Taking Antidepressants During Pregnancy Could Increase Autism Risk by Almost 90%

December 14, 2015 - Taking Prozac and other commonly prescribed antidepressants during pregnancy could increase risk of autism by nearly 90%.

Mums-to-be who take selective serotonin reuptake inhibitors or SSRIs from the third month doubles the risk their child will be diagnosed with autism by seven.

University of Montreal scientists said it was “biologically plausible” SSRIs could affect the development of the brain in the womb at a critical stage.

SSRIs are usually the first choice medication for depression as they generally have fewer side effects than most other types of antidepressant.

Brands prescribed by the NHS are Prozac, Oxactin, Cipramil, Priligy, Cipralex, Faverin, Seroxat and Lustral.

They work by increasing serotonin levels in the brain, a neurotransmitter or messenger chemical that carries signals between nerve cells in the brain.

It’s thought these have a good influence on mood, emotion and sleep and after delivering a message, serotonin is usually reabsorbed by the nerve cells, known as “reuptake.”

SSRIs work by blocking reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells.

The NHS does not recommend taking SSRIs during pregnancy or if breastfeeding unless the benefits outweigh the risks.

Potential complications linked to antidepressants include losing the baby, causing heart defects or pulmonary hypertension, where the blood pressure inside the lungs is abnormally high causing breathing difficulties.

The study followed 145,456 pregnancies and children up to the age of 10 as part of the Quebec Pregnancy Cohort.

It also estimated up to ten per cent of pregnant women take antidepressants.

Professor Anick Berard said: “The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role.

“Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age seven, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.”

article by Tony Whitfield | read original article

The Use and Abuse of Benzodiazepines

November 18, 2015 - The early 1960s saw a dramatic increase in the use of benzodiazepines, better known as minor tranquilizers or sleeping pills. We've since learned how addictive these tranquilizers can be, and why they're designed for short-term use only. So why, in 2015, are they still being prescribed for anxiety and insomnia?

'In my early twenties, I started having panic attacks, and was put on benzos, unaware of the effects they could have on me. I wasn't told much about them, and was just put on them regularly until eventually I started abusing them.'

Ben has been taking drugs for 14 years. His use of benzodiazepines began as part of his treatment for severe anxiety and insomnia.

'For a while I couldn't function without them. I would not go to work if I didn't have any, because I couldn't cope with the anxiety and the panic attacks that were coming on.'

In addition to Xanax and clonazepam, Ben relied heavily on Valium, which he sought through both medical prescriptions and illegal means.

'I was probably spending about $150 every second day,' he says.

'I was on methadone, Suboxone for 10 years, a heavy user of heroin and painkillers, ice as well, but benzos have by far been the hardest thing I've had to go through and to come off. Benzos are just a nightmare.'

According to Ben, prescription medication is harder to kick than any illicit substance.

'There's more treatment for heroin, you can go on methadone and it can control your withdrawals. But having a dose of Valium, I still get withdrawals, it doesn't totally hold me.'

Valium, now known as diazepam, is one of the most common anxiety disorder medications, and is typically prescribed by doctors to relieve stress and anxiety or to help with sleep.

Part of the benzodiazepines family, the drug is used to slow down the activity of the central nervous system and messages travelling between the brain and the body.

'These drugs came into the medical marketplace in the early 1960s, after some development looking into medications that could be used in anaesthesia,' says Dr Mike McDonough, a physician of addiction medicine and toxicology.

According to McDonough, the quantity and variety of benzodiazepines quickly proliferated. The drugs were lauded as one of the most successful discoveries of the psychopharmacological revolution of the 1950s.

However, while the drugs' efficacy generated optimistic expectations amongst professionals and the public, it also brought about a higher risk of dependency and abuse.

'In the late '70s, and certainly into the early '80s, there was increasing concern expressed by medical groups and community groups about benzodiazepine dependence,' says McDonough.

'People were staying on what were considered normal doses for the treatment of things like anxiety or insomnia for several weeks, months and even longer, and having great difficulty stopping or reducing the dose.'

Following two unsuccessful class actions, the UK Medicines Council published a report on benzodiazepine use in the early 1990s, with guidelines for safe use of the drugs.

'Essentially two to four weeks was suggested at that time, and right up to the present day, the most recent guidelines on the usefulness of these medications is very clearly short-term use for particular situations,' says McDonough.

Despite this, it is estimated that one in 50 Australians now takes benzodiazepines for longer than six months, typically for problems relating to anxiety and sleep.

The medications are commonly divided into short, intermediate and long acting categories, and there is a range of brand names available for each.

'There are several bona fide evidence-based situations in acute care medicine, certainly in hospital-based and procedural-based medicine, where benzodiazepines have an immediate, tried and proven effectiveness,' says McDonough.

In Australia, the most common benzodiazepines prescribed include temazepam, used as a sleeping tablet, diazepam, alprazolam, also known as Xanax, and oxazepam.

'When we look at the more wide-scale use of benzodiazepines in the community, it is clear from the evidence and the guidelines ... that short-term use—and that is usually two to four weeks, tops—is the recommended period of time for a person to be exposed, beyond which there is an increased risk of becoming dependent,' says McDonough.

So is prescribing benzodiazepines for anxiety and panic attacks still the most appropriate treatment?

'Many people, up to one in four or thereabouts, can have some experience of mental health problems during their life, and that's commonly anxiety or depression,' says McDonough.

Most medical guidelines stipulate that in general, first-line treatment should be psychological, and include practices such as cognitive behavioural therapy.

'For second and third line consideration, for people with truly disabling anxiety disorders, there are other medications, and they include things like the antidepressants ... but not benzodiazepines,' says McDonough.

'The guidelines clearly articulate that if [benzodiazepines] are going to be considered in the context of a comprehensive treatment approach to, say, anxiety disorder management, they are only ever recommended to be considered for short-term periods.'

Even so, McDonough believes they still are being overprescribed, especially to elderly patients.

'A disproportionately high number of these people are on benzodiazepine-based hypnotics ... They are of great concern to us as a population of vulnerable people who are far more at risk for falls, confusion and incontinence because the tranquillising effect is broad on the body in general.'

Critical body processes like balance control, control over defecation, urination, speech and thinking can all too be impaired by benzodiazepine use.

'The problem that presents to many nurses and other healthcare workers and doctors in aged care facilities is you find the aged patient already on these medications for sometimes years,' says McDonough.

So how do you get patients off these addictive medications?

According to McDonough, research undertaken on elderly people being assisted to 'get off' benzodiazepines demonstrated patients 'feeling better and functioning better' at the end of a gradual withdrawal period.

'It does appear to improve not only their functioning, but their quality of life.'

This withdrawal period, however, is what Ben-who sought help with his longtime dependence on diazepam-found most challenging.

'Just the severe anxiety, the insomnia, it's hard to explain the feelings of unreality, just real spaced-out feeling, the muscle spasms, the hand tremors ... so many withdrawals, I could name them for quite a while.'

Ben, who began his treatment with 40 milligrams per day with 10 per cent reductions from there, still experiences many ups and downs.

'When I got to 20 milligrams of diazepam I was really struggling, so we started doing it a milligram at a time, probably every two to three weeks.

'I've had a couple of slight setbacks where I've got down to three milligrams, needed to take extra because of the severe anxiety and withdrawals, and I've gone back to five. I'm currently down to 4.5 milligrams.'

According to McDonough, treatment for benzodiazepine addiction begins with a patient's readiness to accept the notion that they might be helped by coming off medication.

'The exit plan, that's incredibly important, followed by a planned strategy for gradual reduction and continued reappraisal, and that being explained to the patient so that they know they are not just going to be plucked from the benzodiazepines, they going to be gradually guided and supported on that journey.'

The physician says it's about educating the patient on the realities of the withdrawal process, and highlighting the potentially substantial health benefits if the treatment is successful.

'We now know, for example, that mortality rates are different for people on long-term tranquillisers compared to the rest of the population. Fall rates are different, confusion and even dementia are different.'

Ben, meanwhile, has used his drawing and cartooning skills to create of a poster for Reconnexion, a not-for-profit organisation in Melbourne that provides support for people dependent on tranquillisers. The poster represents the 'dos and don'ts' of benzodiazepine withdrawal.

According to Ben, 'there are a lot of bad days', but it's important to keep seeking support and stay in contact with your drug counsellor.

'Benzos are designed to stop anxiety, but when they stop working for you it just intensifies it and it's just very hard to control.

'I'm going to have to just practice a lot of relaxation, get into yoga. I started shiatsu, which is helping me sleep, a relaxation technique, and just keep up with my counselling and calling the support line at Reconnexion. I don't want to have to go through this again.'

According to McDonough, 'adherence to clinical guidelines' is the most important take-home message with respect to benzodiazepine use.

'The argument against that, that is commonly used by doctors and others, is that not everybody fits the clinical guidelines all of the time, so there are cases where we have to step outside some of those guidelines and prescribe differently.

'But broadly, clinical guidelines should assist all practitioners in avoiding getting into prescribing situations that lead to long-term unnecessary dependence on drugs like benzodiazepines.'

Written by Lynne Malcolm, Olivia Willis | ABC | read original article

Paxil Unsafe for Teenagers Says New Analysis

Fourteen years ago, a leading drug maker published a study showing that the antidepressant Paxil was safe and effective for teenagers. On Wednesday, a major medical journal posted a new analysis of the same data concluding that the opposite is true.

That study - featured prominently by the journal BMJ - is a clear break from scientific custom and reflects a new era in scientific publishing, some experts said, opening the way for journals to post multiple interpretations of the same experiment. It comes at a time of self-examination across science - retractions are at an all-time high; recent cases of fraud have shaken fields as diverse as anesthesia and political science; and earlier this month researchers reported that less than half of a sample of psychology papers held up.

“This paper is alarming, but its existence is a good thing,” said Brian Nosek, a professor of psychology at the University of Virginia, who was not involved in either the original study or the reanalysis. “It signals that the community is waking up, checking its work and doing what science is supposed to do - self-correct.”

The authors of the reanalysis said that many clinical studies had some of the same issues as the original Paxil study, and that data should be made freely available across clinical medicine, so that multiple parties could analyze them.

The dispute itself is a long-running one: Questions surrounding the 2001 study played a central role in the so-called antidepressants wars of the early 2000s, which led to strong warnings on the labels of Paxil and similar drugs citing the potential suicide risk for children, adolescents and young adults. The drugs are considered beneficial and less risky for many adults over 25 with depression.

Over the years, thousands of people taking or withdrawing from Paxil or other psychiatric drugs have committed violent acts, including suicide, experts said, though no firm statistics are available. Because many factors could have contributed to that behavior, it is still far from clear who is at risk - and for whom the drugs are protective.

The maker of Paxil, said it stood by the original conclusions, given what was known at the time. The company also noted that it had provided all the data for the new analysis, “an unprecedented level of data sharing that speaks to our absolute commitment to transparency.”

The team that reanalyzed the data included several longtime critics of the original study, including a psychiatrist who has been a paid expert witness in lawsuits against Glaxo. But with the company’s permission they spent about a year poring over Glaxo’s files on the study, combing through summaries, internal trial reports and a sample of what is known as patient-level data, the detailed descriptions of what happened for each person in the original trial.

The original study began in the late 1990s, when antidepressant makers started testing the drugs in young people. Antidepressant trials are an extremely tricky enterprise, in part because anywhere from a third to more than half of subjects typically improve on placebo. Choices about how to measure improvement - and how to label side effects - can make all the difference in how good a drug looks.

And so it was in the Paxil study. The original research, led by Dr. Martin Keller of Brown University, tracked depression scores over eight weeks in three groups of about 90 adolescents each, one taking Paxil, one on placebo pills and one taking imipramine, an older generic drug for depression. The Paxil group did no better than the other two groups on the study’s main measure - a standard depression questionnaire - but did rate higher on other, “secondary” measures, like another scale of mood problems, the authors reported.

Researchers consider secondary measures like these as akin to circumstantial evidence, potentially meaningful but not as strong as the primary ones.

The drug’s manufacturer - SmithKline Beecham, now a part of GlaxoSmithKline - submitted the trial and others to federal regulators, who told the company that the drug was on track for approval for use in adolescents.

But critics began picking apart the study soon after it was published in the Journal of American Academy of Child and Adolescent Psychiatry, charging that it was not at all convincing, and that serious side effects had been played down.

Dr. Keller and his co-authors responded at the time that the testing of antidepressants in young people was a new area, that the paper was upfront about its use of secondary measures and that charges of bias were baseless. Glaxo stood by the team’s conclusions.

Prescriptions of antidepressants to young people surged in the wake of the study, increasing by 36 percent between 2002 and 2003, according to one analysis. The growth slowed after regulators ordered the black-box warnings on labels.

The reanalysis delivers the same critique as before - no clear effectiveness, and mislabeling of serious side effects - only from the inside, using voluminous data from the study itself. Its authors include Jon Jureidini, of the University of Adelaide in Australia, an early critic, and Dr. David Healy, a professor of psychiatry at Bangor University in Wales, who, with the help of a BBC reporter, Shelley Jofre, first noticed and made public the serious side effects in the early 2000s and who has acted as an expert witness against Glaxo.

In an interview, Dr. Healy said that five of six adverse events labeled “emotional lability” in the original study involved suicidal thinking or behavior but were not presented as such. The patient-level files provided detail on what, exactly, happened in those cases: One teenager was hospitalized after taking 80 Tylenol tablets. Another overdosed on Paxil and other medications after a “disagreement with her mother.” Others suffered “severe suicidal ideation,” and one was “admitted due to severe suicidal and homicidal ideation, towards his parents.” No completed suicides occurred. “When I first heard about this new analysis, I suspected it might be biased,” said Dr. Erick Turner, an associate professor of psychiatry at Oregon Health and Science University, who was not involved in the report. “But I did my own analysis and found, as they did, no significant effect.”

Dr. Turner added, “The only way to really know about adverse events is to dig into the patient-level data.”

Dr. Keller and his co-authors strongly disputed the reassessment of their work. In a joint statement, he and his team said they incorporated secondary measures before knowing which patients were taking Paxil and which were not - not afterward, as the new analysis claims, for some of the measures. “In summary, to describe our trial as ‘misreported’ is pejorative and wrong,” they conclude.  Article by The New York Times | Benedict Carey | Read original article…

Australian Olympic Committee Extends Sleeping Pill Ban

The Australian Olympic Committee (AOC)’s ban on certain hypnotic medications, including Stilnox (zolpidem; brand name Ambien in the United States), remains in place for next year’s Olympic Games in Rio and will come into effect earlier.

The AOC Executive has decided the ban will now apply from the date an athlete is selected on the 2016 Australian Olympic Team and includes:

• Nitrazepam (including but not restricted to the brand name “Mogadon”)
• Flunitrazepam (including but not restricted to the brand name “Rohypnol”)
• Zolpidem (including but not restricted to the brand name “Stilnox, Ambien”)

The AOC introduced the ban on some hypnotic medications in July 2012 three weeks before the start of the London Games.

“First and foremost we banned Stilnox before the London Games because of serious concerns for the welfare of the athletes. We felt then we had an obligation to protect our athletes from serious harm and that remains our priority today,” says Fiona de Jong, AOC CEO, in a release. “By introducing the ban from the date of selection we are giving any athlete taking hypnotic medications time to wean themselves off the drug long before they enter the Village in RIO.”

In 2012 the AOC was criticized for not giving athletes time to stop using the medications. Opponents argued the ban would disrupt their Olympic preparation particularly their sleep patterns.

“The three-week window prior to London caused issues within the Team but this time there is no excuse” de Jong says.

The ban was introduced following revelations from swimmer Grant Hackett who said he had become addicted to Stilnox, the AOC states.

Following the London Olympics it was revealed that members of the Australian men’s 100m freestyle relay team had taken Stilnox at the Team pre-Games training camp in Manchester, England, after the AOC ban was announced.

A subsequent investigation by Bret Walker SC revealed the swimmers were unsure when the prohibition commenced. At that time Stilnox was prescribed for one of the swimmers and this necessitated a “weaning off” period.

“The prohibition now commences from the date of selection of each athlete. This will vary depending on the sport, but there should be no weaning off period immediately prior to the Games. Instead we are recommending athletes adopt healthy sleep strategies, relaxation and meditation techniques, and other drug-free approaches in the lead up to RIO” de Jong says.

Under the 2016 Team Agreement, which all athletes and officials must sign, Team members are prohibited from using, possessing, or trafficking a drug of addiction, poison, or restricted substance in contravention of the Poisons and Therapeutic Goods Act 1966 (NSW).

The Agreement again gives the AOC the right to search bags or other possessions Team Members may bring into the Olympic Village.

It includes the right to seize any suspicious substance they might find and have that substance analyzed and investigated.

Failure to comply will be regarded as a breach of the Team Agreement and could lead to termination as a member of the 2016 Australian Olympic Team Member and being ineligible for selection on future Australian Olympic Teams. Written by The Sleep Review. Read Original Article...

Meth - Are Americans Getting Hooked

Alexander Zaitchik | The Guardian

In 2014, the adult market for pharmaceutical stimulants in the US overtook the long-reigning children’s market. Thanks to the eagerness of many doctors to prescribe so-called ADHD drugs, every high school in the country is sloshing with enough amphetamine to keep five Panzer divisions awake during an extended Africa campaign. But now, for the first time, you are more likely to find drugs like Vyvanse and Adderall in a corporate office park than a classroom.

There is something unsettling about this continuing growth in prescription stimulants. Even though the pills are as strong as street meth – which in any case metabolizes quickly into dextroamphetamine, the main active ingredient in most ADHD drugs – nobody seems to call this class of drugs by its name: “speed.”

For those who have experienced the dark-side of regular amphetamine use, it has been a curious and concerning thing to see speed developed into a boom market extending well beyond narcoleptics and those suffering acute ADHD.

I first used speed while living in Prague during the mid-1990s. The city was awash in “pico”, or Pervitin, the name of the local methamphetamine inherited from the Nazis during World War II. Pico was cheap, strong and easy to get. I used it mostly to hit deadlines, but also as a party drug. The usual cycles always threatened: tolerance; the temptation to fend off deep crashes with another rail; the creeping sense that I couldn’t really be productive or have fun without it. I never got hooked hard, but those speed-fueled years were part roller coaster, part haunted house. I saw a lot of kids go off the deep end. When I returned to the US in the aughts, I saw more kids harmed by Ritalin and Adderall - pills prescribed to them basically for the asking, and which I found to be every bit as powerful, and ultimately dangerous, as bathtub crank.

During our recent industry-guided speed renaissance, “speed” has been turned into “meds”, reflecting the idea that amphetamine for most people remains some kind of safe treatment or routine performance-booster, rather than a highly addictive drug with some nasty talons in its tail. The full extent of this cultural forgetting hit me several years ago, when I asked an otherwise sophisticated street dealer what kind of speed he was holding. He stared at me in utter incomprehension. When I clarified my request with brand names, he said: “Oh, you mean meds.”

The trend in adult speed prescriptions has been driven by what Flemming Ornskov, the CEO of the drug-maker Shire, describes as his company’s “shifting more effort into the adult ADHD market.” This “effort” by Shire and other drug companies has taken many forms.

In the US, it’s involved direct marketing on television using celebrity spokespeople like pop star Adam Levine and tennis great Monica Seles. The industry also sponsors conferences and funds research that encourages more testing, diagnoses and prescriptions. To push these ends, it has recently (re)discovered new adult uses for stimulants. In January, Shire won FDA approval to prescribe its leading patented stimulant, Vyvanse, as a treatment for “binge eating,” suggesting a return to the post-Cold War decades when the “Dexedrine Diet” turned millions of women in the USA and Europe into amphetamine addicts.

Shire has fuelled this oblivion with its aggressive marketing of Vyvanse, a slightly modified d-amphetamine extended-release rocket fuel. The active patented ingredient in its new bestseller is something the company calls “lisdexamfetamine.” Note the “ph” has been replaced with an “f” in a crude but brilliant gambit. The company’s neo-phoneticism is intended to put more distance between its new golden goose and the deep clinical literature on speed addiction, not to mention last century’s disastrous social experiment with widespread daily speed use, encouraged by doctors, to temper appetites and control anxiety.

Many people signing up for Vyvanse and other new-gen daily regimen speeds are happy to buy into this illusion of distance between past and present, between street dealer and doctor’s pad. Poor people do dirty drugs like “meth” and “speed” and ruin their lives. Middle class strivers do “meds” and succeed while slimming down. But the truth is all speed is addictive. And all speed, even elegantly designed concoctions like Vyvanse, leaves users crashed out and riddled with anxiety and depression that deepens with time. Read full article…

Sleeping Pill Use Raises Car Crash Risk

June 11, 2015 | Maggie Fox | NBC News

Sleeping pills such as Ambien and Restoril may double someone's risk of a car crash - even after their effects should have worn off - and may raise the risk as much as having too much to drink, researchers reported Thursday.

A close look at medical and driving records showed that people who took any one of the three popular sleeping aids had anywhere between a 25 percent and three times higher risk of being involved in an accident while driving.

"We found that each of the medications independently was associated with an increased risk of motor vehicle crashes," Ryan Hansen of the University of Washington's school of pharmacy, who led the study, told NBC News.

The findings, published in the American Journal of Public Health, help justify U.S. Food and Drug Administration warnings about the pills.

In 2013, the FDA told makers to cut the recommended doses of sleeping pills because of research showing they can stay in the bloodstream at levels high enough to interfere with morning driving, which increases the risk of car accidents.

The FDA said doctors should aim to prescribe the lowest possible dose.

Hansen's team looked at the medical records and driving records of more than 400,000 people enrolled in a health plan in the state. They chose only adults who were also drivers.
Of them, just under 6 percent were written new prescriptions for sleeping aids between 2003 and 2008.

They collected data on the three pills: zolpidem, sold under the brand name Ambien; trazodone, sometimes sold under the brand name Oleptro; and temazepam, brand name Restoril. Each works through a different mechanism to help people sleep.

People who took Restoril had a 27 percent higher risk of being involved in a crash over the five years studied. People who took trazodone or Desyrel had nearly double the risk - 91 percent higher. Ambien users had the highest risk - they were more than twice as likely as non-users to have a car crash over the five years.

Sleeping pills such as Ambien and Restoril may double someone's risk of a car crash - even after their effects should have worn off - and may raise the risk as much as having too much to drink, researchers reported Thursday.

A close look at medical and driving records showed that people who took any one of the three popular sleeping aids had anywhere between a 25 percent and three times higher risk of being involved in an accident while driving.

"We found that each of the medications independently was associated with an increased risk of motor vehicle crashes," Ryan Hansen of the University of Washington's school of pharmacy, who led the study, told NBC News.

"New use of sedative hypnotics is associated with increased motor vehicle crash risk."
The findings, published in the American Journal of Public Health, help justify U.S. Food and Drug Administration warnings about the pills.

In 2013, the FDA told makers to cut the recommended doses of sleeping pills because of research showing they can stay in the bloodstream at levels high enough to interfere with morning driving, which increases the risk of car accidents.

The FDA said doctors should aim to prescribe the lowest possible dose.

Hansen's team looked at the medical records and driving records of more than 400,000 people enrolled in a health plan in the state. They chose only adults who were also drivers.

Of them, just under 6 percent were written new prescriptions for sleeping aids between 2003 and 2008.

They collected data on the three pills: zolpidem, sold under the brand name Ambien; trazodone, sometimes sold under the brand name Oleptro; and temazepam, brand name Restoril. Each works through a different mechanism to help people sleep.

People who took Restoril had a 27 percent higher risk of being involved in a crash over the five years studied. People who took trazodone or Desyrel had nearly double the risk - 91 percent higher. Ambien users had the highest risk - they were more than twice as likely as non-users to have a car crash over the five years.

FDA recommends lower Ambien dosage0:28

"These risk estimates are equivalent to blood alcohol concentration levels between 0.06 percent and 0.11 percent," Hansen's team wrote. The legal limit in all states for blood alcohol is 0.08 percent.

The effect wears off over time, the researchers found. It may be that people get used to the effects, or they may compensate for them.

"In our study we were just looking at new users of these medications," Hansen said. "We found that over time, the risk increased and it varied from medication to medication, but there was a cumulative effect that then waned after a period of time as well."

What's going on? It seems that people stay sleepy when they use sedatives, the researchers said.

These drugs stay in the blood for a long time, researchers know. "And so, they can have a variety of impacts on risk of crash, including people waking up in the middle of night without knowing it and driving, or waking up in the morning and driving to work and being slightly impaired by the medication still," Hansen said.

"These drugs can make you slow to react to complex situations in driving."

Mallinckrodt Pharmaceuticals, which makes Restoril, said it could not comment specifically on the study without further review.

"Mallinckrodt believes it's medications are safe and effective when used according to product labeling. We encourage patients and healthcare providers to discuss warnings and precautions that may be associated with any drug," the company said in a statement.

Sanofi, which makes Ambien, says virtually all prescriptions of the drug use a generic version now.

"It is important that patients only take zolpidem as directed by their physician. The FDA-approved label states do not take zolpidem unless you are able to stay in bed a full night (7-8 hours) before you must be active again," Sanofi said in a statement.

Ambien, especially, has been reported to cause strange side-effects in users, including sleep walking and taking part in other activities, including driving, with no memory of having done so afterwards.

"I hope that people who are taking these medications, who need to take these medications, will take a moment to talk to their doctor and pharmacist and really better understand the risks that are associated with this," Hansen said.

"It's not just a risk to them, if they're out there driving. It's also a risk to each and every one of us that's out on the road with people who are taking the medications."

At least 8.6 million Americans take prescription sleeping pills and between 50 million and 70 million Americans suffer from sleep disorders or sleep deprivation, according to the Institute of Medicine. Adults typically need between seven and nine hours of sleep a night, but more than a third of adults get less, according to the Centers for Disease Control and Prevention. Read original article...

Combining Antidepressants with Painkillers May Cause Brain Bleeding

(from Utah People's Post) Based on a recent medical study, it appears that combining antidepressants with painkillers may cause brain bleeding. This observation was made after researchers from the University of Medicine from Seoul Korea compared the medical records of 4 million people, who have received prescriptions for antidepressants between 2009 and 2013.

There are many counter indications in relation to the use and administration of antidepressants. Until recently, patients were advised not to combine these medicines with alcohol or other narcotics as they may have strong side-effects and even cause the patient’s death.

A new study proves that there may be many more reasons to worry for patients suffering from depressions. According to the recent data collected during the medical experiment, the combination between anti-depressants and pain killers can lead to brain bleeding, so physicians are now taking into consideration the possibility to completely eliminate them from patients’ treatments.

Brain bleeding is the medical condition during which the patient experiences loss of blood under the skull. The affection may cause permanent damage to the brain and may even lead sometimes to the patient’s death.

The recent experiment shows that the 4 million persons, who have taken antidepressants for the first time during the period between 2009 and 2013 had a stroke when combining these drugs with pain relievers. The most dangerous pain relievers appear to be aspirin, naproxen (Aleve) and ibuprofen (Motrin, Advil).

5.7 percent people in a group of 1,000 respondents suffered an episode of brain bleeding per year as a result of the said combination between antidepressants and NSAIDs. As a consequence, 0.5 people are likely to suffer from brain hemorrhage over the time interval of one year.

Researchers believe that figures should, nonetheless, not worry physicians as the percentage is rather low. They suggest medical experts to carefully weigh their decision of administering pain killers, but they do not believe that these drugs should be completely excluded from patients’ medical treatment.

Antidepressants have been linked to many other affections, particularly stomach diseases. Both pain killers and narcotics are said to cause gastrointestinal bleeding, based on the previous studies. The increased risk of brain hemorrhage, as a result of the use of pain killers and antidepressants has been recently discovered and it will be further studies in the future for additional information. Read original article...

100-year old scientist pushes FDA to ban artificial trans fat

(from Brady Dennis, Washington Post) No one was more pleased by the Food and Drug Administration's decision Tuesday to eliminate artificial trans fats from the U.S. food supply than Fred Kummerow, a 100-year-old University of Illinois professor who has warned about the dangers of the artery-clogging substance for nearly six decades.

"Science won out," Kummerow, who sued the FDA in 2013 for not acting sooner, said in an interview from his home in Illinois. "It's very important that we don't have this in our diet."

In the 1950s, as a young university researcher, Kummerow convinced a local hospital to let him examine the arteries of people who had died from heart disease. He made a jarring discovery. The tissue contained high levels of artificial trans fat, a substance that had been discovered decades earlier but had become ubiquitous in processed foods throughout the country.

Later, he conducted a study showing that rats developed atherosclerosis after being fed artificial trans fats. When he removed the substance from their diets, the atherosclerosis disappeared from their arteries.

Kummerow first published his research warning about the dangers of artery-clogging trans fats in 1957. More than a decade later, while serving on a subcommittee of the American Heart Association, he detailed the massive amounts of trans fat in the shortening and margarines lining grocery shelves, and helped convince the food industry to lower the content in certain products.

Despite Kummerow's research and warnings over the years, artificial trans fats remained a staple of processed food for decades. Well into the 1980s, many scientists and public health advocates believed that partially hydrogenated oils were preferable to more natural saturated fats. And the food industry was reluctant to do away with artificial trans fats, which were cheaper than their natural counterparts, extended shelf life and gave foods desirable taste and texture.

"The industry was very much for trans fat," said Kummerow, noting that each time a group formed to study the issue over the years, it seemed to turn out the same way. "It always ended up that you had to have more research before you could come to a conclusion."

Frustrated by the lack of action, Kummerow filed a 3,000-word citizen petition with the FDA in 2009, citing the mounting body of evidence against trans fat. The first line read: "I request to ban partially hydrogenated fat from the American diet."

By that time, he certainly wasn't alone.

In the 1990s, more and more studies had shown that trans fats were a key culprit in the rising rates of heart disease. The advocacy group Center for Science in the Public Interest also petitioned the FDA in 1994 to require that the substance be listed on nutrition labels -- a move that the agency put into place in 2006. In 2002, the Institute of Medicine found that there was “no safe level of trans fatty acids and people should eat as little of them as possible.” As the dangers of trans fat became clearer, public opinion also shifted, and food companies increasingly removed the substance from products, though it remained in a broad range of foods, from cake frostings to baked goods.

Four years after filing his petition and hearing nothing, Kummerow sued the FDA and the Department of Health and Human Services in 2013, with the help of a California law firm. The suit asked a judge to compel the agency to respond to Kummerow's petition and "to ban partially hydrogenated oils unless a complete administrative review finds new evidence for their safety."

Three months later, the FDA announced its plans to effectively eliminate trans fats by saying that the substance no longer would be assumed safe for use in human foods. Tuesday's action finalizes that initial proposal, and manufacturers will have three years to reformulate products or to petition the agency for an exception.

Glad as he was to see the government finally eliminate most trans fat from the food supply -- a move he thinks will save thousands of lives -- Kummerow doesn't consider his job done. He's pressing forward on research about how fried fats can affect metabolism, hoping to add more academic journal articles to his long list of publications.

As for his own diet, Kummerow said he doesn't spend much time worrying about cholesterol, which he doesn't believe is a central culprit in heart disease (he even wrote a book on the topic). He drinks whole milk and eats eggs. But he does steer clear of fried foods, margarine and anything associated with partially-hydrogenated oils.

Kummerow recalled how last fall, at his 100th birthday celebration, someone brought a ready-made cake to the party. When he studied the label, he quickly noticed that it contained trans fat.

"I threw it out," he joked. "There were a lot of other things [to eat]." Read original article...

Florida Doctors Among Top Tranquilizer Prescribers

(from Health News Florida) In 2012, Medicare’s massive prescription drug program didn’t spend a penny on popular tranquilizers such as Valium, Xanax and Ativan.

The following year, it doled out more than $377 million for the drugs.

While it might appear that an epidemic of anxiety swept the nation’s Medicare enrollees, the spike actually reflects a failed policy initiative by Congress.

More than a decade ago, when lawmakers created Medicare’s drug program, known as Part D, they decided not to pay for anti-anxiety medications. Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them. When Congress later reversed the payment policy under pressure from patient groups and medical societies,it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows. Generic versions of the drugs-alprazolam (Xanax), lorazepam (Ativan) and clonazepam (Klonopin)-were among the top 32 most-prescribed medications in Medicare Part D that year.

Florida, and particularly Miami-Dade County, had more doctors who prescribed large amounts of benzodiazepines than anywhere else in the country. Some 144 Florida doctors wrote at least 2,000 prescriptions for them to Medicare patients, compared to 98 in Puerto Rico and 27 in Alabama, the next highest state.

And it appears these were not new prescriptions.

IMS Health, a healthcare analytics company that tracks drug sales nationwide, logged only a tiny increase in all benzodiazepine prescriptions, including those covered by Medicare, from 2012 to 2013. That probably means Medicare paid mostly for refills of existing prescriptions, not new ones, said Michael Kleinrock, director of research for the IMS Institute.

That millions of seniors are taking Xanax, Ativan and other tranquilizers represents a very real safety concern, said Dr. Brent Forester, a geriatric psychiatrist at Harvard-affiliated McLean Hospital in Belmont, Mass.

The drugs are popular because they are fast-acting-working quickly, for example, to quell debilitating panic attacks. But they can be habit-forming and disorienting and their effects last longer in older patients. For that reason, the American Geriatrics Society discourages their use in seniors for agitation, insomnia or delirium. The group says they may be appropriate to treat seizure disorders, severe anxiety, withdrawal and in end-of-life care.

Forester said he and others who specialize in geriatric psychiatry don’t use benzodiazepines as a “first-, second- or third-line treatment because we see more of the downside than the good side.”

Some of the Florida doctors who ranked among Medicare’s top prescribers of the drugs said any risks were outweighed by their benefits. 

Miami psychiatrist Rigoberto Rodriguez ranked high among Medicare prescribers of benzodiazepines, writing 9,900 prescriptions in 2013, and most of his patients were seniors.

Many, he said, are Cuban immigrants who experienced traumas that left them with lingering anxiety, and they have been taking the drugs for years.

Rodriguez readily acknowledged the risks of the drugs for elderly users – recently, researchers found that the longer a person took benzodiazepines, the higher his or her risk of being diagnosed with Alzeimer’s Disease.The drugs’ labels say they are generally for short-term use but many patients take them for years

He said he has been working to reduce his benzodiazepine prescriptions in light of emerging research. He expects that when Medicare releases data for 2014 and 2015, his totals will be lower.
“This is fresh information coming out in the last couple years that are telling us that benzos are probably not good and you should try to avoid them,” Rodriguez said. “I totally agree with that.”

Roberto Hernando, another Miami psychiatrist who wrote high numbers of benzodiazepine prescriptions in 2013, said he intends to review his prescribing after a reporter told him his totals.
“Some people may need it; some people may not,” he said. “You’re bringing to my attention something that I wasn’t even aware of.”

Some geriatric psychiatrists worry that doctors may have turned to the drugs in place of antipsychotic medications to sedate patients with conditions such as dementia. In the past several years, Medicare has pushed to reduce the use of antipsychotics, particularly in nursing homes, because of strong warnings about their risks.

In 2013, Medicare covered more prescriptions for benzodiazepines than for antipsychotics.
“At the end of the day,” Forester said, “in terms of risk, the risk with benzodiazepines seems so much worse to me….There’s significant danger and there’s no spotlight.”

A spokeswoman at the Centers for Medicare and Medicaid Services declined to answer questions about Medicare’s suddenly soaring tab for benzodiazepines.

Psychiatrist Claude Curran of Fall River, Mass. wrote more than 11,700 prescriptions for benzodiazepines (including refills) in 2013, behind only four doctors in Puerto Rico.

He said the drugs worked well for his patients, many of whom are trying to kick addictions to narcotics but struggle with anxiety and depression.

“First of all, they’re reliable,” he said. “Second of all, they’re cheap because they’re all generic…They tickle the brain in the same way alcohol does.”
Without benzodiazepines, he added, patients in recovery often need higher doses of methadone, which carries significant risks of its own.

The vast majority of Curran’s Medicare patients were younger than 65 and qualified for coverage based on a disability. Disabled patients made up about a quarter of Part D’s 35 million enrollees in 2013, but used benzodiazepines disproportionately, accounting for about half of all prescriptions.

A worrisome aspect of the newly released data is that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, increasing the risk of misuse and overdose. The drugs, paired together, can depress breathing.

ProPublica also found that this pattern was most common in southeastern states, which struggle with opioid abuse and overdoses. In 2013, 158 doctors in Florida wrote at least 1,000 prescriptions each for opioids and for benzodiazepines, tops in the nation.

Alabama, Kentucky and Tennessee also had unusually high numbers of doctors who often prescribed both narcotics and benzodiazepines. The data does not indicate if the prescriptions were given to the same patients. 

Dr. Leonard J. Paulozzi, a medical epidemiologist at the Centers for Disease Control and Prevention, co-authored an analysis showing that benzodiazepines were involved in about 30 percent of the fatal narcotic overdoses that occurred nationwide in 2010.

He expressed concern that doctors could be pairing these types of drugs because of their  “cumulative depressive effect.”

“It increases the possibility of overdoses,” he said.

When Congress created Medicare’s drug program in 2003, there wasn’t much discussion about whether it should cover benzodiazepines.

They were on a larger list of drugs excluded for coverage, along with barbiturates, fertility drugs, drugs for weight loss and cosmetic purposes. The list mirrored one from a law years earlier allowing states to voluntarily exclude certain drugs from Medicaid programs for the poor. (Medicare now also pays for barbiturates.)

Andrew Sperling, director of federal legislative advocacy for National Alliance on Mental Illness, said it’s unclear why Congress made the exclusions mandatory for Medicare when they had only been voluntary for Medicaid. He believes it was a drafting error.

IMS Health data suggests that while the Medicare ban was in effect, seniors and disabled patients paid for benzodiazepines in other ways. Many paid out of pocket for the relatively inexpensive drugs—some cost less than $10 for a 30-day supply. Some, particularly those with disabilities, qualified for Medicaid, which covers the drugs. Another set of patients chose Medicare Advantage plans that offered the drugs as an added benefit.

Dr. Michael Ong, an associate professor at UCLA, co-authored a 2012 paper concluding that many patients continued using benzodiazepines after Congress banned coverage in Medicare Part D and that some turned to more powerful psychiatric drugs.

“Just mandating something and saying we’re not going to pay for the benzodiazepines is probably not the right type of policy solution to change the behaviors of both the providers who are providing these medications and also the patients who are using them,” Ong said.  Article written by CharlesOrnstein and Ryann Grochowski Jones of Propublica.  Read original article…

Conventional Sodium Advice May Be Wrong

(Case Adams) A large international study conducted in 17 countries and recently published in the New England Journal of Medicine has found the advice given by doctors to their heart patients and others with regard to sodium has been WRONG.
Conventional advice given by most Western doctors and even published by the U.S. Office of Disease Prevention and Health Promotion - part of the U.S. Department of Health and Human Services - has recommended that those under 50 years old limit their sodium intake to less than 2,300 milligrams per day, and those over 50 limit their sodium consumption to less then 1,500 milligrams per day.

The recent study, conducted by nearly 400 scientists around the world, followed 156,424 people between the ages of 35 and 70 years old living in 628 cities and villages in Argentina, Bangladesh, Brazil, Canada, Chile, China, Colombia, India, Iran, Malaysia, Pakistan, Poland, South Africa, Sweden, Turkey, United Arab Emirates, and Zimbabwe.

Urinary sodium levels tested
Within this study, the researchers measured urinary sodium and potassium levels among 101,945 people from the five continents by sampling fasting urine in the morning. The urine samples were analyzed and compared with the medical history and prescription history of each subject.

The researchers especially focused upon any history of cardiovascular disease and death among the subjects, correlating the sodium and potassium levels with health history.

The researchers continued to follow the subjects for an average of 3.7 years after the initial samples were taken and analyzed.

Cancer patients were eliminated from the study, and other known predictors of heart disease and death were accounted for.

The researchers found that consuming less than 3,000 milligrams of sodium per day was associated with a 27 percent increase in cardiovascular disease and death.

Consuming between 3,000 milligrams and 6,000 milligrams of sodium each day was found to be associated with a lower risk of cardiovascular disease and death.

Consuming more than 6,000 milligrams per day was associated with a 15 percent increase in cardiovascular disease and mortality.

Remember that current guidelines have been limiting sodium consumption to 1,500 milligrams for those over 50, and less than 2,300 milligrams for those 50 or younger.

And the bottom line of this study finds that consuming between 3,000 and 6,000 milligrams of sodium per day decreases ones risk of heart conditions and death while consuming less than 3,000 and more than 6,000 increases risk. More specifically, the research found that more than 7,000 milligrams per day increases risk significantly.

Why the mistake?
Why has the medical industry been so off about this? In their paper, the study authors suggested that current sodium intake guidelines are based primarily upon shorter studies and study models that don't apply directly to the general population.

This current study removes those elements, allowing for a direct understanding between how much sodium people are consuming, how much is healthy, and how much is not healthy.

Because the kidneys carefully manage the body's levels of sodium and potassium, urinary samples provide an accurate way to monitor someone's total sodium consumption.

Yet this confirms previous research
As I reported several years ago, despite the notion that previous findings have been to the contrary, a 2011 study from Albert Einstein School of Medicine followed more than 360,000 human subjects and another from Canada's McMaster University followed 4,729 human subjects, correlating their sodium levels with cardiovascular health.

These studies found, respectively, that sodium levels less than 2,500 milligrams per day and 3,000 milligrams per day increased the incidence of heart disease among the participants.

Hypertension mostly unrelated to sodium consumption
In addition to these studies, research from University of California more than three years ago also found that sodium guidelines were mistaken.

This research was a compilation of clinical studies including a 2009 U.C-Davis study that included 129 studies and 50,060 human subjects tested with 24-hour urinary sodium excretion examinations.

This research also compiled research analyzed the various studies regarding sale intake and hypertension, along with heart conditions in general.

The central assumption of conventional medicine is that higher sodium levels within the blood that lead to hypertension are produced by higher consumption of sodium.

The research found that the body self-adjusts and regulates the sodium intake within the body, yielding healthy levels. This regulation takes place through the discharge of sodium outside of healthy levels.

Confirming the above studies, this compilation of research also found that healthy sodium consumption ranges between 2,622 to 4,840 milligrams per day.

This research concluded that the decreased rates of hypertension in the U.S. were not connected with reduced sodium intake, as some have proposed. In fact, their statistics found that sodium consumption has been increasing with the increased consumption of processed foods.

Sodium appetite explained
According to the researchers, the body maintains its internal sodium levels by increasing what they called "sodium appetite." When the body senses its internal sodium levels are too low, we will naturally seek more sodium in our foods.

Ayurvedic medicine has long described such a notion as the body seeking foods with saltier flavor - called salt cravings to balance the rasa system.

But if more sodium is consumed than needed, the body will automatically adjust its internal sodium levels by excreting more sodium in the urine. The body uses what doctors refer to as the renin-angiotensin-aldosterone system to balance sodium levels.

Modern refined salt and sodium Balance
The recent study also found that consuming more than 1,500 milligrams of potassium per day was associated with a significantly reduced risk of cardiovascular disease and mortality, while consuming less than 1,500 milligrams was linked to increased risk.

This brings into focus a larger view, that of balancing sodium intake along with other macro and trace minerals. This is important because our sodium levels and its impact upon our health also relates to our consumption of many other important minerals such as potassium, calcium, boron, zinc and many others.

Modern refined salt, however, does not help balance our mineral consumption. Because white salt is stripped of other minerals such as calcium, magnesium, potassium and many trace elements, consuming refined salt helps distort our mineral requirements - with a leaning towards sodium, with sodium chloride out of proportion with what typically accompanies the compound in nature.

Adding insult to injury, modern salt often contains numerous chemical additives such as tricalcium phosphate, silica dioxide, sodium ferrocyanide, ferric ammonium citrate and/or sodium silico-aluminate.

Consuming natural sea salts or rock salts provide a pathway of consuming a better balance of trace minerals. Just be aware that iodine is a typical additive of modern salt that is often deficient in today's diets. Read original article

Anxiety medications may be tied to Alzheimer's Risk

(Amy Norton) -TUESDAY, Sept. 9, 2014 (HealthDay News) -- Older adults who habitually use sedatives for anxiety or insomnia may have a heightened risk of developing Alzheimer's disease, a new study suggests. The drugs in question are benzodiazepines, a widely prescribed group of sedatives that include lorazepam (Ativan), diazepam (Valium) and alprazolam (Xanax). Older adults commonly take the drugs for anxiety or insomnia, often long-term, according to background information in the study. That's despite the fact that guidelines call for only short-term use of the drugs, at most. In 2012, the American Geriatrics Society (AGS) put benzodiazepines on its list of drugs considered "potentially inappropriate" for seniors, because of risks like confusion, dizziness and falls. The current study isn't the first to link benzodiazepines to Alzheimer's risk, but it adds to evidence that longer-term use of the drugs -- beyond three months -- might be a risk factor, according to lead researcher Sophie Billioti de Gage, a Ph.D. candidate at the University of Bordeaux, in France. "For people needing or using benzodiazepines, it seems crucial to encourage physicians to carefully balance the benefits and risks when renewing the prescription," Billioti de Gage said. But the study was only able to find an association between the drugs and Alzheimer's risk. It wasn't designed to definitively prove that the drugs caused the memory-robbing condition, according to geriatrics specialist Dr. Gisele Wolf-Klein, who was not involved in the research. One reason is that the findings are based on prescription records. "We know the drugs were prescribed, but we don't know how often people took them, or if they took them at all," said Wolf-Klein, director of geriatric education at North Shore-LIJ Health System in New Hyde Park, N.Y. Regardless, she said, benzodiazepines have enough known risks to warrant concern. "There is absolutely no doubt these drugs have dangerous side effects," Wolf-Klein said. "It's important for people to understand that they can be addictive, and increase the risk of confusion and falls." The study was published online Sept. 9 in BMJ. For the study, Billioti de Gage's team examined the histories of nearly 1,800 older adults with Alzheimer's, comparing each one with four dementia-free people of the same age and sex. They found that people who'd been prescribed benzodiazepines for more than three months were 51 percent more likely to develop Alzheimer's, versus people who'd never used the drugs. The risk was almost doubled if they'd taken the medications for more than six months. According to Billioti de Gage, people in the early stages of Alzheimer's can have symptoms like sleep problems and anxiety. That raises the possibility that benzodiazepine use is the result of Alzheimer's, and not the cause of the disease. But she said her study was designed to counter this possibility. They only considered prescriptions that were started at least five years before a person's Alzheimer's diagnosis. Billioti de Gage said the medications can be useful short-term. And, she pointed out, the study found no increased Alzheimer's risk among older adults who were prescribed the drugs according to international guidelines; that means using them no longer than one month for insomnia, and no more than three months for anxiety symptoms. Dr. Malaz Boustani, who cowrote an editorial published with the study, said older adults have to be cautious about using the drugs, or any medication that can affect mental function. "We need to take the side effects of these medications much more seriously," said Boustani, an investigator with the Regenstrief Institute and the Indiana University Center for Aging Research in Indianapolis. According to the AGS, a number of drugs can cause older adults to feel groggy and confused. They include other types of sleeping pills, like zaleplon (Sonata) and zolpidem (Ambien); antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (AllerChlor, Chlor-Trimeton); and muscle relaxants. Both Boustani and Wolf-Klein suggested looking for non-drug therapies for sleep problems and anxiety -- partly because medications don't address the underlying problems. When an older person seems to have sleep problems, Wolf-Klein said, changes in routine may be all that's needed -- like avoiding caffeine or limiting liquids at night. When an anxiety disorder is the problem, Boustani said, cognitive behavioral therapy (talk therapy) is often effective. "The bigger message is that we need to take care of our brains," Boustani said. "And the first step is to do no harm." Read original article.

Z Drugs and the world of Ambien, Sonata and Lunesta

(Mathew Edlund) -The back of the alphabet is pushing for primacy. The masked avenger Zorro appeared in 1919; the remarkably popular Z cars television crime series transfixed Britain in the 1960s.

Now is era of  Z drugs. Zolpidem, zaleplon, and eszopiclone - respectively named for the commercially minded ambien, sonata and lunesta - are today’s wildly popular sleeping pills culled from the older and still very commonly used benzodiazepines. The Z drugs have done more than take over the sleep by pill industry; they are now the leading cause of psychiatric adverse drug reactions.

The numbers come from large scale surveys done by the Centers for Disease Control in the years 2009-2013. Ambien is number one.

Last year Dan Kripke and colleagues reported these same Z drugs increased death rates in regular, daily users five fold.  Scandinavian research puts the increased death rates as not quite as severe, but uniformly higher.

How Do Zs Work? The human information system possessed on cell surfaces many benzodiazepine receptors. Two prominent forms are found in the central nervous system (brain and spinal cord) while one version is located on nerve cells everywhere else. Plug a drug into those three receptors like a key into a lock, and people often become sedated, relaxed, less agitated, mellow. Thus was spawned the famous benzodiazepines (BZs) of the 1960s - valium, Librium, ativan and their many cousins.

Looking for the perfect Sleeping Pill, industry logically looked for drugs that would hit one or two but not all three BZ receptors. In the Z drugs, they found ones that hit only one receptor in the brain, producing quick sedation. Many billions of dollars in profit followed. So did reports of bizarre behavior plus falls, accidents and deaths.

Why The Trouble? There are probably many reasons. One is that hitting only one BZ receptor doesn’t appear to produce normal sleep. Some researchers describe the Z drugs’ effects as a sort of “pre-coma” which then allows the body to more quickly fall into sleep.

t’s the “pre-coma” part that begins creating problems. If you take drugs like ambien and don’t immediately get into bed, the “inbetween” states produced by these drugs - neither sleep nor wake - may cause very odd results.

My media favorite - the Calgary man who declared ambien made him sleepwalk to his refrigerator where he downed a quart of vodka and promptly drove his car into several accidents. A more recent example comes from a lovely woman I treat - a strict vegetarian - who woke up with hamburger in her teeth, having devoured her carefully packed husband’s lunch in a middle of the night. She had no idea how that hamburger got there.

Visit a group of sleep labs and you’ll find many of their adult sleepwalking episodes are linked to Z drugs.

A further difficulty arises from the supposed advantage of these medications - their short duration of action.

With a half life of one to two hours, ambien should be “out of your system” well before you awake. It’s gone, so there’s no problem, right?

Wrong. A previous drug company incarnation of such a “safe” short acting sleeping agent was the drug triazolam, or halcion. Several European governments banned it after it caused numerous psychotic reactions, particularly among the elderly.

Next - a further difficulty of these drugs is that they produce amnesia. People don’t know what they did “under the influence.” They can’t remember.

It’s also one of the reasons people feel they slept “well.” Drugs like ambien make people forget how often they woke up. So they feel as if they “slept through the night.”

Amazingly, despite the potential warning of short acting  halcion, the FDA allowed a “smaller” dose of zolpidem/ambien to be marketed under the name “Intermezzo” for middle of the night insomnia.

If something provokes psychotic reactions, sleepwalking and higher death rates, taking a lower dose at 3 AM can’t be that bad, can it?

In 21st century America, sleep is not so natural. Human sleep used to be consist of three phases - first sleep, after lights out; second sleep, with perhaps an hour of  musing following first sleep, ending with “final” waking around dawn; and third sleep, or what we call naps.

Of course that’s a fantasy for almost all of us. But drug companies like selling fantasies. And they will sell you the pills to fulfill the fantasy.

But as most of us know, living on fantasies sometimes provokes tragedies. Humans are not machines. If we treat our bodies as machines, we face peril.

The answer is much more interesting - getting people to use their wondrously regenerative bodies the way they’re actually built.

That means having a rhythm to the day, a time to move and a time to rest. To take the time and make the “effort” to rest before sleep. To not turn sleeping into a job. To recognize that sleep restores, refreshes, and literally rebuilds much of the body, beautifully and regeneratively.

You are partially reborn every morning you awake.

Sleeping certainly pills have their place, especially for brief use, for sleeplessness in times of storm and stress. But they don’t produce “normal” sleep. And the people who take them habitually, lured by the promise of “perfect sleep” should be carefully coaxed off of them, so that they can enjoy the astonishing merits of their normal regenerative activity.

It’s time to say goodbye to the equation pill=sleep. The public health costs - in money, emergency room visits, increased accidents and deaths, are too large.

And yes, there will be an apps for sleep - many apps. But the simplest trick is to rest before sleep.

That's what regeneration is all about. Read original article.

Longboat Key News | Mathew Edlund | Sept. 6, 2014

Alprazolam misuse still send tends of thousands to emergency room

(Donna Leinwand Leger) -Misuse of the popular sedative alprazolam, known by the trade name Xanax, sent more than 123,000 people to the emergency room in 2011, slightly fewer than the year before but more than double the number who went to the emergency room in 2005, a new report shows.

The report was issued Thursday by the Substance Abuse and Mental Health Services Administration.
More than 1.2 million people sought emergency care in 2011 for abusing prescription drugs, the SAMHSA's Drug Abuse Warning Network reported.

Alprazolam, also sold as Xanax XR and Niravam, was the most commonly prescribed psychiatric medication in 2011. It is used to treat anxiety, depression and insomnia.

"We're seeing growth in the number of people who are getting into trouble with these drugs," says Pete Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality. "Patients really need to be educated that if these drugs are misused, they can be really, really dangerous."

Taking the drug with other central nervous system depressants, such as prescription pain killers, can result in depressed breathing and heart rate, and a loss of consciousness, which can lead to death.

DAWN tracks non-medical use of prescription drugs, including taking more than the prescribed dose, taking a drug prescribed for someone else, deliberate poisoning and abuse.

In 2005, 57,419 people sought medical help after misusing Xanax, DAWN reported. In 2010, the number reached a high of 124,902, a 118% increase. In 2011, the number dropped slight to 123,744.

In 81% of the cases, the patient had used the Xanax in combination with other prescription drugs or alcohol, the report found. Nearly two-thirds of those patients used the drug with another prescription drug, including more than a third who used the drug with a prescription pain reliever such as oxycodone.

Nearly 52,000 patients used Xanax with two or more drugs. Of those patients, 85% combined the drug with other prescriptions, 46% used it with illicit drugs and 39% had alcohol.  Read original article…

Donna Leinwand Leger | USA Today

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