make you psychotic?

How about other steroids?

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 Psychosis?

Patients with psychosis are not in touch with the real world. They display symptoms of hallucinations and or delusions. They may also speak incoherently or behave in ways that do not fit their current surroundings.

Hallucinations occur when a person senses something that is not there. This can happen with sight, hearing, touch, and smell.

At times, the patient may experience two or more hallucinations simultaneously. For example, a psychotic patient may kneel to pet a dog that doesn’t exist. They can see the dog and feel the dog as they pet it. They may also hear or smell the non-existent animal.

Delusions happen when a person firmly believes something untrue. They may be convinced they are an influential person or someone famous when, in fact, they are not. Delusional patients may think they are younger than their actual age and in better health. They may also suffer from paranoia and swear that people are out to get them.

These patients may only eat packaged food or stop eating entirely due to fear of being poisoned. Delusions are very hard to treat with medication.

Drugs As A Cause Of Psychosis

When a patient presents with new-onset psychosis, it is vital to obtain a thorough history. If a family member has been diagnosed with a psychiatric disorder, there is an increased chance of the illness spreading to other genetic relatives. We also know a patient often responds to the same medications that were effective for family members.

One of the first things I look for as a pharmacist is possible drugs that can cause psychosis. There are several potential agents to consider, but I classify them into two broad groups.

 

 

 

Drugs Of Abuse

These are drugs that are not prescribed by a physician and have a higher incidence of precipitating psychosis. This is true because of the properties of the substance and the erratic dose the patient receives.

Street drugs are not regulated, so drug content is sporadic. The drugs are usually addictive, and individuals take an increasing dose trying to reach the desired effect. Some examples of these agents are:

Cocaine
Methamphetamine
Marijuana
LSD
PCP
Ecstasy
Ethanol

Prescription Medications

The other group contains medications that are available as prescriptions. It is essential to point out that many of these drugs are also available on the street. Any substance that has the ability to alter mood or perception is a candidate for sale on the black market. Some of these agents are:

Antidepressants
Antipsychotics
Anti-seizure medications
Anticholinergic Drugs (Click to read post on anticholinergics)

Isotretinoin
Dopamine agonists for Parkinsons Disease
Corticosteroids

We will concentrate on corticosteroids for this post.

Types Of Steroids

Anabolic Steroids

These include testosterone as well as synthetic substances that are similar in structure to testosterone and have comparable effects. Testosterone is used to treat specific hormone problems in men. The synthetic molecules are often abused by bodybuilders and athletes to build muscle and boost athletic abilities. These are generally not associated with psychosis. Some examples of this type of steroid are:

Dianabol
Winstrol
Deca-durabolin
Equipoise
Anadrol

Corticosteroids

Corticosteroids are used in modern medicine to remedy a variety of conditions.

They are used in the emergency department to treat asthma attacks, COPD, and croup in children.

They can be used to treat Crohn’s disease, gout, lupus, multiple sclerosis, and other autoimmune disorders. Corticosteroids have an important role in reducing inflammation.

These steroids are also utilized in the treatment of skin conditions such as eczema and rash. They play an essential role in some cancer therapies. Corticosteroids come in a variety of forms including injections, tablets, liquids, creams, ointments, and inhalers. Some examples include:

Prednisone
Prednisolone
Dexamethasone
Betamethasone
Triamcinolone
Methylprednisolone

 

 

Corticosteroid Adverse Effects

Unfortunately, although corticosteroids are useful in many of the conditions described above, they can also cause adverse effects. A few common side effects include:

Weight gain
Agitation
Nausea and vomiting
Insomnia
Headache
Mood swings
Euphoria
Psychosis

Steroid Induced Psychosis

Psychosis is a side effect of corticosteroid use and most commonly occurs at prednisone doses above 20mg/day given over a long period. 1 

2 3 

Roughly ten percent of patients remain psychotic after the steroid dose is decreased. 4 

Patients are usually clear after a two-week course of antipsychotic medications.

Although prednisone is often described as the main corticosteroid involved, other members of the steroid family can also cause psychosis.

Dexamethasone

Dexamethasone is often used in place of prednisone due to its longer duration of action. This glucocorticoid is six times more potent than prednisone.

It is unknown what dose of dexamethasone is most likely to cause psychosis, but it has occurred post-operatively after a single dose.

We should anticipate a psychotic reaction after administering dexamethasone, and for surgery cases, it may be prudent to utilize restraints to prevent self-extubation.

Pre-medicating with haloperidol or olanzapine may prove beneficial in this situation. 5 

Dexamethasone will accumulate in the body more quickly than prednisone due to its longer half-life. For this reason, careful monitoring should occur when giving this agent over a more extended period of time.

Methylprednisolone

An article published in European Psychiatry in March of 2016 describes a case where a thirty-year-old female received three, 80mg daily doses of methylprednisolone following lumbar surgery. This patient had no personal or family history of any psychiatric disorder.

One week after the methylprednisolone was completed, the patient was admitted to the hospital for bizarre delusions, visual and auditory hallucinations, and disorganized thinking.

She was treated with risperidone (up to 6mg/day) and a very short course of diazepam (10mg/day). The patient was discharged several weeks later when the psychosis cleared up. 6 

Treatment

The first thing to attempt when treating corticosteroid-induced psychosis is to stop the offending agent. Unfortunately, this is not always possible.

There are circumstances when the steroids must be continued. In these cases, our best option is to treat the patient with an antipsychotic medication.

Which agent we choose is based mostly on the characteristics of the patient. I could write an entire chapter on this subject but will list the agents we utilize most commonly for psychosis on our unit. I will also explain reasons to choose one agent over the other.

Haloperidol

Haloperidol is still widely used due to its familiarity. Physicians like to use what they are most comfortable with.

Some patients should never receive haloperidol. This medication is contraindicated in Parkinson’s patients. Due to its high dopamine (D2) blocking properties, it makes the movement disorder worse.

Haloperidol is still very effective and is often used for delirium as well as psychosis. It is available in oral, injectable and long-acting injectable forms

Quetiapine

Quetiapine is the first choice in a patient who has Parkinson’s disease. This drug is also helpful in patients who are having trouble sleeping as it is one of the most sedating antipsychotics available. Quetiapine is only available in oral dosage forms which limits its usefulness in acute situations.

Olanzapine

Olanzapine is one of the most effective medications we have for delirium as well as psychosis. Like haloperidol, it is also available in all dosage forms.

The main problem with this agent is weight gain. This can be a positive attribute in patients that have a poor appetite, but these days patients tend to be overweight. Olanzapine is usually the medication I initially recommend.

Risperidone

Risperidone is also an effective agent for psychosis, but it is not available in a quick acting injectable form. It can also cause movement disorder side effects, especially at higher doses.

Ziprasidone

Ziprasidone is popular in the emergency department for acute agitation and psychosis due to its availability as a fast-acting injectable. The powder in the vial does take longer to dissolve than olanzapine, and it has cardiac side effects that make it undesirable for elderly patients.

Final Thoughts

There is evidence linking corticosteroid use to psychosis. These medications are used for a variety of ailments. At times, they are needed to treat life-threatening conditions.

Although prednisone is the agent most commonly associated with corticosteroid-induced psychosis, other agents in this class can also lead to psychotic behavior.

It is essential to be aware of the signs of psychosis and seek treatment if you or someone you know is being treated with any of these drugs.

I suggest having someone check on you periodically if you live alone and are taking these medications. Psychotic patients often have no idea they are having a problem until it is discovered by someone else.

If possible, the corticosteroid should be stopped if psychosis develops. If this isn’t prudent, antipsychotic agents can be used based on patient characteristics.

In severe cases, the patient may need to be hospitalized until stable. Most patients will clear after a few days to a couple of weeks.

I hope you have enjoyed this review of corticosteroid-induced psychosis. If you have any questions or comments, please send me an email.

My goal is to make this site as informative and enjoyable as possible for my readers. We can learn the best way to make that happen together.

As always, live a happy, healthy, healing life and remember to HAVE FUN!

 

 

Anxiety Formula

Calms Mood, Lowers Stress, Helps Cognition. Contains eleven nootropics.


Michael Pharmacist

Michael J. Brown, RPh. BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Michael – Sunshine Nutraceuticals (sunshinentc.com)


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Weighted Blankets For Anxiety And Insomnia, The Tapping Method, Squashing Thinking Errors, And Other Anxiety Reducers

Posted on by sunshineneutraceuticals

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.

How Can I Stop Feeling So Anxious And Get Some Sleep?

All of us become anxious throughout our lives for different reasons. We may be thinking about a test or speaking engagement and believe we are not prepared.

Our kids may be late getting home or fail to answer their phones. Many of us are afraid of heights or flying in airplanes. Preparing for surgery, being called into the supervisor’s office, getting lost in the woods, can all cause various levels of anxiety.

Anxiety is just a normal part of life.

When fear and anxiety lead to trouble sleeping or problems functioning in daily life, it is time to think about treatment options.

What are some of the options we can accomplish ourselves?


Can we teach ourselves to be less anxious?

 

The answer is yes, and we can. I am going to teach you some ways to decrease your anxiety level.

I used to be much more anxious than I am today. I have read a great deal about anxiety and work in mental health, so I am surrounded by the subject daily.

Weighted Blankets For Anxiety And Insomnia

Weighted blankets are often used in children with autism spectrum disorder (ASD) to provide a “cocooning” feeling. They have also been used in the elderly.

The weighted blanket’s effectiveness has previously been shown to be related to the mass of the person using it. A blanket that weighs more than ten percent of a person’s body is more beneficial.1 

A study published in the Journal of Sleep Medicine & Disorders on May 25, 2015, found a chain-weighted blanket was able to improve the quality of sleep in patients with insomnia. The subjects who used the weighted blanket had a calmer night’s sleep and exhibited less movement throughout the night. They also believed the blanket provided higher quality and a more comfortable night’s sleep.2 

I have the pleasure of sharing an office with Kendra Munroe, OTR-L. Kendra is an Occupational Therapist (OT). She states weighted blankets should not be used in patients with open wounds, broken bones, or a history of sexual trauma.

Kendra prefers to use blankets that weigh no more than ten percent of the patient’s total body weight. She mainly uses weighted blankets from a company called Salt Of The Earth because she states they are well made.

For a more comprehensive explanation of weighted blankets and how to choose the best type for your situation, click here.

The Tapping Method

I also asked Kendra about “The Tapping Method.” This is something I had not been exposed to before working on our unit.

Munroe states this method is usually used for patients with anxiety or depression. It regulates the body by using its natural rhythms. It is best to match the speed of the heartbeat when tapping, according to Kendra.

Kendra recommends not using The Tapping Method on patients who aren’t open to it. It usually won’t work for them.

She excludes those unable to follow a pattern, such as those with dementia, as well as actively manic patients.

Play the video above to learn more.

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Breathing Exercises

The two breathing exercises below can help relieve tension and make you feel more relaxed:

Square Breathing Or Box Breathing

This is a breathing exercise where you:

  1. Breathe in (through your nose) for 4 seconds.
  2. Hold your breath for 4 seconds.
  3. Breathe out (through your mouth) for 4 seconds.
  4. Hold your breath for 4 seconds. 
  5. Repeat sequence. 

Square breathing can help with anxiety and make you feel more relaxed. It can also help with sleep and lower blood pressure.

 

Resonate Breathing Or Coherent Breathing

  1. Lie down in a comfortable place.
  2. Close your eyes and concentrate only on your breathing.
  3. Slowly inhale through your nose for six seconds.
  4. Breath out through your mouth for six seconds.
  5. Repeat the sequence.

These two breathing techniques can help tremendously if practiced. I suggest taking a few minutes each day on the above exercises until they become second nature.  

When you start to feel anxious, proper breathing is an excellent initial intervention for quick relief.

 

Progressive Muscle Relaxation

Progressive muscle relaxation (PMR) is a technique that was developed in the 1920s by a physician attempting to get his patients to relax. This method works by counteracting the effects of the fight-or-flight response. This response helps protect us from danger. 

 In some people, the fight-or-flight response becomes a problem by creating an increase in unnecessary anxiety symptoms. It may even lead to a panic attack at times. 

The adrenalin released during this response increases the heart rate. Stress hormones are also released. This may cause shortness of breath, sweating, trembling, and at times a feeling of impending doom. 

 

Follow these steps to increase relaxation. This exercise may be especially helpful when feeling highly anxious or having a panic attack.

 

  1. Find a comfortable place either sitting or lying down, close your eyes, and take several deep breaths. Try to concentrate only on the air entering and leaving your lungs. If other thoughts come into your mind, gently push them aside. Continue until you start to feel relaxed.
  2. Concentrate on your feet. Tighten the muscles in both of your feet and keep them tight for 10 seconds. Release the tension and pay close attention to how your feet feel. Only think about your feet. After about a minute, go to step three.
  3. Progressively move up your body and repeat step 2 using different muscle groups. Legs, hips, stomach, arms, etc.…
  4. It is essential to try to concentrate exclusively on the muscle group you are working on at the time.

 

Like the breathing techniques mentioned above, this exercise will become more productive with practice. I recommend doing this a couple of times per day until it feels natural. You can then utilize the technique whenever you feel anxious or stressed.

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Guided Imagery

Guided imagery is the use of words to guide a person to imagine a specific scenario designed to bring about the desired effect. This technique is often used to help with pain relief or to reduce stress and anxiety. 

There are many apps available for the iPhone that utilize guided imagery. I am a firm believer in this technique, and if you want the best results, my suggestion is to click on the link below. Healthjourneys has many products available designed explicitly for anxiety relief.

Like the other skills mentioned in this article, guided imagery will become much more effective with practice. Give it a try! 

I am not affiliated with Healthjourneys in any way.

https://www.healthjourneys.com/audio-library/anxiety-relief

Sleep Hygiene

One thing I have learned while working with psychiatric patients is that lack of sleep can make almost any condition worse. 

We all need adequate sleep to recharge our body and mind. I thought this post would be a great place to remind my readers about how to maximize sleep. Here are the general sleep hygiene standards:

 

  1. Do not sleep too much during the day unless you work nights! If you sleep during the day, you will likely not be tired at night. Short naps to recharge are OK, but avoid sleeping for long periods during the day.
  2. Sleep at the same time each night if possible. Establishing a routine is essential. If you can go to sleep at the same time each night and wake up at a similar time each morning, your body will become used to this sleeping routine.
  3. Use your bed for sleep and sex ONLY. Do not read, watch television or eat in your bed.
  4. Exercise, but no too close to bedtime! This is beneficial in several ways. Exercising helps decrease anxiety and depression and will also promote sleep. Two of the best things you can do for your body are to eat healthily and exercise. You will hear much more about this topic in future posts.
  5. Avoid alcohol and caffeine late in the day. Alcohol decreases sleep quality, and caffeine is a stimulant that may make it difficult to fall asleep. I prefer to avoid alcohol entirely, but that is a subject for another post. I try to cut the coffee off early in the afternoon.
  6. Try not to eat right before sleeping. It is best to give your food a chance to digest before closing your eyes for the night! Many foods can cause heartburn which may impact sleep quality. It is also prudent to avoid large amounts of fluid before sleeping because waking up to urinate interrupts sleep.
  7. Expose yourself to sunlight during the day. This can help with sleep as well as depression. Walking around outside during the day helps to maintain a healthy sleep-wake cycle. 
 

Frequent nighttime awakenings and daytime sleepiness are the main signs that you need to work on sleep hygiene. Getting this down can improve your physical and mental health.

Squash the Self-Defeating Thinking Errors

Thinking errors can turn us all into our worst enemies.

There are three broad types of thinking errors. In this article, I am going to explain some of the most common type 2, or self-defeating thinking errors that can lead to depression, anxiety, and general unhappiness.

Catastrophic Thinking

Catastrophic thinking is where one concentrates on the worst-case scenario. This certainly can increase anxiety and prevent the individual from taking appropriate action.

This type of thinking usually has no basis in reality. Consider the following example: 

You call your daughter, but she doesn’t answer her phone. You convince yourself something horrible has happened to her. Maybe she is in the hospital or was involved in a car accident? You have a hard time concentrating and start to get extremely anxious. In reality, she is just away from her phone.

Fortune Telling

Fortune telling happens when the person assumes they will fail before even trying because they have not succeeded in the past. This thinking error is linked to anxiety as well as depression.

An excellent example of this is thinking is: “I will never get the job I just interviewed for.” Without knowing who else applied and exactly what kind of person the company is looking for, you cannot legitimately conclude you won’t get the position.

Negative Focus

The person focuses only on the negative aspects of a situation or person. They may also think negatively about themselves. We have all been around this type of person. They are always complaining about how bad things are.

Mind Reading

Mind reading occurs when a person thinks he knows another person’s thoughts or intentions.

This person may be convinced his friend is thinking about something negative in regards to him. None of us can read minds, so he should confront his friend if he believes they have an issue.  Chances are, the friend doesn’t have an issue at all.  Don’t waste time trying to guess what others are thinking.

There are other thinking errors, but this gives you an idea of how our thoughts can make us anxious.

Exercise To Battle Thinking Errors

Whenever you find yourself thinking about something that might be a thinking error, write it down.

Then next to it, in a separate column, list the reasons the statement is erroneous.

I have done this, and it helps. You will soon start to correct yourself without needing to complete the exercise. It is possible to train our minds to think differently with a little practice.

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Nutraceuticals and Dietary Supplements

There are also natural substances that can help with anxiety as well as depression.  Turmeric, which is a spice used in many foods, has been shown to have many beneficial health-related properties.  For more information, read the article by clicking the link below.

 

https://lyfebotanicals.com/health/turmeric-benefits/

Anxiety is something that will be with us throughout our lives. Although it serves a purpose in keeping us on track and protection us from danger in some situations, it can become overwhelming and detrimental.

The tactics described above can help reduce anxiety and help to increase the quality of your life.

Please remember, if your anxiety becomes too much to handle, or you are unable to function, seek professional help. An anxiety disorder is no different than diabetes or heart disease. It too can get out of control at times and deserves proper treatment.

Anxiety relief is one of my favorite topics. I have learned over the years to control it using the techniques described above.

If you have any questions, please click the contact me link next to my picture below and send me an email. You may also sign up to receive our newsletter by filling out the form on the top of this page.  This contains news about our company, sales on our products, and links to our blog posts.

Remember to have a happy, healthy, healing life.

 

 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

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

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
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5 Amazing Composers I Recommend For Relaxation

Posted on by sunshineneutraceuticals

Since I am on vacation this week, I decided to write a post on the music I listen to while working and relaxing. My family and I are vacationing at Black Butte Ranch in Central Oregon. The beauty of the scenery inspired me to write about my most loved subject.

Music has been a critical part of my life and has helped me through many challenging times. I believe everyone can benefit from soothing music throughout their lives. Listening to music can be a simple form of meditation. So sit back, put some headphones on, and try out some of my favorite artists and tunes:

Robin Spielberg

Robin Spielberg is at the top of my list for a reason. I love the feeling and flow of her music. She writes very soothing pieces as well as fast, spunky tunes.

I recommend “On the Edge of a Dream” available through the following link:

https://robinspielberg.com/store/on-the-edge-of-a-dream-audio-cd

I may also suggest “An Improvisation on Canon in D” from her “Dreaming of Summer” LP.

Cathy and I used this tune as she walked down the aisle at our wedding. This song has a special meaning for us.

If you haven’t listened to Robin, I strongly suggest doing so. Her website is listed below:

 

www.robinspielberg.com

Take Me To The Sunshine Store

Kevin Kern

Kevin Kern was born legally blind and began playing the piano at the age of 18 months. You will not be disappointed with Kevin’s music. He has solo piano pieces as well as piano, guitar and string arrangements.

I haven’t listened to anything from this composer that I didn’t enjoy. My favorite CD by Kevin is Endless Blue Sky from 2009.

www.kevinkern.com

Bernward Koch

Bernward Koch is a German composer who plays a variety of instruments. I stumbled upon Bernward while working as a telepharmacist very early one morning. He has since turned into one of my go-to artists for relaxation and meditation.

It is hard for me to pick a single CD from this guy, but I would probably go with “Remembering” from 2015 if I had to choose. I am confident you will love his music.

https://www.bernwardkoch.com

Secret Garden

Secret Garden is a little different from the other artists on this list. They are a bit more diverse but outstanding musicians. I am not going to try to pick one CD from them to recommend. I suggest you listen to all of their music. They can certainly put you in a pleasant, relaxing mood very quickly. Do yourself a favor and go to the web site below and read about them. I promise you will be glad you did!

 

https://secretgarden.no/

Michael Allen Harrison

Last but certainly not least is Michael Allen Harrison. I have had the pleasure of watching this guy play more times than I can count. He is from Portland, Oregon, where I grew up.

He can play solo or perform with a full jazz band. He performs Christmas concerts every year with singers and other musicians at “The Old Church” in Portland. If you have a chance to see this show, GO!

Michael teaches children how to play the piano and allows them to show off before his concerts. Some of his students are truly amazing.

Whenever I need inspiration, I try to see him live. I do have a favorite song from Michael, which is “February’s Child”. This song is on the “Bedtime Lullabies” CD which I strongly recommend.

https://www.michaelallenharrison.com/

The purpose of my blog is to help my readers live a happy, healthy, healing life. This post gives you a look into one of my most treasured tools for relaxation.

Music has been one of the most important aspects of my life. Although I do enjoy multiple genres of music, as I get older, I find myself listening to the artists I have discussed above more often.

I have enjoyed sharing this part of my life with you. Remember to take some time each day to do whatever it is that makes you happy. We can all achieve happiness if we do a little planning.

Comments on my posts are always appreciated!

Michael Pharmacist

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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L-Methylfolate Uses And Side Effects

Posted on by sunshineneutraceuticals
Blood sample tube with laboratory requisition form for vitamin B12 and folate test

About L-methylfolate

L-methylfolate is a medical food used for patients who are deficient in folate. In this post, I will explore the uses and side effects of L-methylfolate. 

Folate occurs naturally in many different foods. Some foods containing folate include:

 

Citrus Fruits

Leafy green vegetables (Spinach, broccoli, kale, cabbage)

Whole grains

Eggs

Nuts and Seeds

Brussel Sprouts

Strawberries

Avocado

Carrots

Bananas

Legumes

Asparagus

Beets

 Folate is a B vitamin (B9) and used by the body in the production of red blood cells. It may play an essential role in stabilizing mood. L-methylfolate is the active form of folate and is the only form capable of reaching the brain by crossing the blood-brain barrier. L-methylfolate indirectly regulates levels of serotonin, dopamine, and norepinephrine.  Low levels of L-methylfolate can lead to a deficiency of these three neurotransmitters. L-methylfolate is available as a prescription product sold under the brand name Deplin.

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Deficiency

Folate deficiency can be caused by poor diet, diseases that affect GI absorption (celiac disease), and alcoholism.  Individuals who use antiepileptic medications or smoke cigarettes are also at risk for low folate levels.

 

 There is also a large percentage of the population that is unable to convert folate to the active L-methylfolate form. This is due to a methylenetetrahydrofolate reductase (MTHFR) polymorphism.  

 

Folate deficiency can lead to anaemia. Signs of anaemia include fatigue, shortness of breath, weakness, irritability, and pale skin.

Folate deficiency also seems to be associated with depression and specifically, treatment-resistant depression. 

 

Uses

Major Depressive Disorder (MDD)

Depression is currently most often treated with psychotherapy and antidepressant medications.  Psychotherapy is time-consuming, and many patients prefer to use antidepressants as the sole treatment. Unfortunately, greater than 50% of patients treated with antidepressants alone will fail to achieve remission. 

 

 

I have had personal experience with depression and anxiety at different stages of my life.  I have learned to control these conditions by changing the way I think.

 

  I can recommend the book “feeling good” written by Dr David Burns.   Feeling good is a must-read for anyone suffering from depression or anxiety.  The book teaches you how to change your thoughts using simple exercises.  Changing the way a person thinks changes the way they feel.

 

 I also felt much better when I stopped drinking alcohol and started exercising.  Exercise releases endorphins in the brain, which naturally improve mood.  Exercise also increases energy and helps with sleep.  It helps relieve stress and improves memory.  

 Alcohol is a depressant and may lead to devastating consequences if abused.   I will certainly write a post about alcohol in the future.  For now, I will say that my life has been much happier and healthier without alcohol.  If you drink too much, or alcohol is causing problems in your life, please get help.  Your body and mind will thank you in the future.

 

I also began to pay close attention to what I was eating.  The Mediterranean diet has many studies to support it.  If you can stick to it, this diet will produce the best all-around results.  Remember, whole foods, and a balanced diet is a significant goal.  Processed foods should be avoided.  Try to limit refined sugars and be sure to eat enough fruits and vegetables.

A study, published in the American Journal of Psychiatry, compared the addition of L-methylfolate to SSRI’s in patients with treatment-resistant depression.  This study concluded that L-methylfolate, 15mg/day may be a safe and effective augmentation agent in patients with major depression who have had an inadequate response to SSRI’s.

 

 

https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.11071114

George I. Papakostas, et.al

American Journal of Psychiatry 2012 169:12, 1267-1274 

 

 

Another study, conducted by Reynolds et al. in May 2015, Explored the possibility that L-methylfolate has intrinsic antidepressant properties. Methylfolate was compared to amitriptyline in this study. The response rate for methylfolate was 42% (8/19). Amitriptyline had a 35% response rate (7/20) and three patients taking amitriptyline withdrew from the study due to side effects. No side effects were reported in the methylfolate group. The methylfolate responders also were found to have a considerable rise in red blood cell folate levels at six weeks, whereas the non-responders had a smaller increase. 

Schizophrenia

Roffman et al. found L-methylfolate supplementation to be beneficial in schizophrenic patients.  This study was published in Molecular Psychiatry in 2018.  

 

L-methylfolate appears to be more beneficial in schizophrenic patients with the MTHFR polymorphism.  This is expected as dopamine, norepinephrine and serotonin levels are affected by this.  

L-methylfolate Side Effects

Side effects with L-Methylfolate supplementation are generally rare.  As with any medication or food supplement, allergic reactions can occur.  Signs of an allergic reaction include trouble breathing, hives, itching, nasal congestion or rash.  Please seek medical attention if allergic reaction symptoms are severe.

 

Other possible adverse effects include:

 

Trouble sleeping

Abdominal swelling

Depressed mood

Nausea

Bloating

Agitation

Loss of appetite

Confusion

Taste disturbances

Conclusion

L-methylfolate is a useful nutraceutical product that may be used along with an antidepressant for patients with depression.  In studies, it appears the 15mg daily dose is more effective than 7.5mg daily.  It may also benefit schizophrenic patient’s although more data is needed.

 

 L-methylfolate is the only form of folate that is able to cross the blood-brain barrier.  This makes it especially useful in people who lack the ability to convert folic acid into its active form.  L-methylfolate is well tolerated and is available as the brand name Deplin.

 

If you have any questions regarding L-methylfolate or any other vitamin or supplement, feel free to reach out to me using the link below:

Answer my question Michael

Michael Pharmacist

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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