November 11th, 2014

Is a Good Night’s Sleep the Best Prescription for Depression and Pain?

sleep14Introduction:

Depression and chronic pain are two common conditions that are also associated with poor sleep quality. While it is often thought that the sleep issues are secondary to these conditions, a new study conducted by researchers from the University of Alabama indicates that depression and pain due to osteoarthritis could be the result of poor sleep quality instead of the other way around.

Background Data:

Prior research has shown that people with hip and knee osteoarthritis (OA) are more likely to have insomnia, daytime sleepiness, and depression, than those without OA. The obvious relationship is that the arthritis pain affects sleep and makes people depressed. However, a 2012 study published in the journal SLEEP looked at sleep quality in people who were in chronic pain, including those with osteoarthritis and researchers found:

  • The amount of pain that people were in before they went to bed had little to do with how well they slept.
  • A person’s sleep quality predicted how much pain they were in the next day. People who slept poorly had more pain the following day.

Other studies have shown that poor sleep quality can trigger inflammatory pathways that make arthritis pain worse, and poor sleep also make people more sensitive to the feeling of pain from any cause.

New Data:

To better examine the relationship between OA, pain, and depression, 367 patients with OA of the knee from a variety of sources were recruited to participate in a trial. The participants completed a detailed questionnaire that identified overall health, depression, pain, joint function, and sleep quality. One-year follow-up was available for 288 patients.

Analysis of the data collected from the questionnaires indicated that comparing the initial baseline with 1-year follow-up data, sleep disturbance at baseline was linked with increased depression and further loss of joint function, but interestingly not more pain.

Since the questionnaire used in the study was not specifically designed to identify the exact sleep issues in OA patients, further research is needed to more fully pinpoint what is abnormal about OA patients’ sleep. Nonetheless, the conclusion from the study is the disturbance in sleep definitely precedes the depression, loss of joint function, and likely increased pain associated with OA. Hence, the takeaway message is that improving sleep quality is a key goal in preventing the progression of OA as well as the associated depression.

Commentary:

Early on in my clinical practice, I realized that improving my patient’s ability to get a good night’s sleep was usually the quickest way to help them feel better in every way. Over the years I have used a number of natural products that can help to improve sleep quality. The specific product that I now recommend as a first step is the one that I developed: Tranquil Sleep from Natural Factors. This formula provides the combination of melatonin (3 mg), 5-HTP (30 mg), and L-theanine (200 mg) in a great tasting chewable tablet or soft-gelatin capsule. These three ingredients work together to decrease the time required to get to sleep and to decrease the number of nighttime awakenings. Here is a brief description of each ingredient as it relates to improving sleep quality. If you don’t use Tranquil Sleep, you can get the same effect by combining them on your own

Melatonin is the most popular natural aid for improving sleep quality. Supplementation with melatonin has been shown in several studies to be very effective in helping induce and maintain sleep in both children and adults and in both people with normal sleep patterns and those with insomnia. Typical dosage is 3 mg at bedtime.

5-HTP (5-Hydroxytryptophan) is converted in the brain to serotonin – an important initiator of sleep. It is one step closer to serotonin than l-tryptophan and has shown more consistent results in promoting and maintaining sleep, even though used at lower dosages. One of the key benefits of 5-HTP is its ability to increase REM sleep (typically by about 25%) while increasing deep sleep stages 3 and 4 without lengthening total sleep time. Recommended dosage for improving sleep quality in combination with melatonin is 25 to 50 mg at bedtime.

L-Theanine is a unique amino acid found in green tea. Clinical studies have demonstrated that L-theanine reduces stress, improves the quality of sleep, diminishes the symptoms of the premenstrual syndrome, heightens mental acuity and reduces negative side effects of caffeine. It is an excellent support agent to melatonin and 5-HTP. Recommended dosage is 200 mg at bedtime.

Reference:

Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in Osteoarthritis: Linkages with pain, disability and depressive symptoms. Arthritis Care Res. 2014 Oct 6. doi: 10.1002/acr.22459. [Epub ahead of print]

Dr. Michael Murray
11/11/2014

November 3rd, 2014

Antidepressant Drugs Blunt Feelings of Love and Sexual Function

images-1sexualdisfunctionIntroduction:

A recent study raises a new issue with long-term antidepressant use, adding another reason for consumers to seek alternatives. The study, conducted by researchers at the University of Pisa, Italy, found that antidepressant drugs affected men and women differently in the areas of feelings of love and sexual intimacy – but, the bottom line is that these drugs adversely affected feelings of commitment and attachment towards their partners in both men and women. This new study raises another question on the real value of antidepressant drugs on quality of life issues.

Background Data:

Since the introduction of Prozac in 1987, antidepressants known as selective serotonin reuptake inhibitors (SSRIs), are now among the world’s most widely prescribed medications, with sales in the U.S alone of about $20 billion per year. These antidepressants also include brands like Zoloft, Paxil, Luvox, Celexa, and Lexapro.

In recent years, the side effects of these drugs, from weight gain and sexual dysfunction to suicidal behavior, have been better defined. In addition, there is growing evidence that in most studies, there is really no difference in efficacy between the placebo and the drug in all but the most severe cases. The presence of unwanted side effects coupled with little real benefit makes these drugs less than an ideal approach.

Approximately 20% of patients experience nausea; 20% headaches; 15% anxiety and nervousness; 14% insomnia; 12% drowsiness; 12% diarrhea; 9.5% dry mouth; 9% loss of appetite; 8% sweating and tremor; and 3% rash. SSRIs also definitely inhibit sexual function. In studies where sexual side effects were thoroughly evaluated, 43% of men and women taking SSRIs reported loss of libido or diminished sexual response.

New Data:

The new study utilized the Sex-Attachment-Love Test (SALT) questionnaire in nearly 200 adults with mild or moderate depression taking either serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs). Questions on the SALT questionnaire are divided into three groups under the sex, attachment, or love domains.

All patients had a diagnosis of mild or moderate depression, had been taking just one antidepressant for at least 6 months, and were involved in what they considered “a loving relationship” (mean length, 150 months) before they had started antidepressant treatment. In addition, 60% of the participants were married, 24% lived with a partner, and 15% lived alone. Also, 93% were heterosexual, and 7% were homosexual.

A total of 76 women and 33 men were taking an SSRI. The most commonly used was paroxetine (multiple brands), followed by escitalopram (Lexapro), citalopram (Celexa) and sertraline (Zoloft). A total of 48 women and 35 men were taking a TCA, with the most commonly used being clomipramine (Anafranil), followed by imipramine (multiple brands), amitriptyline (multiple brands), and trimipramine (Surmontil).

Results showed a significant impairment in sexual desire in women taking TCAs compared with the men, but the men taking SSRIs showed significant impairment in feelings of love, compared to women.

The researchers concluded that the SSRIs seemed to provoke more alterations of some emotional features than TCAs in men, while women seem to be ‘preserved’ by this side effect. The speculation is that since women often feel things deeper than men, SSRIs may not affect them as much in terms of feelings of love. But, there is no question that SSRIs led to impaired sexual desire and when examining specific items from the SALT, the investigators found that, overall, patients taking SSRIs had significantly more “less than before” answers than those taking TCAs to several attachment statements, including the following: “I feel at ease in sharing with my partner thoughts and feelings”, “I address my partner for advice or help”, and “I rely on my partner easily” (P = .001); and to the love statement, “I wish the love I feel for my partner would last forever”.

In general, the patients felt less committed to and more detached from the partner than before the beginning of the treatment. These results are extremely alarming given the importance of intimate relationships to quality of life.

Commentary:

The SSRI antidepressant drugs are thought to works by specifically inhibiting the re-uptake of serotonin at the nerve endings in the brain. As a result, more serotonin is likely to bind to receptor sites on brain cells and transmit the serotonin signal. Serotonin is a very important neurotransmitter derived from the amino acid tryptophan. It is the brain’s own natural antidepressant and tranquilizer. A decrease in serotonin function is thought to be a major cause of depression, anxiety, and insomnia.

Serotonin is not only important in controlling your moods and behavior, it also acts as a kind of chemical traffic cop that regulates the activity of many other neurotransmitters. The level of serotonin present in your brain can have a tremendous impact on how you think, feel, and behave.

Here are some non-drug approaches for depression:

For more information, consult The Third Edition of the Encyclopedia of Natural Medicine.

Reference:

Marazziti D, Baroni, Dell’Osso L. Emotional blunting following long-term antidepressant treatment. Eur Neuropsychopharmacol. 2014;24(Suppl 2):S447

Dr. Michael Murray
11/4/2014

November 2nd, 2014

November is National Diabetes Awareness Month

Introduction

The statistics on the growing epidemic of type 2 diabetes are staggering as it is now estimated that over 100 million Americans have diabetes or prediabetes and are at high risk of developing diabetes. If things do not change one-half of all Americans adults will develop the disease by 2020. It is a serious issue that will bankrupt our society on many levels if the tide is not turned.

Currently, one out of every five United States federal health care dollars is spent treating people with diabetes. The average yearly health care costs for a person without diabetes is $2,560; for a person with diabetes, that figure soars to $11,744. Much of that increase is related to the costs of drugs.

A “Misguided” Organization

The American Diabetes Association (ADA) is the largest and most powerful organization dealing with this deadly disease. Though the ADA does a great deal of good, I wonder if the agenda of the organization is more to be a front for the pharmaceutical industry rather than trying to offer effective answers to patients with diabetes. The ADA’s Standards of Medical Care for Type 2 Diabetes focuses on the complete overreliance on the drug treatment of diabetes and its complications while completely ignoring the use of critical nutritional support.

When medical historians look back at these sorts of position papers they will refer to them as marketing propaganda promoting the dark age of pharmaceutical interventions. These guidelines were obviously written by individuals closely tied to the drug industry – it’s a travesty. The major shortcoming of pharmaceutical interventions in type 2 diabetes are that they do not impact the progression of the disease and in many cases actually accelerate the underlying disease process and increase mortality. Yet, this approach is the only one offered by conventional medicine.

A Rational Solution

The key issue that is not addressed by the ADA or other conventional medical group dealing with diabetes is that the drugs are only biochemical band-aids and some of the drugs actually shorten life expectancy (click here). There is one fundamental truth that is rarely explained to the patient: type 2 diabetes in almost every case is a disease caused by diet and lifestyle. The focus should be on using diet, lifestyle, and natural medicine to achieve ideal blood glucose control and metabolic targets, as well as reducing the risk of the complications of diabetes by focusing on the following four areas:

  1. Providing optimal nutrient status
  2. Reducing after-meal elevations in blood glucose levels
  3. Improving insulin function and sensitivity
  4. Preventing nutritional and oxidative stress

For more information, please see the completely revised and updated 3rd edition of The Encyclopedia of Natural Medicine.