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Vital force for the whole organism!

KETEVAN MIKADZE, Doctor of Medicine, M.D.
Endocrinology, Metabology and Dietology Center “ENMEDIC”, Endocrinologist
The endocrine diseases profile and their manifestation in various systems of a organism are diverse, especially the nervous disorders. Practically all endocrine diseases are characterized by symptom complex characteristic to vegetative nervous system changes and their timely manifestation and treatment is very important in the therapy of basic disease.  
The modern life style, overload of information, time deficiency, economic and private problems, together with the changes of health conditions determine psycho emotional status, which causes serious problems. 
Nervous state aggravates the clinical symptoms of the main disease, that’s why the number of patients who addresses medical institution increases. Accompanying depression increases the risk of complications, decompensation and lethal outcome by 4-6 times, so the early diagnostics and treatment of nervous disorders is necessary.  
Certain endocrine patients often initially address physicians of other profile, including neuropathologists, without high-level of qualification of the letter, the treatment will be inefficient.
This can be approved by study conducted in the United States of America, when the thyroid’s function of outpatients in the Neurologic clinic was studied. The study included up to 700 patients, from which 51% had different kinds of diseases, and only 1% knew about it.
Among numerous thyroid diseases, the Grave’s disease (diffuse-toxic goiter) was characterized by expressed symptoms, mostly by symptoms of vegetative nervous system – excitability, tremor, intensification of reflexes, sweating, vegetative attacks, phobias. The most significant is muscle weakness, sometimes may be developed acute and chronic myopathy, muscle atrophy, even paresis.
The neurological symptoms can be also caused by the deficiency of thyroid hormones, which are manifested by memory loss, constraint, ataxy, loss of hearing. Cerebral encephalopathy, vegetative attacks, sometimes dysphagia, dispnea and polyneuropathy may be developed in elder patients. 
During Cushing’s disease, the first symptoms are of vegetative character. The majority of patients have cerebrovascular disorders because of insufficiency of brain blood supply.
The change of cognitive functions and depression are characteristic. About in 1/3 of patients the vascular attacks are developed, which often lead to stroke. During disorders of peripheral nervous system the polyneuromyopathy syndrome can be developed due to the catabolic processes in muscles. 
During primary hyperaldosteronism the certain neurologic symptoms are developed that are caused by diminishing of coronary blood supply which leads to vascular attacks, also psycho emotional manifestations with cerebral symptoms.
The development of discirculatory encephalopathy with the damage of cortex function is characteristic. It is often in youngers, mostly in women and is manifested by arterial hypertension, polyuria, nycturia, weakness, falling episodes because of myoplegia and other.
During diabetes the central, as well as peripheral and vegetative nervous systems are damaged.
Among patients with diabetes the incidence of depression is high. It greatly exceeds the populational (5-10%) and varies within 14,4 - 41,3%. It is not clear if the incidence in type I and type II diabetes is the same, if the presence of complications is important and so on. 
The majority of authors consider three aspects of diabetes and depression interrelationship: metabolic, somatopsychic and genetic. According to the first, the cause of depression is the metabolism disorder characteristic to diabetes. During hyperglycemia the connection in hypothalamo-pituitary-adrenal axis is damaged, the development of depression may be also associated with the structural and functional changes in cerebral cells during chronic hypoglycemic conditions.
On the other hand, the depression can be due to psycho-traumatic influence of somatic disease. For example the change of everyday life style, acute complications, which limit the patient’s activity, treatment – initiation of insulin therapy and other. 
The supporters of genetic theory use genetic markers, which are common to both diseases.
It is very important to know, that there is no correlation between glycemic control findings of diabetic patients and depression, also between the clinical course and various types of depression and carbohydrate metabolism.
It is well known, that with the purpose of increasing the efficacy of endocrine disease treatment, in addition to endocrinologists, in the treatment participate physicians of other somatic profiles, including neuropathologists. Practically too every fourth patient antidepressants are administered.
The efficacy of treatment with antidepressants is 60-70%, but it has lots of adverse effects: dry mouth, meteorism, disturbance of sexual activity, sweating, urinary retention, loss of vision, disturbance of heart muscle conductivity and contractility function, heart rhythm disorders, arrhythmias, loss of appetite, nausea, vomiting. At the time the tricyclic antidepressants cause sedative effect – somnolence, loss of the ability to concentrate, which makes risky to operate machinery and drive, reduces the social activity. It is necessary to take into account the following contraindications: glaucoma, acute myocardial infarction, pregnancy, lactation, dysfunction of liver and kidneys and so on.
The tranquilizers – benzodiazepine derivatives are widely used, although this method is also associated with a number of adverse reactions, including: reduce of the ability to concentrate, coordination disorders and so on. At the same time, the patients often develop drug dependence. In certain cases it is advisable to use psychotherapeutic drugs, but on the one hand the deficiency of well qualified specialists and on the other hand, the patient’s fear of nervous profile physicians, determine the inadequate treatment. In such cases and also during the mild vegetative nervous system disorders, the herbal remedies are widely used, one of the most important and effective drugs is Vamelan.
Vamelan is the optimal combination of three components: dry extract of valerian 125 mg, Dry extract of Peppermint   25 mg and dry extract of Melissa 25 mg.
The valerian extract has sedative effect. It reduces the psychic stress and tension and irritability characteristic to neurasthenia. During insomnia it restores the normal sleep. Has the spasmolytic activity.
Extract of peppermint acts spasmolitically on the gastrointestinal smooth muscles, has choleletic activity. It is very effective during mild insomnia.
Due to essential oils of melissa’s extract Vamelan has pleasant odor and taste. It easily relieves pain and seizures. Because of this feature it is widely used as spasmolytic, analgetic agent during stab. At the same time, Melissa essential oils have sedative activity; also they help to increase the appetite (loss of appetite in neurasthenic patients is very often). 
In our case Vamelan was used during mild nervous disorder, mainly for the treatment of thyroid diseases and diabetes.
The patients’ biographical particulars, complaints during the first visit and repeated consultations were evaluated. In most cases the general condition and irritability was improved. The sensation of a lump in the throat and grippingwas reduced. The palpitation and excitation were less manifested; the process of falling asleep was facilitated. Nervousness and phobias were reduced due to the drug’s dose and treatment’s duration.
Thus, Vamelan is the effective agent during treatment of mild nervous disorders. It reduces the excitation of central nervous system, improves the coronary blood circulation, and improves the sleep structure and quality. 
Administration of Vamelan is possible during vegetative nervous system disorders as the first aid and also until the patient can receive the consultation of qualified neuropathologists, especially because the contraindications are only hypersensitivity to any drug component and infancy under 12. The application of Vamelan during pregnancy and lactation is possible only under doctor’s prescription and observation.