Sunday, January 5, 2014

Antidepressant drugs and drug-induced liver injury

Philip Copitch, Ph.D.

The American Journal of Psychiatry reports
December 2013, researchers reported in The American Journal of Psychiatry that common antidepressant drugs can cause liver damage in humans. Drug-induced liver injury (DILI) was found in 0.05-3.0% of those taking antidepressants.
The researchers did a PubMed review from 1965 to the present, and reported that all antidepressants can induce hepatotoxicity (liver cell damage or destruction), especially in elderly patients or patients taking multiple prescription medications. This chemically driven cell damage was found to be unrelated to drug dosage and generally occurred between several days and 6 months of starting the medication. 
prescription clipart, www.funfreeclipart.com

The antidepressants associated with greater risks of damaging the liver are:
  • iproniazid
  • nefazodone
  • phenelzine
  • imipramine
  • amitriptyline
  • duloxetine
  • bupropion
  • trazodone
  • tianeptine
  • agomelatine

The antidepressants that seem to have the least potential  to damage the liver are 
  • citalopram
  • escitalopram
  • paroxetine
  • fluvoxamine

The researchers conclude:
Although an infrequent event, DILI from antidepressant drugs may be irreversible, and clinicians should be aware of it.

Thursday, December 26, 2013

Advice for teens - build a life rather than live one

Philip Copitch, Ph.D.

Ashton Kutcher gives great advice
In August 2013, Ashton Kutcher got the “old man’s award” from the Teen Choice Awards. He talked passionately about working towards one’s goals. Watch his 5 minute speech.


When opportunity knocks
Ashton’s speech reminded me of the story of opportunity knocking.
A young man was looking for a way to make money. He didn’t want to just make money; he really wanted a way to make lots of money. He also wanted to feel good about himself as he made his dreams come true.A knock came at the door. The young man opened it to find an older man wearing dirty overalls and work gloves. “I am opportunity,” the older man said. “I came to help you get to your hopes and dreams.”“You don’t look like opportunity,” the young man said. “You’re dirty and look really tired.”“What should opportunity look like?” the man at the door asked.“I guess he would look cool. Like a multimillionaire: wearing a tux and driving a sports car.”“It seems to me that you are confusing opportunity with extravagance,” the man at the door said. “Opportunity doesn’t wear a tuxedo. Opportunity is a diamond in the rough. You have to work with opportunity and polish it into a diamond.”
As Ashton says: you have to build your life - starting with opportunity in the rough - in order to shape and live the life you dream of.

Let me know what you think.

Monday, December 9, 2013

Vicodin, Xanax and the message

Philip Copitch, Ph.D.

Behind the humor, painkiller abuse is deadly
In the January 2014 issue of Consumer Reports, the following tidbit of information was exposed:


What I got from the sports-like shirts is: if you take this drug you don’t need to exercise to stay healthy or to be happy.

I am probably overreacting, but… I regularly work with patients that want some sort of pill to solve a medical or mental health problem. 

The fact is that putting on a comfortable shirt and exercising, often helps people physically and emotionally. 

A 15 minute walk does wonders for our mental health and our overall physical health. 

Vicodin, is also called Lortab or Norco
This combination medication is used to relieve moderate to severe pain. It contains a narcotic pain reliever (hydrocodone) and a non-narcotic pain reliever (acetaminophen). Hydrocodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever. (WebMD)

Xanax
Xanax is used to treat anxiety and panic disorders. It belongs to a class of medications called benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. Xanax works by enhancing the effects of a certain natural chemical in the body (GABA). (WebMD)

Recent FDA changes concurring Vicodin
In October 2013, the U.S. Food and Drug Administration (FDA) announced changes in the way Vicodin may be prescribed by your doctor. The FDA statements starts:

Over the past several years, the U.S. Food and Drug Administration (FDA) has been carefully evaluating and weighing the appropriate use of opioid analgesic drug products. For the millions of American patients experiencing an acute medical need or living with chronic pain, opioids, when prescribed appropriately, can allow patients to manage their pain as well as significantly improve their quality of life.However, in recent years, the FDA has become increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States. While the value of and access to these drugs has been a consistent source of public debate, the FDA has been challenged with determining how to balance the need to ensure continued access to those patients who rely on continuous pain relief while addressing the ongoing concerns about abuse and misuse. Read the complete statement

Let me know what you think about this issue. Please leave a comment.

Thursday, October 24, 2013

Review of Sodastream and the psychology of the taste test


The review of Sodastream
A few days ago I was kidnapped by my bride of 26 years and forced to spend 3 days in Ashland, Oregon celebrating our anniversary. Ashland is a beautiful village best known for the Oregon Shakespeare Festival. The leaves were turning the flaming colors of autumn, and the temperatures were unseasonably warm.


As if this wasn’t enough, my wife, Geri, got me a Sodastream home soda maker. This innovative device allows you to make sodas of all flavors at home. You even get to pick the amount of carbonation you fancy. The company makes loads of flavor choices, or you can easily squeeze your own fruit juices into the effervescent water.

Geri and I had lots of fun trying different combinations of flavors and amounts of carbonation (the machine came with 12 sample packs each making 1 quart). We were not scientific about how we got to our taste conclusions, and that was OK because we were playing with a new soda making machine, not doing drug trials.

But, what if we truly wanted to test the taste preferences of soda drinking consumers? If so, we would need to do a “blind test”. 

A blind test
A blind test is when the test subject doesn’t know what brand they are tasting. If you were to test preferences on say, Coke or Pepsi, the test taster may already have a preference for one or the other before you invited them to participate. The fact that we have preferences before an experiment is called, bias. Part of setting up a taste test is to lower the amount of bias.

So, if we are going to test Coke versus Pepsi, we would place the drinks in unmarked glasses and ask the test subject to try both and tell us their opinion. This however lets lots of other forms of bias wiggle into our simple test. 

What if the first thing we taste or the last thing we taste influences how we judge the drinks in our experiment? In fact we know, from other experiments, that this does influence a subject's preferences, so we have to randomize which soda is tested first or last. 

At one point in our own home test, Geri tasted one sample and said, “It’s not bad, but it will be too sweet for you.” Wow, this is a clear example of research contamination. Her statement would most likely influence how I would judge that soda sample, even if I really tried not to be influenced by her words.

Another form of research contamination is when the person conducting the experiment is aware of the samples or the goal of the experiment. This is called experimental bias.

Double blind
To reduce bias in an experiment, it is best to have both the subject and the person conducting the trial "blinded", unaware, to the facts of the taste test. 

Even if the person conducting the trial honestly tries to keep her opinions to herself, bias will most-likely sneak in. She many not say anything, but just the way she hands the glass to the tester, the minute social subtleties, will give clues to the subject. We humans pick up on social cues even when we are not consciously aware of them. 

Blinding in research is important but very hard to do. For example, the color or temperature of the soda will influence the test subject. The psychological bias of what we expect from a soda will influence how we taste it.  Manufacturers know this so soda is colorized to elicit the correct feeling from the drinker, even though the coloring in the drink does not influence the taste of the drink. But it does influence your perceived taste of the drink.

Perceived value influences taste
Research has shown that wine tastes better in a expense glass versus a cheap glass. But the glass does not affect the taste of the wine. It is just that the drinker feels differently about the wine… and that feeling affects the taste of the wine. 


Ben Hayden, Ph.D - TEDTalk Rochester, NY

Ben Hayden, Ph.D., an Assistant Professor of Brain and Cognitive Sciences at the University of Rochester, has conducted lots of tests on the psychology of consumer preference. He wrote in Psychology Today:

Wine is a multi-billion dollar industry part of the modern world. There are stores devoted just to selling wine, magazines devoted to it, wineries are a major tourist destination, and so on. And yet, weirdly, we know that much of this is a psychological artifact.

We are quite bad at tasting the differences between different wines. Even experts are easily fooled. You put a misleading label on a bottle of wine and the experts’ opinions can change dramatically. You can even warm up white wine and color it red (with food coloring) and many judges will think it is a red wine.

This is not just true for wine. Most people can’t taste the difference between Coke and Pepsi (even though most people think they can – I’ve done the experiments). 

All this being said
Geri and I are enjoying the Sodastream home soda maker. I like the diet cola and the diet ginger ale, while Geri seems to be enjoying an ongoing taste test. Isn’t life wonderful when you get to drink the soda flavor of your choice?

The moral of the story
When it comes to being human, it is often forgotten that we don’t know what we don’t know. We people types are influenced by psychological bias. Our job is to watch for our own psychological biases in our life. So hopefully, when we notice this bias, we can logically make better choices.