Deplin Side Effects

(from Deplin’s Patient Prescribing Information):

The side effects of Deplin are about the same as those of placebo. A placebo is a tablet or liquid with no active medicine. A sugar pill is an example of a placebo. In rare cases, Deplin may cause mild stomach upset or rash. (1)

Deplin is the brand name given to Pamlab’s pharmaceutical formulation of l-methylfolate. L-methylfolate is the bioactive form of the vitamin folate, also known as folic acid or vitamin B9.

Deplin was created and marketed to address a deficiency in individuals who have a genetic mutation that does not allow their bodies to create an enzyme (MTHFR) that transforms regular dietary folate into l-methylfolate.

People who are deficient of this gene have significantly lowered amounts of l-methylfolate. This is significant because l-methylfolate is used to build our most important brain chemicals for mood, cognition and drive. These brain chemicals are serotonin, dopamine and norepinephrine.

Deplin, by introducing the deficient l-methylfolate into these people’s bodies, allows them to produce these brain chemicals or neurotransmitters and see a significant increase in the parameters mentioned above. It is used alone or as an adjunct with an anti-depressant to treat major depressive disorder (MDD). Deplin provides more neurotransmitters for the anti-depressants to work with.

Deplin is a medical food. “Medical foods are foods that are specially formulated and intended for the dietary management of a disease that has distinctive nutritional needs that cannot be met by normal diet alone.” Medical foods must be shown to be essentially harmless to patients, as it is merely a nutritional product that the patient is unable to receive through regular dietary means. Naturally the side effects or adverse reactions to such medical foods are virtually non-existent. Any reactions are usually from an allergic intolerance.

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References

1) Zajecka, J et al. (2012, May) annual Meeting of the American Psychiatric Association. Philidelphia, PA.

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Levomefolic acid is the biologically active form of folic acid, a b-vitamin (B9) essential to human health and function. One of its most notable functions is its role in creating key neurotransmitters or brain chemicals that regulate human mood, cognitive ability and arousal. The three primary brain chemicals are dopamine, norepinephrine and serotonin. Chemically, these brain chemicals are referred to as monoamines. Abnormal amounts (either too much or too little) of these chemicals can cause various forms of mental illness and disease including depression, schizophrenia and attention deficit disorder.

Levomefolic acid has been marketed under such names as Deplin for the treatment of depression. It is usually combined with a traditional anti-depressant.

Levomefolic acid has different names. Other names that it is also known as is:

• L-methylfolate
• 5-MTHF
• 5-methyltetrahydrofolate
• Deplin ( Brand name by Pamlab, LLC )
• Metafolin ( Brand name by Merck KGaA )

Your body does not create its own supply of folic acid (also known as folate), it must be acquired from the diet by eating foods or taking supplements containing this b-vitamin.

Your body then takes the dietary folic acid and uses the enzyme MTHFR (methylenetetrahydrofolate reductase) to transform it into levomefolic acid.  Your body can then use it to carry out a specific range of reactions and functions.

Mood Regulation

1. Dopamine :: People usually know dopamine for its ability to cause pleasure and is one of the main neurotransmitters involved in nicotine and illicit drug use. It provides the feeling of well-being and euphoria in high amounts. Levomefolic acid is used to produce dopamine. Dopamine is the brain chemical responsible for pleasure, reward and motivation / drive.

2. Serotonin :: This neurotransmitter is known just as well or better than dopamine, mostly thanks to the promotion and use of typical anti-depressants that work through serotonin pathways. Drugs like Paxil, Zoloft and Prozac work by increasing the amount of serotonin available to the brain synapses and therefore increase your mood. Levomefolic acid also is used to create this brain chemical. Serotonin is responsible for well-being, obsessions and compulsions and memory.

3. Norepinephrine :: Very similar to the parent compound epinephrine, norepinephrine has many of the same stimulating effects. It provides alertness, concentration and energy. It is involved in the sympathetic nervous system and not only has the ability to affect brain chemistry but also increase heart rate. It is also labeled as a stress hormone and spikes during the sympathetic nervous system’s fight or flight response to stressful or fear-inducing stimuli. Levomefolic acid is used to produce the neurotransmitter norepinephrine.

Cardiovascular / Heart Potential

One of the properties of levomefolic acid is its ability to recycle the amino acid homocysteine back into methionine. Why is this important?

High homocysteine levels are associated with vascular inflammation that result in a higher incidence of heart disease.

Levomefolic acid transforms this inflammatory amino acid back into a more neutral methionine. More scientific research needs to be conducted to investigate the impact of this reduction in homocysteine and whether it does in fact reduce heart disease appreciably.

Currently, homocysteine is more accurately labeled as a “marker” for heart disease and vascular inflammation. We await more conclusive evidence demonstrating the clinical effects of lowered homocysteine levels.

Cancer

Levomefolic acid has also been looked at as a possible means to treat advanced cancers like breast and colorectal cancers. A chemo or cancer drug known as fluorouracil (5-FU) works by binding to and inhibiting the enzyme thymidylate synthetase. This keeps cancer cells from replicating. Levomefolic acid actually binds to thymidylate synthetase better than the cancer drug fluorouracil. This has warranted research into folate analogues ( levomefolic acid ) for cancer treatment.

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Her Self-Proclaimed “Nervous Breakdown”

In the fall of 2010 Demi pulled herself out of the spotlight and her touring responsibilities in order to address her “physical and emotional issues” by checking into a treatment facility geared for such rehabilitation. During her stay at the treatment facility she was diagnosed with bipolar II disorder. And as is common amongst sufferers of such conditions, many other problems sat right alongside Demi, such as bulimia, self-mutilation (in the form of cutting) and substance abuse.

Demi Bravely Speaks Out

After stepping out of treatment and back into the spotlight, Miss Lovato bravely opened up to the public about her breakdown and the personal struggles that led to it. She discussed her diagnosis of bipolar disorder and how her experience with her treatment has allowed her a window to see how she can overcome its obstacles and use them to grow stronger as a person. The experience has given her a lot of personal insights and foundations to build from. In 2012 MTV aired a documentary called “Stay Strong” about her time in treatment and diagnosis of bipolar II. It is believed that Catherine Zeta-Jones possibly came out about her personal struggle as a bipolar II sufferer, inspired by Demi Lovato’s own brave stand. That rumor is merely speculation, but it may very well be true and demonstrates the power of one voice to give strength to many. It becomes a chain reaction that inspires and gives hope to an isolated minority.

Indeed, the experience seems to have only strengthened Lovato as we have seen her prominence in entertainment only expand. She has been a returning judge on the American “X-Factor” show and continues to release albums that garner increasing acclaim and popularity.

Here’s what Lovato had to say about her eating disorder (bulimia) and substance abuse:

“I was about 12 or 13 when I developed my eating disorder, and at that time nobody in the public eye talked about their body issues. I feel that if someone had admitted they had a problem, then I wouldn’t have gone down that route myself. That’s my goal in talking about my problems: I want to be the person for other girls that I needed to admire when I was looking for help and strength, and it’s OK to love your body the way it is, and it’s OK to reach out for help if you have drug and alcohol problems, or if you’re self-harming or being bullied.”

Bipolar Disorder

Bipolar is a psychiatric condition categorized in the mental health system that is characterized as a mood disorder. There are actually two forms of bipolar – Bipolar I and Bipolar II. Bipolar II has been nicknamed “Soft Bipolar” and although very difficult itself, it is usually not as severe and debilitating as Bipolar I. Demi Lovato was diagnosed with Bipolar II just as Catherine Zeta Jones has been.

What other celebrities have been known sufferers of Bipolar II ?

Catherine Zeta-Jones | Kurt Cobain | Trent Reznor | Russell Brand

What is Bipolar II?

The DSM IV is the bible and diagnostic dictionary for psychiatric conditions. It stands for the Diagnostic and Statistical Manual of Mental Disorders and offers a list of criteria to diagnose mental health or psychiatric disorders. It presents the following criteria for Bipolar II:

• The presence of a hypomanic or major depressive episode.
• If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
• Significant stress or impairment in social, occupational, or other important areas of functioning.

What is a Hypomanic Episode?

A mood characterized by persistent and pervasive elevated (euphoric) or irritable mood. In other words you feel a little like you’re on top of the world and have surges of energy and creative thoughts or ideas.

What is a Major Depressive Episode?

A major depressive episode is a depressed mood and loss of interest and enjoyment of most every day activities for two weeks or greater. Other symptoms usually accompany this general characteristic and include sadness, emptiness, anxiety, hoplessness, feelings of being worthless, guilt, irritability, appetite loss or overeating tendencies, difficulty concentrating, memory impairment, thoughts of suicide, insomnia or excessive sleeping, general malaise (aches or pains), fatigue or sluggishness and excessive worrying.

Typical Characteristics of Bipolar II Sufferers

Sufferers of this mood regulation disorder usually experience chronic depression or euthymia (low level depression that does that does not affect ability to function in social or occupational settings) for long periods of time with brief episodes of hypomania or elevated mood and surges of stimulation and creativity. Often times sufferers will be mood “labile” which means their mood can fluctuate rapidly depending on circumstances and stimulus.

What About Bipolar I?

Jim Carrey is a fairly well-known sufferer of Bipolar I. His wife Jenny McCarthy has spoken about it publicly. It can be extremely debilitating.

Like Bipolar II, Bipolar I is a mood disorder but instead of long periods of depressions interrupted by relatively brief episodes of hypomania it is almost flipped around. Bipolar I sufferers have longer manic periods than depressive periods. Mania or a manic period is similar to hypomania but much more extreme. Mania is a state of being marked by intense amount of energy, euphoria, ideas of grandiosity and impulsive or reckless behavior. Full blown mania also includes hallucinations both auditory and sometimes visual. Many people experiencing a manic episode (i.e. experiencing mania) will have hallucinations and delusions related to a religious context such as being a savior, the devil or a prophet of God warning of the world’s impending doom. This doesn’t necessarily occur with all sufferers but is a fairly common theme. There is little need for sleep during a manic episode. People experiencing them will continue on for days without sleep until they finally crash. This condition severely impacts their social relationships and ability to function in society such as holding a regular job. Violent mood swings are very common, including bursts of anger due to high degree of irritability and heightened senses.

Although Bipolar I can be more debilitating than Bipolar II both have their significant battles that must be fought. Medication is usually prescribed for both. In Bipolar I, during depressive episodes, patients usually receive an anti-depressant as well as a mood stabilizer such as lithium, valproic acid (Depakote), an anti-psychotic such as olanzapine (Zyprexa) or an anticonvulsant such as  carbamazepine (Tegretol). The mood stabilizer keeps the bipolar patient from entering a manic or hypomanic episode. Sufferers of Bipolar II are usually not prescribed mood stabilizers as their hypomanic episodes are not so severe that they cause serious harm to themselves or others or require psychiatric hospitalization.

Brave Souls Like Demi Lovato

We must thank those who are brave enough to not only step forward and accept their own diagnosis for their own growth and improvement but those who are also willing to share their affliction publicly so as to spread awareness and offer a voice to those who feel alone and alienated with their struggle.

Demi not only speaks openly about her struggles or past struggles with bipolar, cutting, bulimia and substance abuse but also bullying. She was bullied growing up and it affected her immensely. She is a firm voice speaking out against bullying and those who bully others.

Help Despite the Perceived Stigma & Taboo

If you are suffering from any sort of problems or issues that leave you feeling alone, isolated, depressed, angry, confused, embarrassed or ashamed, please reach out and talk to someone you trust. Whether that someone is a friend, family member, hotline volunteer or counselor, just make sure you do. There is nothing to be ashamed of. We all have our battles, the important thing is facing them bravely and seeking help to improve ourselves. We can’t do it alone.

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Getting to that point is a challenge. I cannot get out of bed for the life of me!

Seriously. If pure laziness and debilitating lethargy aren’t enough of challenges I also have my dreams working against me. I will literally dream of scenarios where I am trying to be woken up but I’m being briefed by some important person or organization that I need to stay in the dream where important business is required for me to accomplish. Sometimes my dreams will incorporate the sound of my alarm clock (s) into my dream and make them something else so I cannot wake up to them. One time I was so concerned about waking up on time I strapped my phone to my ear before I went to bed.

Frankly, it’s a little embarrassing how hard it is for me to rise for the morning. I’m a little envious of friends who wake up bright-eyed and bushy tailed at whatever time they’ve set out for themselves.

Phillip’s HF3470 / HF3471 Wake-Up Light

About a year ago I was researching products and scouring Amazon (which happens to be one of my all-time favorite hobbies) for light therapy boxes and stumbled upon the Phillips Wake-Up Light with Dusk feature. The features seemed very promising and were built on principles that seemed natural.

For hundreds of thousands of years human beings have been waking up to the gradual light increase of the sun during dawn. Our bodies have a natural biological architecture that recognizes this gradual light increase and prepares the body to rise from sleep in a way that leaves us feeling more refreshed.

Sleep Cycles – Did you know that there are different sleep cycles that you rifle through while you sleep such as light sleep, REM sleep and deep sleep. If you are suddenly pulled out of sleep during the wrong cycle you can feel groggy the entire day despite how much rest you actually got.

Jolted – Do you really like waking up in a panic? I know I was either used to waking up in a frantic jolt or my subconscious was finding ways to disguise my alarm sounds as other sounds logical to my dreams.

So this Phillips wake-up light seemed to address a two-fold problem I was having. Waking up in a panic from abrupt loud noises or not responding to sound at all as a cue to wake up. The addition of a light source to help me wake up was a brilliant concept and so I got it. It had great reviews by users and Phillips went so far as to have endorsed by the National Sleep Foundation.

It functions as an alarm clock. It still has a “sound” portion of the alarm that you can choose (radio station, birds chirping, steel drums playing, wind chimes blowing) but before that sound component goes off there is the light component. Let’s say you set the alarm for 6:00am. At 5:30am the faintest amount of light is emitted from this little device and ever-so-gradually gets brighter and brighter until it reaches the full brightness specified. You start to naturally kind of “stir” in bed. At 6:00 am the alarm sound then goes off and completes the full wake-up procedure. A lot of the times I will wake up long before the sound alarm goes off. The genius of mimicking a sunrise becomes very obvious.

There is a snooze button. Don’t worry folks, I know what it’s like to be a chronic “snoozer,” this product still allows you that feature but honestly, you will feel like getting out of bed and that’s the greatest part. I wake up feeling WAY better than I usually do. Now, depending on how much sleep I get (sometimes only 3 hours) my results will vary. It’s not a complete miracle worker. You got to work with it. I can tell you I’m feeling better waking up than I ever have before… even on 3 hours sleep.

Dusk Feature

The dusk feature of the HF3741 model, which I personally purchased was just as helpful and surprisingly effect as the wake-up feature. Once again we’re using a simulation of nature’s cues to help us achieve our sleeping goals. The dusk feature allows you to basically have a light-box countdown to darkness. In increments of 15 minutes (all the way up to an hour and fifteen minutes) you can set the dusk feature. Once activated the light is at the full illumination or brightness ( that you specify ) and over that course of time the light will slowly decrease in brightness until it completely turns off.

If you are trying to have better sleep hygiene you should also try to come up with a before-bed-routine that includes relaxing activities (such as showering, brushing teeth, liesurely reading, etc). This pattern will cue your brain that it needs to prepare for sleep.  I started using the dusk feature of the Phillip’s light box and will read until the time the light becomes too dim. At this point I start feeling naturally sleepy and will just close my eyes and relax/ meditate until the light completely turns off and then I slide under the covers and call it a night.

It works beautifully. I have been very happy with this product and fully endorse it. If you have had problems with waking up or falling asleep I encourage you to check out reviews and read up more on this product the Phillip’s HF3470 / HF3471 Wake-Up Light and you can read Amazon.com reviews on it here. I love this cool little device and couldn’t recommend it more for you fellow night owls and lingering sleepers.

Video Review and Demonstration

I created a video demonstrating some of the features and how the wake-up light / fall asleep light works.

The post Finally Waking Up More Refreshed / Falling Asleep More Easily appeared first on Doctor Scott Health Blog.

If you are reading this than most likely you are aware of the condition known as seasonal affective disorder. This disorder is characterized by the loss of motivation, energy and positive mood during the seasonal change occurring around the time of fall. The effects can be anywhere from mild to nearly paralyzing. Many are unaware of this vicious cycle that plagues them year in and year out. Productivity and quality of life mysteriously seems to take a nose-dive during the fall and winter. Many people attempt to rationalize this change in mood and motivation to external circumstances in their lives, not realizing the very real biochemical factors that precipitate this through the loss of light in our daily schedules.

Fall / Autumnal Equinox

The timing of the fall equinox usually falls around September 22nd or 23rd. To explain in astronomical terms, the plane of the Earth’s equator has fallen in line with the center of the Sun. This marks the time of year or season where there is increasingly more dark hours than there are light hours. From that point forward there will be less and less light during the day until the winter solstice, at which time the amount of light during the day starts to increase again.

Autumn Equinox Consequences in Relation to Mood Disorders in General

The autumn equinox has powerful consequences to those who are sensitive to such changes, mainly those who suffer from mood disorders, such as seasonal affective disorder, depression and bipolar. An unnerving statistic is the fact that during the autumn equinox there is a giant influx of psychiatric based hospitalizations. Many suffering from bipolar are hospitalized for mania or “manic sprees.” During the spring equinox the impact is seen again but on the other side of the spectrum. This period is marked with some of the highest suicide attempts and completions during the year. If you haven’t been one to believe that you and your body are tied to and interwoven with nature, these startling, verifiable facts conclude otherwise.

Daylight Saving Time – “Fall Back” and Seasonal Affective Disorder ( SAD )

While the equinox is especially powerful for those suffering from bipolar disorder, there seems to be an equal stir amongst seasonal affective disorder sufferers and daylight savings time. After the fall equinox we see light slipping further and further from our day. This begins to impact those with seasonal affective disorder but because of the sunlights’ gradual decline it’s effect is gradual and not as dramatically felt. When we set our clocks back during daylight saving’s time, which takes place the first Sunday in November, we are suddenly punctuated with a dramatic loss of sunlight from our day. Many sufferers of SAD feel the hit of this dramatic light shift quite powerfully. This can start a tail-spin descent into the darker regions of depression. Its debilitating effects cause disruption to our lives in countless ways.

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What is Happening in a Scientific, Biochemical Way

You may be asking,

“Why does this happen? I loosely understand that light makes us happy and losing more throughout the day can make us feel gloomier… but why?”

The answer has multiple factors related mainly to the body’s response to light.

Vitamin D Production

Your body is an amazing factory capable of creating many compounds to regulate itself. Your skin has the unique ability to harness sunlight to synthesize vitamin D3. Your skin has 5 layers or “strata,” with the most exterior of which we are the most familiar with being the epidermis. The bottom two layers of these 5 layers ( the stratum spinosum and stratum basale ) use UV rays from light and produce Vitamin D3. Vitamin D helps regulate many things, positive mood being one of them.

Melatonin Production

Your pineal gland, is a little pine cone shaped gland, about the size of a grain of rice and sits in the middle of your brain. It is in charge of producing a hormone called melatonin. It produces melatonin in the absence of sunlight. Among other things melatonin helps regulate our sleeping patterns. During the fall and winter months, where there is an increase of darkness and the body is triggered to produce more melatonin. This can disrupt mood, energy and circadian rhythm.

Season of Frustration

This period of time marks a difficult time for many. Some choose to adapt and cope with their own unique strategies, many of which are mindset and psychological techniques. For some, their methods will help alleviate negative consequences but for others it may not be nearly enough to stave off ill effects. Relationships can suffer, mental activity can diminish, work and productivity can be slowed and self-esteem can plummet.

Treatment Strategies for Seasonal Affective Disorder

Light Box Therapy

Light therapy can be extremely effective at alleviating SAD symptoms and depression. It is causing the halt of melatonin production. There are different wavelengths of light that are given off by different light sources. Blue wavelength light (that the Sun contains) has been scientifically researched to cause melatonin inhibition. So make sure that if you get a light box it emits blue wavelength light. There are many good products. Lightbox devices made by Phillips are very good. I highly recommend the NatureBright Sun Touch Plus Light and Ion Therapy Lamp. I have personally used it and find it works extremely well. I had extreme doubts about the ion component but it proved to be a quite noticeable and beneficial feature of the product. Negative ions have a positive impact on our mood. Check out the WebMD article Negative Ions Create Positive Vibes to learn more.

Medication – Rx Prescription Drugs / Pharmaceuticals

The most common SAD prophylaxis and treatment is Wellbutrin (generic names: bupropion, budeprion). You will need to have your doctor write you a prescription. “Prophylaxis” is the fancy term for preventative treatment. Many people who know they suffer from SAD will begin taking Wellbutrin around the fall equinox before their symptoms start to manifest. This is known as prophylaxis.

Herbal / Over-the-Counter Preparations

St. Johns Wort and SAM-e ( S-Adenosyl methionine ) have been shown to help elevate mood. You can also supplement with Vitamin D because as we discussed earlier many times our skin isn’t getting enough sun to make sufficient amounts of Vitamin D. And Vitamin D helps regulate our mood. I would recommend taking 5,000 IU daily. The NutriGold Vitamin D is an excellent product. Most of NutriGold’s products are superior to their competitors and have high manufacturing standards. You can also see your doctor, have your vitamin D levels determined by a blood sample and if appropriate prescribed prescription Vitamin D which is 50,000 IU and only take once a WEEK.

Conclusion

Seasonal affective disorder can be a serious problem disrupting our lives. Losing an hour of daylight when we “fall back” during daylight saving time in the first week of November can cause our mood and energy to drop off dramatically.  Being aware of this and preparing for it annually can help you stay in your best health and prevent losses. There is no need to suffer the emotional, mental, physical and even spiritual consequences of SAD. Make sure you actively seek treatment that works for you. I invite you to share your related experiences, treatment strategies and recommendations to the community here.

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