Monday, August 18, 2008

Taking migraine medications and antidepressants at the same time

Research suggests that combining migraine medications called triptans with certain antidepressants — including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — may increase the risk of a rare but serious condition called serotonin syndrome. Although the risk appears to be quite low, debate continues about the level of risk.

Serotonin syndrome occurs when your body has too much serotonin — a chemical found in your nervous system. Triptans, SSRIs and SNRIs naturally raise serotonin levels on their own. When these medications are taken together, the effect may be more pronounced.

Signs and symptoms of serotonin syndrome occur quickly — within minutes to hours — and may include:

  • Nausea, vomiting and diarrhea
  • Fever
  • Increased heart rate (tachycardia)
  • Changes in blood pressure
  • Overactive reflexes (hyperreflexia)
  • Extreme agitation or restlessness
  • Hallucinations
  • Loss of coordination
  • Seizures
  • Coma

With prompt treatment — including stopping any medications that may be increasing your serotonin level — signs and symptoms of serotonin syndrome usually stop within 24 hours. Left untreated, serotonin syndrome may be fatal.

Less seriously, there may be a risk of interactions between other antidepressants and migraine medications. A class of antidepressants known as monoamine oxidase inhibitors (MAOIs) can affect how triptans work — increasing the level of triptans in your blood. And SSRIs and MAOIs should be used sparingly with migraine medications called ergotamines, since these antidepressants can slow down the speed at which ergotamines break down.

If you're taking migraine medications and antidepressants, talk to your doctor — especially if you notice any changes in your health. Don't stop or change the dosages of any of your medications on your own. If you experience signs or symptoms of serotonin syndrome, seek immediate medical attention.

Monday, August 04, 2008

Antidepressants and Sexual dysfunction

Sexual functioning can be affected by many things. Some of these factors include: past sexual experiences, religious beliefs, upbringing, self-esteem, medications (both psychiatric and non-psychiatric, such as some blood pressure medications), depression, and medical conditions such as diabetes or sleep apnea. There may be alternative medications you can use. This is by no means an exhaustive list, so talk with your doctor.

People can have difficulty with one or more of the phases of sexual functioning: desire, arousal and orgasm. Libido, or sex drive, may be reduced during a depressive episode. People describe not having interest in sex and in addition may not be able to have an orgasm. In order to achieve orgasm, arousal must occur. Some people can have low sex drive but are still able to become aroused and achieve orgasm.

A study just published this month in the "Journal of the American Medical Association" (JAMA) claims successful treatment of arousal and orgasm. This study was done on women only.

The study, an 8 week trial, included 98 women currently taking a serotonin reuptake inhibitor (SRI) anti-depressant medication. One-half took Viagra and the other half took a placebo. It showed that Viagra improved orgasm delay but not sexual desire, so will not help everyone. Viagra does have side effects, some of which can be very serious. No study is without bias. The number of women included is not a large number, so it is difficult to apply the results to the general population.

Also, the women's depression had to be in remission to be included in the study. So, was their sexual functioning improved because their depression was treated or was it because of the Viagra? Viagra needs to be taken one hour before sexual activity, so some feel that it reduces spontaneity.

As always, talk with your doctor about options if you have sexual dysfunction. Wellbutrin has a low incidence of sexual dysfunction as does Remeron. These both have potential side effects with Wellbutrin sometimes worsening anxiety and Remeron causing weight gain. Some people have sexual dysfunction with antidepressants such as Prozac, Paxil, Effexor, Cymbalta, Zoloft or Celexa, and some do not. We cannot predict who will have what side effect and to what degree at this time. We are learning more all the time, so stay tuned!

Thursday, July 24, 2008

Physical activity helps relieve stress

By now, you should know that exercise does your body good. But did you also know that virtually any form of exercise can decrease the production of stress hormones and counteract your body's natural stress response? It's true. The same regular exercise routine that helps prevent disease and builds muscle can also help you better manage stress.

How does exercise reduce stress?

Exercise increases your overall health and your sense of well-being, which puts more pep in your steps every day. But exercise also has some direct stress-busting benefits.

  • It pumps up your endorphins. Physical activity helps to bump up the production of your brain's feel-good neurotransmitters, called endorphins. Although this function is often referred to as a runner's high, a rousing game of tennis or a nature hike also can contribute to this same feeling.
  • It's meditation in movement. After a fast-paced game of racquetball or several laps in the pool, you'll often find that you've forgotten the day's dilemmas and irritations and concentrated only on your body's movements. As you begin to regularly shed your daily tensions through movement and physical activity, you may find that this focus on a single task, and the resulting energy and optimism, can help you remain calm and clear in everything that you do.
  • It improves your mood. Regular exercise can increase self-confidence and lower the symptoms associated with mild depression and anxiety. This can ease your stress levels and give you a sense of command over your body and your life.

How to get started

Every successful exercise program begins with a few simple steps.

  • Consult with your doctor. Begin any new fitness program by consulting with your health care provider, especially if you have a history of heart disease or other risk factors.
  • Walk before you run. Build up your fitness level gradually. Excitement about a new program can lead to overdoing it and possibly even injury. Plus, if you begin your program slowly, chances are better you'll stick with it.
  • Do what you love. Don't train for a marathon if you dislike running. All forms of movement — from horseback riding to swimming — can increase your fitness level while decreasing your stress. The most important thing is to pick an activity that you enjoy.
  • Pick a time and stick to it. Although your schedule may necessitate morning workouts some days and evening activities the next, carving out some time to move every day helps you make your exercise program an ongoing priority.

Motivation to keep moving

Starting an exercise program is just the first step. Here are some tips for sticking with a new routine or reinvigorating a tired workout:

  • Set some goals. It's always a good idea to begin or modify a workout program with a goal in mind. If your primary goal is to reduce stress in your life and recharge your batteries, your specific goals might include committing to walking during your lunch hour three times a week or, if needed, finding a baby sitter to watch your children so that you can slip away to attend a spinning class.
  • Find a friend. Knowing that someone is waiting for you to show up at the gym or the park can be a powerful incentive. Working out with a friend, co-worker or family member often brings a new level of motivation to your workouts.
  • Change up your routine. If you've always been a competitive runner, take a look at other less competitive options that may help with stress reduction, such as Pilates classes or yoga. As an added bonus, these kinder, gentler workouts may enhance your running while also decreasing your stress.

Exercise = less stress

Whatever you do, don't think of exercise as just one more thing on your to-do list. Find an activity you enjoy — whether it's an active tennis match or a meditative meander down to a local park and back — and make it part of your regular routine. Any form of physical activity can help you unwind and become an important part of your approach to easing stress.

Simple stress management strategies that can help you keep stress at bay

Stress is more likely to rear its ugly head again if you're not taking care of yourself. So remember to put yourself first. These strategies may help you stay on course:

  • Simplify your life. Rather than looking for ways to squeeze more activities or chores into the day, find a way to leave some things out. Ask yourself what really needs to be done: What can wait and what can be dropped entirely? It's OK to say no.
  • Manage your time wisely. Update your to-do list every day — both at work and at home. Delegate what you can and break large projects into manageable chunks. Tackle the rest one task at a time.
  • Be prepared. Anticipate challenges. Whether it's preparing for a project at work, planning a family gathering or handling a sick child, being prepared can help you face stressful situations with confidence. If necessary, set aside extra time to calm your frayed nerves.
  • Exercise regularly. Exercise can help keep depression and anxiety at bay. Consider it a break from the tension of daily life.
  • Eat smart. A diet rich in fruits, vegetables and whole grains can give you more energy — plus the fuel you need to keep stress under control. If you tend to nibble when you're stressed, don't let your emotions take over. Consider whether you're truly hungry before you have a snack. And don't be fooled by the jolt you may get from caffeine — it'll wear off quickly.
  • Adjust your attitude. If you find yourself thinking, "This can't be done," snap back to attention. Think instead, "This will be tough. But we can make it work." Putting a positive spin on negative thoughts can help you work through stressful situations.
  • Take a break. If you begin to feel overwhelmed, take some time to clear your mind. A few slow stretches or a quick stroll may renew your energy for the task at hand. Or you could take a mental vacation — imagine yourself in a calm, relaxing place. Picture yourself accomplishing your task.
  • Relax. Set aside time for yourself every day, even if it's only a few minutes. When you feel your muscles begin to tense, breathe deeply. Inhale to the count of six, pause for a second and then slowly exhale.
  • Laugh. Humor is a great way to relieve stress. Laughter releases endorphins — natural substances that help you feel better and maintain a positive attitude. Studies suggest laughter may lower blood pressure, boost the immune system and increase circulation as well.
  • Let go. Take responsibility for your tasks, but don't worry about things you can't control.

Coping with setbacks

Feeling stressed is normal. So are setbacks in dealing with stress. After all, behavior change doesn't happen overnight. If you lapse into your old ways, don't give up. Focus on what you can do to regain control of the situation.

If once-helpful techniques seem to lose their effectiveness, try something else. If you're facing new stressors, reconsider the best way to approach the situation. Remember, stress is a part of life. How you respond is up to you.

Social support to reduce stress

It doesn't take a scientific study to show that surrounding yourself with supportive family, friends and co-workers can have a positive effect on your mental well-being, but there's plenty of research to confirm it. A strong social support network can be critical to help you through the stress of tough times, whether you've had a bad day at work or a year filled with loss or chronic illness. It's never too soon to cultivate these important relationships — and your social support network can never have too many good friends.

What is a social support network?

A social support network is different from a support group. A social support network is made up of friends, family and peers, while a support group is generally a structured meeting run by a mental health professional. Although both can play an important role in times of stress, a social support network is something you can develop when you're not under stress, providing the comfort of knowing that your friends are there for you if you need them.

You don't need to formalize your support network with regular meetings or an official leader. A coffee break with a friend at work, a quick chat with a neighbor, a phone call to your sister, even a visit to church are all ways to reduce stress while fostering lasting relationships with the people close to you.

Benefits of a social support network

The positive effects of a support network include:

  • Sense of belonging. Spending time with people helps ward off loneliness. Whether it's other new moms, dog lovers, fishing buddies or siblings, just knowing you're not alone can go a long way toward coping with stress.
  • Increased sense of self-worth. Having people who call you a friend reinforces the idea that you're a good person to be around.
  • Feeling of security. By reaching out and sharing yourself with others, you have the added security of knowing that if you start to show signs of depression or exhibit unhealthy lifestyle habits, your friends can help alert you to the problem.

Cultivating your support network

The first step toward developing a strong support network is an evaluation of your own behavior as it relates to building and maintaining friendships. After all, relationships are a two-way street. The better a friend you are, the better your friends will be. Here are some suggestions for nurturing your relationships:

  • Stay in touch. Answering phone calls, returning e-mails and reciprocating invitations let people know you care.
  • Be proactive. Don't wait for someone else to make the first move. If you meet someone you think could be a good friend, invite him or her for coffee. Or be the one to strike up a conversation while in line at the grocery store.
  • Know when to say "no" and when to say "yes." Spending time with people who aren't supportive can add stress and take away valuable time. On the other hand, don't decline an invitation because you feel shy or insecure.
  • Don't compete. Be happy instead of jealous when your friends succeed, and they'll celebrate your accomplishments in return.
  • Be a good listener. Find out what's important to your friends — you might find you have even more in common than you think.
  • Challenge yourself. Keep looking for ways to improve. Maybe it's by complaining less, being more generous or forgiving others' faults.
  • Don't overdo it. In your zeal to extend your social network, be careful not to overwhelm friends and family with phone calls and e-mails. Save those high-demand times for when you really need them.
  • Appreciate your friends and family. Take time to say thank you and express how important they are to you.

Adding to your support network

Ready for more friends, but not sure where to find them? Here are some ideas for extending your social network:

  • Visit the park. Whether you bring your dog, your kids or your running shoes, you'll have something to talk about.
  • Volunteer. Pick a cause that's important to you, and you're sure to meet others who share a similar value system.
  • Ask a friend. Next time you meet a friend for lunch, ask him or her to bring along someone else.
  • Go back to school. A local college or community education course puts you in contact with others who share similar hobbies or pursuits.
  • Look online. In-person relationships may be best, but if you're living in a small town or living abroad, you might find added support through chat rooms or online bulletin boards. Many good sites exist for people going through stressful times, such as chronic illness, loss of a loved one, new baby, divorce and other life changes. Just be sure to stick to reputable sites, and be cautious about arranging person-to-person meetings.

A cautionary tale

Remember that the goal of extending your social support network is to reduce your stress level, not add to it. Here are some things to look out for when evaluating your relationships:

  • Manage obligatory social ties. Some evidence shows that the negative consequences of maintaining obligatory relationships, such as with certain relatives or co-workers, can outweigh the benefits. Although you may not be able to cut ties with a nagging in-law, look for ways to manage the relationship so that it doesn't become a stressor for you.
  • Beware of codependents. A support system with people who are engaged in the same unhealthy behaviors that you're trying to overcome — whether it's substance abuse or simply a negative attitude — can be damaging to your well-being.
  • Avoid a sense of duty. The best support systems have no strings attached. If your peers are constantly demanding repayment for their efforts, or you feel pressured to conform to their beliefs, you're probably better off without them.
  • Pick the right supporter. If you need help through a hard time, consider carefully which friend or family member to ask. A sibling might not be the best choice, for example, in dealing with grief over a lost parent because he or she too is affected by the loss.

Antidepressants and weight gain

he exact relationship between antidepressants and weight gain isn't clear, but weight gain is a reported side effect of nearly all antidepressants.

Certain antidepressants are more likely to cause weight gain than are others. For example, tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) are more likely to be associated with weight gain than are selective serotonin reuptake inhibitors (SSRIs). The exception to this may be long-term use of paroxetine (Paxil) — an SSRI that's more likely to cause weight gain than are other SSRIs.

It's not possible to predict who's most likely to gain weight from taking antidepressants. However, recent research has shown that people who gain weight within about the first week of starting antidepressant treatment are more likely to have significant weight gain from the medication over an extended period of time.

It's important to remember that association is not the same as causation. There are many factors that can work together to contribute to weight gain during antidepressant therapy. Some people lose weight as part of their depression. In turn, an improved appetite associated with improved mood may result in increased weight. Overeating as a result of depression also can cause weight gain. In addition, some medical conditions that mimic depression — such as underactive thyroid (hypothyroidism) — may cause weight gain.

If you gain weight after starting antidepressant treatment, discuss your concerns with your doctor. He or she can determine the likely cause of weight gain. If your antidepressant seems to be the culprit, it may help to adjust the dose or switch medications.

Understand your sources of stress

The kids are screaming, the bills are due and there's a pile of work on your desk that's growing at an absurdly swift pace. It's undeniable — life often seems full of stress. But understanding the types and sources of stress — big and small, short-term and long-term, internal and external — is an important part of stress management. So where does your stress come from?

Two main types of stress

Stress is your body's reaction to the demands of the world, and stressors are events or conditions in your surroundings that may trigger stress. Two main types of stress you face are:

  • Acute stress. Also known as the fight-or-flight response, acute stress is your body's immediate reaction to a significant threat, challenge or scare. The acute-stress response is immediate, it's intense, and in certain circumstances, it can be thrilling. Examples of stressors that may cause an acute-stress response are a job interview, a fender bender or an exhilarating ski run.
  • Chronic stress. This results from long-term exposure to acute stress. The chronic-stress response is much more subtle than is the acute-stress response, but the effects may be longer lasting and more problematic. The stressors that may lead to chronic stress are the nagging, day-to-day life situations that often seem unrelenting. This includes relationship problems, work difficulties and financial woes.

Effective stress management involves identifying and managing both acute and chronic stress.

Symptoms of stress

While mild stress can actually be beneficial — it can spur you into action, motivate and energize you — it's often the buildup of the little things that can really "stress you out." Persistent stress can lead to many adverse health problems, including:

  • Physical symptoms, such as headache and fatigue
  • Mental symptoms, such as poor concentration
  • Emotional symptoms, such as irritability and depression
  • Social symptoms, such as isolation and resentment

Know your stressors

External exasperations
External stressors are events and situations that happen to you. While you may have control over some of these stressors and how much you let them affect you, there are times when they extend beyond your control. Some examples include:

  • Major life changes. These changes can be positive — a new marriage, a planned pregnancy, a promotion or a new house. Or they can be negative — the death of a loved one or going through a divorce.
  • Environment. These stressors could include a noise disturbance, such as a barking dog, or excessive light, as from a billboard across the street.
  • Unpredictable events. This category could include an increase in monthly bills, an uninvited houseguest or a pay cut.
  • Family. The occasional spousal spat, a teenager who refuses to cooperate or a nagging mother-in-law can all contribute to stress.
  • Workplace. Perhaps an overwhelming workload or an impossible boss.
  • Social. For example, a blind date or making a speech to a room full of co-workers.

Internal irritations
Not all stress stems from things that happen to you. Some of the stress response can be self-induced. Those feelings and thoughts that pop into your head and cause you unrest are known as internal stressors. Examples include:

  • Fears. These can be things, such as a fear of flying or heights, or more-subtle apprehensions such as participating in a discussion with a group of strangers at a meeting.
  • Uncertainty. Stemming perhaps from a looming restructuring at the office or waiting for medical test results.
  • Attitude. Having a negative view of the world can be stressful, since you create an unpleasant environment in which to live.
  • Unrealistic expectations. A perfectionist or controlling personality may lead to unnecessarily high stress levels. Overscheduling and not planning ahead can lead to worries.

How you deal with stress

No wonder you're stressed. You're doing more with fewer resources every day at work, and deadlines lurk around every corner. Then when you get home, you take out your frustrations on your family. Weekends are booked solid with household chores and errands. It's been months since you spent an evening alone with your partner.

So how do you handle it? Understanding how you currently respond to stress — for better or worse — is the foundation for successful future stress management.

Reactions to stress vary

Some people seem to take everything in stride. Their naturally laid-back attitudes shine through in every situation. Another deadline? Bring it on. You needed to be there 10 minutes ago? OK, let's go. The dishwasher is leaking? No problem, it'll be a simple repair.

Others get anxious at the first sign of trouble. They pace the floor or have difficulty concentrating on the task at hand. An interruption or change in plans may cause a stir.

Of course, these examples are extremes. Most people have stress responses that fall somewhere in the middle. When you feel confident, you're likely to take new stressors in stride. If you feel cornered or unprepared, your stress level may rise.

Look for patterns in your coping strategies

To better understand your reaction to life's stressors, consider your current coping behaviors.

  • Do you tense up? Neck and shoulder muscle tension or clenched jaws or fists are often early warning signs of stress. Stress may cause an upset stomach, shortness of breath, back pain, headaches and other physical symptoms as well.
  • Do you reach for something to eat? Stress and overeating are often closely related. Stress may trigger you to eat even when you're not hungry or to lose track of your meal and exercise plans.
  • Do you get impatient? Perhaps you find yourself pacing the floor or twitching nervously. You might have trouble concentrating or falling asleep at night. All of these are signs of stress.
  • Do you get angry? Stress leaves many people with a short fuse. When you're under pressure, you may find yourself arguing with co-workers, friends or loved ones — sometimes with little provocation or about things that have nothing to do with what's actually triggering your stress.
  • Are you reduced to tears? Stress may trigger crying spells or other emotional releases.
  • Do you give up? Sometimes stress may be too much to take. You might deny the issue, avoid the problem, call in sick or simply give up.
  • Do you let negative thoughts take over? When you're under stress, perhaps you automatically expect the worst or magnify the negative aspects of a situation.
  • Have you started to smoke again? Even if you quit smoking long ago, a cigarette may seem like an easy way to relax when you're under pressure. And smoking is a double-edged sword. Aside from the obvious health risks of smoking, nicotine acts as a stimulant — triggering even more stress symptoms.
  • Do you turn to alcohol or other drugs? Stress leads some people to drink too much or engage in other risky behaviors, including drug abuse.
  • Do you rely on a single coping technique? Sometimes crying, expressing your anger or isolating yourself from a problem that you can't possibly fix can serve as an effective stress management technique. The same goes for exercising, confiding in friends or other healthy coping techniques. But in the long run, you may need new ways to handle stress, too. If you find yourself using one technique all the time — or you see yourself engaging in unhealthy behaviors — it's time to open yourself up to other stress-reduction strategies.

Take the next step

Try tracking your reactions to stress over the next week. Once you identify how you cope with stressful situations, you can begin to think about alternative strategies. Consider it the first step on the path to positive stress management. The changes won't happen overnight, but new tools to cope with stress are within your reach.

Thursday, June 26, 2008

Triglycerides

Triglycerides are a type of fat found in your blood. When you eat, your body converts any calories it doesn't need to use right away into triglycerides. The triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals. If you regularly eat more calories than you burn, you may have high triglycerides (hypertriglyceridemia).

A simple blood test can reveal whether your triglycerides fall into a healthy range.

  • Normal — Less than 150 milligrams per deciliter (mg/dL) (less than 1.7 mmol/L)
  • Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)
  • High — 200 to 499 mg/dL (2.3 mmol/L to 5.6 mmol/L)
  • Very high — 500 mg/dL or above (5.7 mmol/L or above)

Your doctor will usually check for high triglycerides as part of a test called a lipid panel or lipid profile, which also checks your cholesterol levels. You'll have to fast for nine to 12 hours before blood can be drawn for an accurate triglyceride measurement.


Triglycerides and cholesterol are separate types of fats (lipids) that circulate in your blood. Triglycerides provide your body with energy, and cholesterol is used to build cells and certain hormones. Because triglycerides and cholesterol can't dissolve in blood, they circulate throughout your body with the help of proteins that transport the lipids, called lipoproteins.

Although it's unclear how, high triglycerides may contribute to hardening of the arteries or thickening of the artery walls (atherosclerosis) — which increases the risk of stroke, heart attack and heart disease.

High triglycerides are often a sign of other conditions that increase the risk of heart disease and stroke as well, including obesity and the metabolic syndrome — a cluster of conditions that includes too much fat around the waist, high blood pressure, high triglycerides, high blood sugar and abnormal cholesterol levels.

Sometimes high triglycerides are a sign of poorly controlled type 2 diabetes, low levels of thyroid hormones (hypothyroidism), liver or kidney disease, or rare genetic conditions that affect how your body converts fat to energy. High triglycerides could also be a side effect of taking medications such as beta blockers, birth control pills, diuretics, steroids or the breast cancer drug tamoxifen.

Saturday, April 05, 2008

Description and details on Venlafaxine (Effexor) antidepressant drugs

Venlafaxine (Effexor) is an antidepressant of the serotonin-norepinephrine reuptake inhibitor (SNRI) class first introduced by Wyeth in 1993. It is prescribed for the treatment of clinical depression and anxiety disorders, among other uses. Due to the pronounced side effects and suspicions that venlafaxine may significantly increase the risk of suicide, it is not recommended as a first line treatment of depression. However, it is often effective for depression not responding to SSRIs. Venlafaxine was the sixth most widely-used antidepressant based on the number of retail prescriptions in the US (17.1 million) in 2006.

Venlafaxine is used primarily for the treatment of depression, generalized anxiety disorder, social anxiety disorder, and panic disorder in adults.

Effexor is distributed in pentagon-shaped peach-colored tablets of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg. There is also an extended-release version distributed in capsules of 37.5 mg (gray/peach), 75 mg (peach), and 150 mg (brownish red).

Venlafaxine is a bicyclic antidepressant, and is usually categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI), but it has been referred to as a serotonin-norepinephrine-dopamine reuptake inhibitor. It works by blocking the transporter "reuptake" proteins for key neurotransmitters affecting mood, thereby leaving more active neurotransmitters in the synapse. The neurotransmitters affected are serotonin (5-hydroxytryptamine) and norepinephrine (noradrenaline). Additionally, in high doses it weakly inhibits the reuptake of dopamine, with recent evidence showing that the norepinephrine transporter also transports some dopamine as well, implying that SNRIs may also increase dopamine transmission. This is because SNRIs work by inhibiting reuptake, i.e. preventing the serotonin and norepinephrine transporters from taking their respective neurotransmitters back to their storage vesicles for later use. If the norepinephrine transporter normally recycles some dopamine too, then SNRIs will also enhance dopaminergic transmission. Therefore, the antidepressant effects associated with increasing norepinephrine levels may also be partly or largely due to the concurrent increase in dopamine (particularly in the prefrontal cortex).

Venlafaxine is well absorbed with at least 92% of an oral dose being absorbed into systemic circulation. It is extensively metabolized in the liver via the CYP2D6 isoenzyme to O-desmethylvenlafaxine, which is just as potent a serotonin-norepinephrine reuptake inhibitor as the parent compound, meaning that the differences in metabolism between extensive and poor metabolizers are not clinically important in terms of efficacy. Side effects, however, are reported to be more severe in CYP2D6 poor metabolizers. Steady-state concentrations of venlafaxine and its metabolite are attained in the blood within 3 days. Therapeutic effects are usually achieved within 3 to 4 weeks. No accumulation of venlafaxine has been observed during chronic administration in healthy subjects. The primary route of excretion of venlafaxine and its metabolites is via the kidneys. The half-life of venlafaxine is relatively short, therefore patients are directed to adhere to a strict medication routine, avoiding missing a dose. Even a single missed dose can result in the withdrawal symptoms.

Venlafaxine extended release is chemically the same as normal venlafaxine. The extended release version (sometimes referred to as controlled release) controls the release of the drug into the gastrointestinal tract over a longer period than normal venlafaxine. This results in a lower peak plasma concentration. Studies have shown that the extended release formula has a lower incidence of patients suffering from nausea as a side effect resulting in a lower number of patients stopping their treatment due to nausea.

Generic venlafaxine is available in the United States as of August 2006 and in Canada as of December 2006. A generic form of the extended-release version is available in Canada as of January 2007 and will become available in the United States in 2010. Generic versions of both drug forms are available now in India.

Venlafaxine was shown to be effective for depression in multiple double blind studies. Venlafaxine is similar in efficacy to trazodone and tricyclic antidepressants amitriptiline (Elavil) and imipramine and it was better tolerated than amitriptiline. Venlafaxine appears to have efficacy similar or somewhat better than sertraline (Zoloft) and fluoxetine (Prozac) depending on the criteria and rating scales used. In particular, higher doses of venlafaxine are more effective, and more patients achieved remission or were "very much improved". At the same time the efficacy was similar if the number of patients who achieved "response" or were "improved" was considered. A meta-analysis comparing venlafaxine and combined groups of SSRI or tricyclic antidepressants indicated superiority of venlafaxine.
Based on the same set of criteria, venlafaxine was similar in efficacy to an atypical antidepressant bupropion (Wellbutrin); however, the remission rate was significantly lower for venlafaxine.
Venlafaxine was also marginally inferior in efficacy to a newer SSRI escitalopram (Lexapro) and had twice higher frequency of the side effects, in particular, nausea, ejaculation disorder, somnolence and sweating.

A popular magazine Consumer Reports, which in 2004 had rated venlafaxine as the most effective among six commonly prescribed antidepressants, no longer recommends it. Fluoxetine, citalopram and bupropion have been chosen as Consumer Reports Best Buy drugs in the updated version of their guide, based upon effectiveness, safety, side effects, and cost.

Venlafaxine is not recommended in patients hypersensitive to venlafaxine. It should not be taken by anyone who is allergic to the inactive ingredients, which include gelatin, cellulose, ethylcellulose, iron oxide, titanium dioxide and hypromellose. It should never be used in conjunction with a monoamine oxidase inhibitor (MAOI), due to the potential to develop a potentially deadly condition known as serotonin syndrome. At least 14 days time lag are required between the intake of venlafaxine and MAO inhibitors.

Caution should also be used in those with a seizure disorder. Venlafaxine is not approved for use in children or adolescents. However, Wyeth does provide information on precautions if venlafaxine is prescribed to this age group for the treatment of non-approved conditions. Studies in these age groups have not established its efficacy or safety.

The prescribed dosage of venlafaxine may have to be adjusted for those with liver, thyroid or kidney problems. It is crucial to inform a doctor of any such disorders before taking venlafaxine.

Venlafaxine can increase eye pressure, so those with glaucoma should inform their doctors before taking venlafaxine. More frequent eye checks may be necessary.

The FDA has asked the sponsors of all SNRIs to include the potential risk for persistent pulmonary hypertension (PPHN) in prescribing data as of July 19, 2006. Medications containing Venlafaxine caused a mean heart rate increase of 4 b.p.m in clinical trials, along with a sustained increase in blood pressure in some.

The development of a potentially life-threatening serotonin syndrome may occur with Effexor XR treatment, particularly with concomitant use of serotonergic drugs (including SSRIs, SNRIs, and triptans) and with drugs that impair metabolism of serotonin (including MAOIs). Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).



As with most antidepressants, lack of sexual desire is a common side effect. In trials, delayed ejaculation and delayed orgasm occurred in 8-16% of men. Delayed orgasm occurred in 2-8% of women. Venlafaxine can raise blood pressure at high doses, so it is contraindicated for persons with hypertension.

It has a higher rate of treatment emergent mania than many modern antidepressants, and many people find it to be a more activating medication (one that increases energy or wakefulness) than other antidepressants.[citation needed] Paradoxically, some users find it highly sedating and find that it must be taken in the evening.

There have been false positive phencyclidine (PCP) results caused by Venlafaxine with certain on-site routine urine-based drug tests. Positive on-site results should always be sent to a qualified drug testing laboratory for confirmation before any action is taken against the employee.

The percentage of occurrences for each side effect listed comes from clinical trial data provided by Wyeth Pharmaceuticals Inc. The percentages indicate the percentage of people that experienced the side effect in clinical trials.

* Nausea (21-35%)
* Headache (34%)
* Apathy
* Constipation
* Ongoing Irritable Bowel Syndrome
* Dizziness (11-20%)
* Fatigue
* Insomnia (15-23%)
* Vertigo
* Dry mouth (12-16%)
* Sexual dysfunction (14-34%)
* Sweating (10-14%)
* Orthostatic hypotension (postural drop in blood pressure)
* Vivid dreams (3-7%)
* Impulsive Actions
* Increased blood pressure
* Decreased Appetite (8-20%)
* Electric shock-like sensations also called "Brain zaps"
* Increased anxiety at the start of treatment
* Akathisia (Agitation) (3-4%)
* Memory Loss

A comparison of adverse event rates in a fixed-dose study comparing venlafaxine 75, 225, and 375 mg/day with placebo revealed a dose dependency for some of the more common adverse events associated with venlafaxine use. The rule for including events was to enumerate those that occurred at an incidence of 5% or more for at least one of the venlafaxine groups and for which the incidence was at least twice the placebo incidence for at least one venlafaxine group. Tests for potential dose relationships for these events (Cochran-Armitage Test, with a criterion of exact 2-sided p-value <= 0.05) suggested a dose-dependency for several adverse events in this list, including chills, hypertension, anorexia, nausea, agitation, dizziness, somnolence, tremor, yawning, sweating, and abnormal ejaculation. Most patients overdosing with venlafaxine develop only mild symptoms. However, severe toxicity is reported with the most common symptoms being CNS depression, serotonin toxicity, seizure, or cardiac conduction abnormalities. Venlafaxine's toxicity appears to be higher than other SSRIs, with a fatal toxic dose closer to that of the tricyclic antidepressants than the SSRIs. Doses of 900 mg or more are likely to cause moderate toxicity. Deaths have been reported following very large doses.

There is no specific antidote for venlafaxine and management is generally supportive, providing treatment for the immediate symptoms. Administration of activated charcoal can prevent absorption of the drug. Monitoring of cardiac rhythm and vital signs is indicated. Seizures are managed with benzodiazepines or other anti-convulsants. Forced diuresis, hemodialysis, exchange transfusion, or hemoperfusion are unlikely to be of benefit in hastening the removal of venlafaxine, due to the drug's high volume of distribution.

Friday, March 07, 2008

Depression After a Heart Attack

The increased risk of death associated with depression after a heart attack persists for at least five years, a study finds.

"We've known for a number of years that depression increases the risk of mortality as well as morbidity [illness] after a heart attack for at least three to six months," said study author Robert M. Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis. "We assumed that we would find a decline in risk, but that was not what we found. The risk remained worse after five years."

Carney and his colleagues followed more than 750 people after their heart attacks, according to their report in the current online issue of the Journal of Affective Disorders. Using diagnostic interviews rather than the self-reporting common in most such studies, the researchers determined that 163 had major depression, and 195 had minor depression. Over the five-year study, the death rate was 87 percent higher for those with major depression and 76 percent higher for those with any form of depression.

In real numbers, 62 people diagnosed with depression died during the study, while 44 non-depressed heart attack patients died.

Why depression should increase the risk of dying is a mystery, Carney said. "We think that because depression is a chronic and recurrent problem, the factors causing that risk recur over time," he said. "But we don't know the mechanism."

The researchers have started a trial to determine whether the omega-3 fatty acids that are found in fish oil can reduce that risk. Heart patients are being given an antidepressant drug and a special formulation of omega-3 fatty acids, comparing them with a similar group that gets only an antidepressant.

"A number of studies over the years have found an inverse relationship between the amount of fish people eat and depression," Carney said. "The advantage of giving them in heart disease is that they have an effect on the cardiovascular system as well."

The major finding of the study and the use of omega-3 fatty acids are already in the mainstream of research on depression and heart disease, said Dr. Alexander H. Glassman, a professor of psychiatry at Columbia University Medical Center in New York City.

"There is a torrent of information that depression in relation to vascular disease worsens the outcome," Glassman said. "If you look at post-stroke patients, you find the same data. If you look at heart failure, depression has a similar effect on mortality."

The value of the study is that it had the longest follow-up of any trial using diagnostic interviews, which are regarded as more accurate than self-reporting, Glassman said. "It makes the evidence firmer and extends the evidence," he explained.

The use of omega-3 fatty acids is "a hot issue," being tried in cardiac and non-cardiac cases, Glassman said. "It is a logical thing to do," he added.

The study and the omega-3 trial will still leave some major issues about depression and heart disease open, Glassman said.

"The two key questions that remain are: Does treating depression make the outcome better? And what is it about depression that is causing the problem in the first place?" he said.

Thursday, February 14, 2008

For hepatitis C sufferers

Adelaide scientists will lead a $2 million five-year project to develop new vaccines and explore better treatment options for hepatitis C sufferers.

University of Adelaide virologists Dr Michael Beard and Dr Karla Helbig will work with colleagues from the University of NSW to develop new strategies to treat and prevent hepatitis C, which infects more than 170 million people around the world.

The scientists, who are also attached to the Institute of Medical and Veterinary Science and Royal Adelaide Hospital, hope to identify antiviral proteins that can be used in the fight against hepatitis C.

Currently there is no effective vaccine and the existing treatment is expensive and often causes severe side effects. The success rate also varies between 50-80% so many sufferers cannot be helped by current approaches.

The funds, awarded by the National Health and Medical Research Council (NHMRC), are part of a larger $17.7 million joint program grant, tackling both HIV/AIDS and hepatitis C and involving nine scientists from across Australia.
This latest grant is an adjunct to three NHMRC project grants awarded to Dr Beard’s team in the past two years specifically for hepatitis C research.

In 2006 the virologist was awarded more than $894,000 to investigate the link between alcohol and hepatitis C, and the basic mechanisms of liver disease.

“In Australia, more than 264,000 people have been infected with the hepatitis C virus and there are approximately 10,000 new infections per year. A proportion of these are intravenous drug users, with alcohol playing a significant role in disease progression,” Dr Beard said.

He said vaccines had been trialled for HIV, but with little success. “There is antiretroviral treatment but this does not eradicate HIV, it only keeps it under control for a period of time. It is also very expensive and therefore not accessible on a global scale”.

Wednesday, February 06, 2008

Take Action to Prevent Cancer

As part of National Cancer Prevention Month in February, experts at The University of Texas M. D. Anderson Cancer Center encourage participation in cancer prevention studies to help researchers learn more about the causes of cancer and how to avoid the disease.
Cancer prevention studies are designed for people who have not been diagnosed with cancer or for those who have successfully completed cancer treatment. Today’s standard cancer prevention recommendations are the results of research data from past prevention studies.

Hawk predicts prevention studies will begin to focus more on populations with a high risk of developing cancer, such as persons with a family history of cancer (mother, father, brother or sister) as well as those with a personal history of cancer.

High-risk populations are likely to benefit most from taking medications, adopting healthy lifestyle behaviors that may reduce risk or both. Studies involving high-risk populations also can lay the groundwork for follow-up studies addressing those at lower risk of developing cancer.
A large percentage of the nation’s cancer prevention trials are taking place at M. D. Anderson. Hawk’s extensive involvement in cancer prevention studies gives him insight into ways to expand and enhance M. D. Anderson’s role in the field.

People who participate in prevention studies at M. D. Anderson may take medicines, vitamins or other supplements, or obtain screening exams that may lower their risks of developing cancer. Some prevention studies may collect demographic, lifestyle, medical and family history information to learn more about the causes of cancer and how to prevent them.

The Division of Cancer Prevention and Population Sciences is one the largest cancer prevention programs in the nation. It was established to learn more about the causes of cancer, encourage people to adopt health lifestyle habits that may prevent cancer and develop effective medication that lowers cancer risk.

Saturday, January 12, 2008

Alzheimer's or depression

Early Alzheimer's and depression share many symptoms, so it can be difficult even for doctors to distinguish between the two disorders. And many people with Alzheimer's up to 40 percent, in fact also are depressed.

One important difference between Alzheimer's and depression is in the effectiveness of treatment. While Alzheimer's drugs can only slow the progression of cognitive decline, medications to treat depression can improve a person's quality of life dramatically.

People who have both Alzheimer's and depression may find it easier to cope with the changes caused by Alzheimer's when they feel less depressed.

Similar symptoms


Some of the symptoms common to both Alzheimer's and depression include:


  • Loss of interest in once-enjoyable activities and hobbies

  • Social withdrawal

  • Memory problems

  • Sleeping too much or too little

  • Impaired concentration


With so much overlap in symptoms, it can be hard to distinguish between the two disorders, especially since they so often occur together. A thorough physical exam and psychological evaluation can be helpful in determining a diagnosis. However, many people with moderate to severe Alzheimer's disease lack both the insight and the vocabulary to express how they feel.

Signposts for depression


To detect depression in people who have Alzheimer's disease, doctors must rely more heavily on nonverbal cues and caregiver reports than on self-reported symptoms. If a person with Alzheimer's displays one of the first two symptoms in this list, along with at least two of the others, he or she may be depressed.


  • Significantly depressed mood sad, hopeless, discouraged, tearful

  • Reduced pleasure in or response to social contacts and usual activities

  • Social isolation or withdrawal

  • Eating too much or too little

  • Sleeping too much or too little

  • Agitation or lethargy

  • Irritability

  • Fatigue or loss of energy

  • Feelings of worthlessness, hopelessness or inappropriate guilt

  • Recurrent thoughts of death or suicide


Alzheimer's disease with depression is different


Men and women who have Alzheimer's disease become depressed with equal frequency. This differs from the general population, in which women are more likely to experience depression than are men. People with Alzheimer's may also experience depression differently from people without Alzheimer's. For example, individuals diagnosed with Alzheimer's disease:


  • May have symptoms of depression that are less severe

  • May experience episodes of depression that don't last as long or recur as often

  • Talk of suicide and attempt suicide less often


Treatment options


Support groups and professional counseling may help persons with depression in the early stages of Alzheimer's disease, before their communication skills deteriorate. Regular physical exercise, particularly in the morning, also seems to ease the symptoms of depression. But the most common treatment is prescription antidepressants.


Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the first line antidepressants used for people who have depression and Alzheimer's because of the low risk of side effects and drug interactions. SSRIs include citalopram (Celexa), sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac).


Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs are often tried next if the SSRIs don't work. However, SNRIs which include venlafaxine (Effexor), mirtazapine (Remeron) and bupropion (Wellbutrin) have more side effects, such as sedation, dry mouth and constipation.


Tricyclic antidepressants

These older antidepressants, such as nortriptyline (Pamelor) and desipramine (Norpramin), are no longer used as first-choice treatments because they can cause significant side effects, including increased confusion. However, they may be prescribed if other medications aren't effective.


When medications don't help


Some people with depression and dementia may not respond to medication. In many of these cases, electroconvulsive therapy can help relieve symptoms of severe depression. The procedure delivers electricity to the brain for a few seconds, to trigger a seizure. It's performed under general anesthesia in a hospital.

Electroconvulsive therapy is used more frequently for older people than for younger people perhaps because older people may have more side effects from antidepressants or have more severe complications from severe depression.

What's the link?


Scientists aren't sure of the exact relationship between Alzheimer's disease and depression. Some research has found that the biological changes caused by Alzheimer's may intensify genetic predisposition to depression. Other studies suggest that the presence of depression may increase your chances of developing Alzheimer's disease.

It's clear that depression has a strong effect on quality of life for people with Alzheimer's disease. Depression can lead to:


  • Weight loss

  • Physical fragility

  • Earlier placement in nursing homes

  • Greater disability involving daily living skills

  • Physical aggression toward caregivers


Finding the proper diagnosis and getting appropriate treatment can help make life easier and more enjoyable for both the person with Alzheimer's and his or her caregivers.

Wednesday, January 09, 2008

Factors of a psychotic disorder

It may be possible to predict who will develop psychotic illnesses, such as schizophrenia and bipolar disorder, very early in the disease process.
The study found five factors that were often present prior to the diagnosis of a psychotic disorder in children who were already at high risk of such disorders.

These included a family history of schizophrenia with recent deterioration in functioning; higher levels of unusual thoughts; higher levels of suspicion or paranoia; greater social impairment; and a history of substance abuse.

When two or three of these factors were present, the odds of psychotic illness jumped. Two factors increased the likelihood of psychotic illness to 68 percent, and three factors combined raised the risk to 80 percent.

Not everybody who has early symptoms goes on to develop psychosis. But if we identify the group in which 80 percent will develop psychosis, the efforts of intervention would be best applied to those at highest risk.

Symptoms of psychosis are seen in numerous mental health disorders, such as bipolar disorder, schizophrenia, depression, and with some forms of alcohol or drug abuse.

The two most common psychotic symptoms are delusions and hallucinations, according to AACAP. Delusions are false but firmly held beliefs. Hallucinations are false sensory perceptions, such as hearing voices when no one is talking.

Thursday, January 03, 2008

And Major depressive disorder

Major depressive disorder or MDD is the most common major mental illness, afflicting almost one in five individuals. More than 75% of people who recover from an episode of MDD will have at least one recurrence, with the majority having multiple recurrences. Major depressive disorder is the leading cause of disability of all medical illnesses, with substantial functional impairment, morbidity, and mortality. Few studies have assessed the efficacy of antidepressant medications beyond 1 year of maintenance treatment for the prevention of recurrent depression.

The investigators randomly assigned patients with recurrent depression to receive treatment with either venlafaxine extended-release (ER) or fluoxetine, an antidepressant already established as efficacious as a comparative medication. Although the PREVENT study followed patients for over two years, this article reports only on the acute and continuation phases, which were 10 weeks and 6 months long respectively.

The authors found that nearly 80% of the patients achieved at least an adequate therapeutic response to acute phase treatment with venlafaxine ER or fluoxetine, and almost none of the responders who continued on treatment for 6 months relapsed.

In addition to the high response rates by the patients in this study, the rates of adverse events (side effects) were similar among the two treatment groups