Prascend and Ponies - a perspective

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brucea

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I don't normally post in here, usually avoid it generally. However wanted to talk about a slightly different viewpoint on Prascend and depression in ponies and it may be helpful for folks watching their ponies go through a hard time to hear what I have done.

I have three with Cushings of various degrees in my herd of five, only one has been on Prascend for a number of years, the other two are kind of OK but keeping an eye on it.

The one on Prascend is very badly affected and shows the classical depression and appetite suppression on Prascend, very sleepy a lot of the time and withdrawn. At the end of Summer he was in a wee bit of a state and very low indeed and we were considering our options He's also a chronic laminitic, going into laminitis most years in January usually just after the first person to comment that the days getting slightly longer! His depression type behaviour seems to be cyclic as well

I spoke with our vet about the emotional/depressed type behaviour and he said it was simply a side effect of Prascend and it would pass. It never did pass and became an ongoing symptom. So I discussed treating it as if it was depression, exactly as we would a human and looking at herbs that had a moderately mild effect on dopamine.

So I started him on a mix of supportive nervine herbs. These included hypericum perforatum (St John's wort), valeriana, scuttelaria (skullcap) and matricaria (chamomile) with the addition of leonuris cardiaca and wilthania somnifera and sambucus nigra (elderberry) for the laminitis. We tried a range of mixes, and this seems to be "his" mix. Many of these herbs have more than one action, hypericum is antidepressant but also anti-inflammatory and helps to heal wounds internal and external.

We've seen a marked improvement in him. The depressed/sleepy behaviour disappeared and he was a lot brighter. He still went into laminitis in mid January this year but he has coped with this year's episode far better than he previously did and is recovering a little each day, faster than he previously did. His appetite returned within a few days of initiating the treatment and he is enthusiastic about his feed and gained all the weight he lost in about six weeks.

There's lots of studies around, I found this one useful when I was researching. Treating the Prascend "veil" as depression has worked for me with his horse. It may not work for everyone and it's yours to experiment with.

The herbs I use are in the form of 1:1 fluid extracts (45% ethanol) purchased from a herbalist supplier, the quality is consistent and assured, fluid extracts are reasonably fast acting, and my preferred choice over dry herbs because they can be syringed. Hard to feed dry herbs when the pony won't eat.

[Atypical depression and related illnesses--neurobiological principles for their treatment with Hypericum extract].
[Article in German]
Murck H1.
Author information
Abstract
Atypical depression, somatoform disorder, neurasthenia and fibromyalgia seem to form a spectrum of disorders, who share a common biological basis, i.e. a reduced activity of the hypothalamus-pituitary-adrenocortical (HPA)-system. This is similar to the situation in Cushing's disease, where the central part of the hypothalamus-pituitary-adrenocortical-system is decreased by an increased feedback via increased intracerebral cortisol concentration. Cushing's disease is accompanied by features of atypical depression and of somatisation. Treatment with hypericum seems to disinhibit the hypothalamus-pituitary-adrenocortical-system in healthy subjects and patients with a depression. Furthermore it decreases intracerebral corticosteroids, possibly by increasing the expression of p-glycoprotein at the blood brain barrier. Therefore hypericum might be especially effective in patients with a symptom cluster of atypical depressive features and somatisation. Clinical studies with patients with depression with atypical features like the seasonal affective disorder (SAD) and with patients with a depressive syndrome accompanied by somatic complaints or fatigue support this view.
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As as aside, I started feeding liquorice extract to all three of my big lads because they had an annoying cough with the slightly dusty hay. One of them had a hard lump under his jaw line abut the size of a large grape, been there for just under 3 years. Within two weeks the lump had softened and then it burst with a most spectacular spurt of puss and some fresh blood.

Coincidence? I don't think so. Useful stuff liquorice. If you have a horse with ulcers it may be worth looking at the deglycyrrhinized (DGL) form of liquorice.
 
interesting post. all horses seem to be different in their acceptance of prascend....mine never went through the veil and is only depressed when her acth levels have increased, once her prascend dose is increased she is back to normal and she doesn't seem to have any side effects and luckily has never suffered with laminitis(fingers well and truly crossed!!!!!) hope your ponies continue to do well on their herbs..
 
Thank you for your post. My two have both tested positive but I am monitoring them at the moment, next test in March. My vet reckoned most don't suffer side affects, probably around 10% - but I bet my two will be in that 10%. I will remember this post if I need to start Prascend.
 
A fascinating post, thank you Brucea.
2 of my 4 have Cushings and are on Prascend - I have to say, I have not noticed any depression or lack of appetite so far, but if that changes I will be trying your suggestion.
I hope yours continues to do well. Xx
 
Sprout said:
A fascinating post, thank you Brucea.
2 of my 4 have Cushings and are on Prascend - I have to say, I have not noticed any depression or lack of appetite so far, but if that changes I will be trying your suggestion.
I hope yours continues to do well. Xx
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I had one on pergolide and then Prascend for 6 years, and apart from inappetance for the first couple of weeks, she was completely normal in terms of her outlook on life. My current horse has been on it for 9 months and is grumpy and not eating well but we haven't ruled out other causes. I hadn't heard of depression on pergolide, more so in untreated PPID?
 
The PPID is treated in so far as he has blood tests and is on Prascend and a supportive diet. The depression and somnolence is a side effect of the Prascend or the PPID - or both...
 
If symptoms and side effects persist I would be thinking the dose may be wrong and would probably stop it and reintroduce slowly, at a quarter tablet at a time.
Pergolide is the only thing that can actually slow the progression of Cushing's.
 
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Did that HP. We also did the blood tests. His ACTH was 29 on and 50 off! Yet he is definitely showing all the symptoms of Cushings.

The blood tests are at best a diagnostic indicator - there are horses with very high levels who demonstrate little or nothing in the way of PPID type symptoms.

"Pergolide is the only thing that can actually slow the progression of Cushing's"
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Yes, that's what Boehringer Ingelheim would like us to believe too. ;)

I feel there is the "only tool a hammer" up to a point with PPID. I wonder if there are other PPID like diseases that are getting lumped into PPID. I've considered for a while whether my chap really has PPID or something that has a huge overlap of symptoms with it, but is not PPID. Interesting thought really, would love to talk wiht a real life endocrinologist about all this.
 
There are very, very few drugs to treat Cushings in humans too. Most cases are treated surgically initially, after that there are diagnostic drugs, but very few on the market to treat it.
 
Interesting post thank you. I have one with cushings, she went through the depressed stage when she first started prascend but has since seemed very well on it.

I do agree that PPID could be a 'catch all' diagnosis much like navicular use to be. From my understanding of the disease we see the results of the body not being able to control it's natural steroid efficently. The raised, uncontrolled levels then cause all the syptoms we see, laminitis, coat changes, weight issues, etc, etc. Now surely the reason for the uncontrolled levels could be a number of things? From a tumor/growth in the pituitary gland, to degradation of the dopamine receptors. There could be an overlap of causes but I do believe there could be different causes, for the simple reason every horse seems to have varying degrees of symptoms vs ACTH levels, which could point to the varying degrees of symptoms being symptomatic of the cause? As degradation of the nerve endings upsetting the dopamine response would to my mind be typical for an older horse, things wear out as they get older. But for all those very young horses that are now being diagnosed, could there be something more sinister causing it as you wouldn't expect them to have it through wear and tear?

My horse is a typical age to have the disease at early 20's but has virtually no symptoms (very slight hoof sensitivity was the only symptom), but her levels were very high! Then there are those with low levels but every symptom going...

I may be talking nonesense so feel free to ingnore the waffling above :D.
 
Well interestingly one of the actions of hypericin, a component of St John's Wort, is to reduce the level of glucocorticosteroids in the brain by it's influence on some transport protein whose name I can;t remember.

What we may be seeing in some of these ponies caught in the catch all diagnosis is an increase in the permeability of the blood brain barrier that allows more corticosteroids across. Who knows, but hypericin compound have been shown to significantly reduce the saliva concentrations of cortisol.

What I have noticed is that it needs consistency - the result is sustainable when he gets the herbal fluid extracts twice a day. Once a day is not enough, the absolute dose is less important - 10 or 20 mls, but the frequency is.
 
brucea said:
What I have noticed is that it needs consistency - the result is sustainable when he gets the herbal fluid extracts twice a day. Once a day is not enough, the absolute dose is less important - 10 or 20 mls, but the frequency is.
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I guess very few (if any) companies are doing pharmacokinetic or pharmacodynamic analysis on herbal extracts; but what probably happens is that in the example you give, there is a "quick on/quick off" effect, so that the maximum effect peaks very soon after dosing, and there is a short half life of the product. By dosing twice a day - and in these instances you can usually get away with doing two smaller doses, rather than one larger dose - is that you are getting two smaller peaks, but an overall longer median blood concentration.

However, until someone starts actual testing, on standardized products, it is all guess work.
 
Also the nature of the endocrine system is that any upset in the balance takes time to re-adjust (it's in my opinion why some horses have this depressed state whilst the body gets the balance of cortisol/ dopamine back in a regular level). So keeping the levels stable works much better that letting them swing from one extreme to another.
 
However, until someone starts actual testing, on standardized products, it is all guess work
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There is an interesting aspect to the whole plant approach - using the whole leaf, root, flower, berry rather than the standardised extracts. They are often more effective and don;t have the side effects that the "standardised" extract does.

For example the current scare over the PA's (pyrolizidine alkaloids) in standardised hypericum, nit a problem with the whole fluid extracts (been tested, got the email from my supplier)

Meadowsweet for example is a great component in a mix for ulcers, but the product derived from it Asprin has well known implications for ulcers...

Been lots of testing of standardised Hypericum for human cushings treatment.
 
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