September 25, 2006

Q "When you do not sleep well, do you get depressed. I sleep terribly."

A Depression is associated with sleep disturbance.  However, sleep disturbance caused by breathing disorders can increase the incidence of depression. "Sleep-related breathing disorder (SRBD) has a robust association with depression. For patients with SRBD, Medical treatment (eg, continuous positive airway pressure therapy) or behavioral modification of SRBD (eg, weight loss) may help mitigate or prevent depressive symptoms. There is ignificant dose-response trends of increasing risk of depression with increasing SRBD severity. After adjusting for age and gender, the odds ratio of depression when compared with no breathing disorder was 1.6 for minimal SRBD, 2.0 for mild SRBD, and 2.5 for moderate or worse SRBD. Fully adjusted longitudinal data showed that a two-category transition (for example, from no SRBD to mild SRBD) was associated with an odds ratio for depression of 3.3. The risk of depression was not altered much by adjusting for other cofactors, such as daytime sleepiness or use of benzodiazepines. Nor was the association between the two disorders reflective of specific components of depression. If SRBD is causally related to depression, it seems likely that pathways initiating with cardinal features of SRBD, for example, sleep fragmentation and intermittent hypoxia, are involved."

Arch Intern Med 2006;166:1709-1715.

September 18, 2006

Q "I am wondering if I have panic disorder...I sure am uncomfortable in public."

A That is not likely panic disorder. You are talking about social discomfort. These are quite different, the latter being a common experience and the former being a treatable disorder. 

Nonetheless, you may find this interesting: "... the majority of patients with panic disorder do not receive evidence-based treatment.

Up to 5% of people will experience panic disorder at some point in life. The disorder can result in severe functional limitations and adversely affect quality of life, especially when agoraphobia is also present.

Panic disorder has a significant impact from a societal perspective as well, greatly increasing healthcare usage, absenteeism, and reducing workplace productivity, the report indicates.

Although certain diseases, such as asthma, and various lifestyle factors, like smoking, have been tied to panic disorder, the pathogenesis of the disease is still largely unknown. Genetic factors and early life experiences may also play a role.

Various pharmacologic agents, particularly SSRIs, and cognitive behavioral therapy have proven to be effective treatments for the disorder, but only 19% to 40% of patients receive such evidence-based therapies."

Lancet 2006;368:1023-1032.

September 11, 2006

Q "Don't antidepressants work for almost everyone all the time?  That's what I was told."

A "Chronic major depression seems to be a severe subtype of the illness, associated with earlier onset and greater likelihood of attempted suicide, panic disorder, and substance abuse. It also appears to have a genetic component, manifested as increased risk of chronic major depression among first-degree relatives.

A leading theory for a long time is that genes for neurotransmitters, such as the serotonin system, may play role in depression, but that remains an open question. A more recent hypothesis is that the neurotrophin system -- proteins involved in growth and development of brain cells -- may be impaired. Evidence supporting that theory is that people prone to depression may have a smaller hippocampus.

Chronic illness is defined as being depressed most or all of the time. If the individual feels completely well, it tends not to last terribly long, no more than a couple of months.

Chronic patients were also twice as likely to have a history of attempted suicide compared with episodic patients (31.4% versus 16.9%), and at least one relative with chronic depression (49.1% versus 29.1%). Those with chronic illness were also more likely to have been diagnosed with panic disorder and substance abuse.

The familial clustering of chronicity was stronger for chronically ill with onset before age 13. Relatives had a 48.9% risk of chronic depression compared with15.9% for relatives of pre-teen onset of episodic depression.

In contrast, 34.0% of relatives of subjects with later onset of chronic depression had chronic depression versus 21.5% among those with later onset of episodic depression.

Treatments for depression are good, but any given antidepressant only works about 60% of the time. The key to developing new and better antidepressants is having detailed knowledge of how depression unfolds in the brain and identifying genes related to depression."

Am J Psychiatry 2006;163:1554-1560.
 

September 4, 2006

Q "How come gay people are never anorexic?"

A Actually, quite the contrary: "Sexual orientation may predict future bulimic symptoms. Several large-scale community studies have found people with gay, lesbian, or bisexual sexual orientation to be at elevated risk of numerous psychiatric disorders and symptoms, including suicide attempts, drug use, anxiety, and depression. Several reports have also suggested that eating pathology and weight concerns are more frequent among men with non-heterosexual orientation than those with heterosexual orientation.

Sexual orientation may predict future bulimic symptoms. Several large-scale community studies have found people with gay, lesbian, or bisexual sexual orientation to be at elevated risk of numerous psychiatric disorders and symptoms, including suicide attempts, drug use, anxiety, and depression. Several reports have also suggested that eating pathology and weight concerns are more frequent among men with non-heterosexual orientation than those with heterosexual orientation.

To further investigate, the researcher examined whether sexual orientation predicts bulimic symptoms and whether risk factors, such as thin ideal and poor self-concept, that have been associated with non-heterosexual sexual orientation explain the increased risk.

Same-sex sexual experience predicted bulimic symptoms after 5 years for both sexes. Men who were attracted to the same sex were also more likely than heterosexual men to have bulimic symptoms. These associations remained significant after controlling for initial bulimic symptoms and other potential risk factors.

Non-heterosexual adolescents are at increased risk of bulimia. Although popular explanations, such as thin ideal, body dissatisfaction, and poor self-concept, are associated with both sexual orientation and bulimic symptoms, they do not act as mediators."

Int J Eat Disord 2006;39:448-453.

August 28, 2006

Q "Do people still believe that mood helps with cancer recovery?"

A This may be helpful: "Consistent with prior research on optimism and mental health, a study of women with ovarian cancer undergoing chemotherapy shows that optimism is inversely related to distress and positively associated with health-related quality of life. It is important for health care providers to identify patients who feel less optimistic about life and their cancer and treatment because this population may be vulnerable to distress, diminished quality of life, and suboptimum clinical outcomes. Patients who are less optimistic may benefit from interventions to help them cope with their cancer diagnosis. Women who reported higher optimism about life in general at the start of chemotherapy reported lower concurrent distress (anxiety, depression, and perceived stress) and better concurrent health-related quality of life (social and physical well-being). Women who reported higher optimism about their cancer and treatment also reported lower concurrent distress and better concurrent health-related quality of life (social and functional well-being). Moreover, women who reported higher optimism about life in general at the start of chemotherapy experienced greater declines in their CA 125 levels (cancer antigen 125) during chemotherapy. The association between optimism and CA 125 is plausible given other research linking psychosocial variables to tumor-related markers."

Psychosom Med 2006;68:555-562.

August 21, 2006

Q "Can you tell me a bit about how stress works on the body?"

A  I read this recently: "Reactions to stress affect brain aging via hormonal effects, stress means 'allostatic load,' or the cumulative effect of stress and lifestyle — that is, what we eat, drink, if we smoke, how well we sleep, whether we are physically active — these are determined in part by our life experiences, which include stress and being anxious and worried, under much tension in a job or at home, etc. Effects that we know about include impairment of memory, shrinkage of the hippocampus, impaired glucose utilization. Based on animal models and some human data, the adrenal stress hormone cortisol appears to play an important role in mediating the effects of stress on the brain. The hippocampus, a vital brain region for episodic, spatial, and contextual memory, has many cortisol receptors, which makes it especially vulnerable to stress hormones. Although acute stress seems to enhance immune function and improve memory, chronic stress has the opposite effect and may even lead to disorders that become more prevalent with aging, such as depression, diabetes, and cognitive impairment. Diabetes and obesity are risk factors for cognitive decline and for Alzheimer's disease, as well as for depression, and that comorbidity of diabetes and dementia may first be manifest as geriatric depression. Depressive illness over a long time [years] leads to shrinkage of the hippocampus. The overall lack of physical activity and the epidemic of obesity and diabetes are matters of concern, then, for brain health. The brain may be the most sensitive indicator of chronic stress. A person who has been overexposed to cortisol, due to chronic treatment with high doses of prednisone or excessive duration of experiencing chronic stress, will likely have an atrophied hippocampus. Functionally, this person will likely show deficits in certain types of memory. Disrupted circadian rhythms may also reflect brain aging. Although the brain "clock" efficiently regulates diurnal rhythms of hormonal levels in youth, the aged brain is less efficient in regulating hormonal cycles. The low levels of anabolic hormones or dysregulated levels of cortisol that we often see in the blood of the elderly is likely a reflection of this aged clock losing its sense of timing, in that it now sends the hormone-releasing signals to the body in a more dysregulated way. Aging alone alters most hormonal signals from the brain, leading to lower levels of anabolic hormones, [but] stress can also alter these brain signals, thus speeding up the age-related decline in anabolic hormones. In this way, chronic stress may alter the rate of hormonal aging. With aging, decreased levels of anabolic hormones lead to other age-related changes, such as decreased bone mass, and shifting body composition toward greater fat mass and lower muscle mass. Older people are exposed to more chronic stressors, but they do not necessarily experience greater daily stress. Adaptive coping strategies successfully used by the elderly include finding meaning in life events, strengthening meaningful social ties, and spiritual or religious beliefs. Even in younger individuals, these strategies tend to be linked to more adaptive profiles of hypothalamic-pituiutary axis function (either diurnal rhythm or reactivity) after facing a major stressor."
 

August 14, 2006

Q "What is the current thinking on the relationship, if any, between health and religion?"

A  Faith-based, positive religious resources can help patients recover from cardiac surgery...enhanced hope and perceived social support can protect psychological well-being during stressful procedures and experiences, whereas having negative religious thoughts and struggles may hinder recovery.

"This positive effect was manifest through enhanced hope and perceived social support prior to stressful experiences, such as cardiac surgery. Having negative thoughts and faith-based struggles, which are not limited to patients with a religious faith, were related to poor postoperative recovery.... religiousness probably led to positive religious coping, which in turn led to less psychological distress...As Jung once noted, scientists may have nothing to say about God or creation, yet faith-related phenomena (atheist or theist), as important aspects of human experiences, must be better understood through scientific evidence...acts of positive religious coping were defined as religious forgiveness, seeking spiritual support, collaborative religious coping or fellowship with others who share the same beliefs, spiritual connection, religious purification, and thoughts of religious benevolence. Negative coping styles included spiritual discontent, thoughts of punishing God, insecurity, demonic thoughts, interpersonal religious discontent, religious doubt, and discontented spiritual relations.

Positive religious coping styles had positive effects on both hope and social support, whereas negative styles were inversely related to social support. Perceived social support and hope contributed to less depression and anxiety for postoperative patients who used positive religious coping styles. Negative, but not positive, religious coping styles were also directly related to postoperative distress. Religiousness contributed only to positive, and not to negative, religious coping styles, but there was no direct effect of religiousness on social support, hope, or postoperative distress.

Besides being related to poor postoperative recovery, the negative effect of religious doubts was also manifest through hopelessness and lower levels of perceived social support before stressful experiences such as cardiac surgery...having religious struggles, linked to poor mental health, predicted mortality.

Hope and social support are concepts acceptable to professionals and patients with various belief systems. Faith distinguishes humans from animals and may contribute profound meaning to a patient's life. Through addressing these concerns, professionals may establish a more effective relationship with patients and can help motivate them in coping with disease-related distress....patients' faith can touch a deeper level of their concerns, in contrast to simple manipulation of behavior patterns and regulation of negative emotions and expectations. Findings of this study suggest that integrating faith into mainstream psychology and health research may lead the way to better clinical evaluation and to develop more effective mind-body interventions in the future."

August 7, 2006

Q "Do people with irritable bowel syndrome get depressed, and can antidepressants help them?"

A  This is an interesting finding from a small but encouraging bit of research: "Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants may reduce abdominal symptoms and promote overall well being in patients with irritable bowel syndrome (IBS), independent of their effects on depression.

After three and six weeks of treatment, Celexa significantly improved abdominal pain, bloating, impact of symptoms on daily life, and overall well being compared with placebo.

Celexa's ability to alleviate several IBS symptoms seems unrelated to its effect on depression or anxiety, because depressed patients were excluded from the study and changes in mood did not correlate with IBS symptom improvement.

Celexa provided symptomatic benefit of rapid onset, was well tolerated, and was not associated with the side effects of tricyclic antidepressants, such as drowsiness or constipation.

There may be several mechanisms of action of SSRI antidepressants in IBS. For depressed patients, the antidepressant effect is likely to be important. The most obvious next action is that involving changes in psychological processes, which lead to reduced somatization and a reduced tendency to regard gut sensations as indicative of serious illness.

Gut 2006;55:1065-1067,1095-1103.

July 31, 2006

Q "Can diet and exercise cure Alzheimer's Disease?"

A No, but we may all benefit from several tasks that improve our brain functioning. "Simple lifestyle changes, including memory exercises, daily exercise, relaxation techniques, and a healthy diet, significantly improve cognitive function and brain efficiency in as little as 2 weeks.

In a recent, but small, study 17 healthy volunteers aged 35 to 69 years with mild age-related memory complaints were recruited. Subjects were then randomly assigned to the intervention group, which combined a healthy diet plan, relaxation exercises, cardiovascular conditioning, and mental exercise that included brainteasers and verbal memory training techniques. The control group was simply instructed to maintain their normal routine.

Subjects in the intervention group were told to take brisk daily walks and incorporate daily brief relaxation exercises into their routine. They were also given shopping lists and a menu guide to facilitate a healthy diet plan, which included 5 meals per day high in fruits and vegetables, omega-3 fats, and low-glycemic-index carbohydrates.

Intervention subjects were also instructed to incorporate brainteasers and mental puzzles into their daily routine as well as specific memory training techniques to help focus attention and improve visualization and association skills to improve retention and recall.

Mean baseline subjective and objective cognitive measures did not differ significantly between the 2 groups. However, at follow-up, the intervention group's verbal fluency improved significantly, whereas the control group's did not.

In addition, subjects in the intervention group showed a 5% decrease in left dorsolateral prefrontal activity compared with baseline, whereas the control group showed no significant change in brain metabolism.

The decrease in brain metabolism in participants who followed the healthy longevity program suggests the brain functioned more efficiently and didn’t require as much glucose to perform effectively."

Am J Geriatr Psychiatry. 2006;14:538-545.

July 24, 2006

Q "I read that depression leads to heart attacks. So could not someone just take antidepressants and then not have a heart attack?"

A I am afraid that it is a bit more complex than that.  A recent finding was that: "Patients taking selective serotonin reuptake inhibitor (SSRI) antidepressants before coronary artery bypass grafting (CABG) have a higher risk of long-term post-CABG mortality and rehospitalization.

Depression is increasingly recognized as an independent prognostic risk factor in patients with coronary artery disease and CABG. The use of SSRIs for depression in patients with cardiac disease is becoming more prevalent."

Compared to patients who did not take SSRIs, those on SSRIs were more likely to have diabetes, hypercholesterolemia, hypertension, cerebrovascular disease, peripheral vascular disease, and previous cardiovascular intervention.

After adjusting for baseline differences, the investigators found that patients who took SSRIs had increased risks of mortality, rehospitalization and the composite end point."

Am J Cardiol 2006;98:42-47.

July 17, 2006

Q "Premature babies can have later problems correct, and does this not effect parents as well?"

A Take time to read the following: "An early-intervention program can significantly reduce parenting stress after the birth of a preterm infant.

"Mothers and fathers of preterm infants experience a sustained increase in parenting stress. An intervention program limited in time and costs can reduce this stress to a level similar to parents of term infants.

Researchers evaluated the impact of an early-intervention program based in the Mother-Infant Transaction Program (MITP) program, which also addressed parenting stress in the parents of preterm infants,

The MITP emphasizes the transactional nature of development and tries to enable the parents to appreciate their infant's unique characteristics, temperament, and developmental potential.

Because some studies have shown that parenting stress is a risk factor for later behavioral problems in both preterm and other children, the reduction in parenting stress during the infant's first year of life may potentially be an important factor in reducing long-term behavioral problems in these infantse.

Reduced parenting stress is a benefit for the parents by itself, although the effects on childhood development are still not clear."

Pediatrics 2006;118:e9-e19.

July 10, 2006

Q "Our daughter has had recurrent problems with anorexia, and I now believe that she is abusing drugs?"

A  That is an important concern.  Note this: "Women with eating disorders often abuse amphetamines, cocaine and other illicit drugs. Drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process.

Data suggest that the risk for drug use disorder in women with eating disorders continues over time and should be an ongoing part of assessment for these patients.

Affective (mood) disorder was also very likely to occur in anorexia nervosa and bulimia nervosa with a prospective drug use disorder onset confirms earlier studies linking affective disorders, eating disorders, and substance abuse.

Cocaine, amphetamines, and marijuana were the most commonly abused drugs."

Int J Eat Disord 2006;39:364-368.
 

July 3, 2006

Q "Women can quit smoking easier than men can, right?"

A Please review the following:  "Women metabolize nicotine faster than men -- especially in women taking oral contraceptives, and this could affect women's smoking behavior, as well as their response to nicotine-based quitting aids.

Nicotine clearance rates were significantly higher for women (18.8 mL/min/kg) than for men (15.6 mL/min/kg), the investigators found. The clearance rate was 22.5 mL/min/kg in women who were using oral contraceptives, compared with 17.6 mL/min/kg in those who were not on an OC.

By the same token, mean nicotine half-lives were longest for men (132 minutes), intermediate for women not taking oral contraceptives (118 minutes), and shortest for women taking oral contraceptives (96 minutes), the researchers note. Cotinine half-lives followed a similar pattern.

There appears to be a spectrum of induction of enzyme activity that varies with the level of female sex hormones, progressing (slower to faster) from men and postmenopausal women to premenopausal women not taking oral contraceptives, to women taking oral contraceptives, to pregnant women .

Further research is needed to examine the question of whether oral contraceptive use influences either smoking behavior or intake of tobacco smoke from cigarettes (or both) among women.

Another issue of interest is the optimal dose of nicotine medications to aid smoking cessation. Some studies have shown that "\success rates with nicotine replacement therapies are lower in women than men."

Clin Pharmacol Ther 2006;79:480-488.


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