Monthly Archives: April 2017

Someone’s Mistakes Make Their Life Filled With Depression

Mental illness is difficult to treat, in no small part because patients’ thought processes are affected significantly. With depression, patients have distorted and unhealthy views of themselves and their illness, which can impair smart decision-making and get in the way of finding and following a proper treatment plan. As a result, many patients make mistakes about their disease and what they should do about it.

U.S. News asked two psychiatrists to list some of the more common errors they see their patients making. Dr. Peter D. Kramer is emeritus clinical professor of psychiatry and human behavior at Brown University. Dr. David Mischoulon is an associate professor of psychiatry at Harvard University and director of the Depression Clinical Research Program at Massachusetts General Hospital. Here are their top 10 mistakes.

1. Suffering in silence. Depression typically doesn’t go away on its own, and left untreated it can worsen and progress to a point where a person can become disabled and potentially suicidal. Seeking help is key to getting out of depression, Mischoulon says. “The motto in my psychiatric residency program was ‘don’t worry alone.’ If you are depressed, tell someone about it rather than suffering in silence.” Patients can start by telling a friend or relative, or their primary care physician. “This could represent your first step toward getting the help that you need,” he says.

2. Self-medicating. There are numerous over-the-counter products that claim to treat various psychiatric and emotional symptoms, Mischoulon says. “Many people will try these rather than seeing a practitioner. While some of these therapies have evidence to support efficacy, they have to be used with the same care as prescription medications, and preferably under the supervision of a clinician.” He adds that “self-medication” includes using alcohol or recreational drugs to alleviate depression symptoms. Also a bad idea. “While these may induce a temporary feeling of well-being, over the long term they tend to worsen depressive disorders as well as present a risk of addiction,” he says.

3. Staying wedded to a treatment that is not working. “Sometimes a patient will be intent on relying on alternative treatments, like exercise or yoga, which is fine if the practice brings substantial or decisive relief,” Kramer says. But, “if a given treatment is not working, it will make sense to switch, often to a standard, well-tested approach, like psychotherapy or medication.” Patients may be reluctant to try these, perhaps on idealistic or ideological grounds, he says. That’s a mistake, he explains, because “depressive episodes are harmful to mind, brain and body, and longer episodes are more destructive. We want them to remit.”

4. Choosing the wrong clinician or treatment option. There are many different approaches to treating depression, including but not limited to antidepressant medication; somatic therapies such as electroconvulsive and transcranial magnetic stimulation therapies; and various kinds of psychotherapies, such as psychoanalytic and cognitive behavioral therapy. “While all of these are supported as effective by research studies, they don’t all work for every single individual,” Mischoulon says. “A licensed psychiatrist, psychologist or psychiatric nurse practitioner is in the best position to recommend the right treatment for the right person.”

5. Not staying vigilant. Residual symptoms may occur as an episode of depression resolves or recur at the onset of a new episode. “A great problem with depression is insidiousness,” Kramer says. “It can slip up on you. And because depression brings an altered perspective, you may believe that you have always been a certain way, you deserve to feel bad, the situation is hopeless or entertain similar thoughts.” A spouse, relative or close friend can be of use, he says, if that individual is allowed and encouraged to let the patient know that he or she is slipping back into depression.

6. Not understanding insurance coverage. “Managed care today is very complicated, and insurance plans differ a great deal from each other in terms of what they will cover,” Mischoulon says. He suggests that patients work with their doctor’s office to learn what is covered under their plan, including which antidepressants, what kinds treatment and how many visits within a certain period. “This can prevent you from getting saddled with unexpected bills that your insurance refuses to cover,” he says.

7. Not following doctor’s orders. As with any other doctor, a psychiatrist or psychotherapist can only offer a course of treatment. It is up to the patient to follow instructions regarding how to take medications and how often to see the doctor. “For example, antidepressants should be taken daily and at certain doses, whether or not you are feeling depressed on that particular day,” Mischoulon says. “When you don’t take the medications as prescribed, they don’t work as well, and recovery can be delayed. Likewise, for psychotherapies to work, regular visits are paramount, and every effort should be made to see your therapist with the recommended frequency.”

8. Losing touch with a therapist. “I like to see patients with persistent or highly recurrent depression maintain a relationship with a mental health professional and check in at regular intervals – as a patient with diabetes might,” Kramer says. “The mistake would be in not recognizing that sort of depression for what it is, a chronic ailment. Why should we not need our doctors here as elsewhere?”

9. Not “doing it anyway.” People with depression often feel unmotivated about their work, leisure or social activities. Those who push themselves to remain active despite the depression often find that participating in those activities can actually lift their mood, at least temporarily, and provide a reprieve from depression. “If you are depressed, make every effort to stay engaged in your activities as much as possible, because this can have positive effects on your mood,” Mischoulon says.

10. Ignoring or hiding suicidal thoughts. People with depression may at times feel that life is not worth living or that they may be better off dead. They may think about killing themselves. Don’t push those feelings aside. “If you are depressed and having these thoughts, talk to someone,” Mischoulon says. “If you already have a doctor, talk to him or her about it. Or tell a trusted friend or family member who can assist you in getting the help that you need.” And those friends or loved ones who suspect that someone may be suicidal should be direct and ask about it. “Contrary to popular belief, asking about suicide will not encourage a person to do it,” Mischoulon says. “In fact it may prevent them from harming themselves.”

How to Treat Depression in Children

Depression is, by most accounts, on the rise among America’s children. A recent study published in the journal Translational Psychiatry provided the most disturbing news yet. It looked at data on adolescents ages 12 to 17, from the 2009 to 2014 editions of the National Survey of Drug Use and Health, an annual cross-sectional survey conducted in a representative sample of the U.S. population. Researchers concluded that a whopping 36.1 percent of girls had experienced a first bout of depression. Boys were recorded at 13.6 percent – much lower, but still alarmingly high.

Those children also exhibited more behavioral and academic problems than children with no history of depression, prompting the study’s authors to write: “High levels of impairment, suicide attempts, conduct problems and poor academic functioning argue against a ‘wait and see’ approach to clinical treatment of recent first-onset depression.” In other words, getting depressed kids into proper treatment is paramount.

But how do you treat a child with depression? Children, as most health practitioners are quick to say, are not “small adults.” They have their own biochemistry, their own cognitive capabilities and their own tolerances for medications, psychotherapy and other common treatments for depression. They also have more erratic and potentially dangerous reactions to those treatments, particularly medications. That’s why parents should employ the skills of a trained child and adolescent psychiatrist or psychologist for any child with mental illness.

Psychotherapy

“Most psychiatric symptoms were first described for adults, then later extrapolated to kids,” says Dr. Steven C. Schlozman, assistant professor of psychiatry at Harvard Medical School and associate director of the Clay Center for Young Healthy Minds. “That makes it a bit like fitting a square peg into a round hole.” That fit is made smoother by adding knowledge about childhood development into the geometry, he says. For instance, depression in children may manifest as irritability, rather than sadness or melancholy. “It is important for the physician to recognize this, because you might not think of someone who is irritable as being depressed,” he says.

Likewise, treatments must be adjusted to meet the developmental stage of the child. The treatments are, in broad strokes, the same as those used for adults. The American Academy of Child and Adolescent Psychiatry, or AACAP, says that treatment for childhood depression should include both psychotherapy and medication. “In milder forms of depression, it is reasonable to start with a psychotherapy, but treatment with a medication and psychotherapy should be considered for moderate to severe forms of major depression,” it recommends.

The AACAP says the following therapy styles can be used to help depressed children:

  • Individual therapy. Well-studies therapies include cognitive behavior therapy, or CBT, and interpersonal therapy, or IPT. CBT teaches how to recognize and change unhealthy patterns of thinking that cause feelings and moods that can affect behavior. IPT helps depressed children identify interpersonal events and how these events affect their relationships, their moods and their lives.
  • Family therapy. Here, a therapist helps the entire family – the child or adolescent, parents, siblings and even grandparents – improve communication and support skills to work together in more positive and constructive ways.
  • Group therapy. Multiple patients are led by one or more therapists who teach the group how to better understand and recover from depression.

Why Type 2 Diabetes Is Increasing In Children And Adolescents

With the rise in Type 2 diabetes among adults, you may wonder if there’s also an increase among children and young adults. Turns out, there sure is.

A large study called SEARCH for Diabetes in Youth found that newly diagnosed cases of Type 2 diabetes in children and teens increased by about 4.8 percent in each year of the study’s period between 2002 and 2012.

What’s driving this increase? “Prior to the 1980s, Type 2 diabetes was extremely uncommon in children and adolescents,” says diabetologist and certified diabetes educator Dr. Fran Cogen, interim co-chief of the Division of Endocrinology and Diabetes, director of the Childhood and Adolescent Diabetes Program at Children’s National Health System and professor of pediatrics at George Washington University School of Medicine and Health Sciences in the District of Columbia. “Unfortunately, the rate has increased as our lifestyles have become increasingly sedentary, and we’ve seen an explosion of processed, high-sugar and fast-food options.” Couple that with lower physical activity and more time in front of screens, and that’s a recipe for an increased diabetes risk.

Poor diet choices and lower levels of physical activity increase the risk for obesity, which is the most powerful determinant of Type 2 diabetes in childhood, adolescence and young adulthood, says Dr. Michael Freemark, professor of pediatrics and chief of the Division of Pediatric Endocrinology and Diabetes at Duke University Medical Center in Durham, North Carolina. In fact, several large population studies have found that childhood obesity that continues in the teen years can increase the risk for adult-onset Type 2 diabetes four- to 28-fold, Freemark says. “It’s therefore not surprising that the global rise in the prevalence of childhood Type 2 diabetes has coincided with a dramatic increase in childhood obesity,” he says.

There’s also a genetic role in Type 2 diabetes. In other words, if you have a parent or sibling who has it, there’s a greater chance that you’ll develop the disease as well.

It can be confusing to try and track Type 2 diabetes symptoms, especially in children. Sometimes, there are no symptoms. However, increased thirst, urination, bedwetting and unexplained weight loss could indicate Type 2 diabetes. Another symptom in children is a darkening around the neck and underarms, which is a sign of insulin resistance, says Dr. Robert Rapaport, professor of pediatrics and chief of the Division of Pediatric Endocrinology and Diabetes at the Icahn School of Medicine at Mount Sinai in New York. Insulin resistance is when your body can’t respond correctly to the insulin it produces.

Other possible symptoms of Type 2 diabetes include early puberty, especially in at-risk population groups such as African-Americans and American Islanders, Rapaport says. An increasing number of Staphylococcus skin infections or vaginal yeast infections in girls also can be signs of Type 2 diabetes.

Of course, depending on your child’s age, you may not spot all of the symptoms easily, and your child may not share them or even be aware of them.

Parents may not always have Type 2 diabetes on their minds. “That’s one of the scariest factors of the disease. In many cases, it’s not even on a parent’s radar,” Cogen says.

Even in parents who are aware of diabetes risks, it’s hard to overcome factors like the convenience of fast food, the lack of time to prepare healthier food at home and the higher cost of certain fresh foods. “Parents may also fail to connect the dots between their own family histories of metabolic disease and the child’s risk of obesity and Type 2 diabetes,” Freemark explains.

If you suspect your child has symptoms of Type 2 diabetes, make sure to visit your family doctor or pediatrician. Their office can consider screening for diabetes. When a child is very overweight or has signs of insulin resistance, health professionals are more likely to check blood sugar and possibly hemoglobin A1C level, Freemark says. If there’s a family history of diabetes or signs of polycystic ovary syndrome in teenage girls (including menstrual irregularity and having acne or excess facial hair), there’s a greater chance that they will get their blood sugar tested. A pediatric endocrinologist may need to help care for a child or teen with abnormal results.

Here are some ways to help lower your child’s risk for Type 2 diabetes:

As a family, plan to eat healthier and exercise more. “The key is to make small, incremental changes that the whole family can participate in so no one feels isolated or singled out,” Cogen says. These small changes can help your child lose weight if that’s a problem, and that lowers the chance of developing Type 2 diabetes. Healthier habits are especially important when there’s a long family history of diabetes, but there shouldn’t be the impression that anyone will inevitably develop Type 2 diabetes. “Operating as a team, a family, is much more likely to be successful,” she adds.

Find out about healthier food choices. These include lean meats, vegetables and fruitsand fewer concentrated sweets, sugars, high-density starchy foods, saturated fats and fried and fast foods, Freemark says.

Educate your children as they get older. This creates awareness that will help them when they are adults. For example, research finds that young adult women should have a healthy weight even before they get pregnant to reduce the chances of diabetes both for themselves and their future children, Freemark says. By arming them with information as a teen or young adult, they can make better choices.

Although the increase in Type 2 diabetes in children and teens may seem daunting, there is a silver lining, Freemark says. The risk for Type 2 diabetes in people who were overweight or obese as children but not as adults was no higher than the Type 2 diabetes risk in adults who were never overweight. In other words, you can cut your risk if you lose weight earlier in life. “This encouraging finding suggests that reversal of childhood obesity may prevent subsequent development of Type 2 diabetes,” he says.

Filtered Cigarettes Reduce Lung Cancer Risk

You know that cigarette smoking is the No. 1 risk factor for lung cancer (and a host of other serious diseases). However, if you do choose to smoke, you may wonder if filtered cigarettes are a safer alternative than unfiltered cigarettes. They’re not. In fact, there’s a major effort underway to convince the Food and Drug Administration to ban cigarette filters with holes in them.

In 1964, the Surgeon General’s report stated that smoking caused lung cancer. Tobacco companies were encouraged to make changes in their product to reduce damage to smokers, says Dr. James Davis, medical director at the Duke Center for Smoking Cessation.

The tar in cigarette smoke had known carcinogens (cancer causing agents), so it was a reasonable idea that reducing tar content would lower lung cancer risk. To do this, manufacturers added tiny holes in their filters. When a smoker inhales, these holes bring in outside air along with the smoke. The filters help trap tar, and the highly porous filter paper also allows toxic chemicals to escape. “If you combine air with smoke, you expect to get less smoke and less carcinogens,” Davis says.

Almost all cigarettes sold have these filters with holes, says Dr. Peter Shields, lead investigator and deputy director of The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Institute. “Regular cigarettes have them. Light cigarettes have them, but more. Ultra light cigarettes have them even more. [The filters] made the smoke smoother, so smokers thought [these cigarettes] were healthier.”

When scientists analyzed smoke from filtered cigarettes on a smoking machine – a device that mimics a person smoking – they did show more air and less tar. “It made sense to everyone that [the holes in filters] were helpful,” Davis says.

It turns out, however, that when scientists looked at lung cancer rates by when people were born, they found that despite an overall decrease in lung cancers, the rate of new adenocarcinomas, a certain type of lung cancer, was increasing.

“In the 60s and 70, the most common type of lung cancer was squamous cell carcinomas [which accounted for about two-thirds of cases]. Now, two-thirds of lung cancers in men are adenocarcinomas,” Shields says. Since women really started smoking en masse in the 1970s, after the implementation of filters with holes, they primarily developed adenocarcinomas lung cancers. “The evidence was absolutely clear that adenocarcinomas were going up when they shouldn’t be,” Shields says.

Cigarettes burn differently with ventilation holes, Shields says. You actually get more – not less – bad chemicals. Furthermore, because smokers are addicted to nicotine and get less of it with filtered cigarettes, they compensate by smoking more and taking bigger, deeper puffs, thus inhaling more smoke, more deeply into the far corners of the lungs where adenocarcinomas develop. Smoking machines, researchers learned, do not mimic how real people actually smoke.

According to Davis, it’s difficult to say with certainty if there’s a causal relationship between filter holes and the high rates of adenocarcinomas. “It’s hard to say one thing causes another,” he says, “but by my reading of the evidence, it’s really strong. We don’t wait to see [data showing] bold causality when we see a strong relationship that’s causing real harm. The scientific community should be concerned.”