Latest / Morning Medical with Dr. Chow / FDA Tianeptine Warning, SURMOUNT-5 Insights, and Social Prescribing Benefits

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FDA Tianeptine Warning, SURMOUNT-5 Insights, and Social Prescribing Benefits · Morning Medical with Dr. Chow

• 0:00
  Welcome to another episode of Morning Medical with Dr.
• 0:03
  Chow, where we delve into the latest medical and health news from around the world.
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  I'm your host, Dr.
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  Chi-Ming Chow.
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  Today, we're focusing on a particularly alarming issue highlighted by the United States
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  Food and Drug Administration.
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  It's about a substance ominously nicknamed "gas station heroin," which is posing a significant
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  risk, especially to young people.
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  The head of the United States Food and Drug Administration, Commissioner Martin A.
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  Makary, recently issued a stark warning about the dangers of a drug called tianeptine.
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  This substance, often referred to as "gas station heroin," is being sold in various
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  places like gas stations, convenience stores, vape shops, and online retailers, despite not
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  being approved by the Food and Drug Administration.
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  It's marketed under different brand names such as ZaZa, Tianna Red, and Neptune’s Fix, to name
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  a few.
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  Commissioner Makary expressed grave concern over this growing health trend, especially its
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  impact on young individuals.
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  Tianeptine is recognized in some countries as an atypical antidepressant, prescribed in
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  controlled doses.
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  However, when taken in higher doses, it can lead to euphoria, which unfortunately makes it
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  appealing for recreational use.
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  The dangers of tianeptine are significant.
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  If consumed inappropriately, it can lead to severe adverse effects such as agitation,
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  confusion, coma, and even death.
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  Other symptoms include drowsiness, hypertension, nausea, respiratory depression,
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  and tachycardia.
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  This is particularly worrying given that the drug can cause withdrawal symptoms similar to
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  those seen with opioid withdrawal, which include cravings, sweating, and diarrhea.
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  The Food and Drug Administration has been actively monitoring the distribution of these
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  products and has issued alerts to raise public awareness.
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  In fact, two years ago, health officials in New Jersey reported a spike in illnesses linked to
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  products containing tianeptine, such as Neptune’s Elixir and ZaZa Red.
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  This prompted the Food and Drug Administration to release a warning about these products and
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  their potential to cause severe health issues.
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  It's important for anyone using tianeptine or products containing it to be aware of these
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  risks.
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  If you're experiencing any withdrawal symptoms or adverse effects, it's crucial to seek
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  medical assistance immediately.
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  You can also contact the National Poison Control Center for support.
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  As we continue to monitor this situation, it's vital to spread awareness about these dangerous
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  substances.
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  Stay informed and stay safe.
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  We'll continue to bring you the latest updates on this and other pressing health issues in
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  upcoming episodes.
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  Today, we're diving into a pivotal study comparing two medications that have been making
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  waves in the realm of obesity management: tirzepatide and semaglutide.
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  These drugs, known commercially as Zepbound and Wegovy respectively, were put head-to-head in
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  the SURMOUNT-5 trial.
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  The results, recently published in the New England Journal of Medicine and presented at
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  the European Congress on Obesity, reveal some compelling findings.
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  In this trial, tirzepatide came out on top, demonstrating a more significant impact on
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  weight loss compared to semaglutide.
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  Over a period of 72 weeks, participants using tirzepatide lost an average of 20.2% of their
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  body weight, while those on semaglutide lost 13.7%.
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  This translated to an average weight loss of about 50.3 pounds with tirzepatide and 33.1
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  pounds with semaglutide.
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  The study also highlighted other benefits of tirzepatide.
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  Participants experienced greater reductions in waist circumference, losing an average of 5.4
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  centimeters more than those on semaglutide.
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  Additionally, tirzepatide users showed more significant improvements in systolic blood
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  pressure.
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  While both groups saw cardiometabolic risk factor improvements, the greater reduction in
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  systolic blood pressure with tirzepatide could be clinically relevant, as even small decreases
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  in blood pressure have been associated with a reduced risk of cardiovascular events.
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  The trial included 751 participants, and it was noted that tirzepatide users were more likely
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  to achieve substantial weight loss milestones.
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  For instance, 81.6% of tirzepatide users achieved a 10% reduction in body weight
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  compared to 60.5% of those on semaglutide.
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  The trend continued with higher weight loss targets as well, with tirzepatide consistently
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  outperforming semaglutide.
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  Interestingly, the trial observed a gender difference in weight loss, with men
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  experiencing about 6% less weight reduction than women in both treatment groups.
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  This might explain the slightly lower overall weight reduction in this trial compared to
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  previous ones.
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  The SURMOUNT-5 trial had a higher proportion of male participants compared to past studies
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  involving semaglutide.
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  As for safety, both medications were generally well-tolerated, though not without side
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  effects.
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  Most adverse events were gastrointestinal in nature, which is expected with these types of
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  medications.
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  However, these side effects were mostly mild to moderate.
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  Interestingly, fewer participants on tirzepatide discontinued treatment due to
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  adverse events compared to those on semaglutide.
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  The trial was conducted across various sites in the United States and Puerto Rico, involving
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  adults with obesity but without type 2 diabetes.
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  Participants had a body mass index of at least 30, or at least 27 if they had an
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  obesity-related complication.
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  The study also explored the maximum tolerated doses of each medication, aiming to address
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  real-world applicability.
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  While the results of the SURMOUNT-5 trial are promising, further research is ongoing.
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  The ongoing SURMOUNT-MMO trial is examining tirzepatide's potential to reduce morbidity and
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  mortality in adults with obesity, which may offer more insights into its cardiovascular
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  benefits.
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  As always, it's crucial for patients and healthcare providers to consider all aspects of
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  treatment options, including efficacy, safety, and individual patient needs.
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  In a fascinating development in the field of hypertension management, the BedMed trial has
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  shed light on the timing of antihypertensive medication administration, revealing that it
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  may not play as crucial a role as previously thought.
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  Conducted in Canada, this trial randomized individuals to take their blood
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  pressure-lowering medications either at bedtime or in the morning, and the findings have
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  significant implications for both patients and healthcare providers.
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  The study, which included over 3,200 participants, was led by Dr.
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  Scott Garrison from the University of Alberta.
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  It explored whether there was any difference in cardiovascular outcomes between those taking
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  their antihypertensives at different times of the day.
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  Interestingly, the results showed no significant difference in the risk of major
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  cardiovascular events or death over a median follow-up period of 4.6 years.
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  Whether participants took their medications at bedtime or in the morning, the rates were
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  comparable at 2.3 versus 2.4 per 100 patient-years.
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  This trial, published in the Journal of the American Medical Association, also included a
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  sister study known as BedMed-Frail, which looked at nursing home residents with a median
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  age of 88 years.
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  Both studies concluded that the timing of taking antihypertensives did not impact the
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  cardiovascular outcomes, providing reassurance that patients can choose their medication
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  timing based on personal preference and convenience.
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  Dr.
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  Sandra Taler from the Mayo Clinic, in an editorial accompanying the study, emphasized
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  the importance of consistency in taking medications over the specific timing.
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  She noted that loosening the rules on timing could better accommodate caregivers' schedules,
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  allowing them to provide more effective oversight.
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  The theory behind bedtime dosing was that it might align better with a person's natural
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  circadian rhythms, potentially lowering sleep-time blood pressure.
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  However, this concept, previously supported by the Hygia trial from Spain, faced criticism for
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  its findings and methodology.
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  The BedMed trial's robust design and findings now provide a more reliable perspective,
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  suggesting that the timing of medication does not significantly affect outcomes.
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  The BedMed trial included a wide range of antihypertensive medications such as
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  angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel
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  blockers, and beta-blockers.
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  The primary outcomes measured were all-cause death and hospital visits for stroke, heart
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  failure, or acute coronary syndrome.
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  No individual component of these outcomes showed a preference for either timing strategy.
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  A substudy involving ambulatory blood pressure monitoring revealed that while nighttime dosing
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  reduced overnight blood pressure by about 7.4 over 2.7 millimeters of mercury, it did not
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  translate into better cardiovascular outcomes.
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  This suggests that while there may be physiological changes with nighttime dosing,
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  they do not necessarily result in improved clinical outcomes.
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  Ultimately, the BedMed trial underscores the importance of medication adherence and
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  flexibility in dosing schedules, allowing patients to tailor their treatment to fit their
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  lifestyle without compromising efficacy.
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  This trial, supported by the Canadian Institutes of Health Research and Alberta
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  Innovates, highlights that we can rest easy knowing that the timing of antihypertensive
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  medication does not significantly impact cardiovascular health.
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  Now, let's turn our attention to an interesting discussion about the common habit of falling
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  asleep while listening to your favorite shows.
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  Many people have heard the advice to avoid screens before bed, but experts are saying that
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  listening to something like an audiobook, music, podcasts, or even a television show can
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  actually help some individuals fall asleep.
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  According to a 2018 study, more than half of people with sleep disturbances use music as a
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  sleep aid.
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  But what if you are not watching, just listening?
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  Dr.
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  Rachel Salas, a sleep medicine specialist at the Johns Hopkins University School of
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  Medicine, likens this to a "Goldilocks" situation, where it's all about finding what
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  works for you.
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  She emphasizes that it's not just about the practices of your bedtime routine, but also
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  about your environment and all the contributing factors.
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  It's important to recognize that everyone is different, and for some, falling asleep while
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  listening to something might lead to a great night's rest.
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  However, there are a few key practices to keep in mind to ensure you're getting the most out
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  of this habit.
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  Dr.
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  Shalini Paruthi, a sleep medicine physician at John J.
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  Cochran Veterans Hospital, points out that while listening to something can help you wind
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  down, it should not keep you engaged or awake, as this can replace actual sleep time, which is
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  detrimental to health.
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  Adults should aim for at least seven hours of sleep regularly for optimal performance.
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  A predictable kind of noise can signal to your body that it's time to wind down.
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  Dr.
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  Salas suggests that if listening to something is part of your comforting bedtime routine,
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  that's great.
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  Dr.
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  Lindsay Browning, a psychologist and sleep expert, adds that it's best to choose content
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  that isn't too engaging, so your brain isn't motivated to stay awake.
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  For instance, a sleep story might be more suitable than an exciting audiobook.
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  Another consideration is when to turn off the sound.
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  Dr.
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  Browning recommends setting an auto-timer to mute the sounds shortly after you fall asleep.
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  Continuous sounds throughout the night, particularly if they have unexpected noises or
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  changes in volume, can cause micro-awakenings that might disturb your sleep, even if you
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  don't fully wake up.
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  A steady sound, like white noise or ASMR, can improve sleep quality, especially in noisy
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  environments.
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  For those dealing with insomnia, listening to something might help quiet racing thoughts at
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  night.
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  Dr.
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  Browning suggests addressing busy thoughts earlier in the day, perhaps by setting aside
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  time to think about worries or using cognitive shuffling, a technique that involves thinking
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  of random, non-emotionally charged words to distract your mind.
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  It's a better approach than masking those thoughts with external sounds.
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  If you find that listening to something doesn't help your insomnia after a few weeks, it might
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  be time to consult a board-certified sleep physician.
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  Dr.
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  Paruthi mentions that proven therapies, like cognitive behavioral therapy for insomnia, or
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  medications, when appropriate, can be effective treatments.
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  Remember, these strategies are about finding what works best for you to achieve restful
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  sleep.
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  In a fascinating exploration of a new approach to healthcare, we're delving into a concept
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  known as "social prescribing." This idea isn't about a new medication or treatment you find in
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  a pharmacy—it's about prescribing activities that connect you with your community, and it’s
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  gaining traction in the United States.
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  Social prescribing involves healthcare referrals for community activities rather than
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  just medications.
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  Imagine a prescription that recommends joining a local art class, participating in a nature
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  walk, or volunteering at a community center.
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  These activities focus on movement, nature, art, service, and fostering a sense of
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  belonging.
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  It's about recognizing the significant role our environment and relationships play in our
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  health outcomes.
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  While social prescriptions don't aim to replace conventional medicine, they complement
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  traditional treatments by incorporating social interventions.
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  The idea is to add more options to the table, enhancing the healing process.
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  For example, you might take your prescription antidepressant and also join a weekly walking
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  group, both contributing to alleviating depression.
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  The science supports the effectiveness of social prescriptions in easing symptoms of
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  various conditions, including attention deficit hyperactivity disorder, chronic pain, dementia,
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  and loneliness.
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  Engaging in meaningful community interactions has a powerful impact on our health.
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  Take the story of Akeela, who found relief from chronic pain by volunteering for a children's
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  charity.
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  Her focus shifted from her pain to helping others, demonstrating the profound effect of
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  social engagement.
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  Social prescribing works because it's personalized.
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  It connects individuals with activities that resonate with their personal values and
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  interests.
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  Pain psychologist Dr.
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  Rachel Zoffness encourages patients to visualize their pain as a dial, which can be
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  turned down by positive emotions and engaging activities.
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  This personalization makes social prescribing effective for a wide range of people.
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  While social prescribing is more mainstream in countries with nationalized healthcare systems
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  like the United Kingdom, it's gaining ground in the United States.
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  An increasing number of providers are issuing social prescriptions across the country.
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  For those interested, starting with free or donation-based local activities can be a simple
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  way to begin.
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  Loneliness has a profound effect on both physical and mental health.
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  It can increase the risk of premature death, anxiety, depression, and even dementia.
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  Social prescriptions create meaningful connections that are more compelling than
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  staying at home, providing significant health benefits.
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  Humans have evolved to need social connections as much as food and water.
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  While online connections can be beneficial, particularly for those with limited mobility,
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  they often lack the restorative elements of in-person interactions.
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  Quality connections provide feelings of inclusion and belonging, which are crucial for
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  our well-being.
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  Solitude is important at times, but when being alone becomes a norm, it can lead to health
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  consequences.
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  Belonging is healing, and the strength of our relationships is a key predictor of health and
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  longevity, as shown by the Harvard Study of Adult Development.
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  Social prescribing also addresses societal issues.
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  A lack of belonging can lead people to harmful and extreme political causes.
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  By investing in community engagement opportunities, we can counter this trend and
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  promote healthier societies.
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  The pillars of social prescribing—movement, nature, art, service, and belonging—are not
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  just add-ons but essential for life.
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  They improve our health by releasing beneficial chemicals in our bodies and fostering community
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  engagement.
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  The future of social prescribing in the United States looks promising.
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  It's a bipartisan solution addressing healthcare access, affordability, and system
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  efficiency.
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  By investing in social prescribing, we can improve health outcomes, reduce healthcare
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  costs, and appeal to a wide range of political perspectives.
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  As we wrap up today's episode, it's clear that the integration of social prescribing into
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  healthcare could be a game-changer.
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  By recognizing the impact of our environments and relationships on our health, we can create
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  a more holistic and effective healthcare system.
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  Thank you for joining me on Morning Medical with Dr.
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  Chow.
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  Until next time, stay healthy and connected.