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New York Times | Sheila Kaplan

Benzodiazepines — commonly prescribed for anxiety, insomnia, seizures and panic disorders — are highly addictive and come with health risks, especially when combined with other drugs.

The Food and Drug Administration said on Wednesday that it would require a new warning label on a class of common psychiatric drugs, called benzodiazepines, to better warn the public and health professionals about the serious risks of abuse and addiction.

Benzodiazepines are prescribed for anxiety, insomnia, seizures, panic disorders and other health problems. They are also often given before certain medical procedures. They slow brain activity, causing sedation or calming effects.

The drugs are enormously popular. In 2019, according to the agency, roughly 92 million prescriptions for benzodiazepines — such as the highly prescribed Xanax, Klonopin and Ativan — were dispensed in the United States.

In a press statement, Dr. Stephen Hahn, the F.D.A. commissioner, said he was concerned about widespread misuse of the drugs, especially when they are taken with opioid pain relievers, alcohol or other medicines. The National Institute on Drug Abuse reports that more than 30 percent of opioid overdoses also involve benzodiazepines.

“We are taking measures and requiring new labeling information to help health care professionals and patients better understand that while benzodiazepines have many treatment benefits, they also carry with them an increased risk of abuse, misuse, addiction and dependence,” Dr. Hahn said.

The current labeling information on the drugs “does not provide adequate warnings about these serious risks and harms associated with these medicines,” the F.D.A.’s announcement said.

The agency also warned that people could become physically dependent on the drugs in a matter of days and might have difficulty stopping them safely. Withdrawal can take months, the agency said. It called on doctors to be more careful when prescribing benzodiazepines with opioids or other medicines that depress the central nervous system. Such combinations can cause serious side effects, respiratory distress or death.

The F.D.A. action followed a review of reported serious side effects — known as “adverse events” — and scientific studies of the drugs. The agency did not disclose how many adverse events had been reported in its database.  Read original article

Reference links:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class

Medical Xpress | University of Eastern Finland

January 2017 - Antidepressant use nearly doubles the risk of hip fracture among community-dwelling persons with Alzheimer's disease, according to a new study from the University of Eastern Finland. The increased risk was highest at the beginning of antidepressant use and remained elevated even four years later. The findings were published in the International Journal of Geriatric Psychiatry.

For each person with Alzheimer's disease, two controls without the disease were matched by age and sex. Antidepressant use was associated with two times higher risk of hip fracture among controls. However, the relative number of hip fractures was higher among persons with Alzheimer's disease compared to controls.

The increased risk was associated with all of the most frequently used antidepressant groups, which were selective serotonin reuptake inhibitors (SSRI drugs), mirtazapine and selective noradrenaline reuptake inhibitors (SNRI drugs). The association between antidepressant use and the increased risk of hip fracture persisted even after adjusting the results for use of other medication increasing the risk of fall, osteoporosis, socioeconomic status, history of psychiatric diseases, and chronic diseases increasing the risk of fall or fracture.

Antidepressants are used not only for the treatment of depression, but also for the treatment of chronic pain and behavioral and psychological symptoms of dementia, including insomnia, anxiety and agitation. If antidepressant use is necessary, researchers recommend that the medication and its necessity be monitored regularly. In addition, other risk factors for falling should be carefully considered during the antidepressant treatment.

The study was based on the register-based MEDALZ cohort comprising data on all community-dwelling persons diagnosed with Alzheimer's disease in Finland between 2005–2011, and their matched controls. The study population included 50,491 persons with and 100,982 persons without the disease. The follow-up was four years from the date of Alzheimer's disease diagnosis or a corresponding date for controls. The mean age of the study population was 80 years. Read original article ...

Article by NJ MMA News

Serotonin, dopamine, oxytocin, endorphins & Co. are our physiological “antidepressants”: they promote good mood, fight stress, keep us away from anxiety and sadness . Here are small strategies to be adopted to increase production naturally

Article by Qardio

Recent times have caused a substantial amount of worry and uncertainty around what coronavirus means for heart health and those suffering with heart disease. We spoke to 3 doctors to answer your questions and give you some useful insight to help.

Q: How does coronavirus affect people with heart disease?
A: The more we understand about coronavirus, we learn that this virus attacks our hearts as well, not only the lungs. 1/4 people admitted to the hospital have evidence of heart damage directly related to the virus. That’s additional stress to those who have underlying medical conditions.

Coronavirus enters the cardiac cells using the same receptors it uses to attack the lungs, creating direct damage on the heart. The respiratory failure also creates additional stress burden on the heart.  Those with prior cardiac history have reduced capacity to adapt to increased demands, therefore they incur additional cardiac damage.
Dr. Luiza Petre

Q: What should people with heart disease do to protect themselves from coronavirus?
A: Observing the guidelines issued by health departments such as the CDC are the best things anyone can do. And check local guidelines too, for American citizens IF you have to go out, wear a mask and gloves. Wipe down packages and anything from outside. Wash your hands thoroughly.
Dr. Lou Vadlamani

Q:How do I differentiate coronavirus from heart problems?
A: Differentiating coronavirus and heart problems is somewhat difficult as the two symptoms (shortness of breath and chest pain) overlap differently in each person inevitably. You want to be under the care of a doctor or physician who can advise on the optimal treatment for your specific needs. If you experience these symptoms speak to your healthcare provider immediately.
Dr Bill Code

Q: What should I do if my heart problems get worse during isolation?
A: Medical experts universally agree that if you are over 60 with any comorbidity (the presence of one or more additional conditions co-occurring with a primary condition) at all – stay home and don’t risk exposing yourselves to the virus. However, let this be clear, that anyone experiencing heart attack symptoms during this COVID-19 outbreak should try to contact their physician immediately by whatever means necessary, then call 911 or head directly to the ER. Again, the best thing is to seek professional help. Call your doctor right away, discuss your symptoms, let them decide what the best course of action is. 
Dr. Lou Vadlamani

Q: If I have symptoms, do I have to keep taking my (heart) medicine?
A: Never stop your heart medicine unless approved by your doctor.
Dr. Luiza Petre

Q: Why are some people at greater risk from coronavirus?
A: Anyone with prior cardiac history or underlying medical conditions is more vulnerable to getting sick from this virus. Their immune system is weaker and they have less endurance to take the stress of any illness.
Dr. Luiza Petre

Q: How can I improve my immune system?
A: Take daily a good MultiVitamin/Multimineral, 30 mgs Zinc, 200-500 mgs of Magnesium, Vitamin D3- 5,000 ius/day,Vitamin C 500 mgs 4 times per day. Take a quality probiotic especially containing Bifidus. Bifidus is quite depleted in Americans. Eat organic whole foods (will have much less glyphosate) and 6-7 different grains per week instead of just wheat. Aim for 40-50 different whole foods and spices per week. Drink more water. Exercise daily as this helps immune system, do whatever you can.
Dr Bill Code

Staying home and social distancing is more important than ever. Stay safe. Clinicians emphasize that it’s key to pay attention to your heart health and keep blood pressure well-controlled during the coronavirus pandemic. People living with heart disease or stroke are advised to stay home as much as possible to minimize your risk of being exposed to coronavirus. Read original article.

Article by Annamarya Scaccia | Rolling Stones

On Thursday morning, news broke that Chris Cornell, the groundbreaking singer who helped shape grunge, died by suicide the night before in his Detroit hotel room. Cornell's unexpected death shocked family, friends and fans, some of whom watched the 52-year-old vocalist and guitarist perform with Soundgarden hours before he passed. A local medical examiner ruled the cause of death as suicide by hanging.

Cornell's wife, Vicky Cornell, released a statement on Friday morning remembering her late husband and father of three children, and also calling into question what may have led to his death. According to Vicky, Cornell may have taken more than his recommended dosage of Ativan, a medication used to ease symptoms of anxiety. During one of their last phone conversations, Cornell seemed "different" and was "slurring his words," according to her statement. He had told her he "may have taken an extra Ativan or two," which prompted her to call security to do a welfare check.

"What happened is inexplicable and I am hopeful that further medical reports will provide additional details," Vicky said in the statement. "I know that he loved our children and he would not hurt them by intentionally taking his own life."

It could take days to learn the results of Cornell's full autopsy and toxicology reports, according to a spokesperson with the Wayne County Medical Examiner's Office. So the role that Ativan played in his death by suicide is not yet known - a point Cornell's family attorney, Kirk Pasich, acknowledges. Still, what exactly is Ativan's connection to suicide? Could the drug contribute to a person's death? We talked with medical experts find out more about the anti-anxiety medication. Here, what you need to know. 

What is Ativan?
Ativan is the brand name for lorazepam, a type of benzodiazepine medication used foremost to treat severe anxiety and panic disorders in the short term. Benzodiazepines - or "benzos," as they're commonly called - are a broad class of highly-addictive sedatives that "have some effective medicinal uses," said Dr. Joseph Lee, medical director of the Hazelden Betty Ford Foundation Youth Continuum. (The experts interviewed by Rolling Stone spoke generally about Ativan, suicide and their alleged link. None of them have reported a connection to the Cornell family.) In addition to anxiety, Ativan and other benzodiazepines such as Xanax or Valium can be used to treat seizures and substance withdrawal symptoms, as well as help with sedation during medical procedures, Lee tells Rolling Stone.

Public health officials do not recommend the drug for people with addictive disease, depression, psychosis or lung or breathing problems.

How does Ativan affect your brain?
Benzodiazepines are depressants that slow down your nervous system to make you feel calm. They act on the brain's gamma aminobutyric acid - or GABA - receptors, one of the most common neurotransmitters in the central nervous system. According to The Ochsner Journal, GABA receptors reduce the excitability of neurons, which creates a meditative effective on the brain.

Ativan is a short-acting anti-anxiety medication, often prescribed in low doses for a few weeks at a time. When used correctly, the medication can "work very nicely" for someone dealing with severe anxiety or panic attacks, says Dr. Stuart Gitlow, executive director of the Annenberg Physician Training Program in Addictive Disease and former president of the board of directors for the American Society of Addiction Medicine. For example, a person may take a low dose of Ativan if they're experiencing panic attacks before boarding a plane. But when misused, Ativan could cause harmful side effects similar to alcohol, he says.

Prolonged use or abuse of Ativan will cause a person to "build up too much tolerance" to the point where the drug no longer works, Gitlow tells Rolling Stone. They would have to take higher and higher doses in order to "achieve the original effect" as the brain pushes back against "this outside artificial influence," he says. "When the brain pushes back, what that essentially means is that after the drug wears off, you're more anxious, more irritable, more distressed, more uncomfortable than you were to begin with."

People who've taken an excessive amount of Ativan may exhibit unusual behaviors, shakiness, trouble speaking and slurred speech, among other symptoms, according to the U.S. National Library of Medicine. Those side effects are made worse when the medication is combined with another substance, such as alcohol or barbiturates.

What is the correlation between Ativan and suicide?
Research has shown that benzodiazepines, like alcohol, can cause anterograde amnesia if a person takes an excessive amount of the drug. Anterograde amnesia - or what's otherwise known as "blackouts" - is the inability to create new memories, meaning that the brain doesn't record events as they happen forward in time. In other words: You lose chunks of time.

Similar to alcoholic blackouts, people experiencing anterograde amnesia from consuming too many benzodiazepines can engage in disinhibited and dangerous behaviors. That can include driving while intoxicated, committing crimes and even attempting suicide, Lee says. "We've seen a lot of people who had no [prior] disruptive behaviors have really serious consequences from their benzodiazepine use," he tells Rolling Stone. "So it can be a serious problem." (Valeant Pharmaceuticals International, Inc., which manufactures Ativan, did not return Rolling Stone's request for comment.)

The experts who spoke with Rolling Stone noted that prolonged use or misuse of Ativan can exacerbate negative feelings in people with depression or a history of suicidal ideation (Cornell, a recovering addict, had been public about his issues with depression). Though rare, researchers have found a correlation between benzodiazepine misuse and increased suicide risk (a similar link has been with alcohol dependency). But it's highly unlikely that Ativan would be the sole cause of a completed suicide, as suicide has no single cause, says Dr. Jeffrey Lieberman, chair of psychiatry at New York-Presbyterian/Columbia University Medical Center and former president of the American Psychiatric Association.

If someone were to die by suicide during an Ativan blackout, he continues, they may have been dealing with underlying mental health issues. "Ativan would be the least contributory factor," Lieberman tells Rolling Stone.

Though not always, people who've attempted or died by suicide often exhibit signs beforehand, says Dr. Joel Dvoskin, a clinical psychologist and assistant professor in the University of Arizona's Department of Psychiatry. They may tell you they have no reason to live or that they feel like a burden to others. They may seem depressed or angry. They may act reckless, abuse drugs, or say goodbye without reason.

Yet routinely, he adds, people take these signs as someone "being dramatic" or as a "cry for help." "A suicide threat is a cry for help, but that doesn't mean they're not going to kill themselves," Dvoskin tells Rolling Stone. "If somebody says something that implies suicide, take it seriously."

What to do if you're concerned about taking Ativan
Do not stop taking Ativan cold turkey. A sudden drop-off in daily use could have harmful consequences; not only could your anxiety worsen, you may also experience withdrawal symptoms such as hallucinations, convulsions, headaches, stomach pains and trouble sleeping, according to the U.S. National Library of Medicine.

"Like alcohol, withdrawal from these drugs like Ativan can be dangerous, potentially deadly," Gitlow says. "So just stopping is not an option."

Instead, Gitlow tells Rolling Stone, people who want to stop taking Ativan would need to decrease their dose slowly and under the care of their doctor. When a person tapers off Ativan, your body will have time to adjust to life without the drug, minimizing withdrawal symptoms. But, he notes, you will feel worse during the process until about a month or two after you've ended use. "There is unfortunately no way around that," Gitlow said.  

by namarya Scaccia | Rolling Stones | Read original article ...

by Janice Neumann | Health & Science

Several months ago I developed a stomachache after taking an over-the-counter medication for symptoms suggesting acid reflux.

When I told the doctor about my reaction, she said the medication, which she had prescribed, should not have caused my stomachache.

But the Food and Drug Administration lists stomach pain and upset stomach as among the drug’s possible side effects. The episode reminded me that physicians rarely counsel me on side effects when they tell me to take a medication.

Other people feel the same way, I’ve discovered, lamenting drug side effects and looking for answers and

moral support on Internet message boards.

So I started to wonder: How much knowledge do doctors have about medications? What can patients do to educate and protect themselves?

For Liz Awbrey of Oklahoma, finding answers meant finding a new doctor.

Awbrey was in her 50s when a doctor suggested she try a sedative that would allow her to get a better night’s sleep and help ease her chronic fatigue syndrome.

She lost 20 pounds and started falling during exercise class. Her doctor said he wouldn’t be worried if the weight loss plateaued, which it did.

When she told her doctor she wanted to stop the drug — because it wasn’t helping her condition — he didn’t warn her about withdrawal. When she developed insomnia, depression and anxiety, the doctor suggested an antidepressant, which she declined.

“I was, like, ‘I was fine before I got on it, so it’s got to be the drug,’ ” Awbrey said.

Awbrey, now 60, turned to an organization (Point of Return, Inc) that helps people get off addictive drugs with tapering suggestions, nutraceuticals (medicinal food products) and other support. The organization suggested supplements, advising her to ask her doctor about them.

She also found a new doctor who talks to her about side effects and often suggests vitamin and supplement alternatives to drugs. She is now back to her old self.

“The doctor who gave me that, he’s not a bad doctor,” Awbrey said of the physician who prescribed the sedative. “He’s a nice man,” she said, but added that drug companies may not warn doctors sufficiently about side effects.

Doctors learn about drugs in medical school and later during continuing-education programs. But those programs are often funded by drug companies, according to J. Douglas Bremner, a professor of psychiatry and radiology at Emory University School of Medicine in Atlanta.

Bremner said pharmaceutical companies even reach medical students by influencing those who train them.

“They’re not really trained to be scientists, they’re trained to be apprentices,” Bremner said. “That’s what the drug companies know. . . . If they can get the person who trains them to change what they’re prescribing, they can get them to.”

When Bremner taught continuing-education sessions, the pharmaceutical companies that paid him provided the slides. Because the slides seemed to favor those companies’ drugs, he started using his own.

“When I did that several times, they stopped asking me,” Bremner said.

Adriane Fugh-Berman, a professor in the Department of Pharmacology and Physiology at Georgetown University Medical Center, said doctors often “prescribe irrationally,” pushing branded over generic drugs, new over old, and suggesting medication for diseases invented or exaggerated by drug companies.

“We’re in sort of a bad situation now where the people in control of prescribing drugs know the least about the drugs,” said Fugh-Berman, who directs PharmedOut at Georgetown, which researches drug marketing and educates health-care professionals about its influence.

But Andrew Powaleny, director of public affairs for PhRMA, said the pharmaceuticals trade group’s "Cod on Interactions with Healthcare Professionals" says that ethical relationships are needed to provide the latest information about prescription medicines. Information about side effects, Powaleny said, should be included in discussions.

Fugh-Berman said patients need to become their own experts, researching drugs on websites — such as the government database MedlinePlus - that are "free of [the pharmaceutical] industry.”

Doctors have a responsibility to listen to their patients about side effects, too, she said.

“I tell medical students: If a patient develops a symptom after they’ve gone on their drug, it’s always the drug’s fault until proven otherwise,” said Fugh-Berman.

Amy Thompson, a clinical pharmacist and an associate professor at the University of Michigan’s College of Pharmacy, said doctors have plenty of knowledge about drugs, but there are so many available they don’t know the possible side effects of all of them.

"But they have access to look into it,” she said, referring to online databases, continuing education and pharmacists.

“I think it’s important the patient understand what the medication is, what they’re taking it for, what they should expect to see,” Thompson said. “If the medication has some sort of very serious side effect, I would want them to know what to look for.”

Marlene Beggelman, founder and chief executive of Enhanced Medical Decisions, a health information technology company in Cambridge, Mass., said the FDA might be underestimating side effects because doctors often don’t report them. Although the FDA collects reports on its Adverse Event Reporting System, the reporting is voluntary and adverse reactions are considered underreported.  Beggelman described her own experience with side effects in a blog post on KevinMD.com.

Beggelman, an internal medicine physician, said doctors mean well even when the care they deliver has negative consequences.

“I think that very often it’s a human quality of not wanting to think that what you’re doing to try to help people is actually causing problems,” she said.

Awbrey, the woman who took the sedative, said doctors need to do better.

“I feel like I was greatly harmed because all I did was take something that a doctor told me would make me better,” she said. “It ruined my life.”

Article by Janice Neumann | Health & Science | Read original article

by Peter R. Breggin MD

Why do so many individuals persist in taking psychoactive substances, including psychiatric drugs, after adverse mental and behavioral effects have become severe and even disabling? The author has previously proposed the brain-disabling principle of psychiatric treatment that all somatic psychiatric treatments impair the function of the brain and mind. Intoxication anosognosia (medication spellbinding) is an expression of this drug induced mental disability. Intoxication anosognosia causes the victim to underestimate the degree of drug-induced mental impairment, to deny the harmful role that the drug plays in the person’s altered state, and in many cases compel the individual to mistakenly believe that he or she is functioning better. In the extreme, the individual displays out-of-character compulsively destructive behaviors, including violence toward self and others.

by Maia Szalavitz | vice.com

Pharmaceutical Marketing is often said to be a key cause of the opioid crisis.  That doesn't explain the deadly rise of benzos.

On a recent Saturday, photographer Nan Goldin and a band of roughly 100 fellow activists threw pill bottles into the reflecting pool near the Temple of Dendur at the Metropolitan Museum of Art in New York City. The space was funded by the Sacklers, the family that owns the drug Oxycontin's manufacturer Purdue Pharma, and the group was trying to call the clan to account for the opioid overdose catastrophe, a crisis spurred in part by aggressive marketing of that pill.

"We are artists, activists, addicts," Goldin shouted, according to a New York Times report.  "We are fed up."

But the simultaneous rise of another potentially addictive and deadly prescription in America has received far less attention. Understanding why could shed light on the best way to manage both the opioid epidemic and this less-notorious one—and help prevent or at least mitigate future crises.

Between 1999 and 2016, as many Americans are now at least vaguely aware, the number of deaths from overdoses that included opioids quintupled.  However, during roughly the same period, the number of OD deaths that involved benzodiazepines (a.k.a. "benzos") increased by a mind-boggling factor of nearly eight. In terms of the absolute number of deaths, opioids are more deadly, but it’s important to note that more than 30 percent of opioid-overdose deaths are actually better described as fatal mixtures of the two classes of drugs.

Benzodiazepines include drugs like Xanax, Klonopin, and Valium, the drug immortalized in the Rolling Stones track “Mother’s Little Helper” for its sedative and calming (albeit, at least in the song, ultimately deadly) properties. As with opioids, a great deal of the harm associated with benzos comes when they are combined with other drugs. Opioids, alcohol, and benzodiazepines are exponentially riskier when taken together because their effects in slowing breathing are synergistic, not simply cumulative. Indeed, research has suggested that as many as 90 percent of benzodiazepine-associated deaths also involved an opioid and about 80 percent of benzo recreational use was carried out in concert with other substances.

But while attention has rightly focused on the role of pharmaceutical marketing in the opioid crisis, which included pushing hospitals to declare pain as"the fifth vital sign," that doesn't seem to explain the surge of benzo use and overdoses in recent years.

Benzodiazepines are overwhelmingly available in generic form, and no company was out there marketing them, at least in the past few decades, the way giants like Purdue promoted newer behemoths like Oxycontin. “The biggest seller now is Xanax, which came on the market in 1986,” explained Allen Frances, MD, a leading psychiatrist and author of Twilight of American Sanity.

Nor did most activists make the case that anxiety was massively under-treated or that benzodiazepines were not as addictive as previously believed. Hospitals did not dub anxiety—among the primary symptoms these drugs are used to treat—another "vital sign."

Nonetheless, filled benzodiazepine prescriptions increased 67 percent

between 1996 and 2013 alone—and the number of pills actually dished out, adjusted for potency, at least tripled. So what happened?

“America has had a love affair with sedatives, going back at least to the 20s and 30s,” said David Herzberg, associate professor of history at the State University of New York at Buffalo, and author of Happy Pills in America: From Miltown to Prozac. Drugs with sedative qualities include barbiturates and benzodiazepines—and, at some doses, alcohol and opioids. Basically, a sedative is any drug that makes you calm and sleepy; they are also sometimes known as depressants.

According to Herzberg, in the 1940s and 50s, measured on a per capita basis, the overdose death rate from barbiturate tranquilizers in the United States was actually worse than the rate associated with opioids in 2013, when opioid overdose deaths had already risen for 11 consecutive years. This is ironic, because, Herzberg noted, barbiturates first rose to popularity after concerns were raised about opioids—drugs like opium, morphine, and heroin—in the 1910s and 20s. These fears, stoked in large part by panic over immigration and race, led to strict controls on supply, including complete criminalization of opium and heroin.

That, in turn, led doctors to switch to barbiturates for patients who had Insomnia, “nerves” or anxiety. Barbiturates, however, are at least as risky in terms of overdose as opioids—and withdrawal from them may be even worse because it can cause potentially deadly seizures.

Growing recognition of the barbiturate overdose and addiction problem in the 40s and 50s led to another substitution: The first benzodiazepine was introduced in 1960. This class of drugs is indeed significantly safer: Barbiturates can be fatal at just ten times the therapeutic dose, while it takes 100 times an effective dose of benzodiazepines to kill, according to Herzberg. It took until 1975, however, for the potential harm that is nonetheless associated with benzodiazepines— including addiction, worsened anxiety, and physical dependence—to be recognized and for them to become controlled substances.

But panics over drugs aren’t usually directly associated with the amount of damage they do or their specific dangers: As Herzberg put it, drugs become “an object of popular fascination when it serves the need of groups that want to make them that way.”

In the 1970s, this concern seems to have been specifically gendered. The misogynistic sneer of “Mother’s Little Helper,” for instance, inadvertently illustrated why feminists began to raise hell over benzos' widespread use to tranquilize housewives, whom they saw as appropriately upset with American society rather than mentally ill. Claims were made that a third of all women took drugs in this class at that time—feminists argued

this suggested a serious problem with life conditions for American women, not a need to medicate them into submission.

“Feminists found Valium to be a really useful symbol of way that women’s problems that they interpreted as political were instead treated as signs of hysteria and instability and treated with drugs by doctors,” Herzberg told me. By the 1980s and 90s, a new class of psych meds was on the rise, led by Prozac, which was first sold in the US in 1988. Once again, it was helped along by the backlash against the immediately previous favorites, which was, in that case, benzos.

There is no easy marketing explanation for benzos' more recent resurgence, however—although substitution due to disenchantment with serotonin drugs like Prozac could be part of it.

At some point, though, this longer arc of America's drug story begs the question: Why do we always need some chemical fix? Kelly Knight, associate professor of anthropology at the University of California, San Francisco Medical School, noted in an interview the “deaths of despair” theory put forward to explain the rise in opioid, alcohol, and suicide mortality. She asked, "Is there something socio-culturally happening in US that is making folks particularly anxious, insecure and depressed?”

The obvious answer is yes, as is so vividly illustrated by the rise of Donald Trump and the preceding explosion of inequality that has decimated the middle class. While drug use has always existed in human society, a sudden, widespread increase in addiction, suicide and multiple-drug overdose cannot just be a result of flashy ads and increased availability of numbing substances.

"It’s silly to imagine that we’re all just pawns of marketers," Herzberg told me. “What marketers do is take things that do matter to us and are real suffering and try to channel it in certain ways—and they are most successful when they really do have something to offer.”

This is not to excuse pharma or suggest that supply increases are completely irrelevant. Nor is it to argue that we should shift from panicking over opioids to panicking over benzodiazepines—while both classes of drugs can clearly do harm, there are just as clearly some who benefit.

Instead, Americans need to take pain, suffering, and anxiety seriously and provide genuine help to those who are afflicted. Stopping a prescription doesn’t end an addiction—nor does it treat pain; indeed, cutting off patients who are functioning well on opioids can lead to disability and even suicide. As the Times reported Tuesday,

an expected Medicare regulation limiting prescription of pain medications was being widely denounced by doctors out of fear it would cause more needless suffering and even death.

Companies like Purdue Pharma need to pay for the role they played in this crisis. But unless we rebuild the connective fabric that supports a healthy society, create the conditions for meaningful work and family life for as many as possible and protect the most vulnerable, a new drug epidemic will always be just around the corner.  Read original article.

By S. LaCorte

Benzodiazepines are a class of drugs that are prescribed for treating a wide variety of disorders, including various forms of anxiety disorders, epilepsy, muscle spasms, insomnia, and tinnitus. Benzodiazepines are sometimes characterized as “minor tranquilizers,” due to their potentially sedating effect. Benzodiazepines are thought to exert their anxiolytic effect by enhancing the activity of the inhibitory  neurotransmitter, GABA (gamma-aminobutyric acid). Among the most prescribed benzodiazepine drugs are clonazepam, brand name Klonopin, alprazolam, brand name, Xanax, lorazepam, brand name Ativan, and diazepam, brand name, Valium. A major drawback to benzodiazepines, however, is that long term use, including normal therapeutic dosing, can lead to the development of physical dependency and withdrawal symptoms upon discontinuance [1]. For those who use  benzodiazepines at therapeutic doses, benzodiazepine dependence is primarily concerned with the negative subjective effects of withdrawal upon discontinuance and not reward-seeking effects of the benzodiazepine use [2].

Observations that benzodiazepine withdrawal associated symptoms can be severe and protracted... Read full article.

by Kelly Brogan MD Team
When you go to the doctor for any kind of discomfort with any kind of diagnosis, chances are that the doctor will write out a slip of paper and send you to the pharmacy. Every illness, every injury, every bodily inconvenience has some kind of corresponding medication for us to take. So that’s what we’ve done for the greater part of the last century. It’s tempting to think that we can be “fixed” by medication because it’s quick and easy. That’s why the United States pharmaceutical market was valued around 446 billion U.S. dollars in 2016 alone.

But the truth is that our bodies are more complex than we’ve been taught, and more importantly, we know much less than we think we do. Only recently have we started to understand how connected the gut, brain, hormones, and immune systems are. So it’s not a huge surprise that we think of our bodies as machines—that we can feed them some chemicals and they’ll run smoothly again like a car that just got an oil change.

The severity of consequences that result from thinking this way hasn’t really settled into the public consciousness yet, but a June 2018 study published in the Journal of the American Medical Association explores that very question:

What does this society-wide reliance on prescription drugs really cost us?

Apparently, often times, our wellness.

More Than 200 Commonly Used Prescription Drugs Have Depression as a Potential Side Effect

In the aforementioned study, researchers analysed the medication use patterns of 26,192 adults between 2005 to 2014, which were collected as part of the National Health and Nutrition Examination Survey.

The research discovered that more than 200 commonly used prescription drugs have depression or suicide listed as potential side effects. The drugs on that list run the full gamut across antidepressants, blood pressure drugs, allergy medications, hormones and more.

A short and incomprehensive summary of the study’s offending drugs was compiled by the Washington Post and they include (and are certainly not limited to):

1.  Beta blockers and angiotensin-converting-enzyme inhibitors (blood pressure drugs): metoprolol, atenolol, enalapril and quinapril.
    
2.  Antidepressants: sertraline (Zoloft and generic), citalopram (Celexa and generic), bupropion (Wellbutrin and generic) and amitriptyline.
3.  Anti-anxiety drugs: alprazolam (Xanax and generic), clonazepam (Klonopin and generic), diazepam (Valium and generic), and lorazepam (Ativan and generic), as well as the sedative zolpidem (Ambien and generic).

4.  Opioids: hydrocodone combination meds (Lorcet, Norco, Vicodin, generic and more) and tramadol (ConZip).
    
5.  Corticosteroids: prednisone and others.
    
6.  Over-the-counter proton-pump inhibitors: omeprazole (Prilosec, Zegerid and generic) and esomeprazole (Nexium and generic), as well as the antacids ranitidine (Zantac and generic) and famotidine (Pepcid and generic).
  
7.  Allergy and asthma medications: over-the-counter cetirizine (Zyrtec and generic) and the prescription drug montelukast (Singulair).
   
8.  Anticonvulsants: gabapentin (Neurontin and generic) and topiramate (Topamax and generic).
    
9.  Hormones: estradiol (Delestrogen, Elestrin, EstroGel and generic) and finasteride (Proscar, Propecia and generic).

As a matter of fact, the study found that the more drugs people took, the more likely they were to have depression. While about 7 percent of those taking one such drug were depressed, 15.3 percent of the patients taking at least three were depressed. Additionally, the study showed that one-third of US adults may unknowingly use medications that can cause depression.

The most alarming thing is that even your doctor who may have prescribed the drugs to you might not know about these side effects.

In an interview with Science Daily, Mark Olfson, one of the study researchers who is a professor of psychiatry and epidemiology at the Columbia University Irving Medical Center in New York said, “Many physicians may not be aware that several commonly prescribed medications are associated with an increased risk of this disorder.”

Are prescription medications really worth it?

This June 2018 study analysed more data than other previous studies have, but really, science has known that common prescription drugs cause depression for a while. Are we really that surprised that so many medications, all researched and developed under a one-size-fits-all assumption that all medications will work the same for everyone, are wreaking havoc on our unique bodies?

For example, depression has been consistently associated with interferon α treatment of hepatitis C—45% to 60% of treated patients developed mild to moderate depression and 15% to 40% of treated patients developed moderate to severe depression 15% to 40%. Other studies have linked hormonal contraceptives,  β-blockers, and more drugs to depression.

The June 2018 study doesn’t detail exactly how these listed drugs can lead to depression, and there are too many for us to explore the mechanics of each one, but we might be able to get a general sense by understanding depression as a syndrome of “evolutionary mismatch.”

Think about it. Depression is our body telling us that something about our lifestyle isn’t working right. It’s our immune system yelling at us, saying our evolutionarily-unprecedented environment is out of sync with our optimal health. It’s our immune systems telling us that our lifestyle decisions—or maybe the pharmaceutical products we’re putting in our bodies— are really stressing it out.

And when our immune systems get stressed, inflammation can become chronic leading to the symptoms of depression.

Even antidepressants, which are supposed to “cure” us of depression, still come with so many problems attached. Recent studies have also uncovered antidepressant tachyphylaxis, or the loss of antidepressant “efficacy” over time. Basically, people on antidepressants lose the initial drug effect over a time period that leaves them physically dependent so that they are rendered medicated, symptomatic, and unable to easily stop taking medication due to withdrawal symptoms. Other studies have found that antidepressant use also actually induces chronic depression, a phenomenon called tardive dysphoria.

So, the study authors are working on bringing more awareness to the fact that depression is a potential side effect to so many drugs, but the study results might just be a red flag that is signaling something even more fundamentally wrong with how we approach healing and our bodies. Why make louder warnings that prescription drugs might cause depression when we should be finding pharmaceutical-free alternatives?

There’s a lot about our bodies that we don’t fully understand, and it’s time to acknowledge a new biology. We can no longer participate in impersonal medicine,  ignoring details of our lifestyle, environment, relationships, and trauma histories. We’re humans, and that means that our beliefs, our stressors, our diets, our exposures, our sense of meaning and purpose all play a role in how healthy we are. As science helps us understand more about the complexity of our health, maybe it’s time to turn to a more holistic, more empowered kind of lifestyle medicine to heal ourselves, side effect free. 

Kelly Brogan MD Team