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.
Antidepressants are known to cause a slew of side effects, take weeks to take effect, and may not work at all on many people. But what if there was a way to determine in advance if a particular antidepressant would work on you?
Researchers at Stanford University School of Medicine may have found a solution. Using a combination of brain scans and finding out if a patient has an history of early life trauma such as abuse and neglect, they were able to predict – with 80% accuracy – whether an antidepressant would be effective.
The Stanford’s team assessment method, if further proven, could become essential in the treatment of depression since it would eliminate the trial-and-error process of finding the right antidepressant for an individual patient, or whether an antidepressant would be effective at all.
In their study, the researchers enrolled 80 people with depression. They were hooked up to functional MRIs while they were shown images of happy and fearful faces on a display in front of them. The faces triggered activity in the brain’s amygdala, a part of the brain that regulates emotion.
The scans were conducted both before and after the subjects were treated with 1 of 3 antidepressants for 8 weeks: Zoloft (sertraline), Lexapro (escitalopram) and Effexor (venlafaxine). They also completed a questionnaire about early life stress, such as abuse, neglect, family conflict, illness or death before 18.
Participants exposed to a lot of childhood trauma were most likely to have success with antidepressants if the amygdala was reactive to the happy faces, the researchers reported in the Proceedings of the National Academy of Sciences. Those with a high level of childhood trauma whose amygdala showed little reactivity to the happy faces were less likely to succeed with antidepressants.
The researchers also created a table that could one day be used by doctors to determine if antidepressants are recommended based on brain scan results and level of childhood trauma experienced.
People who take certain blood pressure-lowering medications may be at an elevated risk of developing mood disorders, including depression and bipolar disorder.
Researchers examined data on more than 144,000 adults with an average age of 56. Just over 32,000 of them were taking one of 4 types of drug to treat their hypertension: angiotensin agonists (ACE inhibitors and angiotensin receptor blockers), beta blockers, calcium channel blockers and thiazide diuretics.
Common angiotensin agonists include Cozaar (losartan), Diovan (valsartan), Lotensin (benazepril) and Altace (ramipril); common beta blockers are Lopressor (metoprolol), Coreg (carvedilol) and atenolol; common calcium channel blockers include Norvasc (amlodipine) and Cardizem (diltiazem); and common thiazide diuretics include hydrochlorothiazide (HCTZ, HCT, HCZ).
Over a 5-year period, those on a beta blocker or calcium channel blocker were twice as likely to have been hospitalized for a mental illness (mostly depression) compared to those on an angiotensin agonist, the researchers reported in the journal Circulation.
People on an angiotensin agonist were also 50% less likely to be hospitalized with a mood disorder compared to those who weren’t on any hypertension drug. And those taking a thiazide diuretic had no impact on risk for hospitalization.
It’s important to note that the study was observational in nature, meaning the researchers aren’t sure exactly what led to the increase in mood disorders with some of these drugs. However, the results may indicate that patients with high blood pressure that are at risk for mood disorders could be better off with an angiotensin agonist.
A controversial new study claims healthy people — who have no prior history of mental illness — that are given antidepressants are twice as likely to become violent and suicidal as those not on the drugs. While for years antidepressants have had a strong “black box” warning on the risk of suicidal thoughts and behaviors in children, adolescents and young people taking the drugs, the study is the first to examine this risk in healthy adults. Researchers examined 13 trials involving antidepressants that enrolled a total of 612 patients. They found that health volunteers treated with antidepressants had a 1.85 times higher risk of harm related to suicidality and violence. Writing in the Journal of the Royal Society of Medicine, the researchers also claim that prior studies have underestimated the harms associated with antidepressants. “It is well documented that drug companies under-report seriously the harms of antidepressants related to suicide and violence, either by simply omitting them from reports, by calling them something else or by committing scientific misconduct.” Posted October 11, 2016. Via the Journal of the Royal Society of Medicine.
Although websites for prescription drugs sponsored by pharmaceutical companies have risk disclosures, most people visiting them do not notice or take the time to read them. Two researchers enrolled 29 people with seasonal allergies. The participants were told they were investigating how people look for health information online and that they would be looking at a website for a new prescription allergy drug. The researchers used eye tracking to determine where and how long the people looked at each part of the site, as well as survey questions asking how much risk information they read. Although 80% of the participants claimed to have read at least half of the risk information, the eye tracking data and their responses to questions about the risks associated with the drug showed otherwise. The researchers suggest that risks be presented before benefits and risk information should be highlighted with borders or colors. Posted October 12, 2016. Via Journal of Risk Research.
While fewer Americans are taking a daily multivitamin pill, more of them instead are turning to fish oil and vitamin D pills, as well as probiotics. In 2012, about half of Americans were taking some kind of dietary supplement, a figure that was about the same as in 1999. In 2000, 37% of adults were taking a multivitamin, according to data published in JAMA. By 2012, that number dropped to 31%. Meanwhile, over the same period, vitamin D supplement use surged from 5.1% to 19%, and fish oil pills rose from 1.3% to 12%. Use of supplements with vitamins C and E, as well as selenium — all antioxidants — also dropped. Posted October 11, 2016. Via JAMA.