Anti-Depression medications – One size does not fit all!

In today’s world ‘stress’ has become a common household phenomenon. Professional, social, economic and personal issues drive people to unimaginable level of stress and the outcome is that 1 in 4 people are afflicted with depression (Mental health statistics, UK). True, happiness is a state of mind but it is also a fact that people have different intrinsic capacities to deal with stressful conditions and not many can cope with a chronic onslaught of ‘stressful’ conditions!

We have come a long way in the field of psychiatry since the time when lithium used to be prescribed for ‘treating’ mental disorders like depression. The older tricyclic antidepressants (Doxepin, Imipramime etc.) have been superseded by the newer SSRIs (Selective Serotonin reuptake inhibitors), SSREs (Selective serotonin reuptake enhancers), atypical antidepressants (Bupropion) and the MAOIs (Monoamine oxidase inhibitors). It would look as if we have a good arsenal to fight this menace. 

But if one scratches the surface, one would realize that in many cases these medications are the problem and not the solution. The side effects of these ‘newer’ class of drugs range from the ‘manageable’ nausea, dry mouth, weight gain/loss to the dangerous cases of increased suicidal tendencies and anxiety. The problem is that still the theories behind the probable cause of depression revolve around the differential levels of neurotransmitters (Serotonin, dopamine) in depressed patients. Although, many scientific reports have validated these claims but doubts persist. To top the level of confusion, both classes of drugs such as SSRIs and SSREs which target the neurotransmitter serotonin level (one increases its level and the other decreases it) have been shown to alleviate symptoms of depression!

Also, unlike other modern medicines, antidepressants take longer time to show their effects (if at all). We do not understand why this is so though there are theories that suggest that the medicines can lead to modifications at the genomic level and hence the time-delay of their action! Psychiatrists themselves try and experiment with different class of medicines to see the best fit for their patients. But in doing so not only crucial time is lost, there are  issues leading to patient compliance and severe side effects and even death (suicide).

The need of the hour is therefore to use modern genomic data to predict the outcome of these medications before embarking on the prescription. As 'mind' is unique to every individual, this is a fit case where the newer field of 'personalized medicine' should kick in with all its technology in its arsenal.We have already started doing the same for oncology drugs with newer drugs being accompanied by companion diagnostic tests. Also, the drug companies need to be more transparent with their data of the side effects of anti-depressants as it has been found of late that many pharma companies did not divulge the true nature of the side effects and later the drugs had a serious ramifications on the patients’ health and many of them were either withdrawn or were forced to have ‘black box’ label warnings!

Effective diabetes treatment gets a nutraceutical pitch!

Type 2 Diabetes is a lifestyle disorder of an epic proportion. It is widely speculated that US, India and China are or are going to be the worst affected by this problem.

Current therapies focus on various strategies to control blood sugar but there is no cure at this stage. The older sulponylureas and metformins to the newer TZDs (thiazolidinediones), GLP-1 analogues and even SGLT2 inhibitors are vying to capture the diabetes market. The whole exercise is to promote medication that can control the HbA1c to controllable levels. 

Dietary extracts containing polyphenols, L-arginine etc. have been shown to have anti-diabetic potential. In a recent publication in the journal Endocrinology(Endocrinology August 19, 2013 en.2013-1529), it has been shown that dietery L-arginine can regulate glucose metabolism indirectly by inducing GLP-1 release in mice. Although the exact mechanism has not been dissected in the paper yet the authors suggest that G protein coupled receptor pathways might be involved. 

Since current strategies involve targeting the GLP-1 system by either inhibiting its rapid clearance by dipeptidyl-peptidase IV or using dipeptidyl-peptidase IV-resistant GLP-1 mimetics, it would be interesting to see development of novel approaches like dietary supplement with L-arginine and or L-arginine based therapies to enhance GLP-1 secretion from intestinal L cells. In essence, this study raises the possibility that nutritional-based strategies aiming to improve endogenous GLP-1 release may provide an alternative therapeutic approach to treat patients with metabolic disorder