MEDICATION - Just a spoonful of water helps the medicine go down: Scientists discover the best way to swallow tablets

Just a spoonful of water helps the medicine go down: Scientists discover the best way to swallow tablets

• Researchers from the University of Heidelberg devised two techniques
• The 'pill bottle' method was best for traditional 'chalky' tablets 
• People asked to put tablet in mouth and swallow water with sucking motion
• 'Lean forward' method used to help people swallow drugs in capsule form
• Taking a sip of water people were asked to swallow while bent forward
• A tablespoon of water, around 20ml, was found to be the most effective 
• 
  

By LIZZIE PARRY FOR MAILONLINE

PUBLISHED: 12:43 GMT, 13 November 2014 | UPDATED: 15:06 GMT, 13 November 2014

If swallowing tablets invokes a fear of choking followed by unpleasant gagging and a nasty taste in the mouth, there is now a little ray of hope.

While some people suffer the medical condition dysphagia - usually the result of stroke or conditions including multiple sclerosis and Parkinson's - most simply face a mental barrier.

But scientists in Germany believe they may have the devised a new foolproof guide to help people take their medication with ease.

Dr Walter Haefeli, who led the study at the University of Heidelberg, said he believes it will help people who struggle finish full courses of medication.

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Scientists believe they may have devised two methods to help people who struggle to take tablets, pictured above are the 'pop bottle' 

and 'lean forward' methods

He said around 10 per cent of patients who struggle to swallow use it as an excuse not to take their tablets. 

The study examined 151 adults as they were given 16 differently shaped placebos, totally 283 between them.

Researchers looked at both traditional shaped tablets and capsules/

They found for both types, swallowing the pills with at least 20ml of water - around a tablespoon - was most effective.

After taking each pill the participants rated the ease of swallowing.

Researchers then asked them to try swallowing the tablets and capsules in specific positions, using techniques they had devised. 

They discovered the best way to take chalky tablets is the 'pop bottle' method.

SO WHICH METHODS ARE BEST? 

CHALKY TABLETS

The researchers discovered the best way to take chalky tablets is the 'pop bottle' method.

This is where the tablet is placed on the tongue, the lips are tightly closed around the opening (of the bottle) and the tablet is swallowed in a swift suction movement.

CAPSULES

Here, the 'lean forward' technique' is best, the researchers say.

Capsules are swallowed in an upright position with the head bent forward.

Dr Haefeli said choosing which method to use depended on the shape of the medication.

'Capsules, with a density lower than water, will swim in the mouth and so head position matters.

'In contrast, to swallow tablets, which have almost always higher densities than water, it is necessary to focus on flushing the medicines into the pharynx [the cone-shaped passageway leading from the nose and mouth towards the oesophagus and voice-box].' 

This is where the tablet is placed on the tongue, the lips are tightly closed around the opening (of the bottle) and the tablet is swallowed in a swift suction movement.

However for capsules, the 'lean forward' technique' is best, the researchers say.

Here, capsules are swallowed in an upright position with the head bent forward.

In the study, volunteers were asked to try both methods and rate how easy it was to swallow the pills.

The 'pop bottle' technique improved swallowing by 60 per cent, while 88 per cent of those who tried the 'lean forward' method said it was easier. 

Dr Haefeli told the Guardian: 'Both the techniques we describe were remarkably effective in participants with and without reported difficulties in swallowing pills and should be recommended regularly.'

He said choosing which method to use depended on the shape of the medication.

'Capsules, with a density lower than water, will swim in the mouth and so head position matters.

'In contrast, to swallow tablets, which have almost always higher densities than water, it is necessary to focus on flushing the medicines into the pharynx.'

This is the cone-shaped passageway leading from the nose and mouth towards the oesophagus and voice-box. 

Dr Haefeli added that round tablets were found to perform worse.

The report stated: 'This study showed for the first time that two targeted techniques to facilitate tablet and capsule intake were remarkably effective and easy to adopt in the general population.

'This included patients with swallowing difficulties, and should therefore be generally recommended.'

The study was published in the journal Annals of Family Medicine.  

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Researchers at the University of Heidelberg studied 151 adults taking 16 different placebo pills. The 'pill bottle' method was found best for those taking regular tablets, while the 'lean forward' technique helped those participants trying to swallow capsule pills 

Source: http://www.dailymail.co.uk

HEALTH - The Truth about Painkillers

PRESCRIPTION PAINKILLER ABUSE

While the use of many street drugs is on a slight decline in the US, abuse of prescription drugs is growing. In 2007, 2.5 million Americans abused prescription drugs for the first time, compared to 2.1 million who used marijuana for the first time.

Among teens, prescription drugs are the most commonly used drugs next to marijuana, and almost half of the teens abusing prescription drugs are taking painkillers.

Why are so many young people turning to prescription drugs to get high?

By survey, almost 50% of teens believe that taking prescription drugs is much safer than using illegal street drugs.

What is not known by most of these young people is the risk they are taking by consuming these highly potent and mind-altering drugs. Long-term use of painkillers can lead to dependence, even for people who are prescribed them to relieve a medical condition but eventually fall into the trap of abuse and addiction.

In some cases, the dangers of painkillers don’t surface until it is too late. In 2007, for example, abuse of the painkiller Fentanyl killed more than 1,000 people. The drug was found to be thirty to fifty times more powerful than heroin.

WHAT ARE PAINKILLERS?

Prescription painkillers are powerful drugs that interfere with the nervous system’s transmission of the nerve signals we perceive as pain. Most painkillers also stimulate portions of the brain associated with pleasure. Thus, in addition to blocking pain, they produce a “high.”

The most powerful prescription painkillers are called opioids, which are opium-like1compounds. They are manufactured to react on the nervous system in the same way as drugs derived from the opium poppy, like heroin. The most commonly abused opioid painkillers include oxycodone, hydrocodone, meperidine, hydromorphone and propoxyphene.

Oxycodone has the greatest potential for abuse and the greatest dangers. It is as powerful as heroin and affects the nervous system the same way. Oxycodone is sold under many trade names, such as Percodan, Endodan, Roxiprin, Percocet, Endocet, Roxicet and OxyContin. It comes in tablet form.

Hydrocodone is used in combination with other chemicals and is available in prescription pain medications as tablets, capsules and syrups. Trade names include Anexsia, Dicodid, Hycodan, Hycomine, Lorcet, Lortab, Norco, Tussionex and Vicodin. Sales and production of this drug have increased significantly in recent years, as has its illicit use.

Meperidine (brand name Demerol) and hydromorphone (Dilaudid) come in tablets and propoxyphene (Darvon) in capsules, but all three have been known to be crushed and injected, snorted or smoked. Darvon, banned in the UK since 2005, is among the top ten drugs reported in drug abuse deaths in the US. Dilaudid, considered eight times more potent than morphine, is often called “drug store heroin” on the streets.

“At the age of 20, I became an addict to a narcotic,2 which began with a prescription following a surgery. In the weeks that followed [the operation] in addition to orally abusing the tablet, crushing it up enabled me to destroy the controlled release mechanism and to swallow or snort the drug. It can also be injected to produce a feeling identical to shooting heroin. The physical withdrawal from the drug is nothing short of agonizing pain.” —James

1. 1.opium: a brownish, gummy extract from the opium poppy.
2. 2.narcotic: a drug affecting the central nervous system (brain and spinal cord), which can cause dizziness, lack of coordination and unconsciousness.

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STREET NAMES
PAINKILLERS: Generic Name Oxycodone Propoxyphene Hydromorphone Meperidine Hydrocodone	Brand Name OxyContin Percodan Percocet Roxiprin Roxicet Endodan Endocet Anexsia Dicodid Hycodan Hycomine Lorcet	Lortab Norco Tussionex Vicodin Darvon Dilaudid Demerol	Street Name Oxy 80s oxycotton oxycet hillbilly heroin percs perks pain killer vikes hydros pinks footballs

UNDERSTANDING WHY PAINKILLERS BECOME SO ADDICTIVE

Family members protest deadly painkillers. Rehab experts say addiction to powerful painkillers such as OxyContin is among the hardest of all to kick.

Photo credit: OxyABUSEKills.com

Opioid painkillers produce a short-lived euphoria, but they are also addictive.

Long-term use of painkillers can lead to physical dependence. The body adapts to the presence of the substance and if one stops taking the drug abruptly, withdrawal symptoms occur. Or the body could build up a tolerance to the drug, meaning that higher doses have to be taken to achieve the same effects.

Like all drugs, painkillers simply mask the pain for which they are taken. They don’t “cure” anything. Someone continuously trying to dull the pain may find himself taking higher and higher doses—only to discover that he cannot make it through the day without the drug.

Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (known as “cold turkey”), and involuntary leg movements.

One of the serious risks of opioids is respiratory depression—high doses can cause breathing to slow down to the point it stops and the user dies.

“I am addicted to prescription pain medication. I first started taking prescription painkillers [some] years ago when my doctor prescribed them to treat post-surgical pain following spinal surgery....Over the past several years I have tried to break my dependence on pain pills and, in fact, twice checked myself into medical facilities in an attempt to do so.

[I have] recently agreed with my physician about the next steps.”

— Excerpted from radio commentator Rush Limbaugh’s on-air statement, Friday, Oct. 10, 2003, according to Premiere Radio, his broadcaster.

OXYCONTIN THE “HILLBILLY HEROIN”

Because it reacts on the nervous system like heroin or opium, some abusers are using one brand of oxycodone painkiller, OxyContin, as a substitute for, or supplement to, street opiates like heroin.

Armed robberies of pharmacies have occurred where the robber demanded only OxyContin, not cash. In some areas, particularly the Eastern United States, OxyContin has been the drug of greatest concern to law enforcement authorities.

OxyContin, widely known as “hillbilly heroin” because of its abuse in Appalachian communities, has emerged as a major crime problem in the US. In one county, it was estimated that addiction to this drug was behind 80% of the crime.

“I didn’t think I had a ‘drug’ problem—I was buying the tablets at the chemist [drugstore]. It didn’t affect my work. I would feel a bit tired in the mornings, but nothing more. The fact that I had a problem came to a head when I took an overdose of about forty tablets and found myself in the hospital. I spent twelve weeks in the clinic conquering my addiction.” —Alex

MENTAL & PHYSIOLOGICAL EFFECTS OF PAINKILLERS

• Constipation
• Nausea
• Vomiting
• Dizziness
• Confusion
• Addiction
• Unconsciousness
• Respiratory depression
• Increased risk of heart attack
• Coma
• Death

“Pretty much as long as I can remember I’ve had highs and lows. I would get easily upset by the littlest things, I would have anger outbursts, or hate someone for no reason at all. For a long while I had thought I was bipolar. I started using drugs last October to help me with my unwanted feelings. But believe it or not, it just made stuff worse! I had to now deal with my addiction and my emotional problems.” —Thomas

PAINKILLERS: A SHORT HISTORY

Highly addictive opiates, derived from the opium poppy, have been used for thousands of years for both recreational and medicinal purposes.

Photo credit: AP Wideworld

Opiates, originally derived from the opium poppy, have been used for thousands of years for both recreational and medicinal purposes. The most active substance in opium is morphine—named after Morpheus, the Greek god of dreams. Morphine is a very powerful painkiller, but it is also very addictive.

In the sixteenth century, laudanum, opium prepared in an alcoholic solution, was used as a painkiller.

Photo credit: AP Wideworld

Morphine was first extracted from opium in a pure form in the early nineteenth century. It was used widely as a painkiller during the American Civil War, and many soldiers became addicted.

Codeine, a less powerful drug that is found in opium but can be synthesized (man-made), was first isolated in 1830 in France by Jean-Pierre Robiquet, to replace raw opium for medical purposes. It is used mainly as a cough remedy.

Morphine, the most active substance in opium, is a very powerful painkiller that hooked many US Civil War soldiers.

Photo credit: AP Wideworld

Throughout the early nineteenth century, the recreational use of opium grew and by 1830, the British dependence on the drug reached an all-time high. The British sent warships to the coast of China in 1839 in response to China’s attempt to suppress the opium traffic, beginning the “First Opium War.”

In 1874, chemists trying to find a less addictive form of morphine made heroin. But heroin had twice the potency of morphine, and heroin addiction soon became a serious problem.

A bottle of codeine tablets—all opiates temporarily relieve pain but are highly addictive.

The US Congress banned opium in 1905 and the next year passed the Pure Food and Drug Act requiring contents labeling on all medicines.

Methadone was first synthesized in 1937 by German scientists Max Bockmühl and Gustav Ehrhart at the IG Farben company. They were searching for a painkiller that would be easier to use during surgery, with less addiction potential than morphine or heroin.

Yet methadone is believed by many to be even more addictive than heroin.

Meanwhile, the illegal opium trade boomed. By 1995, Southeast Asia was producing 2,500 tons annually.

New painkillers came on the market with approval from the Food and Drug Administration: Vicodin in 1984, OxyContin in 1995 and Percocet in 1999.

These are all synthetic (man-made) opiates which mimic (imitate) the body’s own painkillers.

INTERNATIONAL STATISTICS

Among those using illicit drugs for the first time in 2007, the most popular substances were marijuana and prescription painkillers—each used by roughly the same number of Americans aged 12 and older. Non-medical use of painkillers rose 12%.

One in ten high school seniors in the US admits to abusing prescription painkillers.

Misuse of painkillers represents three-fourths of the overall problem of prescription drug abuse. The painkiller hydrocodone is the most commonly diverted and abused controlled pharmaceutical in the US.

Methadone, once used in addiction treatment centers and now used by doctors as a painkiller, was found as the cause of 785 deaths in one state alone, Florida, in 2007.

Prescription drug abuse is also climbing in older Americans, particularly involving anti-anxiety drugs such as Xanax and painkillers such as OxyContin.

In the UK, tens of thousands of people are said to be dependent on painkillers such as Solpadeine and Neurofen Plus.

Doctors and rehabilitation therapists report that prescription painkiller abuse is one of the most difficult addictions to treat.

WARNING SIGNS OF PRESCRIPTION PAINKILLER DEPENDENCY

 
Most commonly prescribed painkillers (OxyContin, Vicodin, Methadone, Darvocet, Lortab, Lorcet and Percocet), while offering relief from pain, can also cause individuals’ bodies to start “needing” the drugs in order to feel just “normal.”

Here are ten warning signs to watch for if you think someone you know may be experiencing a dependency on these drugs:

1. Usage increase: increase of one’s dose over time, as a result of growing tolerant to the drug and needing more to get the same effect.

2. Change in personality: shifts in energy, mood, and concentration as a result of everyday responsibilities becoming secondary to the need for the drug.

3. Social withdrawal: withdrawal from family and friends.

4. Ongoing use: continued use of painkillers after the medical condition they were meant to relieve has improved.

5. Time spent on obtaining prescriptions: spending large amounts of time driving great distances and visiting multiple doctors to obtain the drugs.
 
6. Change in daily habits and appearance: decline in personal hygiene; change in sleeping and eating habits; constant cough, running nose and red, glazed eyes.

7. Neglects responsibilities: neglect of household chores and bills; calling in sick to school or work more often.

8. Increased sensitivity: normal sights, sounds and emotions becoming overly stimulating to the person; hallucinations.

9. Blackouts and forgetfulness: forgetting events that have taken place and experiencing blackouts.

10. Defensiveness: becoming defensive and lashing out in response to simple questions in an attempt to hide a drug dependency, if users feel their secret is being discovered.

Source: http://www.drugfreeworld.org/

MEDICATION - Take the right pain killer

Don't just pop the same pill for every 

ailment, whether it's a headache or cold

 

Got a hangover? Painful knee? Just pop some painkillers. It's easy to self-medicate, with painkillers available over the counter and in supermarkets. Yet Australians are in danger of becoming addicted. The Medical Journal Of Australia says misuse of over-the-counter painkillers is the third most common category of substance abuse after cannabis and ecstasy.

Before you treat your pain, you need to pinpoint the type. "There are two types," says Dr Ronald McCoy, spokesman for the Royal Australian College of General Practitioners. "There's the familiar pain, such as period pain, which you can treat as you usually would. But a new pain, which you haven't experienced before, appears unusual or lasts longer than about 24 hours, is an alert that you should see your GP." If pain is severe, see a GP as soon as possible.

Headaches

Headaches have affected 84 percent of Australians at some time in the past 12 months.

What to take: If it is the sort of headache you have had before, take one or two paracetamol pills.

Paracetamol doesn't have any anti-inflammatory side effects, so is generally safe for children and adults, provided it is taken as directed: 500 to 1000 milligrams for adults (usually one or two tablets), every four to six hours. Do not take more than the maximum of 4000 milligrams (eight pills) in a day.

"Don't take a dosage more than every four hours. If you need extra, see a doctor," Dr McCoy says. You should also examine the cause of the headache. "It could indicate dehydration, muscle strain or missing your morning coffee, so drink one or two glasses of water first," he says.

Stomach pain

"The most common cause of gut pain is from spasm. This is often associated with irritable bowel disease or diverticular disease, but can also result from bloating or wind in the gut," says Professor Terry Bolin, The Gut Foundation president.

What to take: "Choose a medication that will relieve the spasm and not simply dampen down the pain," Professor Bolin says.

He says non-steroidal anti-inflammatories such as Nurofen mask the symptoms but do not treat the cause. Instead, try the over-the-counter antispasmodic Buscopan, which is taken before a meal, or perscription-only antispasmodic Colofac (mebeverine hydrochloride). "Or try Iberogast (STW 5), a herbal solution available from your pharmacy. Take 20 drops, three times a day," he advises.

Chest pain

If you have not experienced this type of pain before, it needs to be investigated immediately.  "The majority of chest pain is caused by muscle strain - usually a one-off stabbing pain - which can be treated with paracetamol," Dr McCoy says.

What to take: "Continual chest pain is one pain you should never ignore," Dr McCoy says.

The Heart Foundation says if you have chest pain for longer than 10 minutes, call an ambulance.

Muscle pain

The type of muscle pain you're experiencing depends on the type of treatment you require. "Inflammatory pain will hurt after a period of rest and feel better with small amounts of movement," physiotherapist Clare Singleton says. "Mechanical pain is worse on movement and better with rest."

What to take: "If the pain is inflammatory, take ibuprofen or Voltaren Rapid [diclofenac potassium]," she says. "If it's mechanical, take paracetamol."

Joint pain

Joint pain can be caused by problems around a joint, arthritis or rheumatoid arthritis.

What to take: "It depends on what form of arthritis a patient has, and can range from simple treatments such as fish oil and paracetamol to stronger pain-relieving medications or non-steroidal anti-inflammatory drugs," rheumatologist Professor Malcolm Smith says.

Colds

Adults get about two to four colds a year, while children catch colds about eight times a year.

What to take: "If you have aches and pains, take a paracetamol or aspirin, up your fluid intake and rest," says Associate Professor Dominic Fitzgerald, physician at The Children's Hospital at Westmead, Sydney.

Period pain

"Period pain is mainly caused by a substance called prostaglandin," says Kellie Holland, from Women's Health Queensland Wide. "This causes the uterus to contract and inflame. Women who have period pain have too much prostaglandin or are sensitive to it."

What to take: Take an ibuprofen and a paracetamol two hours later, with food. "If you have persistent pain or bleeding, see a GP," Holland says.

Flu

If you have aching limbs, a chesty cough, lethargy and are feeling hot and cold, it's proper flu.

What to take: "Take paracetamol for several days, but no more than eight a day," Dr McCoy says.

If flu persists, visit your GP to check it's not an infection. And are cold-and-flu tablets worth the money? "They contain decongestants, which remove sinus pain," Dr McCoy says. "They're especially good if you're travelling."

Natural painkillers

If you want to avoid pharmaceutical medicines, try these natural remedies.

• Painful periods: Daily evening primrose oil supplements can ease symptoms.
• Headache: Massage the back of the neck with lavender essential oil.
• Colds: Add a few drops of eucalyptus essential oil to the bath.
• Digestive discomfort: Drink peppermint tea after meals.
• Hay fever: Take 1000mg of garlic oil capsules three times a day.
• Heartburn: To assist digestion, take bromelain or papain (available from health food shops) as directed.

Source: The Essential Natural Health Bible by Nerys Purchon (Hodder).

HEALTH - The "poisonous cocktail" of multiple drugs

A 78-year-old woman was found unconscious on the floor of her apartment by a neighbour who checked on her. The woman could not remember falling but told doctors that before going to bed she had abdominal pain and nausea and had produced a black stool, after which she had palpitations and felt lightheaded.

Her medical history included high blood pressure, coronary artery disease, atrial fibrillation, congestive heart failure and osteoarthritis. She also had a cold with a productive cough. For each condition, she had been prescribed a different drug, and she was taking a few over-the-counter remedies on her own.

These were the medications:

Lopressor - to control high blood pressure.

Digitalis - to help the heart pump and control its rhythm.

Coumadin - to prevent a stroke caused by blood clots.

Furosemide - a potent diuretic to lower blood pressure.

Lipitor - to lower serum cholesterol.

Baby aspirin - to reduce cardiac risk from blood clots.

Celebrex - for arthritis pain.

Paxil - for depression and anxiety.

Valium - as needed, to help her sleep.

Levofloxacin - an antibiotic for the cough.

Ibuprofen - for body aches.

Cough medicine.

This is what doctors call polypharmacy, otherwise known as a “poisonous cocktail” of many drugs that can interact in dangerous ways and cause side effects that can be far worse than the diseases they are treating. Elderly people are especially vulnerable because they often have several medical problems for which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking.

The woman described above passed out because she had a bleeding stomach ulcer from a combination of drugs that irritate the stomach, Celebrex, ibuprofen and aspirin, and thin the blood, coumadin and aspirin, made worse by an antibiotic that raises blood levels of coumadin.

She recovered after a transfusion of 2 units of packed red blood cells and was sent home with strict instructions to stop the Celebrex, ibuprofen and aspirin and advice to “contact her internist and psychiatrist regarding possible medication changes that might decrease the risk for future adverse events”, Dr Michael Stern reported in the June issue of Emergency Medicine.

Dr Stern, a specialist in geriatric emergency medicine at New York Presbyterian Hospital/Weill Cornell Medical Center, noted that the elderly took about 40% of prescribed drugs, roughly twice what younger adults take, and that they suffered twice as many adverse drug reactions as younger people.

“The average community-dwelling older adult takes 4.5 prescription drugs and 2.1 over-the-counter medications,” Dr Stern reported. Polypharmacy is responsible for up to 28% of hospital admissions and, he added, if it were classified as such, it would be the 5th leading cause of death in the United States.

The effects of ageing

Various drugs taken by the elderly can interact dangerously. Some drugs use the same metabolic pathway and, thus, compete with one another, which can result in hazardous blood levels of one or more drugs. Some drugs cause effects like dehydration that reduce kidney function and the ability to eliminate drug metabolites. The combined effects of some drugs can be more potent than the prescriber intended.

In addition to seeing several doctors, many older people use multiple pharmacies to buy prescriptions. There may be no single health professional who knows what they are taking and could alert them to dangerous combinations. This is especially true in places where chain stores have replaced independent pharmacies or when the patient’s drug plan requires that medications be ordered by mail.

It is not just the number of diseases, drugs or doctors that is the problem. Age-related changes in physiology can worsen matters significantly, even if just 2 or 3 drugs are being taken. Just as a child is not the same as a small adult, pharmacologically speaking, an elderly person is not just an older young adult.

Major organ systems function less efficiently in older people. The heart’s ability to pump blood declines with age, as does absorption by the gut, the breakdown of drugs by the liver and the ability of the kidneys to excrete them. With ageing, the percentage of lean body mass declines, and body fat increases. Thus, ageing affects how much of a drug reaches the bloodstream, how well it is distributed in the body and how effectively it is cleared from the system.

Drugs like digitalis and coumadin, which are primarily distributed in lean tissues, are likely to reach higher blood levels in people older than 65. So the prescribed dosages should be lowered to reduce the risk of toxic side effects. Other drugs, like Valium and barbiturates that are distributed in fatty tissue can accumulate in the elderly body and remain active longer, increasing side effects like sedation.

Ageing also results in fewer protein binding sites for drugs, resulting in a higher blood level of the drug that loses the competition for sites.

Furthermore, aging can affect the responses to certain medications. This is especially true for those that influence blood pressure and the brain. Drugs like Valium, antidepressants and antihistamines can cause effects like delirium, agitation, sleepiness, depression and worsening dementia in older people, Dr Stern wrote.

Preventing problems

Keep a list of all medications you take and their dosages and dosing schedules. This should include prescription drugs, over-the-counter and herbal remedies and vitamin and mineral supplements. Take the list whenever you go to the doctor, and make sure that the doctor reviews it before prescribing something else. In addition, because doctors are not always familiar with the actions of all drugs, take the list to the pharmacy when ordering a new prescription and ask the pharmacist to review it for potential interactions.

Never take an over-the-counter or herbal remedy without checking with your doctor. If your doctor is hard to reach or ill informed, ask the pharmacist whether the remedy is safe in view of the other drugs you take.

Carefully review and abide by all dosing directions, especially those that say, “Take with food”, “Take 1 hour before meals”, “Do not consume alcohol while on this drug”, or, “Do not take this medicine if you are also taking ...”.

Ask the prescribing doctor what side effects to expect and what should prompt an immediate call to the doctor. Do not assume that a decline in well-being is caused by a disease or age. It could be a drug side effect.

Source: New York Times, 18 September 2007

HEALTH - The drug-free way to fight depression: New hope to the one in five people threatened by the illness

The drug-free way to fight depression: New hope to the one in five people threatened by the illness

• It is thought that one in five people succumb to depression, the most common mental health problem
• But although prescription rates are rising - from 15 million in 1998 to 40 million in 2012 - for some 62 per cent of sufferers, they have little effect
• Alternatives to anti-depressants include magnetic helmets, vegetables and oily fish
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By LEAH HARDY FOR MAIL ON SUNDAY

PUBLISHED: 21:04 GMT, 11 October 2014 | UPDATED: 21:04 GMT, 11 October 2014

From magnetic helmets to vegetables and oily fish, how these alternatives to anti-depressants give new hope to the one in five of us threatened by the illness.

Statistics about depression make for sorry reading. It is now thought that one in five of us will succumb to this most common mental health problem. 

Yet it is becoming clear that the most popular prescribed drugs simply aren’t up to the job for the majority of sufferers. 

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Although prescription rates are soaring - from 15 million in 1998 to 40 million in 2012 – for some 62 per cent of depression sufferers, they have little to no effect

Most will be offered anti-depressants, generally in the form of SSRI (selective serotonin re-uptake inhibitor) drugs, such as Prozac, Cipramil and Seroxat. 

It was thought that a deficiency of the neurotransmitter serotonin was a key cause – and SSRIs increase serotonin levels. So far, so simple.

However, although prescription rates are soaring – from 15 million in 1998 to 40 million in 2012 – for some 62 per cent of depression sufferers, they have little to no effect.

So how do we combat depression in future?

We looked at the new solutions that offer hope to millions... 

 

TREATMENT: Repetitive Transcranial Magnetic Stimulation (rTMS)

BEST FOR: Severe long-term depression

HOW IT WORKS: One of the latest treatments is rTMS.

This uses magnetic pulses, similar to those used in MRI scans, to stimulate the left pre-frontal cortex area of the brain, the area involved in mood regulation, emotion, memory and motivation. It tends to be less active in people with depression.

This newly licensed FDA- approved treatment is for patients with severe, chronic depression, for whom multiple treatments with anti-depressants have failed.

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It is now thought that one in five people will succumb to depression, the most common mental health problem

It is available at The London Psychiatry Centre and the private Nightingale Hospital, also in London.

Pulses are delivered via a metal coil in a helmet that patients wear during five 25-minute sessions a week over two to six weeks, with studies showing most people need 12 to 20 treatments.

The studies indicate that more than 30 per cent of people who don’t respond to any other treatment recover using rTMS.

Psychiatrist Dr Michael Craig, senior lecturer in reproductive and developmental psychiatry at King’s College, London, who offers treatment at the Nightingale, says: ‘Success rates will double if used as a first-line treatment.’

It is available only privately (not through insurance) and treatment costs from £1,000 a week.

 

TREATMENT: Sleep therapy

BEST FOR: Depression caused by insomnia

HOW IT WORKS: Many sufferers from depression complain of insomnia, but there is now evidence that lack of sleep precedes and even causes depression.

In 2013, researchers at Ryerson University, Toronto, found depression lifted significantly among patients whose insomnia was cured. Treatment consisted of four talk-therapy sessions over eight weeks, and was twice as effective as taking medication or a placebo. This has been described as ‘the biggest advance in depression treatment since Prozac’.

Patient advice included: stick to a specific wake-up time; get out of bed when awake but don’t eat, read or watch TV; and avoid taking daytime naps.

Jason Ellis, a professor in psychology at Northumbria University and director of the Northumbria Centre for Sleep Research, says: ‘We aren’t entirely sure why insomnia makes us more vulnerable to depression, but there is some evidence that the changes that occur in our sleep, and particularly to our REM sleep when we first get insomnia, may impact on our mood.

‘REM – or dream – sleep is vital for regenerating connections in the brain. Older people, who are far more prone to depression, have less REM sleep, as do people with depression.’

He is studying if treatment at the first signs of insomnia can prevent depression.

 

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To combat depression, most people are offered anti-depressants, generally in the form of SSRI (selective serotonin re-uptake inhibitor) 

drugs, such as Prozac, Cipramil and Seroxat

TREATMENT: Oestrogen therapy

BEST FOR: Depression caused by hormones

HOW IT WORKS: According to new evidence, women who suffer depression at certain times of the month may have Reproductive Depression, or Premenstrual Dysphoric Disorder (PMDD). They could be sensitive to the surge in progesterone that follows ovulation and precedes menstruation. PMDD can cause rage, suicidal feelings and extreme tearfulness.

Dr Michael Craig, a gynaecologist and psychiatrist, has opened the first female hormone clinic at London’s Maudsley NHS psychiatric hospital with Dr Mike Marsh, a gynaecologist based at King’s College Hospital.

Dr Craig has published research saying PMDD responds positively to the prescription of certain agents that suppress ovulation, such as oestrogen gel, patches and pills.

John Studd, a former professor of gynaecology at Imperial College, runs the private London PMS & Menopause Clinic. He treats women with PMDD using oestrogen gel, which patients are told to rub on to an arm or leg every day.

 

TREATMENT: Lifestyle changes

BEST FOR: Depression caused by inflammation

HOW IT WORKS: There is growing evidence depression is linked to chronic, low-grade inflammation in the body, which may be caused by illness, infection or an overactive immune system.

Professor Graham Rook, Emeritus Professor of Medical Microbiology at University College London, says: ‘Millions of people have raised levels of inflammatory chemicals such as C Reactive Protein [CRP] and we know they are at increased risk of depression later in life.’

Inflammation-linked depression may be connected with alterations in the gut ‘microbiome’, the composition of the millions of microbes in the gut that communicate with the brain. We can unbalance our microbiome and cause inflammation by eating processed food or being too clean, too stressed, too sedentary or too fat. Studies have shown that you can cut inflammation by spending time in green spaces, eating a diet low in sugar and processed carbohydrates and high in vegetables, fruit, lean protein (particularly oily fish) and olive oil. Exercise moderately, sleep more and try to control stress.

Source: http://www.dailymail.co.uk/