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December 31, 2001
Q
"My son has grown up with my alcoholic second husband. He has
been victimized in more ways that I care to mention. Can he come
through this or is he at risk for anything in adulthood?"
A
Adverse childhood events, from abuse to incarceration of a family
member, strongly influence the risk of suicide attempts throughout a
person's life span, according to study results reported in the
December 26th issue of The Journal of the American Medical
Association.
Adverse childhood experiences included frequent
emotional abuse, frequent physical abuse, any sexual abuse, other
domestic violence, a household member who abused drugs or alcohol, a
household member with mental illness or depression, parental
separation or divorce, or incarceration of a household member.
For every increase in the adverse childhood experience score,
the risk of suicide attempts increases by about 60%.
Other nurturing relationships, fortunate life events, or
neurobiological developmental strengths confer protection against the
self-destructive, depressive thought patterns that often accompany adverse
childhood experiences.
JAMA
2001;286:3089-3096,3126-3127.
December 17, 2001
Q
"We seem to know so little about Alzheimer's Disease. Since it
is a brain disorder, does a person's amount of education effect the
disease?"
A
A low level of education is
associated with an increased incidence of Alzheimer's disease (AD)
and dementia among elderly individuals, according to the results of
a Swedish study. However, mortality rates attributed to these
disorders appear to be unaffected by years of schooling,
investigators report in the December issue of the Archives of
Neurology.
An educational level of less than 8 years was
associated with increased incidence of AD and dementia, for which
the relative risks were 2.6 and 1.7 compared with individuals with
at least 8 years of education. The relationship was stronger among
women than men, and among those ages 75 to 84 years old than among
those 85 years old and older.
The incidence of dementia was not significantly different for
individuals with a high school versus a university education. Nor was
educational level below 8 years associated with mortality from AD or dementia.
The study supports the "cognitive reserve hypothesis," in
which individuals with higher educational attainment cope with advanced
pathologic changes of dementia more effectively by maintaining function longer
than their less educated counterparts. They admit, however, that their findings
could also be due to detection bias.
Arch Neurol 2001;58:2034-2039.
December 10, 2001
Q
"Are there medications that reduce the symptoms of
posttraumatic stress disorder?."
A Treatment
with paroxetine (Paxil, GlaxoSmithKline) improves the three main
symptom clusters associated with chronic posttraumatic stress
disorder (PTSD) and decreases concomitant impairment and depression,
according to results of a multi-site trial.
Traumas studied included physical or sexual
assault, witnessing injury or death, serious accident or injury, and
combat. Average time since the index trauma was 15.7 years.
Impairment was judged to be moderately severe to severe.
Among the 64% of subjects who completed the 12-week study,
improvements in reexperiencing the trauma, avoidance/numbing, and hyperarousal
were significantly greater for those taking paroxetine compared with those
taking placebo. Those receiving the active drug also scored better on the
Treatment Outcome PTSD Scale, the Sheehan Disability Scale, and the Montgomery-Asberg
Depression Rating Scale.
"Outcomes did not vary according to patients' gender, trauma
type, time since onset of trauma, or the severity of PTSD or depressive symptoms
at baseline.
Another selective serotonin reuptake inhibitor, sertraline
hydrochloride, was approved by the US Food and Drug Administration for the
treatment of PTSD in 1999.
Am J Psychiatry
2001;158:1982-1988.
December 3, 2001
Q
"Does Ritalin really help my son aside from calming him down?
He has ADHD."
A
Methylphenidate
enhances the ability of children with attention deficit
hyperactivity disorder (ADHD) to coordinate the performance of
multiple tasks, according to a report in the November issue of the
Journal of the American Academy of Child and Adolescent
Psychiatry.
"The medication selectively enhanced the children's
ability to rapidly and accurately switch between tasks and to focus
attention on the currently relevant response set," write Arthur F.
Kramer, PhD, a professor of psychology at the University of Illinois
at Urbana-Champaign, and colleagues.
While on and off medication, 20 children with ADHD, ages 8-14,
were tested on their ability to switch between two different tasks,
discriminating the value of a number presented on a computer screen and deciding
how many numbers were present on the screen. As a control, the children also
performed each task individually.
When medicated, the children were faster and more accurate in
single tasks, were better at ignoring incorrect responses, and were better able
to switch from one task to another.
"This study helps to elucidate the nature of methylphenidate
effects on the cognitive processes which support the ability to coordinate the
performance of multiple tasks," the authors write. "Medication appears to
selectively enhance inhibitory processes which support task-switching."
November 26, 2001
Q
"My girlfriend is pregnant with our baby. She continues to use
cocaine. She reads this website. Can you tell her some of the risks?"
A
Infants born to cocaine-using
mothers show decreased heart rate variability during the first days
of life, according to a report in the November 15th issue of the
American Heart Journal.
Such infants "have a 3- to 8-fold increase in
sudden infant death syndrome...and...may be attributed to abnormal
autonomic function."
Compared with the two control groups, infants exposed to
cocaine had an overall significant decrease (p < 0.05) in global heart rate
variability. The investigators also note that heavily cocaine-exposed infants
had lower vagal heart rate parameters than other infants.
They add that "whether low heart rate variability is a marker
for increased risk of sudden death in infants (as it is in adults with
structural heart disease) is unknown.
Am Heart J 2001;142:828-832.
November 19, 2001
Q
"Can my having one of the herpes viruses result in mental
problems for my unborn child?"
A
Elevated maternal levels of IgG
and IgM, as well as antibodies to herpes simplex virus type 2
(HSV-2) prior to delivery, increase the risk of psychotic illness in
adult offspring, according to an analysis of data from the
prospective Collaborative Perinatal Project.
A series of restricted analyses showed that the
association between elevated antibodies and psychosis were not the
result of the mother's socioeconomic status, history of psychiatric
treatment, weight gain, or level of cigarette smoking. None of the
offspring who developed a psychotic disorder had evidence of
encephalitis or another major neurological abnormality apparent at
birth.
The investigators suggest that the potential relationship
between HSV-2 infection and psychosis in adult offspring is plausible given the
tropism of HSV-2 for the infant central nervous system and previously reported
instances of psychosis onset following HSV encephalitis.
Arch Gen Psychiatry
2001;58(11):000-000
November 12, 2001
Q
"How about a brief overview on depression. My family doctors
tells me that I am depressed, but I am not sad...I think he is
wrong."
A Everybody feels
sad at times, but depression is more than just sadness or grief. It
is a condition that affects not only your moods, but also your
thoughts, behavior, and physical health. A person is clinically
depressed if he or she has at least five of the following nine
symptoms -- including at least one of the first two -- most of the
time for at least two weeks:
- Depressed mood -- feeling sad, tearful, helpless, or hopeless.
- Loss of interest or pleasure in daily activities that you used
to enjoy.
- A decreased or increased appetite, with a weight loss or gain
of more than 5% of your normal weight.
- Sleep disturbances -- either sleeping too much or having
difficulty sleeping.
- Agitation or slowed movements. A person with depression may be
agitated, restless, and irritable -- or may move and speak slowly
without showing much emotion.
- Fatigue or loss of energy.
- Low self-esteem -- feelings of guilt or worthlessness.
- Difficulty thinking clearly or concentrating.
- Thoughts of death or suicide.
Other symptoms may include anxiety, constipation, and aches and
pains (such as headaches, backaches, or stomach aches). Depression often runs in
families, and some people may have a genetic susceptibility. Many experts
believe that a combination of genetic and environmental factors can cause an
imbalance in brain chemicals that results in depression. In some cases,
depression may be a symptom of a chronic illness. Long-term use of certain
medications -- including some blood pressure medications, sleeping pills, and
birth control pills -- can cause depression. Alcoholism, smoking, and other drug
abuse also can contribute to depression. The main types of depression include
the following:
- Major depressive disorder (MDD). This type of depression may be severe
enough to prevent a person from functioning well at work or socially. Symptoms
may include overwhelming feelings of sadness, loss of interest in activities
that are normally enjoyed, feelings of guilt or worthlessness, poor sleep,
fatigue, difficulty concentrating, and suicidal thoughts or behavior.
- Dysthymia. This type of depression is less severe but more continuous than
MDD -- lasting at least two years. The symptoms usually aren't disabling, but
having dysthymia puts a person at risk for MDD and suicide.
- Bipolar disorder. In this disorder -- previously called manic-depressive
disorder -- the person has episodes of both depression and elation (mania).
During an episode of mania, a person may have increased creativity or
productivity; however, judgment is impaired so that the person may get into
trouble by making unwise decisions.
- Seasonal affective disorder (SAD). This type of depression is related to
decreased light exposure during the winter months. The depression lifts as the
days grow longer.
Medications used to treat depression include the following:
- Selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil,
Zoloft, and Celexa.
- Tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor),
and desipramine (Norpramin).
- Monoamine oxidase inhibitors (MAO inhibitors) such as phenelzine (Nardil)
and tranylcypromine (Parnate). These drugs can cause potentially serious
interactions with certain other medications and foods and therefore are
usually not the drugs of first choice.
- Other antidepressants such as trazodone (Desyrel), Effexor, and Wellbutrin.
- Mood stabilizers such as lithium (Eskalith or Lithobid), valproate (Depakene
or Depakote), and carbamazepine (Tegretol). These drugs are most commonly used
to treat bipolar disorder.
Although all the antidepressants are effective, individual
people may respond differently to different drugs. In choosing an
antidepressant, your doctor will take into consideration the match between your
symptoms and the medication's side effects. For example, if you have trouble
sleeping, a sedating antidepressant (such as one of the tricyclics) may be best
for you. On the other hand, if you feel sluggish most of the time, then a more
energizing antidepressant (such as one of the SSRIs) may be more helpful.
November 5, 2001
Q
"If my son is treated with Ritalin, I have been told that he is
more likely to develop a drug abuse problem later in life."
A
Children with attention deficit
hyperactivity disorder (ADHD) are less likely to become substance
abusers if they receive treatment with a stimulant such as Ritalin.
The findings of this meta-analysis were the
opposite of some of the concerns expressed, which have been that
children are more at risk of substance abuse if they get stimulant
treatment for ADHD.
Pooled data showed that children with ADHD who received
stimulant treatment for their disease were half as likely as the others to
develop a substance-use disorder in adolescence or adulthood.
These findings showed that if you treat any depression and
ADHD that is present in adolescents who are substance abusers, their status
improves and their substance abuse declines.
October 28, 2001
Q
"Depression after heart attack is associated with increased
risk of dying, is it not? How does that happen?"
A
Autonomic dysfunction as reflected
by reduced heart rate variability may be the mechanism by which
depression increases the risk for cardiac mortality in post-MI
patients, investigators report in the October 23rd issue of
Circulation.
Tapes from ambulatory ECG monitoring were analyzed
for heart rate variability (HRV), which the investigators point out
is "a widely used method for studying cardiac autonomic modulation."
Results showed that patients with depression exhibited significantly
lower log-transformed indices of HRV than did their nondepressed
counterparts.
After adjusting for age, sex, diabetes, and current cigarette
smoking, depression remained significantly associated with three of four indices
of heart rate variability.
Depression is responsible for the lower HRV. As a result, it's
more likely that lower HRV may explain most if not all of the effects of
depression on mortality.
Circulation 2001;104:2024-2028.
October 21, 2001
Q
"I read that breast feeding can help with the depression that
some women have after childbirth?"
A
While
breast-feeding during postpartum depression may be emotionally
gratifying and promote faster maternal recovery and mother-infant
bonding, effects of antidepressant medication in breast milk could
be problematic.
Now a new study provides some reassurance that it is
safe to administer SSRIs to breastfeeding women with depression.
According to a study in the October issue of The American
Journal of Psychiatry, mothers taking sertraline can
breast-feed without significantly affecting serotonin (5-HT)
transport in their infants.
These data suggest substantial blockade of the platelet 5-HT
transporter in mothers receiving sertraline, but not in their nursing infants.
"In most cases, the effects on infant uptake [of 5-HT] are
negligible; the effects that may occur in infants appear substantially smaller
than the effects seen on maternal uptake," the authors write. They recommend
additional research on the safety of sertraline on breast-feeding and on the
effect of other SSRIs.
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October 15, 2001
Q
"I tell my wife that she worries so much about conceiving a
child that her stress is working against her. She says there are no
data to support that believe. Can you provide me with some?"
A
The success of infertility treatments may depend on minimizing the
worries and fears of women who undergo these procedures, according
to the results of a new study in the October issue of
Fertility and Sterility.
Women who were optimistic that the treatment would
work were more likely to give birth. In fact, women with the highest
levels of stress were 93% less likely to deliver an infant by the
end of the 5-year study compared with their more relaxed peers.
"This research determined that success rates for in vitro
fertilization (IVF) or gamete intrafallopian transfer (GIFT) may, in part, be
related to psychological stress."
Women who reported the highest stress levels at the outset had
fewer eggs retrieved and fertilized, compared with women who expressed optimism
that they would become pregnant. Stressed women also had fewer embryos
transferred into their wombs, the researchers report.
Women who reported feeling angry, hostile or depressed had
fewer eggs to fertilize and fewer embryos to transfer.
The infants of women who felt "guilty" for considering
stopping fertility treatment had infants with lower average birth weights and
women who said that they "would do anything for a child" were five times more
likely to have a multiple birth.
While stress showed negative effects in this study, the
findings can also be seen in a positive light since optimism was linked with
greater success.
Fert Steril 2001;76:675-687.
October 8, 2001
Q
"Do people commonly become depressed
after a heart attack and does this contribute to more heart
attacks?"
A
There is some preliminary evidence suggests that drug treatment of
heart attack survivors does lower the risk of subsequent cardiac
events.
Depressed patients die from cardiac disease at a
much higher rate. Mounting evidence indicates that depression
earlier in life, before the onset of heart disease, predisposes
individuals to cardiovascular or cerebrovascular disease. This may
be due to depression's effect on platelets and other risk factors."
The antidepressants referred to as SSRI's,
selective serotonin reuptake inhibitors, not only treat depression
but also have a very strong antiplatelet effect. They may be better
at reducing platelet clustering than aspirin, and might reduce
cardiac mortality but not by virtue of the fact that you are
treating depression, but by virtue of the fact that you are giving a
potent anticoagulant in the post-heart attack period."
October 1, 2001
Q "Is
stress related to back problems. My husband is under terrible work
stress, and his back pain seems to be getting worse?"
A
People in their early 20s who have high levels of psychological
stress are at increased risk of developing low back pain in their
early 30s. Smoking also has a modest independent effect on the
likelihood of low back pain.
The researchers caution that further prospective
data are needed to confirm the findings "before implications for low
back pain prevention can be assessed." However, there are literature
reports that support the "biological plausibility" of the
relationship between psychological stress and physical pain, Dr.
Power's group notes. "In particular, it is suspected that perception
of lack of well-being operating through the
hypothalamic-pituitary-adrenal axis and the sympatho-adrenal
medullary axis alters muscle tone and function, leading to a
predisposition to injury. "
Am J Public Health
2001;91:1671-1678.
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