Health and Shopping Blog

Did you see the news last December that Terry Pratchett has Alzheimer’s. He is only 59. When I was younger, we used to congratulate anyone who approached their sixtieth birthday without dying. Now, with the improvements in diet and medical science, we all expect to live a lot longer. This is all a little double-edged.

As I grow older, one of the things I fear is that my mind may die before my body. There is nothing more depressing than watching your own personality disappear, leaving nothing but apparently immortal flesh behind. As an interested spectator, I have had relatives who sat or lay like vegetables in nursing homes for several years while we all waited for them to die. Which makes the anecdotal point that depression affects many when they are diagnosed with Alzheimer’s. As the disease progresses, depression also spreads to the immediate carers in the family, other relatives and friends. Perhaps we carers should all be reaching for the Zoloft.

The clinical evidence suggests that about 25% of people with Alzheimer’s suffer persistent depression, although there are no formal studies that map the relationship between the two. What we can say is that, when it arises, depression significantly affects the quality of life for all involved. Patients can be more quickly shuffled off into a nursing home or there is a risk of suicide by any of those involved.

The research links serotonin and the neurotransmitter systems with depression, but the evidence for the use of Zoloft and other Selective Serotonin Reuptake Inhibitors (SSRIs) in the treatment of those with Alzheimer’s has been patchy. Part of the problem is in assembling statistically significant sized groups of participants with broadly similar levels of symptoms (from mild to demented). The other problem is money. In the UK, there are about 700,000 people with Alzheimer’s, but only £10 per patient is spent each year on research into the disease — less than 5% of the amount spent on research into cancer. However, in Arch Gen Psychiatry, Jul 2003 there was a slightly better attempt made to test the safety and effectiveness of Zoloft for both the person with Alzheimer’s and, indirectly, for the caregivers. This was a 12-week randomised, placebo-controlled trial.

The first piece of good news was that the intellectual level of people diagnosed with Alzheimer’s who received Zoloft remained relatively stable, whereas the placebo group declined. However, there is a problem in that the evaluations were based on the caregivers’ reports and their expectations (and hopes) may have played a part in skewing the results. Nevertheless, the finding is interesting. There were few side effects in those who took the Zoloft.

The second piece of good news is that Zoloft did reduce the depression experienced by the Alzheimer’s patient and this significantly relieved caregiver distress. Given that private care is usually of a better quality than institutional care, this is a major step forward. It also has significantly economic implications for the state that may otherwise have to subsidise long-term care in an institutional home or hospital. Those receiving the Zoloft were less likely to wander around, or become agitated or aggressive. If confirmed in continuing trials, such behavioural improvements will mean that caregivers can continue to give personalised and individualised care for longer. This may slow the loss of personality and lessen the burden of guilt when the patient is finally sent into an institution.

So should all of us Baby Boomers reach for the Zoloft if we feel ourselves slipping away or bulk buy Zoloft for distribution to our potential caregivers? Well, this research is simply a useful indicator. There are many difficulties in relying on one set of findings to give generalised advice. I suppose that is the benefit of continuing research. So long as it delivers good news before we die, of course.

Well, yes, I am going to talk about a new book. Appropriately enough for a site devoted to Ambien, it is Insomniac by Gayle Greene (published by the University of California Press in March, 2008 — 978-0-520-24630-0). So here is an autobiographical take on what it is like to live with insomnia by a woman who ought to know. Gayle Greene has the distinction of being a non-professional member of the American Academy of Sleep Medicine (AASM). She wins this prize even though not a medical researcher because she is the “patient representative” on the board of the American Insomnia Association, which operates within the AASM’s umbrella. In her spare time (sic), she labours at the Scripps College, Claremont California as Professor of Literature and Women’s Studies. This latest tome (quite heavy at 520 pages) adds to her impressive resume of academic publications.

This is a highly personal account by an articulate and intelligent woman who has been afflicted by insomnia for most of her adult life. In one sense, the only person who can really tell you what it is like in a foreign country is one who has been there. For those of us who have always been able to sleep without difficulty, insomnia is like a foreign country, and the idea of having to use a medication like Ambien as the passport to get into sleep is alien.

Conventional wisdom always says that insomnia is somehow related to anxiety or stress levels, perhaps aggravated by drinking too many cups of real coffee. Greene comes up with a simple and practical explanation of what insomnia is. Insomnia means nothing more than you cannot get the number of hours of sleep you need to feel good about yourself and function efficiently. There is no reason for this. It is nothing more than a failure to sleep. There should be no pejorative implication. To use stress as an excuse is to blame the person for being weak or neurotic when there is no reason to blame yourself or anyone else. Instead of looking for some psychological explanation or a less judgemental physical cause, we should just accept that it happens to about 20% of the population at one time or another during their lives. Such a vast number of people yet so little is spent on researching the condition and its causes. Greene comments that the National Institutes of Health in the United States spent less than $20m in 2005, whereas Sanofi-Aventis spent more than $120m promoting Ambien in the same year. This is neither to praise nor condemn Ambien. It is all a question of priorities. Why bother to spend Government money on researching the cause of a condition when private capital has already invented Ambien as a cure for it?

She debates what we really understand about cause and effect. It is so easy to get the cart before the horse, or should that be the other way round? Perhaps conventional wisdom has also got things back-to-front. Instead of stress and anxiety being the cause of insomnia, perhaps living with insomnia makes you stressed and anxious. Who is to say in these more modern times, that we did not have disturbed sleep patterns in past times living on the land? Folk tales may tell us that we went to sleep when dusk fell and waited for the cock to crow before waking. But was that actually the case? Who can say what the real biological norms were before electricity came along and gave everyone the chance to live through the darkness. As it stands, no researcher can actually explain why we have to sleep nor why some people sleep more than others. It is all guesswork.

All that we can say with any certainty is that those who are deprived of sleep do not do as well as those who sleep through the night. The sleepless so often end up demotivated, their sense of humour worn thin, their judgement warped. Some grow fat. Others find their immune system affected. Sleep seems so indispensable yet no-one can really control it. Greene describes everything she has tried over the years from relaxation therapies to medication like Ambien, but concludes that, like any intimate relationship, how we relate to sleep is always personal.

She is a passionate advocate for greater patient power to persuade disinterested bodies to research insomnia.

For one who has had to depend on Ambien and the other medications for so long, she feels she and all other sufferers deserve better answers than those served up by the pharmaceutical companies.

For one who has never had problems sleeping nor had to take Ambien , Insomniac was a riveting insight into the condition and the problems it causes. Required reading for everyone who reads this article.