Mark Corson

By Q. Ramirez. Rocky Mountain College. 2018.

All of these factors have one thing in common: they lower serotonin levels by impairing the conversion of tryptophan to serotonin generic 40mg pepcid otc. A health-promoting lifestyle and diet go a long way in restoring optimal serotonin levels and relieving depression purchase pepcid 20 mg on line. Possible Underlying Causes Depression can often have an underlying organic (chemical) or physiological cause buy pepcid 20 mg with mastercard. Identification and elimination of the underlying cause is a critical step in most cases. Failure to address an underlying cause will make any antidepressant therapy less successful. It is important to rule out simple organic factors that are known to contribute to depression, such as nutrient deficiency or excess, drugs (prescription, illicit, alcohol, caffeine, nicotine, etc. Regardless of any underlying organic cause, counseling is always recommended for the depressed individual. Organic and Physiological Causes of Depression • Preexisting physical conditions Diabetes Heart disease Lung disease Rheumatoid arthritis Chronic inflammation Chronic pain Cancer Liver disease Multiple sclerosis • Prescription drugs Anti-inflammatory agents Birth control pills Blood pressure lowering drugs Antihistamines Corticosteroids Tranquilizers and sedatives • Premenstrual syndrome • Stress/low adrenal function • Heavy metals • Food allergies • Hypothyroidism • Hypoglycemia • Nutritional deficiencies • Sleep disturbances Counseling There are a number of counseling techniques that can be quite useful. The therapy that has the most merit and support in the medical literature is cognitive therapy. In fact, cognitive therapy has been shown to be as effective as antidepressant drugs in treating moderate depression. People taking drugs for depression tend to have to stay on them for the rest of their lives. That is not the case with cognitive therapy because the patient is taught new skills to deal with the psychological factors that cause depression. First, they help patients recognize the negative automatic thoughts that flit through consciousness at the times when the patient feels the worst. The second tactic is disputing the negative thoughts by focusing on contrary evidence. The third is teaching patients a different explanation to dispute the negative automatic thoughts. The fourth involves helping patients learn how to avoid rumination (the constant churning of a thought in one’s mind) by better controlling their own thoughts. The final tactic is questioning depression-causing negative thoughts and beliefs and replacing them with empowering positive thoughts and beliefs. It is a solution- oriented psychotherapy designed to help patients learn skills to improve the quality of their lives. Hormonal Factors Many hormones are known to influence mood; however, it is beyond the current scope of this chapter to address all of them. Low Thyroid Function Depression is often a first or early manifestation of thyroid disease, as even subtle decreases in available thyroid hormone are suspected of producing symptoms. Please see the chapter “Hypothyroidism” for more information on determining thyroid function and promoting function when needed. Stress and Adrenal Function As with the thyroid gland, altered function of the adrenal gland is closely associated with depression. Often this dysfunction is the result of chronic stress—a major factor to consider in depression. It is critical to develop a positive way of dealing with the stress of modern life. A laboratory technique that many nutritionally oriented physicians use to assess a patient’s level of and response to stress is the adrenal stress index. The elevations in cortisol reflect a disturbance in the control mechanisms for adrenal function that reside in the hypothalamus and pituitary gland located at the center of the brain. Defects in adrenal regulation seen in affective disorders include excessive cortisol secretion (independent of stress responses) and abnormal release of cortisol. Defects in control mechanisms for adrenal hormones and thyroid function are hallmark features of depression. The brain effects of increased release of natural cortisol by the adrenal gland mirror the effects of synthetic cortisones such as prednisone: depression, mania, nervousness, insomnia, and, at high levels, schizophrenia. The effects of cortisol on mood is related to its activation of tryptophan oxygenase. This activation results in shunting of tryptophan to the kynurenine pathway at the expense of serotonin and melatonin synthesis. Environmental Toxins Heavy metals (lead, mercury, cadmium, arsenic, nickel, and aluminum) as well as solvents (cleaning materials, formaldehyde, toluene, benzene, etc. As a result, a variety of psychological and neurological symptoms can occur, including depression, headaches, mental confusion, mental illness, tingling in extremities, abnormal nerve reflexes, and other signs of impaired nervous system function. These mobilization tests measure the level of toxic metal excreted in the urine for a period of 6 hours after taking the chelating agent. For more information on dealing with environmental toxins, see the chapter “Detoxification and Internal Cleansing. It is particularly important to stop smoking and decrease the consumption of alcohol, sugar, and caffeine. These lifestyle changes, coupled with regular exercise and a healthful diet, are more than likely to produce better clinical results than antidepressant drugs, with no side effects. Alcohol Alcohol is a brain depressant that increases adrenal hormone output, interferes with many brain cell processes, and disrupts normal sleep cycles. Chronic alcohol ingestion will deplete a number of nutrients, all of which will disrupt mood. The resultant drop in blood sugar produces a craving for sugar because it can quickly elevate blood sugar.

The dosage recommendation is based on body weight: 25 to 50 mg niacinamide per kg of body weight 40 mg pepcid with visa, up to a maximum dosage of 3 g per day generic 20 mg pepcid otc, in divided doses proven 40mg pepcid. However, because large doses of niacinamide could possibly harm the liver, a blood test for liver enzymes should be performed every three months to rule out liver damage. The line of research on its potential role in recent-onset type 1 diabetes began with examining the bark from the Malabar kino tree (Pterocarpus marsupium). This botanical medicine has a long history of use in India as a treatment for diabetes. Initially, epicatechin extracted from the bark was shown to prevent beta cell damage in rats. Further research indicated that both epicatechin and a crude alcohol extract of P. Another reason is that green tea polyphenols exhibit significant antiviral activity against rotaviruses and enteroviruses, two types of virus suspected of being involved in the development of type 1. Recommended dosage for green tea extract in children younger than age 6 is 50 to 150 mg; for children 6 to 12 years old, it is 100 to 200 mg; for children over 12 and adults, it is 150 to 300 mg. The green tea extract should have a polyphenol content of at least 80% and be decaffeinated. Type 2 Diabetes Causes The major risk factor for type 2 diabetes is obesity or, more precisely, excess body fat. Approximately 80 to 90% of individuals with type 2 are obese (body mass index greater than 30). When fat cells (adipocytes), particularly those around the abdomen, become full of fat, they secrete a number of biological molecules (e. Also important is that as the number and size of adipocytes (fat cells) increase, this leads to a reduction in the secretion of compounds that promote insulin action, including adiponectin, a protein produced by fat cells. Not only is adiponectin associated with improved insulin sensitivity, but it also has anti-inflammatory activity, lowers triglycerides, and blocks the development of atherosclerosis (hardening of the arteries). The net effect of all of these actions is that fat cells severely stress blood glucose control mechanisms, as well as lead to the development of the major complication of diabetes, atherosclerosis. Because of all these newly discovered hormones secreted by adipocytes, many experts now consider adipose tissue to be part of the endocrine system, joining glands such as the pituitary, the adrenals, and the thyroid. As metabolic stress increases and insulin resistance becomes more significant, eventually the pancreas cannot compensate and elevations in blood glucose levels develop. As the disease progresses from insulin resistance to full-blown diabetes, the pancreas starts to “burn out” and produces less insulin. Fortunately, the pancreas can recover and continue to secrete insulin for the rest of a person’s lifetime if ideal body weight is achieved and steps to improve insulin sensitivity are taken. Data from family studies also provide additional support: children who have one parent with type 2 have an increased risk of diabetes in their lifetime, and if both parents have the disease, the risk in offspring is nearly 40%. The Case of the Pima Indians The Pima Indians of Arizona have the highest rate of type 2 and obesity anywhere in the world. Research has demonstrated a strong genetic predisposition, but even with this strong tendency it is extremely clear that the high rate of type 2 in this group is almost totally due to diet and lifestyle. The Pima Indians living traditionally in Mexico still cultivate corn, beans, and potatoes as their main staples, plus a limited amount of seasonal vegetables and fruits such as zucchini, tomatoes, garlic, green peppers, peaches, and apples. The Pimas of Mexico also make heavy use of wild and medicinal plants in their diet. They work hard, have no electricity or running water in their homes, and walk long distances to bring in drinking water or to wash their clothes. They use no modern household devices; consequently, food preparation and household chores require extra effort by the women. In contrast, the Pima Indians of Arizona are largely sedentary and follow the dietary practices of typical Americans. Although roughly 16% of Native Americans in general in the United States have type 2, 50% of Arizona Pimas have type 2, and 95% of those diabetics are overweight or obese. By contrast, type 2 is a rarity among Mexican Pimas and only about 10% could be classified as obese. The average difference in body weight between the Arizona and Mexican Pima men and women is more than 60 lb. When patients are placed on a more traditional diet along with physical exercise, blood glucose levels improve dramatically and weight loss occurs. The focus right now by various medical organizations such as the National Institutes of Health is to educate children on the importance of exercise and dietary choices to reduce diabetes risk. Other Genetic and Racial Factors Racial and ethnic groups besides Pima Indians that have a higher tendency for type 2 include other Native Americans, African-Americans, Hispanic-Americans, Asian-Americans, Australian Aborigines, and Pacific Islanders. In all of these higher-risk groups, again, it is important to point out that when they follow traditional dietary and lifestyle practices, the rate of diabetes is extremely low. It appears that these groups are simply sensitive to the Western diet and lifestyle. Of individuals with type 2, 69% did not exercise at all or did not engage in regular exercise; 62% ate fewer than five servings of fruits and vegetables per day; 65% obtained more than 30% of their daily calories from fat, with more than 10% of total calories from saturated fat; and 82% were either overweight or obese. By comparison, the 300 million typical Americans living alongside them have, over the past 250 years, willingly adopted advances of modern technology, making life less physically demanding. Although the typical Amish person’s diet is not very different from the average American’s and the rates of obesity are very similar as well, the rate of diabetes is about 50% lower. Although the percentage of Amish with impaired glucose tolerance (prediabetes) is about the same as the rate among other white populations in America, apparently not as many Amish go on to develop diabetes. This trend suggests that physical activity has a protective effect against type 2, independent of obesity. Lifestyle changes alone are associated with a 58% reduced risk of developing diabetes in people at high risk (those with impaired glucose tolerance), according to results from the Diabetes Prevention Program, a large intervention trial of more than 1,000 subjects. The two major goals of the program were achieving and maintaining a minimum of 7% weight loss and a minimum of 150 minutes per week of physical activity similar in intensity to brisk walking.

Very high cholesterol concentrations usu- and contraction of the uterus during oviposition generic 40 mg pepcid amex. There is a reasonable agreement in Method: Most currently used assays are based on the the values among the most commonly used meth- Jaffe reaction discount pepcid 40mg without a prescription. Lipemia or hemolysis of the sample can interfere with photometric methods of measurement cheap 40mg pepcid visa, giving falsely Physiology: Blood creatinine is derived mainly from 11 elevated values. This is less likely to occur with the catabolism of creatine found in muscle tissue. Physiology: Glucose is continuously required as an It is freely filtered and reabsorbed in the tubules. In periods of starvation, glucose is increasingly de- rived from the breakdown of fats and proteins, pri- Diagnostic Value: There is a slim margin between marily from muscle tissue, through gluconeogenesis the physiologic and pathologic levels of creatinine. All plasma glucose is For many analyzers, physiologic values are below the filtered from the blood through the renal glomeruli detectable range. Interestingly, 73 hours of starvation in pigeons in- Physiologic Influence: Normally, creatinine produc- duces hyperglycemia rather than starvation hypo- tion is relatively constant and is minimally affected 57 glycemia. This finding has important consequences by catabolism of dietary or tissue proteins. Theoreti- for avian anesthesia and gastrointestinal surgery, as cally, the pool of creatine from which creatinine is presurgical fasting varying from four hours (empty- liberated depends on the total muscle mass. How- ing of the crop) to 24 hours (emptying of the entire ever, in all avian species that have been investigated, gastrointestinal tract) can be advantageous. Pro- the reference interval for creatinine has been be- longed fasting is not recommended in birds that tween 0. Diagnostic Value: Glucose is often a part of a labora- Pathologic Changes: Severe kidney damage can 25,43,73 tory panel even though pathologic changes in lead to increased creatinine levels, especially if the 36 birds are seldom detected. Juve- A rise in plasma glucose concentration starts during nile budgerigars were found to have higher concen- the scotophase, reaching peak values early during the trations than adults. Afternoon plasma glucose concentra- Pathologic Changes: Increased plasma inorganic tions in birds that are fed early during the photophase phosphate levels can be seen in some cases of severe are significantly higher when compared to fasted 2,36,73 kidney damage due to vitamin D hypervitami- birds. For example, increases occur after meals, decreased plasma inorganic phosphate levels may with excitement or stress or because of decreased occur from hypovitaminosis D (calcium level also glucose usage (diabetes mellitus). Iron is transported should not be used because they interfere with the in the plasma attached to a β-1-globulin known as formation of the phosphomolybdate complex. A recent report shows a failure to correlate serum iron levels with liver biopsy and subsequent Method: Most assays for inorganic phosphate rely on toxicologic analysis for iron. It is a major constituent of bone and a vital nificantly lower values than their free-ranging coun- cellular component, playing important roles in the terparts. Very little data different standards are used (eg, human, bovine, from birds is available. Because it is impossible to have a have little importance in diagnosing hemochroma- 74,75 species-specific standard for all species presented to tosis, but insufficient research has been performed. This enzyme functions in compensated and already calibrated in scales ex- the digestion of fat in the diet. For ters yielded higher values than the biuret method, diagnostic purposes, a blood sample from a repre- with the temperature-compensated instrument be- sentative of the same species should be included for ing consistently higher in readings than the non- comparison. Temperature stress (hypothermia or sults from the refractometer and the biuret methods hyperthermia) is associated with nitrogen loss, in- may not be possible in some species. Hypoproteinemia can reflect reduced synthesis Physiology: Most plasma proteins, with the excep- caused by chronic hepatopathies, malabsorption tion of immunoglobulins and protein hormones, are caused by chronic enteropathies (enteritis, tumors, synthesized in the liver. They form the basis of organ parasitism), increased loss caused by proteinuria due and tissue structure, operate as catalysts (enzymes) to renal disease, blood loss and malignant tumors in biochemical reactions, are regulators (hormones) (rarely seen in birds) or starvation and malnutrition. The biological activity of tious diseases that stimulate production synthesis of proteins for these various functions is dependent gamma globulin. The proteins are the yolk precursors (vitel- Electrophoresis logenin and lipoproteins), which are synthesized in Sample: Serum is most commonly used for protein the liver and transported via the plasma to the ovary electrophoresis in mammals, so fibrinogen is not in- where they are incorporated in the oocyte. Hemolysis will affect electro- phoresis results, and heparinized plasma is often Diagnostic Value: Total protein is often used as an 50,54,72 used to prevent this problem. Determi- nation of plasma protein concentrations may be of Method: Electrophoresis is used to separate differ- value in diagnosing gastrointestinal, hepatic or renal ent types of plasma proteins, making it possible to diseases. Furthermore, plasma proteins will be ab- determine their relative proportion in a particular normal in infectious diseases that cause a stimulation sample. Although determination of supported on a specific matrix, is placed in an electri- plasma proteins seldom leads to a specific diagnosis cal field, causing the different protein fractions to (eg, in the case of monoclonal gammopathies), it will migrate at varying speeds toward the anode based on help the clinician to evaluate the severity and pro- their relative charge. The length and height of each peak dietary protein, temperature stress, state of hydra- ithin the pattern indicates the relative amount of a tion, hemorrhage and inflammation. Some immunoglobulins, including IgM and IgA, also migrate in the β-globulin range. The γ-globu- Sample: Serum and lipemic specimens should be lin fraction is mainly composed of immunoglobulins 66 warmed to 37°C and vigorously mixed prior to analy- (IgA, IgM, IgE and IgG). Diagnostic Value: In healthy birds the albumin frac- Method: Usually, triglycerides are enzymatically de- tion is the largest protein fraction. Often albumin concentrations are decreased in these situ- Physiology: Triglycerides are the major storage form ations. The combined effect of these changes is a of lipids, and are a major energy source. Examples of diseases with a decrease in the A/G ratio are egg-related peritonitis, and Diagnostic Value: Triglyceride values have been in- chronic infectious diseases such as aspergillosis, psit- sufficiently evaluated in birds. Serum or plasma protein electrophoresis can be used to monitor response to treatment.