Antidepressants May Increase Risk of Stroke or Death in Postmenopausal Women

“The Women's Health Initiative (WHI) of the National Institutes of Health followed more than 160,000 postmenopausal U.S. women for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.”

The researchers collected data from 136,000 participants that were not taking antidepressant medications when they first began the study. It was noted during their first follow up between one and three years later that roughly 5,500 of those women had begun taking antidepressants. “The research team compared that group's subsequent history of cardiovascular disease with that of participants who had not started taking antidepressants.”

Results showed that the women taking antidepressants had a small, but statistically significant increased risk of stroke and/or death compared to participants declaring that they were not taking antidepressants.

Lead author, Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, explains that although it is necessary to treat depression because it is a serious illness, it is equally important for older women to discuss their treatment options with their physician before committing to one because of the various risks involved.

The DSM IV defines depression as experiencing feelings of sadness, helplessness and hopelessness. It is a state of low mood and aversion to activity. Episodes of depressed mood are a core feature in various psychological disorders.

Some symptoms of depression can include:

• Anxiety
  
• Sleep disturbances
  
• never seem to be enough
  
• dullness
  
• chronic sadness never seeming to end
  
• obsessions
  
• shakiness when feeling most down
  
• mood swings

Medications used to treat depression:

Tricyclic antidepressants

• Amitriptyline
  
• Imipramine
  
• Nortriptyline
  
• Desipramine

Side effects: Fatigue, dry mouth, blurred vision, light-headedness

Selective serotonin-reuptake inhibitors (SSRI)

• Fluoxetine
  
• Fluvoxamine
  
• Sertraline
  
• Paroxetine

Side effects: Nausea, gastrointestinal upset, sleep disturbances, headache, agitation

Reversible inhibitors of monoamine oxidase:

• Moclobemide

Side effects: Insomnia, headache, constipation

5-HT2 antagonists:

• Nefazodone

Side effects: Fatigue, light-headedness, nausea, headache

Serotonin-norepinephrine reuptake inhibitors:

• Venlafaxine

Side effects: Nausea, agitation, sweating

MAOIs (monoamine oxidase inhibitors):

• Phenelzine (Nardil)
  
• Tranylcypromine (Parnate)
  
• Isocarboxazid (Marplan)
  
• Selegiline (Emsam)

Side effects: Drowsiness, Constipation, Nausea, Diarrhea, Stomach upset, Fatigue, Dry mouth, Dizziness, Low blood pressure, Light-headedness, Decreased urination, Decreased sexual function, Sleep disturbances, Muscle twitching, Weight gain, Blurred vision, Headache, Increased appetite, Restlessness, Shakiness, Trembling, Weakness, Increased sweating

“Depression is a known risk factor for cardiovascular disease and premature death, and one of the reasons that tricyclic antidepressants are used less frequently is their potential for negative effects on heart function. Selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot-related cardiovascular disorders.”

Although no relationship was established between antidepressant use and heart disease, follow-up appointments nearly six years later indicated that participants using antidepressants had an increased risk of death and those treated with SSRIs had an increased risk of stroke.

Even though results seem frightening it seems to me that further investigation is needed as there are several problems with this study. The researchers have not distinguished whether the problem really lies within the link between antidepressants and cardiovascular disease or depression itself and cardiovascular disease. Prior studies will show that depression has risks that are just as high as those who use antidepressants in this study. If anything, the study may indicate that treatment with antidepressants could exacerbate those risks. After careful review of this study, it seems difficult to place blame on antidepressants, but more could be revealed with further investigation.

Additionally, the study does not specify whether these women were being treated for depression or for anxiety nor is there any indication that lifestyle factors such as stress, smoking or diet have been accounted for. Furthermore, the study is too group-specific; therefore it cannot suggest that results can be generalized to the other populations, such as men or premenopausal women unfortunately.

Despite the lack of concrete evidence, it seems logical that women with cardiovascular risks would benefit from exploring treatment options other than antidepressants, but in the end, for most, the benefits of antidepressants may far outweigh the costs.

Increased Risk of Death, Stroke in Postmenopausal Women Taking Antidepressants, Study Finds
Monoamine Oxidase Inhibitors
Medications for Treating Depression

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No Evidence That Ginkgo Biloba Benefits Cognition

A recent study, Ginkgo Evaluation of Memory (GEM), by Beth E. Snitz, Ph.D., of the University of Pittsburgh, demonstrates that the use of the herbal supplement Ginkgo biloba does not slow the rate of cognitive decline among older adults as construed.

“The randomized, double-blind, placebo-controlled clinical trial included 3,069 community-dwelling participants, ages 72 to 96 years, who received a twice-daily dose of 120-mg extract of G biloba (n = 1,545) or identical-appearing placebo (n = 1,524). The study was conducted at six academic medical centers in the United States between 2000 and 2008, with a median (midpoint) follow-up of 6.1 years. Change in cognition was assessed by various tests and measures.”

In 2000, older adults that had normal to mild cognitive impairment were chosen and observed. The researchers placed the subjects into 3 distinct groups. Some were given a placebo over the 8 year period. Others were given either Ginkgo biloba or the placebo, where their group identity was not disclosed to the participant or the experimenter. The third group was randomly assigned to either of the groups. Double-blind studies are said to achieve greater scientific rigor than other types of research. The conclusion of this double-blind study is that Ginkgo biloba is not effective in reducing the incidence of Alzheimer dementia or dementia in general. In addition, no evidence was found to support any effects on memory, language, attention, visuospatial abilities and executive functions. Furthermore, no differences were detected through age, sex, race, education or baseline cognitive status.

Basically, no evidence was found to support the widely marketed fact that Ginkgo biloba slows the rate of cognitive decline.

What is Ginkgo Biloba?

Ginkgos are very large trees, normally reaching a height of 66–115 feet, with some specimens in China being over 50 m. The tree has an angular crown and long, somewhat erratic branches, and is usually deep rooted and resistant to wind and snow damage. A combination of resistance to disease, insect-resistant wood and the ability to form aerial roots and sprouts makes ginkgos long-lived, with some specimens claimed to be more than 2,500 years old. Extreme examples of the Ginkgo's tenacity may be seen in Hiroshima, Japan, where six trees growing between 1–2 km from the 1945 atom bomb explosion were among the few living things in the area to survive the blast. While almost all other plants and animals in the area were destroyed, the ginkgos, though charred, survived and were soon healthy again. The trees are alive to this day.

Extracts of Ginkgo leaves contain flavonoid glycosides and terpenoids and have been used pharmaceutically. Ginkgo supplements are usually taken in the range of 40–200 mg per day. Ginkgo has many alleged nootropic properties, and is mainly used as a memory and concentration enhancer, and an anti-vertigo agent. According to some studies, in a few cases, Ginkgo can significantly improve attention in healthy individuals. Allegedly, the effect is almost immediate and reaches its peak in 2.5 hours after intake.

Ginkgo has been used for…

• Alzheimer's disease
  
• Improving blood flow
  
• Protecting against oxidative cell damage
  
• Blocking the effects of platelet-activating factor (platelet aggregation, blood clotting)
  
• Intermittent claudication
  
• Easing the symptoms of tinnitus
  
• Improving cognition and fatigue in those with multiple sclerosis
  
• Arresting the development of vitiligo

Ginkgo may have undesirable effects, especially for individuals with blood circulation disorders and those taking anticoagulants such as ibuprofen, aspirin, or warfarin. Ginkgo should also not be used by people who are taking certain types of antidepressants (monoamine oxidase inhibitors and selective serotonin reuptake inhibitors) or by pregnant women, without first consulting a doctor.

Side effects can include…

• possible increased risk of bleeding
  
• gastrointestinal discomfort
  
• nausea
  
• vomiting
  
• diarrhea
  
• headaches
  
• dizziness
  
• heart palpitations
  
• restlessness

Other precautions…

Ginkgo biloba leaves contain long-chain alkylphenols together with the extremely potent allergens, the urushiols (similar to poison ivy). Individuals with a history of strong allergic reactions to poison ivy, mangoes, and other urushiol-producing plants are more likely to experience an adverse reaction when consuming Ginkgo-containing pills, combinations, or extracts.

The nut-like gametophytes inside the seeds are particularly esteemed in Asia, and are a traditional Chinese food. When eaten by children, in large quantities (over 5 seeds a day), or over a long period, the raw gametophyte (meat) of the seed can cause poisoning by MPN (4-methoxypyridoxine).

Bottom line...

It is very important to remember that herbal supplements are not regulated by the FDA in the US and Canada’s regulation of such health products is quite often confusing and inconsistent. Therefore, personal responsibility is essential when relying on this type of treatment.

Ginkgo Biloba Does Not Appear to Slow Rate of Cognitive Decline

Wikipedia

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Ecstasy May Cause Sleep Apnea In Healthy Young Adults

New research from Johns Hopkins University suggests that ecstasy, or methylenedioxymethamphetamine (MDMA) use increases the risk of developing sleep apnea among healthy young adults.

What is ecstasy?

Ecstasy is a synthetic drug that causes both hallucinogenic and stimulant effects. It was developed in Germany in the early twentieth century as an appetite suppressant, but today it is consumed for its hallucinogenic and stimulant effects.

Who uses ecstasy?

Most MDMA users are teenagers or young adults. More than 10% of high school seniors have tried MDMA at least once, and more than 2% have used the drug in the past month, according to the University of Michigan's Monitoring the Future Survey. MDMA users typically come from middle- and upper-class households. MDMA is inexpensive. The average retail price of an MDMA tablet is between $20 and $30 making it attractive and accessible to younger users.

What are the potential risks of ecstasy use?

The effects produced by consuming MDMA can last for 4 to 6 hours, depending upon the potency of the tablet. Using the drug can cause confusion, depression, anxiety, sleeplessness, craving for the drug, and paranoia. Use of the drug also may result in muscle tension, involuntary teeth clenching, nausea, blurred vision, tremors, rapid eye movement, sweating, or chills. People who have circulatory problems or heart disease face particular risks because MDMA can increase heart rate and blood pressure.

What is Sleep Apnea?

Clinically significant levels of sleep apnea are defined as five or more episodes per hour of any type of apnea. There are three distinct forms of sleep apnea: central, obstructive, and complex (a combination of central and obstructive). Breathing is interrupted by a lack of respiratory effort in central sleep apnea, while breathing is interrupted by a physical block to airflow despite respiratory effort in obstructive sleep apnea. In complex (or "mixed") sleep apnea, there is a transition from central to obstructive features during the events themselves.

Obstructive sleep apnea is a serious breathing problem that interrupts your sleep. It means you have short pauses in your breathing when you sleep. These breathing pauses – called apneas or apnea events – last for 10 to 30 seconds or longer. People with obstructive sleep apnea can stop breathing dozens or hundreds of times each night.

Obstructive sleep apnea (also called OSA or obstructive sleep apnea-hypopnea syndrome) stops you from having the restful sleep you need to stay healthy. If it’s not treated, sleep apnea can lead to major health problems, accidents, and early death.

The two main symptoms of sleep apnea are:

• You’re very sleepy during the day, but you don’t know why.
  
• You snore and have pauses in your breathing while sleeping.

Some other signs and symptoms of sleep apnea are:

• You have high blood pressure.
  
• You’re irritable.
  
• You gasp or choke during sleep.
  
• You’re very tired (you have fatigue).
  
• You’re depressed.
  
• You can’t concentrate.
  
• You have morning headaches.
  
• You have memory problems/ memory loss.
  
• For men: you have impotence (difficulty keeping an erection).

How is Sleep Apnea treated?

The best treatment for obstructive sleep apnea is continuous positive airway pressure (C.P.A.P.). CPAP is the first choice treatment for all mild and moderate sleep apnea. It's the only effective treatment for severe sleep apnea.

If you have mild or moderate sleep apnea, your doctor may recommend one of these alternate treatments instead of CPAP:

• Making lifestyle changes: losing weight, avoiding alcohol and sedatives
  
• Dental appliances
  
• Surgery, including tonsillectomy and UPPP (uvulopalatopharyngoplasty)

Sleep apnea can lead to various health problems such as diabetes, heart disease, neurological problems, cognitive deficits, impulsive behaviour and altered brain wave patterns during sleep.

This study included 71 MDMA users that were recruited from newspaper and flyer ads seeking “club drug users”. The MDMA users had all used at least 25 times in their past. This amount appears to be significant enough to cause lasting effects on serotonin levels. Researchers also recruited 62 participants with similar patterns of illegal drug use. All of the volunteers were physically and psychologically healthy and had abstained from using for at least 2 weeks prior to participating in the study.

During the study subjects were hooked up to various machines that measured breathing such as air flow monitors in the nose and mouth and bands around the chest and abdomen.

“The researchers diagnosed sleep apnea by counting the rate of incidences of shallow or suppressed breathing, with mild apnea requiring five to 14 of these incidences, moderate apnea requiring 15 to 29, and severe apnea requiring 30 or more.”

Results of mild sleep apnea were similar in both groups where 15 MDMA users and 13 of the control group were affected. There were 8 MDMA users that had moderate sleep apnea and one had the most severe form of the disorder. Most shocking is that of the 24 with sleep apnea, 22 were 31 years of age or younger. The control group had no participants that fell into the moderate or severe forms of this disorder. In addition, it seems the amount of MDMA use is associated with the severity of sleep apnea as those who had used more in the past had more severe forms of the disorder.

“Though the researchers suspect that the cause for the MDMA users' sleep apnea centers on affected serotonin neurons, the exact mechanism remains a mystery. McCann explains that these neurons appear to help sense blood oxygen levels, control airway opening and generate breathing rhythms. Any of these pathways could be separately influenced by ecstasy use, she says.”

Ecstasy Use May Lead to Sleep Apnea: Illegal 'Club Drug' Poisons Neurons Involved in Control of Breathing during Sleep

Sleep Apnea

Canadian Lung Association

National Drug Intelligence Center

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Paraskevidekatriaphobia: Fear of Friday the 13th

“It’s called paraskevidekatriaphobia: a morbid or irrational fear of Friday the 13th. It's believed that as many as 25 million Americans will change their behavior today because of superstition: They’ll stay away from shopping malls and won't set foot on airplanes. The cost of all this fear comes close to $800 million per day in lost business, according to the Stress Management Center and Phobia Institute in North Carolina.”

The word is derived from three Greek words: paraskevi meaning Friday, dekatrels meaning thirteen and phobia, which means fear. From a mental health perspective, a phobia is an intense irrational fear of objects, events or situations.

Friday the 13th appears to be safer than any other typical Friday according to Dutch researchers with the Center for Insurance Statistics as results show that traffic accidents, fires and thefts seem to be fewer on these superstitious days.

A “Finnish study in 2002 found that women have a 63 percent greater risk of dying in traffic accidents on that date.” It seems the reasoning behind this statistic is that a fear that something bad will happen actually increases the likelihood that a person will crash. The British Medical Journal studied traffic accidents on Friday the 6th versus Friday the 13th and concluded that “The risk of hospital admission as a result of a transport accident may be increased by as much as 52 percent. Staying at home is recommended.”

University of California Professor David Phillips has found no significant increase in deaths on Friday the 13th when analyzing death certificates. He did, however, notice an increase of deaths among Americans of Japanese and Chinese ancestry on the 4th of every month. The number 4 is considered an unlucky number among the Chinese and Japanese as this number sounds almost exactly like the word death in Mandarin, Cantonese and Japanese. “Across the United States, he found 13 percent more Asian American cardiac-related deaths on the fourth than expected. In California, where these populations are concentrated, he discovered 27 percent more deaths“.

If anything people should fear those who are superstitious instead of the superstition itself. Results seem to suggest that it might be best to avoid people with paraskevidekatriaphobia as their fear may be the very cause of their own misfortunes.

Should you be afraid of Friday the 13th?

Friday the 13th

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Military in Dire Need of Mental Health Professionals

The recent tragedy in Fort Hood illustrates the dire need for mental health professionals in the military. “More than two years after the nation's political and military leaders pledged to improve mental-health care, their promises have fallen short at military hospitals around the country, according to mental-health professionals, Army officials, and wounded soldiers and their families.”

This deficiency in staffing escalates all the way the very top where Ellen Embrey can be found temporarily fulfilling the position of assistant secretary of defense for health affairs. Many of her colleagues seem to lack confidence in her ability to improve health care in the military.

In addition, the principal deputy, the deputy for clinical programs and policy, and the chief financial officer post are currently vacant. These vacancies clearly need to be filled as the suicide rate among soldier continues to increase. So far there have been 117 soldiers that have committed suicide this year; already an increase from last year’s total of 103 soldiers.

Despite the clear shortage of appropriate professionals managing the health care in the military, the Pentagon press secretary, Geoff Morrell, insists that more assistance is being offered than ever before. The problem lies in the way in which this help is communicated to those in need.

“Some 34,000 soldiers have been diagnosed with post-traumatic stress disorder since 2003, according to the Army surgeon general's office.” The amount of attention given to the mental health of soldiers has certainly increased since the Walter Reed scandal, where a series of allegations against the facility had been made because of unsatisfactory conditions and management.

Since then, the number of mental health professionals are said to have increased as well. According to the Washington Post, “200 behavioral-health personnel are deployed in Iraq and 30 in Afghanistan. The military has also hired 250 additional behavioral-health providers and more than 40 marriage and family therapists in recent months. The Army currently has 408 psychiatrists for its force of 545,000 people.” Walter Reed Army Medical Center, the facility that interned Major Nidal Malik Hasan, has increased their staff by 35% since 2007. That being said, do the numbers add up? Is there sufficient mental health staff available to treat 34,000+ soldiers with PTSD, not to mention the soldiers that may be dealing with other types of mental illness?

Due to such a shortage, many patients are stuck with whatever service they can get. Joe Wilson, a former social worker at Walter Reed, claims that soldiers have no choice but to stick with the psychiatrist they’ve been appointed because a switch could only make matters worse by delaying the determination of whether a soldier should remain in the service or not. This could force patients to keep quiet about poor or unsatisfactory service out of fear they may be deployed.

Not only are patient/doctor relationships somewhat of a dilemma, but many soldiers may have no choice but to accept pharmaceutical treatment because of the persistent shortage of mental health professionals available to treat the military. This leaves most soldiers with post traumatic stress disorder to be treated with medication such as sleeping pills and mood-altering drugs instead of one-on-one therapy.

The wife of an amputee soldier recovering at Walter Reed with traumatic brain injury and PTSD said that mental-health services are so uncoordinated and ineffective that the couple decided to pay for private psychotherapy sessions with a civilian provider at $130 an hour.

The couple sought private treatment elsewhere after spending a few minutes with a Walter Reed psychiatrist, who then referred the soldier to a social worker for treatment.

"It was a joke," said the wife, who asked not be identified because her husband, a sergeant, is still recovering at Walter Reed. "She was a lovely person, but we have a serious problem here and she just didn't get it . . . She essentially directed me to a Web site."

Many soldiers with mental illness may feel ignored in comparison to physically wounded soldiers. Sophia Taylor, a patient at Walter Reed that is currently being processed for dishonorable discharge, claims that amputees get treated, but those with mental illness lack appropriate treatment. “I have a lot of respect for them. But I lost my mind, and I couldn't even get a simple 'thank you for your service.' "

At Walter Reed, a palpable strain on mental-health system

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The Brain Can Distinguish Religion From Fact

Lead author, Sam Harris, professor of psychiatry at the UCLA Staglin Center for Cognitive Neuroscience, and co-lead author, Jonas Kaplan, research assistant professor at the USC's Brain and Creativity Institute, performed the first neuroimaging study to systematically compare religious faith with ordinary cognition.

The study has demonstrated that our brains respond differently to religious and nonreligious statements, however the information seems to get processed in the same brain regions. In other words, our judgement on the truthfulness of religious statements occurs within the same brain regions, despite whether we believe or not.

The study included 30 adult subjects, in which half were devout Christians and the remaining half were non-believers. All subjects judged the reliability of religious and non-religious statements while undergoing three functional MRI (fMRI) scans. The statements used were certain to generate agreement in both groups.

The ventromedial prefrontal cortex (VMPFC), a brain region said to be involved with reward and judgements of self-relevance, showed increased activity when evaluating statements related to beliefs in God, the Virgin Birth and ordinary facts.

However, religious thought appears to be more associated with areas of the ventromedial prefrontal cortex that govern emotion, self-representation and cognitive conflict in both believers and nonbelievers.

Conversely, our thoughts about ordinary facts seem more reliant upon areas associated with memory retrieval. This study helps to illustrate that no matter how much or how often religion is forced upon us, our brains still believe that religion is not based on factual knowledge.

Interestingly, “activity in the brain's anterior cingulate cortex, an area associated with cognitive conflict and uncertainty, suggested that both believers and nonbelievers experienced greater uncertainty when evaluating religious statements.”

This research suggests that one day it may be possible to distinguish religious belief versus disbelief via neuroimaging techniques. “These results may have many areas of application — ranging from the neuropsychology of religion, to the use of 'belief-detection' as a surrogate for 'lie-detection,' to understanding how the practice of science itself, and truth-claims generally, emerge from the biology of the human brain." In addition, this type of research could shed new light on the study of cult behaviours.

Where Religious Belief And Disbelief Meet

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GUEST POST: ADHD: Recognizing it, Controversy

ADHD is an extremely common disorder that is characterized by difficulty paying attention, distractibility and hyperactivity. And some say it's even more common than previously thought. For one, it's now believed to be common in adults - not just children - and that a diagnosis of ADHD doesn't always have all the symptoms commonly associated with it.

That means you don't have to be hyperactive to have ADHD, though what you have would then be characterized by ADD, or Attention Deficit Disorder, not Attention Deficit Hyperactive Disorder.

It turns out there are several types of ADHD each with its own criteria. There's the typical hyperactive form and then the inattentive form, characterized by poor attention. And then there's the combined form, which has both. That puts the total at three, but some have argued for the existence of six different types.

There are good and bad aspects to this wider approach. On the one hand, it means that effected adults will greater understand what's going on in their life and potentially get access to treatment. On the other, it's part of a trend that increasingly makes normal human experiences into mental disorders.

After all, it's only human to occasionally feel restless, unable to focus, or distractible. And despite claims of some ADHD proponents, there's still no real test for ADHD like there is for Diabetes. There are diagnostic lists, but ultimately no black and white physical signs of the condition.

Yet there is research being done into this, and the signs seem to be that there is some evidence on a neural level for ADHD. Importantly, ADHD is genetic, meaning it runs in families.

Treatment for ADHD is no simple matter. Although the medications seem to be safe, they are potent stimulants, all of which have been used as street drug. Adderall, for instance, is also popular as "speed." While medications work most of the time, especially when combined with supportive therapy, it's not clear what that means.

Stimulant medications are, after all, also used by college studies to cram for tests. Some say that they would help anyone focus and be less impulsive. Proponents respond that stimulants seem to have a paradoxical calming effect on people with ADHD. Instead of making them hyperactive and energetic, stimulants might calm them down and help them be focused.

Ultimately, everyone is a little ADD. Just like everyone is occasionally a little depressed, a little anxious. It's when the symptoms are serious that treatment is called for.

By line:
Author David Gurevich is a entrepreneur with a love for biology. You can catch him at his site, Health and Life, a Medical Blog where he talks about subjects like Comparing Zoloft vs Prozac.

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