Menopausal Women on Antidepressant Have Increased Risk of a Stroke

A recent study by researchers from the Albert Einstein College of Medicine was recently published in the Archives of Internal Medicine and sounds a warning for menopausal women who are subject to depression.

Depression is already a known risk factor for cardiovascular disease but it seems that taking antidepressants may significantly increase the risk of stroke for women who are post menopause. The study is based on data from the well respected Women’s Health Initiative which was responsible for proving that hormone replacement therapy significantly increased the risk of heart attack, stroke, cancer and death in postmenopausal women.

This was a long term six year study of over 136,000 women between the ages of 50 and 79. They found that those taking antidepressants were 45 percent more likely to suffer from a stroke in that time than women not taking the drugs, and 32 percent more likely to die from any cause. The risk of stroke for a postmenopausal woman taking an antidepressant was roughly one in 200 in each given year and the increased stroke risk from antidepressants remained the same regardless of which drug class women were taking, whether they were selective serotonin reuptake inhibitors (SSRIs) or tricyclics. However SSRIs appeared to pose a higher risk for a hemorrhagic stroke caused by brain bleeding.

The Stroke Association are currently funding further studies to look into the links between depression and the risk of stroke. If you want to reduce your own risk then simple measures to take are to make lifestyle changes such as reducing your blood pressure, giving up smoking, reducing alcohol intake, improving your diet and getting plenty of exercise.

Depression and the Internet

It’s not often I comment on a mainstream news item, but The Guardian has reported that a new study links depression and excessive internet use. Now as someone who could not make a living without the Internet for research, it caught my eye as I am also someone who has experienced depression since my early teens. So in the current age of heavy internet use, particularly by teens, just how much is too much?

Work has been done in South East Asia on this, but nothing to date in the UK until researchers at Leeds University did a study on a group of young people and adults to see at what point their Internet use became a problem. It’s already known that for a small proportion of users it becomes an addiction but less well known is that people in this group were more likely to be depressed than non-addicted users, particularly males with an average age of just over 18.

It seems to be a chicken and egg situation: which comes first – are depressed people drawn to the internet or does the internet cause depression? What is useful, particularly for parents, is that it is clear is that, for a small subset of people, excessive use of the internet could be a warning signal for depressive tendencies according to Dr Catriona Morrison of the University’s Institute of Psychological Sciences.

A more worrying concern for me is that addicts spend proportionately more time browsing sexually gratifying websites, online gaming sites and online communities and that the research concurs that these again reinforce the belief that over use of the Internet is serving to replace normal social function. In other words, keep a close eye on the amount of computer online time is being spent – not always easy when most teenagers have their machines in their bedrooms, or have laptops so monitoring use is even more difficult.

If you also find that depression is affecting memory, whatever age, then Ginkgo appears to be as effective in younger people as it is in the elderly. It can also be useful as a short term supplement (5-7 days) before exams to help with focus and short term retention.

Log on to treat depression

Those enterprising Aussies have potentially found a new treatment approach for depression. Researchers from the University of New South Wales have shown that Internet-based therapy programmes are as effective as face-to-face therapies.

Actually getting an appointment can be the first hurdle in treating depression so anything that offers instant access is worth investigating. They set up the Sadness programme which was based solely on email contact with a therapist. On average participants needed an average of only 111 minutes of contact with a therapist over an eight-week period, which is significantly less than other comparable treatment.

Social phobias and other anxiety disorders have been previously treated online, but this is a first. It has been assumed that depression would be more difficult because of the lack of motivation usually associated with the condition, but this is clearly not the case.

The programme consisted of six online lessons with weekly homework assignments and contact by email from a clinical psychologist. Evaluation of those who h ad completed the programme showed that more than a third (34 percent) no longer met the criteria to be diagnosed as depressed and that is a result similar to face-to-face therapy. A significant majority (82 percent) who completed a post-treatment questionnaire reported being either very satisfied or mostly satisfied with the overall program.

To me there are significant benefits to this idea. First, many people do not have easy access to qualified therapists either by means of lack of facilities in their area, lack of time to travel and see a therapist due to their work or lack of mobility. This, plus the fact it is still not easy for people to admit to wanting to see a mental health professional, make this a good step forward.

I know there is resistance to working online, but on a different tack I coach creative people by email and once they have experienced how easy and convenient it is they are usually converts. To be able to log on for a treatment programme in the privacy of your own home, and at a time that is convenient for you, is going to be attractive to many people.

More trials are to be set up, and I will keep you posted on whether this is an Aussie export that will successfully make it across the pond.

Kava helps reduce anxiety

Australian researchers at the University of Queensland have used Kava – which has a long history of medicinal use in the South Pacific – to treat anxiety.  They found a traditional extract of Kava, a medicinal shrub, to be safe and effective in reducing anxiety. When taken in small doses, kava helps increase awareness and activity without increasing tension.As a natural mood enhancer Kava is often suggested by naturopathic practitioners for those suffering from chronic anxiety and mild depression.
It has no addictive properties, unlike antidepressants, and has less risk of any side effects. Taken in excess Kava has been linked to liver problems, though this is still debated, and does not occur with water soluble extracted Kava, the traditional way of producing it. It should be taken occasionally for anxiety, or for a period of less than a month for more chronic conditions.

Kava is not available for sale in the UK, though it is perfectly legal to order it online for personal use.

Omega 3, dieting and depression

Studies in the US have linked a low dietary intake of omega 3 fatty acids and dieting with growing rates of depression. Interestingly, the risk of developing depression has increased at a rate similar to the rise in consumption of omega 6 fatty acids from sources like vegetable seed oils and is relative to the decrease in omega 3 fatty acids from fish, walnuts, and flaxseed. Many nutritionists feel that this is a direct result of the increased consumption of processed foods as opposed to eating ‘real’ food.

The study gave either a fish oil capsule or a sugar pill in addition to their antidepressant medication to the participants. Just two weeks into the study, there was an improved sense of well being and sleeping patterns in the omega 3 supplement group. After four weeks a substantial had a significant reduction in the symptoms of depression as compared to those taking the sugar pill. The study concluded that the fatty acid EPA may be used as an antidepressant booster, but I would go further and suggest that it can be used proactively to help anyone with a tendency to depression before they start medication. Dietary changes have already been substantiated as helping depression, and adding in adequate amounts of Omega 3 can definitely help.

Heart disease and depression link

Being diagnosed with coronary heart disease can be frightening and stressful, however optimistic the prognosis. It can be a time to revaluate lifestyle, relationships and work and can place enormous pressure on the individual and their family, affecting all aspects of life – including mental health. Now, the American Heart Association has recommended that coronary patients should also be screened early and regularly for depression. They have spoken out because of the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook.

Many studies have now shown that major depression is associated with worse prognosis in patients with coronary disease. What has also now been confirmed is that more severe depression is associated with the patient having earlier and more severe cardiac events.

In many cases, depression can often be treated with exercise, counselling, good nutrition and cognitive-behavioural therapy. American Psychiatric Association suggests that two questions can identify patients who may need further follow up and treatment. The doctor should ask: ‘Over the past two weeks, how often have you been bothered by the following two symptoms?

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

If the answer to either question is yes, they have been bothered by those symptoms then the follow up questions are: ‘how often have you been bothered in the past two weeks by:

1. Trouble falling asleep, staying asleep, or sleeping too much

2. Feeling tired or having little energy

3. Poor appetite or overeating

4. Feeling bad about yourself, that you are a failure, or that you have let yourself or your family down

5. Trouble concentrating on things such as reading the newspaper or watching television

6. Moving or speaking so slowly that other people could have noticed or being so fidgety or restless that you have been moving around a lot more than usual

7. Thinking that you would be better off dead or that you want to hurt yourself in some way.

This is not a definitive way to define depression, but it is a useful tool to evaluate how someone is coping after having a coronary and can help you decide whether or not help is needed.

Often used strategies for patients who have coronary disease and depression are antidepressant drugs, cognitive behavioural therapy, and physical activity, such as aerobic exercise. Diet can also play a part, and most nutritionists would recommend a diet that excluded sugar, caffeine and alcohol.

St John’s Wort – Does it work?

Get ready – this is the rant! As someone who has been writing about health for 20 years, I thought I had become anaesthetised to the ‘false information’ syndrome that seems to accompany most natural medicines. Linus Pauling is a fine example. He was one of the first scientists to work in the fields of quantum chemistry, molecular biology and orthomolecular medicine, was awarded two Nobel Prizes in different fields which you would have thought was enough qualification for anyone. However, his research into the benefits of vitamin C on health were systematically rubbished for years, and now a natural supplement that has been proven to help thousands cope with depression is getting similarly clobbered.

In the best Parliamentary tradition, I have to declare an ‘interest’ in the subject as I have been subject to depression since childhood and have tried virtually every form of treatment, both chemical and natural, over the years. St John’s Wort works for many people – but not for everyone, so I am never surprised to read research that shows it hasn’t been effective within certain parameters.

What I am surprised, and horrified, to discover is that the latest round of ‘St John’ bashing has come from a group of medical men who concluded “that the St.John’s Wort herb is useless in treating ADHD in children”.

That it is true I don’t doubt, because what they didn’t disclose at the time was that all the children used in the study were given inactive forms of the herb, where the active ingredients had been oxidized and rendered useless. Even the Journal of American Medicine admitted that:

“The product used in this trial was tested for hypericin and hyperforin content at the end of the trial and contained only 0.13% hypericin and 0.14% hyperforin.”

That constitutes a sub-clinical dose, barely containing any usable St. John’s Wort at all. It is in fact barely one-tenth of one percent of the active chemical constituents in the herb, and any decent supplement typically contain up to five percent hyperforin, or thirty-five times the amount of active ingredient used in this trial. JAMA felt obliged to point out:

“Hyperforin is a very unstable constituent that quickly oxidizes and then becomes inactive, which is likely what happened to the product used in this clinical trial.”

In other words, they admitted that it was an inactive, ineffective, form that had been used.

Even more worrying is the fact that there were only 54 children used in the results of the trial, with 27 receiving a placebo and 27 receiving St. John’s Wort. This is a very small sample size to justify any declaration that it doesn’t work, especially given the fact that it has been safely and effectively used by tens of millions of people around the world in just the last decade or so.

Incredibly, more than 40 percent of the children used in the study had previously also used psychiatric medications, and we already know that such drugs actually cause behavioural disorders, shown by the fact that so many children commit violent acts against themselves and others after taking psychiatric medications.

This trial was set up to fail on so many levels; for example, six children who displayed a large response to the placebo were supposed to have been dropped from the study to isolate the herb’s effects from placebo effects. However, they were ‘accidentally’ randomized and their results put into the final conclusion, which had the effect of distorting the final results in favour of placebo responders, and reducing the numbers who responded positively to the St John’sWort.

Another example of the study’s bias is that young boys are far more susceptible to the kinds of behaviours that are labelled as “ADHD,” compared to young girls, and yet in this study, the placebo group consisted of only about 50% boys while the herb treatment group consisted of nearly 75% boys. In other words, the placebo group was predisposed to a positive outcome simply due to its composition of girls vs. boys, while the herb treatment group was predisposed to a less-than-favourable response.

To say nothing of the sheer cynicism of this research, and trying not to boil over at them using young children to test something for a serious condition that they absolutely had guaranteed in advance would not work, they then sent numerous press releases out that warned parents not to use the herb. Some of the headlines included:

St. John’s Wort Doesn’t Work for ADHD Washington Post

St. John’s wort no better than placebo for ADHD, Bastyr study finds Seattle Times St. John’s wort doesn’t help ADHD, study finds Reuters That would certainly put most parents off, but it is not really so surprising when you know that one of the study’s authors, Dr. Joseph Biederman, secretly took $1.6 million from drug companies while conducting psychotropic drug experiments on children, and is currently on the payroll of several drug pharmacies selling ADHD medications – a fact he did not disclose when publishing the study in the Journal of the American Medical Association. So he was not likely to want to find that St John’s Wort, or any other natural alternatives, had any effect on treating a condition cheaply and without recourse to drugs. The whole point of the study of course was to make natural medicines look bad. I had thought after Linus Pauling’s hard battle to get his views accredited that it might have got a bit easier – but clearly the agenda is still a commercial, rather than a medical one.

In case you were wondering, St. John’s Wort has been clinically proven to be even more effective than antidepressant drugs for treating mild to moderate depression. That is a much better track record than all the SSRI drugs ever invented, whether it works for ADHD I don’t know, but I would want to see much better research before it is so cavalierly dismissed.

Alert – The placebo effect and antidepressants

Five centuries ago, the Swiss alchemist and physician Paracelsus (1493-1541) wrote: “You must know that the will is a powerful adjuvant of medicine.” In a nutshell that sums up the effect that placebos can have on our bodies: they can effect change without containing any active chemical ingredients that could medically make a difference to the state of our health, and yet they often can provoke therapeutic effects – both positively and negatively – when administered to patients.

Researchers now believe that belief in the placebo as being part of a curative treatment seems to stimulate the body’s own healing mechanism – if we believe it is doing us good, then it is. Our belief stimulates certain bio-chemical responses and reactions and increases our ability to initiate our own healing process.

The term placebo literally means “I shall please” and was used in mediaeval prayer in the context of the phrase Placebo Domino (“I shall please the Lord”). Much later, during the 18th century, the term was adopted by medicine and was used to imply preparations of no therapeutic value that were administered to patients as “decoy drugs.” Over time it became recognised as having an important role in the therapeutic treatment of patients and in more recent studies, the placebo effect was estimated at 60% of the overall therapeutic outcome. In a recent review of 39 studies regarding the effectiveness of antidepressant drugs, psychologist Guy Sapirstein concluded that 50 per cent of the therapeutic benefits came from the placebo effect, with a poor percentage of 27% attributed to drug intervention. Now an even more startling study by the FDA has revealed that the new generation of SSRI anti-depressant drugs are even less effective than Sapristein’s study showed.

I have a vested interest in the subject as I have been treated for depression since my teens and now 50 years on have tried many drugs, therapies and natural alternatives and finally discovered that I just have to learn to recognise it and live with it as for me nothing has proved effective over the long term and the side effects of antidepressants have seriously affected both my creativity and natural personality. Depression is a serious medical illness caused by imbalances in the brain chemicals that regulate mood. I am certainly not alone with my experience of depression as it affects one in six people at some time during their life, making them feel hopeless, worthless, unmotivated, even suicidal.

Doctors measure the severity of depression using the “Hamilton Rating Scale of Depression” (HRSD), a 17-21 item questionnaire. The answers to each question are given a score and a total score for the questionnaire of more than 18 indicates severe depression.

Mild depression is often treated with psychotherapy or cognitive-behavioural therapy to help people to change negative ways of thinking and behaving. For more severe depression, current treatment is usually a combination of psychotherapy and an antidepressant drug, which is used to normalize the brain chemicals that affect mood.

Antidepressants include “tricyclics,” “monoamine oxidases,” and “selective serotonin reuptake inhibitors” (SSRIs). SSRIs are the newest class of antidepressants and the FDA (Food and Drug Administration) in the USA has reported on both published and unpublished trials on SSRIs submitted to them during their licensing process. The findings have rocked the medical world as it has indicated that these drugs have only a marginal clinical benefit. On average, the SSRIs improved the HRSD score of patients by just 1.8 points more than the placebo. The most effective clinical rating for SSRI’s was for severely depressed patients and the FDA again reported that this reflected a decreased responsiveness to placebo rather than an increased responsiveness to antidepressants. I am not saying don’t take antidepressants, I have done so myself, but I am saying think before you go down the drug intervention route.

That ‘will’ that Paracelsus referred to that certainly has a powerful role to play, particularly in the area of whether we regard our treatment positively or negatively, regardless of what it contains. Positive or negative thinking seems to be a decisive risk factor for every treatment, perhaps even more important than medical intervention, so looking at our attitude to life could be the first place to start. Research clearly indicates that positive thinkers live on average 6 years longer than those who always respond negatively to life – it’s not about being a ‘Pollyanna’ and forever looking on the bright side but it is about taking those lemons life hands out and making some lemonade, or in my case lemon curd, rather than leaving them in the bowl to rot and decay.