Antidepressants Blog

Bile acid sequestrants

Drag names and brand names: Cholestyramine (Questran Lite), colestipol (Colestid Granules).

How do bile acid sequestrants work? They bind with cholesterol containing bile acids in the intestines, and are then removed in bowel motions. These drugs typically lower LDL cholesterol by 10-20%. Sometimes a bile acid sequestrant is given with a statin drag in order to lower cholesterol levels more efficiently. Together, these two drags can lower LDL cholesterol by approximately 40%. Triglycerides are not lowered by bile acid sequestrants. These drags usually come as powders and are mixed with water or juice and consumed once or twice daily with meals.

Side effects of bile acid sequestrants: These drags reduce your ability to absorb other medications you take. They also inhibit the absorption of the fat soluble vitamins A, E, D and K, therefore long term use of bile acid sequestrants usually requires vitamin supplementation. Antacids impair the effectiveness of bile acid sequestrants, therefore the two drags should not be taken together. The most common side effects of these medications are digestive upsets such as gas, nausea, bloating and constipation.

Cholesterol absorption inhibitors

Drug name and brand name: Ezetimibe (Ezetrol).

How do cholesterol absorption inhibitors work? This is a new class of drugs which was first approved by the US FDA in late 2002. Ezetimibe inhibits the intestinal absorption of cholesterol found in bile and the diet. When given by itself, ezetimibe reduces LDL cholesterol by 18-20%. It is often given with a statin, especially in people who get side effects from high doses of statins. Ezetimibe can increase HDL cholesterol, but the way it does this is not yet known. It has no effect on the absorption of triglycerides, bile acids, fatty acids and fat soluble vitamins. This drug is taken in tablet form once daily.

Side effects of cholesterol absorption inhibitors: So far studies have shown that side effects in people taking ezetimibe were no greater than those taking a placebo. It is generally well tolerated if taken on its own.

*31/53/5*

Doctors are divided over the importance of stress in infertility and yet stud-have shown that it can affect a man’s fertility to the point where not only the count is reduced but also the quality of the sperm, with abnormal sperm and decreased motility.

Stress can also affect a man’s hormone balance, lowering his levels of testosterone and luteinising hormone.

The release of the stress hormone prolactin in response to a crisis can affect a woman’s ability to conceive and in extreme cases can stop her ovulating. It seems to be nature’s way of protecting women from getting pregnant at a time when they would find it hard to cope. Women going through a bereavement or other kind of trauma for instance can stop having periods altogether.

Couples trying for a baby often experience high levels of stress, particularly if medical intervention is required. The longer it takes, of course, the more anxious you may become – and the more chance there is of stress inhibiting your fertility. A number of studies show that if a woman becomes totally obsessed with having a baby she may release eggs which are not mature enough to be fertilised.

There are many anecdotes concerning couples who have given up fertility investigations, put their names down for adoption, and then found themselves pregnant. One lady I saw gave up work to have a baby and got so bored that she decided to find another job and then got pregnant. Other women may find that the stress of the job they are doing may be affecting their fertility. We are all so different and what affects one person may not trouble another – ‘one man’s meat is another man’s poison’.

Many couples find that they conceive on holiday when they are relaxed and have forgotten about all their domestic worries. Infertility is clearly a multi-factorial problem, which is why this book looks at all the possibilities, not only the physical aspects (such as hormones and nutrition) but also the psychological and emotional side.

*16/73/5*

At least two million Americans have glaucoma, the second leading cause of preventable vision loss after diabetes. The disease – a result of extra pressure on the optic nerve from improperly draining eye fluid – isn’t curable, but it’s treatable, often with pressure-reducing eye drops.

In other words, you don’t have to go blind if you get glaucoma. But some people do.

“There’s no excuse for vision loss from glaucoma other than personal neglect,” insists Richard Bensinger, M.D., a spokesman for the American Academy of Ophthalmologists in Seattle. “Either you never got your eyes checked or your physician didn’t nag you hard enough to follow the medical regimen.”

Why should you have to be nagged into not going blind? According to Dr. Bensinger, it’s not just the mild inconvenience of an eye drop routine but also the lack of immediate payoff. “We don’t have to encourage people with arthritis because they’re hurting, and when they take their medicine, the pain goes away,” he says. “But with glaucoma the results seem like nothing. You don’t see any better or feel any better after you take the drops.”

There’s a similar reluctance about eye checkups, even though if you catch glaucoma in the bud via an eye-pressure test, you keep most of your sight. “The problem is that garden-variety glaucoma doesn’t have any symptoms,” Dr. Bensinger says.

So don’t wait till it’s too late. Dr. Bensinger recommends that you get your eyes examined every five years from age 25 to 50, and every two years after that. And you should have your eyes checked more often if there is a history of glaucoma in your family.

And please, take your medicine.

*94/36/5*

The DSM-HI-R (Diagnostic and Statistical Manual of Mental Disorders) is more than just a psychiatric cookbook. No mere list of diagnostic criteria can describe the many ways a mental disorder affects people, while diagnosing by symptoms alone will not fully explain a condition. To enhance its usefulness, the manual describes some of the other features of anorexia nervosa.

For example, it notes the different ways weight loss can occur. One woman might rely on reduced food intake alone. Another might reduce intake but exercise excessively as well. Others use self-induced vomiting or laxatives or diuretics. The manual thus acknowledges that bulimia and anorexia may indeed coexist.

The compulsion to exercise is very common in anorexia. Even doctors a century ago recognized the symptom.

Many anorexics feel they have to run everywhere, that walking is just a missed opportunity to burn off more calories. Parents often tell me that their anorexic daughter “never stands still” or that she “always runs up the stairs” or that she “pedals her exercise bike until after midnight.”

Anorexics aren’t driven to exercise because they want to be physically fit. They simply want to burn off energy (and thus weight) in any way possible. Excessive exercise may also trigger some pleasurable changes in brain chemistry, producing effects such as the “runner’s high” that many joggers report. Thus anorexics may exercise to experience a neurochemical “reward.”

Besides exercise, other weight-loss methods include use of laxatives to stimulate bowel movements or diuretics to decrease water in the body. Anorexics frequently resort to such tricks to speed up the removal of food from the body.

The results can be disastrous. Many patients-some of whom use between thirty and a hundred laxative tablets a day-report cramps and abdominal pain. What’s more, the body, robbed of its ability to regulate elimination on its own, can become dependent on a laxative. I find that weaning patients from laxatives is one of the hardest tasks in treating eating disorders.

Laxatives and diuretics can produce severe dehydration and electrolyte imbalance. Electrolytes are chemicals such as sodium and potassium that help transmit electrical signals within the body. An insufficient supply of electrolytes puts tissues and organs, particularly the heart, at risk of failure. Patients who abuse laxatives and diuretics risk problems with their hearts and other organs, problems that in some cases lead to death. Ironically, laxatives don’t even help that much. A laxative abuser loses no more than 10 percent of available calories through this method, and most of the weight loss is merely “water weight” anyway, as I mentioned earlier.

Of course, the problem with starving yourself is that you’re always hungry. No matter how carefully you defend yourself against food, sooner or later you will have to eat something or die. Because the hunger can be overwhelming, eating even small amounts can trigger a binge.

For people with these disorders, eating anything, especially when it leads to a binge, represents loss of control. Vomiting restores control-at least until the next urge to eat comes along.

About half of all anorexics practice self-induced vomiting. I’ll have more to say about the physiological impact of vomiting in the discussion about bulimia in the next chapter.

By acknowledging these weight-loss practices, the DSM-III-R recognizes the differences between anorexics who attempt to starve themselves exclusively through reduced food intake (restricting anorexics) and those who reduce weight by extraordinary means (bulimic anorexics).

The manual goes on to describe some of the other common features of anorexia nervosa-for example, the “magic power” that food has over its victims.

Once I discovered that a patient named Debbie had stuffed whole packages of cookies, cheese, fruit, and candy into her underwear drawer in her hospital room. When I asked whether she was preparing for an eating binge, she replied, “Oh, no. I’m not going to eat that stuff. I just keep it there to show myself how much control I have over it. The more food I can lay my hands on, the greater the temptation to eat. And the more I can hold out and not eat, the stronger I feel.”

Like Debbie, many anorexics exhibit peculiar behavior connected to food. They imbue food with enormous, almost supernatural force. Some prepare elaborate meals for their families, but eat nothing themselves. Or they toy with the food on their plate, poking it around with their forks, and finally throwing the whole meal away.

Anorexics see their starvation not as a defect, but as something that makes them special. “Look at me,” they seem to say. “See how much control I have over my body.” Almost every one of my patients, at one time or another in the course of her illness, will feel something to the effect that “Not everyone can do this.”

Because they deny the problem, anorexics feel that therapy, or any attempt to intervene, constitutes a deadly threat, a plot to rob them of their “specialness.” Needless to say, such an attitude makes my job as their doctor much more difficult..

*25/35/5*

Marlene Dropp was so out of shape that she couldn’t even walk around the block. Seven years later, at age 51, she walked a marathon.

A veteran dieter, Marlene had struggled with her weight all of her life. Sometimes she’d lose a few pounds, but they would always come back.

Then one day, as she looked in the mirror, Marlene realized how much she disliked the image that she saw. “I was a frumpy 200-pound matron,” says the mother of four. “My dress had stripes, a frilly collar, and fluffy sleeves, like something my mother would have worn. I couldn’t fit into more fashionable clothes. That’s when I started feeling like a blimp.”

That’s also when she decided to do something about it. Because of her weight, Marlene had always felt too self-conscious exercise in public. But this time, she was determined.

So one beautiful morning in 1989, with her husband at home to watch the kids, Marlene decided on impulse to take a walk around her Hibbing, Minnesota, neighborhood. To her surprise, she arrived home energized. “That’s when I decided to make walking part of my daily routine,” she says.

Immediately, Marlene set a goal for herself. She wanted to advance from walking around the block to walking 5 miles a day. Her neighborhood is laid out in half-mile circles, so she just kept adding circles to her route. Within 2 months, she achieved her goal. So she set her sights on a new objective: She wanted to cover a mile in 13 minutes. A year later, she could do it with ease.

Within 2 years of starting her exercise program and making some changes in her eating habits—primarily avoiding fats and sweets—Marlene lost 50 pounds. As she got faster, she began entering racewalking competitions—milers, 2-milers, and 5Ks. In 1996, she celebrated her 51st birthday by entering a marathon. She completed the 26-mile course in less than 6 hours.

Even though she continues to compete, Marlene credits those daily walks around the block with jump-starting her weight-loss efforts. Today, at age 55, she maintains a healthy weight of 150 pounds.

WINNING ACTION

Follow the 10 percent rule. Just as Rome wasn’t built in a day, neither is an exercise program. Whatever activity you choose—walking, running, cycling, swimming, or something else—start slow and easy. Gradually build to

your desired duration and intensity A good rule of thumb is to increase your level of activity by 10 percent a week. So if you’re able to walk for 10 minutes your first time out, stay at that level for 1 week. Then add 1 minute—10 percent—to your workout the next week. Continue until you’re walking for 30 minutes a day.

*79\89\8*