Is a Good Night’s Sleep the Best Prescription for Depression and Pain?

sleep14Depression and chronic pain are two common conditions that are also associated with poor sleep quality. While it is often thought that the sleep issues are secondary to these conditions, a new study conducted by researchers from the University of Alabama indicates that depression and pain due to osteoarthritis could be the result of poor sleep quality instead of the other way around.

Background Data:

Prior research has shown that people with hip and knee osteoarthritis (OA) are more likely to have insomnia, daytime sleepiness, and depression, than those without OA. The obvious relationship is that the arthritis pain affects sleep and makes people depressed. However, a 2012 study published in the journal SLEEP looked at sleep quality in people who were in chronic pain, including those with osteoarthritis and researchers found:

  • The amount of pain that people were in before they went to bed had little to do with how well they slept.
  • A person’s sleep quality predicted how much pain they were in the next day. People who slept poorly had more pain the following day.

Other studies have shown that poor sleep quality can trigger inflammatory pathways that make arthritis pain worse, and poor sleep also make people more sensitive to the feeling of pain from any cause.

New Data:

To better examine the relationship between OA, pain, and depression, 367 patients with OA of the knee from a variety of sources were recruited to participate in a trial. The participants completed a detailed questionnaire that identified overall health, depression, pain, joint function, and sleep quality. One-year follow-up was available for 288 patients.

Analysis of the data collected from the questionnaires indicated that comparing the initial baseline with 1-year follow-up data, sleep disturbance at baseline was linked with increased depression and further loss of joint function, but interestingly not more pain.

Since the questionnaire used in the study was not specifically designed to identify the exact sleep issues in OA patients, further research is needed to more fully pinpoint what is abnormal about OA patients’ sleep. Nonetheless, the conclusion from the study is the disturbance in sleep definitely precedes the depression, loss of joint function, and likely increased pain associated with OA. Hence, the takeaway message is that improving sleep quality is a key goal in preventing the progression of OA as well as the associated depression.

Commentary:

Early on in my clinical practice, I realized that improving my patient’s ability to get a good night’s sleep was usually the quickest way to help them feel better in every way. Over the years I have used a number of natural products that can help to improve sleep quality. The specific product that I now recommend as a first step is the one that I developed: Tranquil Sleep from Natural Factors. This formula provides the combination of melatonin (3 mg), 5-HTP (30 mg), and L-theanine (200 mg) in a great tasting chewable tablet or soft-gelatin capsule. These three ingredients work together to decrease the time required to get to sleep and to decrease the number of nighttime awakenings. Here is a brief description of each ingredient as it relates to improving sleep quality. If you don’t use Tranquil Sleep, you can get the same effect by combining them on your own

Melatonin is the most popular natural aid for improving sleep quality. Supplementation with melatonin has been shown in several studies to be very effective in helping induce and maintain sleep in both children and adults and in both people with normal sleep patterns and those with insomnia. Typical dosage is 3 mg at bedtime.

5-HTP (5-Hydroxytryptophan) is converted in the brain to serotonin – an important initiator of sleep. It is one step closer to serotonin than l-tryptophan and has shown more consistent results in promoting and maintaining sleep, even though used at lower dosages. One of the key benefits of 5-HTP is its ability to increase REM sleep (typically by about 25%) while increasing deep sleep stages 3 and 4 without lengthening total sleep time. Recommended dosage for improving sleep quality in combination with melatonin is 25 to 50 mg at bedtime.

L-Theanine is a unique amino acid found in green tea. Clinical studies have demonstrated that L-theanine reduces stress, improves the quality of sleep, diminishes the symptoms of the premenstrual syndrome, heightens mental acuity and reduces negative side effects of caffeine. It is an excellent support agent to melatonin and 5-HTP. Recommended dosage is 200 mg at bedtime.

Reference:

Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in Osteoarthritis: Linkages with pain, disability and depressive symptoms. Arthritis Care Res. 2014 Oct 6. doi: 10.1002/acr.22459. [Epub ahead of print]

Dr. Michael Murray
11/11/2014

Contrary to News Headlines, Robin Williams Was on Drugs at the Time of His Death—Antidepressant Drugs

    “The antidepressant found in Williams' toxicology test, Mirtazapine (Remeron), has 10 drug regulatory agency warnings citing suicidal ideation.”

“The antidepressant found in Williams’ toxicology test, Mirtazapine (Remeron), has 10 drug regulatory agency warnings citing suicidal ideation.”

If news headlines were to be believed about the autopsy findings of beloved actor/comedian Robin Williams, who tragically committed suicide nearly two months ago, no drugs were found in his system at the time of his death, as evidenced by headlines from USA Today, NBC News, the BBC and others proclaiming “no alcohol or drugs” were found. These headlines couldn’t be more wrong.

The medical examiner’s report cites an antidepressant drug was in Williams’ system at the time of his death. The particular antidepressant, Mirtazapine, (also known as Remeron) carries 10  international drug regulatory warnings on causing suicidal ideation.

According to the autopsy results, not only was Williams under the influence of antidepressant drugs, but the powerful antipsychotic Seroquel was also found at the scene and appears to have been recently taken by Williams. While toxicology tests apparently were negative for the antipsychotic Seroquel, the fact remains that a bottle of Seroquel prescribed to Williams on August 4th,  just seven days prior to Williams’ suicide, was missing 8 pills. The Seroquel instructions advise to take one pill per day as needed. Side effects associated with Seroquel include psychosis, paranoid reactions, delusions, depersonalization and suicide attempt.

The question that has to be asked is why the press continues to promote the idea that no drugs were found in Williams’ system? At what point did mind-altering psychiatric drugs, which have side effects rivaling those of heroin or crack cocaine, stop being called drugs? And for those in the press who did “mention” the fact that Williams was found to have antidepressants in his system, the acknowledgement seems to promote the fact that “therapeutic concentrations” of prescription psychiatric drugs “improved his condition and kept him active until his death.”

This is a highly misleading take on the events leading to Williams tragic suicide, especially in light of the fact that not only was Williams receiving mental health “treatment,” he was under the supervision of a psychiatrist, was not abusing illegal drugs and had not “fallen off the wagon.”

The facts regarding antidepressant drugs are these:

  • Food and Drug Administration’s Medwatch Adverse Drug Reports include 470,000 adverse reactions for psychiatric drugs between 2004-2012. The FDA admits only 1% of side effects are ever reported to them, so the actual number of reported side effects is assuredly much higher.
  • Mirtazapine (also known as Remeron) carries the Food and Drug Administration’s (FDA) “Black box” warning for suicidality.
    • There are ten warnings of suicide associated with Mirtazapine alone and suicide is among the top 2 side effects reported to the FDA on this particular antidepressant
  • The FDA’s MedWatch drug adverse event reporting system recorded 411 attempted and completed suicides associated with the antidepressant Mirtazapine alone (and the FDA estimates only 1% of side effects are ever reported to them)
  • 90,000 emergency room visits are attributed to psychiatric drugs each year in the U.S.
  • 23,755 suicides are attributed to psychiatric drugs each year in the U.S. alone.

Given the above data, one can only wonder why Williams’ psychiatric drug use has effectively been dismissed by reporting organizations. A careful review of Williams’ psychiatric “non-drug” use paints a very different tragic story.

What was found in Williams’ system were prescription psychiatric drugs with side effects that not only rival illegal street drugs, but also carry the FDA’s “Black box” warnings—the federal agency’s most serious warnings—about increased thoughts of suicide.

The fact is that two of the drugs Williams had been prescribed list suicidal thoughts as possible side effects. The Seroquel he was prescribed (and appears to have taken in the week prior to his suicide), and the antidepressant that was still in his system at the time of his suicide.  Moreover, considering the FDA’s Medwatch drug adverse event reporting system recorded 411 attempted and completed suicides associated with the antidepressant Mirtazapine alone (and the FDA estimates only 1% of side effects are ever reported to them), it becomes even more bizarre that the world’s press ignore even the possibility that these drugs could be involved in Williams’ suicide.

The much-loved comedian’s death is a great loss, but the tragedy is further compounded by the mainstream press glossing over the serious and well-known association between suicide and the psychiatric drugs Williams was taking. If only the sentiments from one of Williams’ finest roles in Awakenings had been taken literally in his personal life: “The human spirit is more powerful than any drug and that is what needs to be nourished: with work, play, friendship, family. These are the things that matter.”

 

Source: cchrint.org