Antidepressants and other psychotropic medications

Anxiety and depression are frequent symptom complaints among the chronically ill. They are also among the symptoms that can be exacerbated by excess exposure to light.

Patients considering the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP) may already be taking anti-anxiety agents and antidepressants. As with many drugs, these can act in immunomodulatory ways, sometimes in ways that have yet to be fully understood.

Although the ultimate goal is to discontinue taking these medications, patients experiencing intolerable anxiety or depression should seek relief. If anti-anxiety agents and antidepressants palliate severe symptoms and allow patients to continue the MP in a safe and tolerable manner, these drugs are not contraindicated.

It is important to point out that many patients report that depression and anxiety resolve over the course of treatment with the MP.

The following is a list of some common anti-anxiety agents and antidepressants.

• amitriptyline (Apo-amitriptyline, Elatrol, Elavil, Endep, Laroxyl, Saroten, Sarotex, Tryptizol)
• aripiprazole (Abilify), bupropion (Budeprion SR/XL, Bupropion SR/XL, Wellbutrin SR/XL, Zetron, Zyban SR)
• citalopram (Alcytan, Celexa, Cipramil, Cittá)
• diazepam (Ducene, Ivax Pharm, Stesolid, Valium)
• duloxetine (Cymbalta)
• escitalopram (Cipralex, Esipram, Lexapro, Seroplex)
• fluoxetine (Actan, Fluxene, Lorien, Lovan, Prozac, Tuneluz)
• fluphenazine (Modecate, Prolixin Decanoate, Dapotum D, Anatensol, Fludecate, Sinqualone Deconoate, Dapotum Injektion, Flunanthate, Moditen Enanthate Injection, Sinqualone Enanthate, Prolixin, Permitil, Dapotum, Lyogen, Moditen, Omca, Sediten, Selecten, Sevinol, Sinqualone, Trancin) – shown to be “a direct inhibitor of the innate immune signaling pathway”¹⁾
• nortriptyline (Aventyl, Norpress, Pamelor)
• paroxetine (Aropax, Paxil, Paxil CR, Paxxet, Pexeva, Sereupin, Seroxat)
• S-Adenosyl-L-Methionine (SAM-e)
• sertraline (Eleva, Lustral, Sertra, Xydep, Zoloft) – shown to be “a direct inhibitor of the innate immune signaling pathway”²⁾
• St. John's wort – contains about a dozen compounds of potential pharmacological activity. St. John's wort induces hepatic drug metabolism through activation of the pregnane X receptor, among other mechanisms. The activation of PXR would give immunosupression similar to minocycline. Contraindicated.
• trazodone (APO-Trazodone, Desyrel, Donaren)
• trifluoperazine (Eskazinyl, Eskazine, Jatroneural, Modalina, Stelazine, Terfluzine, Trifluoperaz, Triftazin) – shown to be “a direct inhibitor of the innate immune signaling pathway”³⁾
• venlafaxine (Effexor, Effexor XR, PMS-Venlafaxine XR, Venlafaxine XR)

I became increasingly more and more irritable and angry on St. John's Wort, and I kept raising the dose, trying to compensate. When I finally got up to the maximum dose after about 9 months on it, and figured out it was the St. John's Wort that was responsible for my anger and irritability, I stopped it cold turkey. And ended up in a psychiatric ward two days later from being suicidal, with very disjointed and slow thinking processes, and a lot of confusion/brain fogThe loss of intellectual functions such as reasoning; memory loss; and other neurological abilities that is severe enough to interfere with daily functioning. and severe depression.

L.J.

According to Trevor Marshall, PhD:

Brand name Valium product does not seem to be addictive in our cohort, whereas there are problems weaning off some of the generics.

valium produces anxiolytic effect and CNS depression by stimulating gamma-aminobutyric acid receptors. Relaxes skeletal muscles of spine by inhibiting polysynaptic afferent pathways. Controls seizures by enhancing presynaptic inhibition.

It is okay for patients to take:- Only the brand name, Valium, has seemed to work for patients with Th1 inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue..

• half the 2mg (white tablet, the one with the V cut from the center) seems to often be enough to reduce anxiety and calm restless muscles.
• stay away from the generic diazepam and the higher strengths.
• make sure your doctor orders Valium 2mg to use “as directed” and writes “no substitutions” on the prescription; Valium is usually taken 1-4 times per day.

According to published reports, lithium affects the immune system profoundly.

Lithium has some antiviral effects. A 2000 study stated that the drug has been shown to have antiviral effects in experimental and clinical conditions, particularly against herpes viruses.⁴⁾ However, the antidepressant's immunosuppressive effects may be dominant over its anti-infective impact. Lithium may exacerbate autoimmune conditions such as thyroiditis or rarely Graves' disease.⁵⁾ The common clinical side effects of the drug are goitre (swelling in the thyroid gland) in up to 40% and hypothyroidism in about 20%.

Patients or physicians contemplating the Marshall Protocol should work out a plan with their doctor to wean lithium prior to beginning minocycline.

As described in a Medscape article, a 2010 review of four meta-analyses of efficacy trials submitted to the US Food and Drug Administration (FDA) suggests that antidepressants are only “marginally efficacious” compared with placebo and “document profound publication bias that inflates their apparent efficacy.”⁶⁾

In addition, when the researchers also analyzed the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, “the largest antidepressant effectiveness trial ever conducted,” they found that “the effectiveness of antidepressant therapies was probably even lower than the modest one reported…with an apparent progressively increasing dropout rate across each study phase.

“We found that out of the 4041 patients initially started on the SSRI [selective serotonin reuptake inhibitor] citalopram in the STAR*D study, and after 4 trials, only 108 patients had a remission and did not either have a relapse and/or dropped out by the end of 12 months of continuing care,” lead study author Ed Pigott, PhD, a psychologist with NeuroAdvantage LLC in Clarksville, Maryland, told Medscape Medical News.

“In other words, if you're trying to look at sustained benefit, you're only looking at 2.7%, which is a pretty jaw-dropping number,” added Dr. Pigott.

Overall, “the reviewed findings argue for a reappraisal of the current recommended standard of care of depression,” write the study authors.

• atherosclerosis – Antidepressants may boost mood at the expense of accelerated atherosclerosis for middle-age men, according to an observational study of more than 500 twins who had served in the Vietnam War.⁷⁾
• obesity – According to a 2009 JAMA article, subjects treated with antipsychotics became overweight or obese in as little as 12 weeks.⁸⁾ A team led by Dr. Christoph Correll of Zucker Hillside Hospital and the Feinstein Institute for Medical Research in New York studied 272 children and teens aged 4 to 19 with bipolar disorder, schizophrenia and disruptive or aggressive behavior spectrum disorders.⁹⁾ After roughly 11 weeks, those who took Zyprexa gained an average of 18.7 pounds (8.5 kg), those on Seroquel gained 13.4 pounds (6.1 kg), those on Risperdal gained 11.7 pounds (3.5 kg) and those on Abilify gained 9.7 pounds (4.4 kg). “The weight gain is dramatic, rapid and pervasive,” Correll said in a telephone interview.
• risk of autism – A case control study, which looked at medical records of California mothers, found that expectant mothers who took an antidepressant medication increased their risk of delivering a child with autism spectrum disorder (ASD).¹⁰⁾ The 2011 analysis suggested that exposure to a selective serotonin reuptake inhibitor, particularly during the first trimester, may somewhat increase the risk of ASD.

MP patients should consult with their physicians as their symptoms resolve to experiment with taking lower levels of anti-anxiety agents and antidepressants. Weaning anti-anxiety agents and antidepressants may increase immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed..

Though patients on anti-depressants tend to have more extreme Herx [immunopathology] reactions, and there is evidence suggesting antibiotic effects of psychiatric meds which may be counter-productive to the intention of the MP, I do not recommend reduction of anti-depressants until symptoms improve.

Then, very gradual reduction of anti-depressants can be initiated, but one should expect that it will take months and months to slowly wean off.

Greg Blaney, MD

• The Epidemic of Mental Illness: Why? – In an essay in The New York Review of Books, Marcia Angell, former editor in chief of The New England Journal of Medicine, favorably entertains the premise that “psychoactive drugs are useless.”
• Fluoxetine inhibits coxsackie virus replication – A 2012 study showed that Prozac reduced the synthesis of viral RNA and protein.¹¹⁾