Anorexia Nervosa is an important problem in young adolescent people: it increases the risk for death and for Hospitalization. It is characterized by a deformation of consideration on the own aspect (a girl thinks to be fat and ugly when she is physically NORMAL).
I propose the Piracetam as safe drug therapy for anorexia in young adolescents.
I think Piracetam can be useful and safe.
But if a patient is an homozigous or a symptomatic heterozigous for MethylenTetraHydroFolate Reductase I advise when Piracetam is taken to supplement with choline because Piracetam is GABAergic (non directly) and Cholinergic and so in these patients it can be necessary to give choline or phosphatydilcholine too.
To ameliorate AcetylCholine synthesis, in HyperHomocysteinemic patients, can be helpful to lower Homocysteine where some of the following essential nutreints are necessary: with folic acid, vitamin B12, Vitamin B6 (in Homocistinuria); and also Trimetylglycine can lower it.
Because: if serum Homocysteine is high, as result methionine is low and then the acetylation reactions as for AcetylCholine synthesis are diminished.
I think Piracetam can cure anorexia by activating Endocannabinoid System.
Endocannabinoid system has CB1 and CB2 receptors. An important effect of activation is the increase in eating pleasure and finally food intake. This can be an effect of orally taken piracetam.
Moreover, piracetam can exhibits an anticonvulsivant effect like its derived compound levetiracetam: "There is substantial evidence that the endocannabinoid system and in particular the type 1 cannabinoid receptor (CB1R) is involved in epilepsy" (Van Laere K, Neuropharmacology, 2008). Levetiracetam, maybe from "LEVo EThyl pIRACETAM) can cause aggressive behaviours: maybe by increased dopamine stimulation on Amygdales?
Endocannabinoid Receptor counts as about 50% of all receptors present in the Brain: they are very important and significant.
I am referring to young patients (for example: 14 years old) in whom it can be harmful to give SSRI: these drugs can cause suicidal behaviour.
If to familial psychotherapy Piracetam is associated (in some cases with choline), I think the life of these patients will better.
Piracetam also affects coagulation by slightly inhibiting a coagulation factor. Perhaps, can it be helpful with Magnesium in Pre-Eclampsia and especially CONVULSIVE ECLAMPSIA safe treatment and in prevention of Postpartum cerebral venous thrombosis? (in post partum it can be necessary to control thyroid function: postpartum depression can be determined by hypothyroidism, whereas Baby Blues can be a physiologic response to a dopaminergic inhibition by oxytocin and prolactin increased increction). Recently, researchers discovered that "Podocyturia Predicts Preeclampsia Before Symptoms Appear". Calcium and Vitamin D right doses supplementation during pregnancy can lower pre-eclampsia risk (see in comments), but please avoid Milk-alkali syndrome! AN IMPORTANT THINK TO KNOW ABOUT PRE-ECLAMPSIA IS: it can be necessary one year of "sexual contacts" between the two partners to summon an immuno tollerogenic response and so to prevent preeclampsia. Pre-eclampsia can be considered an immune maternal response against fetus (against paternal antigens expressed on fetus). For that, "Inadequate tolerance induction may induce pre-eclampsia" (see Comments: the importance of long term maternal exposure to seminal fluid). Excess of factor VIII predisposes to venous thromboses, whereas a slight factor VIII deficit can cause hypertrophic scars, in differential diagnosis with cheloids (severe deficit is the Hemofilia A). Postpartum cerebral venous thrombosis is rilevant in thrombophilic patients: these are for example coagulation disorders (VIII factor excess, Leiden V factor, prothrombin polymorphisms, hyperhomocysteinemia especially in women who do not eat vegetables, etc) and the age: a sixteen pregnant and new mother woman has a less thrombosis risk than older pregnants.
I think Piracetam can be helpful in low doses and in high doses in treating adolescent Nervous Anorexia: 600 mg to about 4 grams daily in the morning.
Piracetam today in Italy is approved for central cortical myoclonus (and for some elderly cerebrovascular patients). Central Myoclonus is caracterized from tremor present even by sleeping (whereas Parkinson's tremor, not necessary to do Parkinson diagnosis, is absent in the sleeping).
Piracetam is a drug of the less toxic ezisting drugs at all. A mechanism with which piracetam effects have been explained is that it ameliorates the two cerebral hemispheres intercommunications.
Pidotimod is a safe Italian immunostimulant I think derived from Piracetam.
Oral zinc supplementation helps moreover to increase food intake by activating the olfactory epithelial receptor (they are zinc- enzymes).
Finally, my advice as therapy proposal for young adolescent nervous anorexic patients is one pill that contains togheter:
- piracetam (600 mg)
- zinc citrate (2,5 mg)
- choline or better phosphatodylcholine (200 mg)
- biotin (vitamin B8 or vitamin H) 1 mg in my opinion increase food intake
And the dosage of this "hypothetical one pill" can be 1 to 6 daily (maximum 15 mg of zinc alone because more than 15 mg can cause copper deficiency) in the morning.
It is important to take piracetam only in the morning because after the lunch (if taken in the afternoon) causes insonnia.
Be careful: when a patient takes piracetam, BETTER NOT TO TAKE ALCOLICS:
piracetam, acetylsalicilate, and many other drugs (analgesic, etc) potentiate the alcolics depressant effects on the brain.
Piracetam does not agree with alcolics but agress TOO much with music till to melomanic listening pleasure.
Guido Emanuele Galasso MD