What if you could find out if a drug would cause you side effects or wouldn’t work at all before you started taking it? That now may be possible for 150 drugs used for depression, cholesterol, heart disease and pain through a swab of the cheek as part of a genetic test.
The test, which costs about $266, is called the mygeneRx. It was developed by a South African company, DNAlysis. It works by examining genetic variation in genes that influence enzymes involved in the metabolizing of medications.
The enzymes control how fast the drug is used by the body. If a drug is metabolized too quickly, it won’t have time to work. But if it metabolizes too slowly, it can provoke an overdose or side effects.
The testing is part of the field of pharmacogenomics, which can help to predict a person’s likelihood to have a bad reaction to a drug.
However, some medical experts say the tests are not yet advanced enough to be used regularly by patients.
“Most of the [laboratories] only test for a few genetic markers‚ as also indicated in this test‚ which are not enough for personalized treatment,” Mamoonah Chaudhry‚ PhD, a postdoctoral fellow at the University of Pretoria’s Institute for Cellular and Molecular Medicine, told the Sunday Times.
The vast majority of people who receive psychotherapy through the Internet benefit from the treatment, though a small number do experience some kind of side effect.
Alexander Rozental, PhD, a psychologist, decided to explore the side effects of online cognitive behavioral therapy (CBT). Online CBT is similar to the CBT one would get from seeing a mental health professional directly or reading a self-help book, but support is given through email with a psychiatrist. The dissertation is thought to be the first examination of the side effects of Internet-based therapy.
Rozental’s research found that only 6% of 3,000 patients receiving Internet-based therapy got worse during treatment.
When he examined patients who received psychotherapy in an outpatient setting that were asked if they had negative effects of the treatment, one-third said they had a difficult memory resurface, had more anxiety or felt stressed. In addition, some said they had a poor relationship with their therapist or the treatment was subpar.
Rozental explained that what is needed in further research is a better understanding of therapy side effects, both to identify patients who become worse early in treatment and to shield patients from bad therapists.
“’I hope that psychologists and psychotherapists become more aware that there can actually be side effects and that they need to ask patients whether they are experiencing any,” he said.
A functional MRI (fMRI) brain scan may be able to predict whether a patient will respond to an antidepressant. Researchers at the University of Illinois and the University of Michigan gave an fMRI scan to patients with major depressive disorder who were about to begin antidepressant therapy. Some of those patients would receive 1 of 2 antidepressants, while the others would receive no drug at all. The researchers looked at activity patterns of the brain while participants executed a cognitive-control task that would determine whether the scan predicted a response to drug treatment. The results showed that the tested model predicted which patients would respond well to antidepressant treatment, and which would not with a 90% accuracy rate. Being able to predict a response to drugs could reduce the time it takes patients to begin feeling better since antidepressants typically take 8 to 12 weeks to take effect. Posted January 24, 2017. Via Brain.
The total economic cost of smoking was more than $1.4 trillion in 2012, or 1.8% of the world’s GDP. In addition, diseases attributable to smoking accounted for 12% (2.1 million) of all deaths among working age adults (30–69 years of age), with a high proportion in Europe and the Americas, according to data from the World Health Organization and the World Bank. Researchers also say that due to smoking-related ill health, the number of working years lost added up to 26.8 million, 18 million of which were lost to death with the remainder lost to disability. Smoking-related health expenditures accounted for $422 billion, with again, the highest share being in Europe and the Americas. Posted January 30, 2017. Via Tobacco Control.
Men who are suspected to have prostate cancer can avoid an unnecessary biopsy and overdiagnosis by receiving an MRI scan. About 1 in 4 men can avoid a biopsy if a Multi-parametric MRI (MP-MRI) test is given beforehand. If men experience prostate cancer symptoms or have a “prostate specific antigen (PSA)” that reveals elevated levels of the PSA protein in their blood, then they usually receive a biopsy. But PSA tests are sometimes inaccurate, resulting in many men undergoing unnecessary biopsies. A new study found that the MP-MRI should be used before a biopsy procedure. There were 44 serious adverse events during the study, but they resulted from biopsies rather than the MP-MRI scan. The scans could reduce overdiagnosis of harmless cancers by 5%, as well as improve the detection of aggressive cancers. Posted January 19, 2017. Via The Lancet.
Depressed people that take antidepressants are more likely to suffer from the side effects of that drug class if they also have panic disorder.
A new study examined data from 808 people with chronic depression that were prescribed an antidepressant. About 10.5% of the people also had panic disorder.
Overall, about 9 out of 10 participants reported at least 1 side effect during the 12-week study duration. However, those with depression and panic disorder were more likely than those with only depression to self-report gastrointestinal (47% vs. 32%), cardiovascular (26% vs. 14%), neurological (59% vs. 33%), and genital/urinary side effects (24% vs. 8%).
Participants with co-occurring panic disorder were also more likely to report a worsening of their symptoms of depression over 12 weeks if they reported multiple side effects, researchers reported in the Journal of Clinical Psychiatry.
“Because [patients with panic disorder] experience panic attacks — which are sudden, out-of-nowhere symptoms that include heart racing, shortness of breath, and feeling like you’re going to die — they are acutely attuned to changes in their bodies that may signal another panic attack coming on,” said Stewart Shankman, MD, professor of psychology and psychiatry at the University of Illinois-Chicago and the main author of the paper. “So it does make sense that these tuned-in patients report more physiological side effects with antidepressant treatment.”
Put down the Xanax. This week, MedShadow Founder Su Robotti and Content Manager Jonathan Block talk about using easy forms of meditation to manage stress during the holidays.
Su Robotti: Hello and welcome to MedShatowTV. My name is Sue Robotti, and I’m the founder of MedShadow.
Jonathan Block: And I’m Jonathan Block. I’m the content manager for MedShadow.
SR: Today, we’re going to talk to you about stress. We’ve been feeling a lot of stress. The holidays are coming, and stress is caused by too much food, too many relatives, too much pressure, too much gift shopping, too much drinking.
The key here is too much. Today, we want to help you take it down a notch, calm down, and we want to help you do that through meditation.
First of all, what is stress? The physical response to a stressful situation is adrenalin and cortisol enter your bloodstream. It increases your blood pressure, and your heart rate starts to go stronger. And if this isn’t dealt with easily or quickly, and it continues for a period of time, it can lead to gastrointestinal problems. It can lead to heart disease. It can lead to brain dysfunction like I’m having now. It can lead to a lot of long-term issues with heart disease and gastrointestinal problems among other things.
But Jonathan, what do you suggest we do? Should we pop a pill? That would be very quick.
JB: Absolutely, don’t. You’ve actually alluded to it, and that was through meditation, which is the main part of an idea known as mindfulness, which is defined as being aware of the present. I mean, I know what a lot of people are thinking — the same thing that I was thinking when I heard the word mindfulness. That just sounds like a whole bunch of new age hooey.
JB: I’m going old school. I can tell you from a personal experience as somebody who’s dealt with stress, and anxiety, and depression. Meditation associated with mindfulness actually does work. It works well.
And why don’t you take a pill? Because pills have side effects.
Mindfulness meditation — and we’ll be discussing this in a little bit — there are clinical studies that have demonstrated that mindfulness meditation can be used for a number of different conditions avoiding these sort of drugs, which as our MedShadow audience knows, most of which — if not all — are associated with side effects, drug interactions, or other nasty effects.
SR: In fact, is meditation as effective as antidepressants?
JB: Yes, it is. There’s been, I want to say, 40 to 50 clinical studies done just on comparing mindfulness and meditation with antidepressants. They’ve all come to the same conclusion. Mindfulness meditation is as effective as antidepressants.
So why — I know what you’re going to say. I’m going to read your thoughts. But why not just take a pill, right?
SR: Why not?
JB: I know that’s the easy way to go out. The thing is is that as I just mentioned, antidepressants and other antianxiety pills like the Xanax or the Valium that some people in our audience may be taking, have taken, or thinking about taking.
Mindfulness meditation is something that you can teach your brain how to think. It helps you relax without the use of drugs, and therefore you can learn how to deal with stress and anxiety over the long term. It’s actually much better for you, because you’ll actually train your brain how to better handle stress and anxiety but without the nasty side effects of a pill which means it is harder work.
But in the long term, the long-term efficacy of it has been demonstrated whereas with antidepressants, we know that people develop problems, and they lose their efficacy. And for some people taking antidepressants and anti-anxiolytic drugs, they just aren’t even effective anymore.
SR: So let’s take a breath.
SR: And how do you meditate? Do you have to sit cross legged? Do you have to hold your fingers in the air? Do you have to say, “Ohmm”?
JB: No, you’re thinking of some of the Buddhist meditation. But this type of meditation like the meditation that pretty much busy people or people that don’t want to go, “Ohmm,” want to do — can take as little as 10 minutes.
That’s what I do a day. I only do 10 minutes. I do some breathing exercises. There are also ways which if you learn more about mindfulness and we’ll provide you with some information about that in a second — the mindfulness, actually, you train your brain to relax. I know this sounds weird, because I didn’t believe it until I started doing it. And then in the words of a great Monkees song, “I’m a Believer,” and I’m a believer now about how effective mindfulness is and how effective mindfulness meditation is as well.
SR: So do you take classes? How do you learn to do this?
JB: I do a combination of things. I have read some books. There’s an excellent website that is operated by the fine people at UCLA known as the UCLA Mindfulness Awareness Research Center. That address is http://marc.ucla.edu. They actually have free relatively short meditations that you can download and listen to, and you can start on your own.
There’s another resource that I use a lot. This is a paid resource. It’s an app, and you can also do on your computer called Headspace. But I pay — I find it particularly effective. I looked at a lot of them, and I find Headspace — just to let the audience know, neither Headspace nor UCLA has asked us to mention them. This is just from my own personal experience.
SR: And then I’ll add one that’s free that I use; it’s called Breathe. But there are many, and you’ll find the one that you like if you just Google guided meditations, and you’ll find it.
I started meditating by simply becoming quiet and not using guided meditation — just setting a timer and trying to still my thoughts calmly for 3 minutes at a time. I got up to 5 minutes. And honestly, guided meditation is much easier.
JB: Oh, yes.
SR: And I would like to graduate to regular quiet meditation. But for now, I’m finding that I become more calm and happy using the guided meditation.
JB: And if you’re a novice — I still consider myself a novice — I find that the guided meditation works a lot better.
Just one other point because I know we’re talking a lot about this. It’s that mindfulness meditation is actually good not only for — works well, I should say — works not only well for depression, anxiety, and stress, but it’s been shown that people that want to lose weight through practice of mindfulness meditation, they can actually teach themselves to eat less.
SR: Eat less during meditation?
JB: No, afterwards, because they train their brain.
SR: You mean through their mindfulness.
JB: Right, because they think — like they ‘think before.’ You’ve heard the term, “Think before you act.”
JB: You teach yourself how to think before you eat, and you’re more careful at what you eat. But just by taking a few — by doing 10 minutes of meditation every day and then when you go and decide to have your meal, people who have done meditation and mindfulness, they train their brain to think, “Maybe I don’t need that side of French fries. Maybe I should get a side of quinoa or something of that nature, something of a more healthy starch.”
SR: Yes. My downfall is more of when I’m in a family situation, and there’s cheese, and crackers, and nuts, and all these good stuff in front of me, and I find I’m eating without thinking. I think you’re going to tell me that that’s not mindful.
JB: It’s not mindful, but everybody is allowed during the holidays to cheat a little bit. The thing is not to make it a regular part of your life. And even if you just have a few — if you — let’s say you cut out — maybe you only eat nuts, but instead of reaching for the Ferrero Rocher chocolate, maybe in parties you might have had 3. Now, maybe you’ll only have 1. That’s even mindfulness just like making even a slight change. And then as you get better and better at mindfulness and meditation, you’ll learn to control yourself better.
SR: Okay. So instead of taking a pill, instead of eating chocolate, instead of taking a long hot soak in the tub, what we’re going to do is try meditating to de-stress.
JB: Actually, taking a long hot soak in the tub is actually very good.
SR: Soak in the tub — we’re saying yes to this.
JB: We are saying yes to that.
SR: What about taking a walk or a jog?
JB: Also excellent.
JB: Just lose the medications and go easy on the chocolate.
SR: Okay. Do that and have a great holiday.
JB: Yes. From all of us here at MedShadow, thank you for making MedShadowTV, which just premiered this year, such a wonderful success, and a happy holidays to you and your family. Take care.
Nearly 17% of Americans — 1 in 6 adults — took a drug to treat a mental illness at least once in 2013, with antidepressants as the most common prescription filled.
About 12% of adults said they used antidepressants; 8.3% filled a prescription for an anxiolytic, sedatives or hyponotic; and 1.6% reported taking an antipsychotic.
White adults were the most likely to have taken a psychiatric medication. Nearly 21% of them did. Next were black adults at 8.7%, followed by Hispanic and Asian adults at, respectively, 8.7% and 4.8%
The analysis, published Dec. 12 in JAMA Internal Medicine, was based on data from the 2013 Medical Expenditure Panel Survey. The authors said that the use of these drugs could even be much higher as the prescription use data was self-reported.
Older age was also associated with higher psychiatric drug use. About 25% of adults 60 to 85 reported use compared with 9% of adults 18 to 39 years of age. Also, women were significantly more likely than men to take medication for a mental health issues.
“Safe use of psychiatric drugs could be improved by increasing emphasis on prescribing these agents at the lowest effective dose and systematically reassessing the need for continued use,” the authors noted.
When the days get shorter, some of us begin to feel gloomy. If that feeling deepens into a depression that interferes with your daily life, you may have seasonal affective disorder.
Seasonal affective disorder, or SAD, is a depression that may begin almost any time in the fall. For some people it begins when the summer months are over, and for others it may not start until daylight savings time ends in early November.
It also tends to recur every year, or most years. “When working with patients, this may be their first presentation for a mood problem, but when they look back retrospectively it becomes very apparent that around the same time each year as the light begins to diminish, their [symptoms] escalate,” says Alan Schwartz, PsyD, the director of behavioral health integration at Christiana Care Health System in Delaware.
Besides depression, SAD can also include other symptoms that don’t seem to be directly related to your mood. Besides feeling sad or having low energy, some people with the condition gain weight or crave carbohydrates during the colder months. Some experience sleep problems, for example, sleeping more than usual and having a very difficult time waking up each morning.
Very mild symptoms may not require treatment, aside from making sure to get exercise, good nutrition and full nights of sleep. But you should see a professional if the symptoms are interfering with your daily life. For example, if you can’t make it to work on time because of trouble waking up, or if you drop exercise or socializing out of your schedule because you’re low on energy, it’s time to seek help.
Your primary care physician is a good place to start, says Dr. Schwartz, to rule out other conditions that could cause fatigue and other symptoms. If you do have SAD, you’ll probably be referred to a mental health provider. Here are the 3 most common and effective types of treatments for SAD.
Light therapy, or phototherapy, is considered the first line-treatment for SAD. Exposing yourself to bright light in the morning can counteract the effect the darkness has on your brain.
Light therapy takes the form of a cool white light fixture, in a device that looks like a TV screen that produces intense white light instead of a picture. To use the device, you set it up near your face — for example, on your kitchen table as you are eating breakfast — and allow yourself to be exposed to the light for the amount of time your provider recommends. This could be anywhere from 30 minutes to a 3-hour session each morning. The main downside to this treatment, for many people, is simply finding the time.
Most people respond well to this extra light in the morning. “If that doesn’t start to work in a few days, or makes them worse, we switch the light timing to 7:00 to 9:00 in the evening,” says Al Lewy, MD, PhD, professor emeritus of psychiatry at Oregon Health and Science University in Portland. Morning and evening lights have opposite effects on the body’s circadian rhythms, so your provider will tell you to do one or the other, not both.
Phototherapy devices don’t produce ultraviolet or “full spectrum” light. Instead, they emit white light at a very bright intensity, between 2,500 and 10,000 lux. The instructions that come with the device will tell you how far away to position the device from your eyes to use the light safely and effectively, says Dr. Lewy. You don’t need to stare directly at the light, but should face the general direction of the light and scan your eyes across it. Side effects are not common, Dr. Schwartz says, but can include eyestrain or nausea. If you do experience problems, your provider can try lowering your “dosage” of light.
You can start to feel the benefits from phototherapy in as little as 2 days, and will typically feel the full effect within 2 weeks. Once you start feeling better, it may be okay to use the light box less often. Treatment continues through the winter, and you should be able to stop using it in the spring when the days get longer.
Medication options for SAD are similar to the medications used for other types of depression, and commonly include selective serotonin reuptake inhibitors, or SSRIs.
Side effects of these medications can include gut problems like nausea and diarrhea, and can cause headaches or an agitated, jittery feeling. For some people, the symptoms only occur during the first few weeks on the drug, but for others they persist. If the side effects are severe, you may need to stop taking the drug.
Antidepressant medication doesn’t work instantly, so your provider can start you on the medication before you expect each year’s symptoms to kick in. It may take 6 to 8 weeks for the medication to fully take effect.
While the other treatments alter your brain chemistry more directly, cognitive behavioral therapy, or CBT, can give you the mental tools to challenge depressive thoughts. It’s often used in conjunction with light therapy and medication.
Sessions of CBT involve talking to a psychologist for weekly sessions of 30 to 60 minutes, although as you learn the technique, you may not need to come in as often. CBT focuses on identifying problematic thoughts and exploring how they are connected to your behavior. If you can identify those thoughts when you begin to have them, and challenge how accurate those thoughts are, you can change your way of thinking about the world.
“Therapy can work sometimes, which is particularly challenging while you’re depressed,” says Dr. Schwartz. If you stick with it, though, CBT has more lasting effects than the other types of therapy. Next year, for example, your medication and light therapy would have long since worn off, but you can use the techniques from CBT to deal with depression as soon as it begins to occur.