Be Nice To Yourself and Don’t Buy Supplements Online

Buying supplements online seems like a good idea, a cheap way to get supplements we want or can’t get in our country. I’m Canadian and some stuff just isn’t available here. I admit, I used to be a bit of a diet pill junky, or collector. I’d buy the stupid things and take a couple, get sick, and throw them all out when I got busted by my mom. I did that for 8 years. I wasted a lot of money. I admit, I still scour the Internet for diet pills. Bad habit. I don’t use them anymore, but I find them interesting.

simpsons

I am a very pro-treatment and pro-medication kind of gal. I’ve never found that naturopaths or homeopaths have worked for me, but I know those they’ve worked very well for. I’ve tried over the counter stuff for my bipolar disorder and it hasn’t worked. If it’s worked for you, great. Feel free to share experiences. I won’t deny that over the counter stuff works, it has helped me with other problems (pain, PMS, cramps. I hate painkillers, for example). I also won’t deny that it isn’t as tightly regulated as it should be, and that it can be dangerous. People need to see their doctors before taking it and follow precautions, especially if they mix it with meds. These are medications, too, just not as tightly regulated.

People are wary of prescription drugs. In the US, in one year, they spent $26.7 billion(1) on non-prescription supplements. I’m making a guess at this, but there is less guilt in taking something over the counter, less embarrassment than asking your doctor? It seems the world is split, some avoid prescription meds, and some overuse them. The happy medium isn’t big enough!

The FDA and a subsection (Dietary Supplement Health and Education Act DSHEA) have found:
– Some supplements found in stores and online can cause heart, kidney and liver problems with no warnings.
– There is little to no quality control and toxic substances such as pesticides, heavy metals or (for some strange reason) even prescription drugs are being sold with no knowledge to the customer.
– China is a major supplier of raw ingredients, which are often contaminated, have never had their factories inspected by the FDA.
Many products also exaggerate their claims, meaning, they say the supplement can prevent, treat or cure a disease. This is harmful advice, and this is illegal.
Consumers of the products often have no idea
A lot of the users of the supplements don’t know what they’re getting. It’s like a surprise, but it can hurt or kill you! A lot of vitamins and supplements purchased online contain very little nutritional value and can kill you, your kids or your pet. Seriously, if they get into them. There are a few reasons why buying online is a bad idea(2).

counterfeit

1. A medication can be “counterfeit” and dangerous. (I’m picturing a pill in fake Adidas with an Ak-47)
2. The product has probably expired, if it is real, and the seller has repackaged it for resale.
And for the best one 3. It’s stolen. No quality control.

If you can’t get it at home, don’t order it online. This includes even Amazon.

Counterfeit?
Counterfeit basically means “fake”, or “ripped off”. This is different from medications where there is a brand name and a generic, because the generic actually has real ingredients in it. A counterfeit mediction just looks real. It doesn’t act real. It’s never going to have as much active ingredient as it claims, and if you check out the link to where I’m getting this info, you’re literally paying a lot for a little bit of sawdust, according to the FDA.

roundup

Note: The criminals rarely get charged because it’s too hard to figure out who to charge, where it began and so on. Sad. This is costing a lot of money, $600 billion, to be, well, estimated, which is almost as much as terrorism costs. Cheap is so tempting, but it’s not legit.

Expired
All medications expire and can do weird things after they do. They can become more potent, less potent, or make you change colours and see things (or make you see yourself change colour?) It’s a bad idea to take that expired cough syrup. You’ll probably cough it back up into the toilet, for example, if you’re lucky. Generally a medication or supplement is good for 6-12 months after being filled at the pharmacy. Sometimes longer. Selling an expired product is illegal, its dangerous, because the product may or may not work, it could make you sick, and all the criminal has to do is slap a new date on the package.

expired

They can get any amount of $ they want. The pills aren’t counterfeit. If someone complains it doesn’t work, the “seller” and throw them a few good pills, or ignore it. Nobody knows exactly how effective this stuff is anyways. It’s a dangerous game when you buy online. Here’s a link on expired medications: http://www.rxlist.com/script/main/art.asp?articlekey=87599

As for stolen, well, that’s self explanatory. You could get a good product once, a bad product another time. Hit or miss.

When In Doubt
If you’re going to use supplements:
1. Don’t buy them online. Go to a local health food store.
2. See your doctor and pharmacist. Check for interactions. Get that physical every year, or every other year. Some doctors are very open to supplements. I know many that have a few concoctions for PMS and cramps!
3. Don’t take anything for weight loss, sexual ehancement or building muscle.
4. If it’s from the US, or you’re living in the US, it has a “USP Verified”(3) mark on the bottle. Their website is linked below with everything they verify.
5. You CAN overdose. More is not better.
6. If something feels wrong, tell your doctor. If it’s really wrong, go to an emergency clinic, or the ER.

Safely Buying Supplements
1. Buy from the manufacturer or a reputable operation in your own country. Try not to cross borders. Do not import things illegal in your country. (For example, ephedra, easy to get OTC in Canada, is illegal in most USA States)
2. Reputable companies supply a lot more information, ingredients, quality control info, and websites with more info, and even have phone numbers.
3. Avoid really cheap stuff.
4. Avoid sites like ebay and amazon, this is your health!

1. http://www.consumerreports.org/cro/2012/05/dangerous-supplements/index.htm
2.http://www.garyshealthtips.com/why-you-should-never-buy-supplements-on-amazon-or-ebay-a-must-read-by-former-fda-special-agent-gary-collins/wn

3. http://www.usp.org/usp-verification-services/usp-verified-dietary-supplements

Scary Side Effects Part 3 – Antidepressant Induced Mania?

In the 1980’s, bipolar disorder was called manic depression and was a feared word. It was changed to bipolar (two poles) later in the 1980’s and diagnosed more and more. But often, the patient will present with depression symptoms, and get prescribed an antidepressant, which can cause horrible hypomanic, mixed, and even full blown manic episodes. This can be because we go to the doctor when we feel down, not up. After years and years of being bipolar, I know when to see a doctor for mania. (Also called “insight”)

 Mania can feel great, but it can also be dangerous. Impulsivity, people giving away all their money. Then comes the inevitable crash. Many bipolar suicides are accidental during a mixed or manic state. Some may say that antidepressant induced mania is just a side effect, it isn’t indicative of bipolar disorder. There are a lot of controversies about it.

 Some people put on antidepressants are bipolar, but it can have the same effect on somebody who isn’t bipolar. Their moods start cycling(1) and they start showing clinical features and meeting the diagnostic criteria of bipolar disorder. Is this a lasting effect? It can be. The criteria for bipolar disorder is one manic episode, although most have several.

 The findings of this study confirm that treatment-induced mania is a clinical phenomenon that belongs within the bipolar spectrum rather than a coincidental treatment complication, and that it should be placed under ‘bipolar disorders’ in future classification systems.” (1)

Statistics

Thirty-five percent of the patients had a manic episode rated as likely to have been antidepressant-induced. No variable was a predictor of vulnerability to antidepressant-induced mania. Cycle acceleration was likely to be associated with antidepressant treatment in 26% of the patients assessed. Younger age at first treatment was a predictor of vulnerability to antidepressant-induced cycle acceleration. Forty-six percent of patients with antidepressant-induced mania, but only 14% of those without, also showed antidepressant-induced cycle acceleration at some point in their illness. (2)

 Antidepressants can be devastating to someone with bipolar disorder. It can send the patient into a mixed or manic state. Some people are able to tolerate antidepressants such as tricyclics, MAOI’s, or Wellbutrin, but SSRI’s and SNRI’s have a tendency to push you over the edge. However, this may not be true at all!

 

Myth or Mania? Controversy

Sometimes the myth is just an incorrect use of language. Many people have detected a temporal association between the use of tricyclic antidepressants and mania in patients with bipolar disorder, but no mechanism is indicated. There is an assumption the association could extend to all antidepressants despite chemical and pharmacological transformations.(3) 

This association between mania and SSRI’s hasn’t been found. Studies find that the switch rate is no different than that of normal bipolar disorder when the patient is on an SSRI or SNRI.

 Revisiting the Controversy

Mania is likely to be antidepressant-induced and not attributable to the expected course of illness in one-third of treatment-refractory bipolar patients, and rapid cycling is induced in one-fourth. Antidepressant-induced mania may be a marker for increased vulnerability to antidepressant-induced cycle acceleration. Antidepressant-induced cycle acceleration (but not antidepressant- induced mania) is associated with younger age at first treatment and may be more likely to occur in women and in bipolar II patients.”(4)

 

Conclusion

Antidepessants can make a bipolar patient exhibit signs of mania. When the antidepressant is stopped, the mania generally goes away. Antidepressants are often prescribed for those that are bipolar, for the symptoms during depression. (I take Luvox for Pure-O OCD). However, a mood stabilizer with an antidepressant effect such as Lamictal or Lithium would be more effective than adding on antidepressants.

 

There are controversies, so keep that in mind. Also, with any medication and diagnosis: YMMV (your mileage may vary)

 

 

  1. http://psychcentral.com/news/2011/10/13/antidepressant-induced-mania-similar-to-bipolar-disorder/30300.html

  2. http://www.ncbi.nlm.nih.gov/pubmed/7625459

  3. http://thelastpsychiatrist.com/2005/07/do_antidepressants_induce_mani.html

  4. http://ajp.psychiatryonline.org/article.aspx?articleID=171161

Scary Side Effects Part 2 – Neuroleptic Malignant Syndrome

I’m not writing this because I’m anti-medications or anything. I’m a big fan of being on my medications or I wouldn’t be functional at all. But when you introduce different chemicals into the body, it can affect more than what it’s meant to do. I took Seroquel for many, many years, and eventually switched to Zeldox (Geodon). I switched back to Seroquel, and at 400mg, I could hardly get out of bed to go to the washroom after I took my night dose. The highest dose I had been on was 900mg. 300Mg’s 3 times a day.

Then I noticed some weird side effects. I couldn’t swallow. Then I would start to panic, get up, drugged out, drink water, try to sleep, have to pee, wash rinse repeat. I also noticed fluttering in my chest, my heart kept beating “wrong”. Too fast, too slow. I would panic until I was eventually knocked out by the ‘quel but it took a while since I’m quite the insomniac. Upon hearing my symptoms, the Seroquel was discontinued and I heard of something called neuroleptic malignant syndrome, and it fit. I mostly had symptoms of dysautonomia.

 What is Neuroleptic Malignant Syndrome?

NMS is a neurological disorder generally caused by some (not all, and very rarely) antipsychotics.(1) It is potentially deadly and starts in the first two or three weeks of antipsychotic use. It is a bit more common in the original antipsychotics (for example, Thorazine), and happens on the occasional atypical antispychotic, which is the new treatment for psychosis and mood stabilization.(2)

 What are the symptoms of NMS?

  • high fever, sweating, unstable blood pressure, stupor, muscle rigidity and dysautonomia(3).

  • Dysautonomia is a disease in itself. It is a medical term used for a group of conditions caused by the autonomic nervous system (ANS). Symptoms include:

  • — tachycardia (extremely fast heart rate)
    — bradycardia (slow heart rate), palpitations
    — chest pain
    — dangerously low blood pressure
    — wide swings/sudden drops in blood pressure
    — orthostatic intolerance (the inability to remain upright)
    — excessive  fatigue exercise intolerance
    — dizziness, fainting/near fainting
    — gastrointestinal problems
    — nausea, insomnia
    — shortness of breath
    –anxiety tremulousness
    — frequent urination
    — convulsions
    — cognitive impairment
    — visual blurring or tunneling
    — migraines

What causes NMS?

An adverse reaction to an antipsychotic or neuroleptic drug.

What is the treatment?

Immediate discontinuation of the medication, the symptoms are treated (mostly the fever) and a dopamine agonist can be useful. There is no diagnostic test.

What happens if it goes untreated?

It can be fatal.

  1. http://www.ninds.nih.gov/disorders/neuroleptic_syndrome/neuroleptic_syndrome.htm

  2. http://emedicine.medscape.com/article/288482-overview

  3. http://www.uptodate.com/contents/neuroleptic-malignant-syndrome

  4. http://www.medicalnewstoday.com/releases/76785.php

Medications Part 2 – Anticonvulsants

Some anticonvulsants are found to have a mood stabilizing effect. These medications are a first or second line treatment in bipolar disorder, with lithium being one of the first. More modern anticonvulsants often have less side effects. For example, Epival (Depakote in the USA) is great for rapid cycling, when lithium is only partially effective.

The three most commonly used are Depakote, Lamictal and Tegretol, or Trileptal (a newer version of Tegretol). If those fail, other meds like Topamax or Gabapentin can help. Gabapentin also works great for anxiety. Dilantin, one of the oldest seizure medications, is used, but not very often anymore. These are the main medications I’m going to cover in this article, and I’ll add some personal experience to them as well.

Why anticonvulsants?
There is a link between bipolar disorder and seizure disorders, but these medications are made to control seizures. Why do they also control mood?

They calm nerves in the brain, making them less excitable1. This evens out the chemical imbalance. They do take a bit to work and have unpleasant side effects at times. Most antivonculsants need to be “titrated up”(2) With medications like Lamictal, this can be very frustrating. Lamictal is approved to treat bipolar depression, as well, but it comes with the potential, 1/3000 odds of getting Steven-Johnson’s Syndrome3, which, for a quick explanation, is a flesh eating rash that is potentially fatal.

I titrated up slowly on Lamictal in the hospital and one day I broke out in a rash. They confirmed it was Steven-Johnson’s Syndrome and took me off the Lamictal immediately and gave me another mood stabilizer, because even if you’ve never had a seizure before, rapid discontinuation of an anticonvulsant can cause seizures, in very rare cases.

Some anticonvulsants need blood work done, but not necessarily to establish a therapeutic level, like with lithium. Depakote needs blood levels done to check on the liver, as it can be hard on the liver.

Depakote
Depakote is usually the first tried, at least with me, anticonvulsant. It is approved for bipolar disorder and helps with rapid cycling more than lithium, or other anticonvulsants. It is also a first-line treatment with seizure disorders. It has some unpleasant side effects4, it should not be taken while pregnant or breastfeeding, it can cause birth defects. Hair loss, liver toxicity, pancreatitis are other side effects, while rare, they do happen, so this medication must be monitored by a doctor. It can also, ironically, make you suicidal.

My experience with Depakote, the first time, well, it made me suicidal, and I attempted suicide. This landed me in the ER chugging charcoal and my psychiatrist refused to see me after that. They just sent me home and told my parents to hide the pills. I was 17. It knocked me out for the first couple of weeks, but I’m on it now, and I don’t have nearly as many problems. Minor side effects are stomach upset, hair loss, both of which I’ve never had problems with. I currently take 1000mg of Depakote a day in my “cocktail” (Depakote, Luvox, Xanax, Abilify and Benadryl). I’d recommend this drug, it is quite helpful.

Tegretol
Tegretol is similar to Depakote. It used to be an off-label prescription, but has been approved for bipolar disorder under a new name. It is good for mixed states and manic states, and is often used if lithium and Depakote fail6. Unfortunately, it can cause other medications (like antipsychotics, antidepressants, birth control, and more) to become less effective. It can also affect white blood cell count. Trileptal is similar, but newer, and has less side effects. It doesn’t require regular blood levels but it can lower sodium levels in the bloodstream. I haven’t taken Trileptal, but Tegretol made me halucinate. It did come in tasty chew tablets, though.

Lamictal
Lamictal is approved to treat bipolar depression and also works as a mood stabilizer. It isn’t an antidepressant, but it has antidepressant effects. It is considered one of the most long term treatments for bipolar disorder7. There aren’t a lot of side effects, but the ones you get can be bad. There is a potential to develop Steven-Johnson’s Syndrome (I did, because I’m damned like that)3. You need to very slowly titrate2 up or you can end up with SJS or another type of rash that isn’t as dangerous. It works best for Bipolar II.

It starts working when you’re in the 200mg-400mg dosage range8. It can begin working very quickly at low doses for depression. It is often considered the best medication for people with bipolar disorder, but does have it’s side effects. There is a risk of mania, because of the antidepressant qualities. There is the risk of “the rash3”, and a lot of anxiety while titrating up. It can impair cognitive functioning a bit and cause drowsiness. If the benefits outweigh the side effects, this is a good drug.

Topamax
Topamax is an anticonvulsant used for seizures and migraine prevention. It is also used for bipolar disorder off-label. It just went generic, so my insurance covers it, and I tried it for about two months, but the nickname “dope-a-max” comes to mind. Titrating up sucked, I was tired all the time. It has one good side effect: weight loss, but it can cause foods to taste differently. Like pop, Coca-cola just tasted off. It comes in pill or sprinkle form.

It has major side effects at times and can effect congitive functioning, kidney stones/damage, glaucoma, extreme sensitivity to heat and making the blood to acidic9. It is a last-line treatment for bipolar disorder.

Gabapentin (Neurontin)
This is another anticonvulsant drug and also helps with neuropathic pain. It is not effective on it’s own for bipolar disorder, but it pretty handy with anxiety. It can cause suicidal thoughts or actions and has a hellish discontinuation syndrome.

“Neurontin has not been shown to be effective in treating acute mania or depression. In other words, if you’re currently experiencing mania or depression, Neurontin will not be effective in stopping the acute mood episode.10”

There are minor side effects, and it can be added on as a treatment for bipolar disorder, but lithium, depakote and lamictal are better first-line treatments.

 

  1. http://abcnews.go.com/Health/BipolarTreatment/story?id=4396044

  2. Titration is starting at a low dose and adding to it until the therapuetic level is reached.

  3. http://bipolar.about.com/od/lamictal/a/Stevens-Johnson-Syndrome-Symptoms.htm

  4. http://www.depakoteer.com/

  5. http://epilepsy.emedtv.com/tegretol/tegretol-for-bipolar-disorder.html

  6. http://blogs.psychcentral.com/bipolar/2008/08/bipolar-disorder-medication-spotlight-tegretol-carbamazepine/

  7. http://lifeloveandbipolar.com/lamictal-for-bipolar-disorder

  8. http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Lamictal

  9. http://bipolar.about.com/od/topamax/a/profile_topamax.htm

Medications Part 1 – Lithium

Lithium was a great med for me. I took 900mg of it per day and it stabilized my moods, I was happier, but I gained weight. I went to my GP to see if he could find a reason for my weight gain, and he figured I had type 2 diabetes.

Well, the good news was I didn’t have type 2 diabetes. I have a rare condition, instead, called diabetes insipidus. Type 1 and Type 2 diabetes effect the pancreas and the way the body handles sugar. Diabetes insipidus is when the kidneys aren’t filtering, and it is also known as “water diabetes”.

Basically, I was thirsty all the time and peeing a LOT. I thought this was a side effect from my medication cocktail. Meds dry you out, so I’d drink a lot of water, juice, etc, and well, urinate a lot as well. Seems like a good explanation.

My doctor immediately pulled me off Lithium, no tapering down or anything and it was time to start looking for a new drug. I take Depakote now, but it’s not the same. And coming off Lithium cold turkey did wonders for my moods. NOT.

I didn’t lose any weight coming off of the Lithium. The diabetes insipidus didn’t go away in three months like they said it would. I have a physical tomorrow and am getting referred to a kidney doctor, and a new psychiatrist, as mine is retiring in 10 days. (Thanks for the short notice, asshole!)

Okay, so back to lithium. It is the only true mood stabilizer. Lithium affects the flow of sodium through nerve and muscle cells in the body(1). Sodium effects mania. Oh, I also craved salt like nothing else when I was on lith. I practically needed a salt lick. (Lithium is a salt by chemical structure)

Image

With lithium, there is a therepeutic dose, found by blood tests, which should be done once a week for the first month or so, then every other week, then every month, every three months, etc. It ranges from 0.4-1.2mmol/L in the blood. Anything lower than 0.4 means lithium isn’t effective, and if you go too high, the lithium doesn’t work either, and you can get toxic from the lithium.

Lithium toxicity has some very unfun symptoms as the following: nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears.

Lithium effects the kidneys and thyroid. Both can be countered with other medications, but if it gets really bad, it’s time to discontinue.

Side effects that put up a red flag to STOP taking lithium (with a doctor’s discretion!) are: extreme thirst/urination, weakness, restlessness, eye pain, blurry vision, restless movements in the eyes, tongue, jaw or neck, pain, cold feeling, discoloration in the fingers or toes, feeling light-headed, fainting, bradycardia, hallucinations, seizures, fevers.

Common side effects are a minor tremor in the hands. Everyone noticed my tremor. They thought I was nervous or in shock. It made soldering in electrical engineering very hard. Sometimes there is weakness or lack of coordination, nausea, and itching. I sometimes got nauseous, but the tremor (and kidney problems) were the main side effects I ended up with. My level was ~0.8, which is a good level.

Lithium doesn’t play well with NSAID’s, it can increase the amount of lith in your body by 150% and send you into toxicity. Doctor’s rarely listened to that when I informed them I was on lith. My pharmacy would catch the interaction, call the doctor, and give me something else. Pain in the ass!

Lithium prevents mania, but studies have shown that it is very effective when combined with an anti-depressant for treating depression.

“Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis.”(2)

If you read my article on glutamate here’s another fun fact:

“The University of Wisconsin researchers found that lithium exerts a dual effect on receptors for the neurotransmitter glutamate – acting to keep the amount of glutamate active between cells at a stable, healthy level, neither too much nor too little.”

I’m full of fun facts tonight:

“For the last 60 years, lithium has been the preferred treatment for bipolar disorder, but little research has been carried out to discover how it impacts the brain and the body clock. New research from the University of Manchester has found that lithium strengthens the body clock’s rhythms, which could lead to new treatments with fewer side effects.”(3)

Lithium has been used for 60 years, one of the oldest psychiatric medications. It is incredibly effective in many people, if they can tolerate the side effects. I loved it, but I need my kidneys.

1. http://www.drugs.com/lithium.html
2. http://bipolar.about.com/od/lithium/a/010312_lithium1.htm
3. http://psychcentral.com/news/2012/03/14/regulating-body-clock-may-be-key-to-treating-bipolar-disorder/35966.html