Depression Common in U.S., Women Hit Hardest

News Picture: Depression Common in U.S., Women Hit HardestBy Steven Reinberg
HealthDay Reporter

TUESDAY, Feb. 13, 2018 (HealthDay News) — Nearly one in 10 U.S. adults has depression, and the rate is almost twice as high for women as men, health officials say.

National survey data showed that more than 8 percent of adults aged 20 and older suffer from low mood, according to a new report from the U.S. Centers for Disease Control and Prevention.

Among women, slightly more than 10 percent have depression, versus 5.5 percent of men. And the mood disorder affects everyday life for a majority of these people, the 2013-2016 questionnaires show.

“One of the findings that surprised us the most was that for both men and women, about 80 percent of adults with depression had at least some difficulty with functioning with daily life,” said lead author Debra Brody.

These include going to work, completing daily activities at home and getting along with other people, said Brody, of the CDC’s National Center for Health Statistics (NCHS).

“This report should make people aware how serious depression is, and that it impacts everyday life,” she added.

According to the report, depression is most prevalent among blacks (9 percent) and least so among Asians (3 percent). Among whites and Hispanics, the rate is about 8 percent.

Also, as income levels fall, depression rises. Poor Americans are four times more likely to have depression than middle class or rich people — about 16 percent versus 4 percent, respectively.

According to Dr. David Roane, chairman of psychiatry at Lenox Hill Hospital in New York City, “The biggest issues with depression are diagnosis and treatment.”

In most cases, primary care doctors are able to diagnose depression, he noted. “But people often don’t get adequate treatment in terms of both medication and psychotherapy,” Roane said.

He stressed that anyone with depression should be monitored by a doctor or mental health professional, such as a social worker, nurse or therapist.

Effective treatment includes antidepressant medications and talk therapy, Roane explained.

However, there are obstacles to treatment, he said. For one thing, people often don’t realize they are depressed, even if they have mood problems and changes in thinking.

Also, mental health problems are still often considered taboo. “The stigma related to depression has decreased somewhat, but it’s still a major issue for someone to be diagnosed with a mental health disorder,” he said. In addition, many cases of mild depression will resolve over time, so some patients don’t want treatment.

“The problem is that if you are having functional impairment, it can be highly disruptive to your life,” he said. “Six months is a long time to suffer from depression, and I don’t recommend that.”

Anyone with recurrent depression, suicidal thoughts or manic and depressive swings should be under the care of a mental health professional, Roane advised.

He said that depression affects all aspects of life, affecting people emotionally and physically.

When people are depressed, they don’t sleep or eat well. They are sad and have a negative view of life and feelings of hopelessness, he explained.

The researchers reported that the percentage of American adults who suffered from depression in a given two-week period remained steady from 2007 to 2016.

The study authors also pointed out that major depression is associated with high societal costs and greater functional impairment than other chronic diseases, such as diabetes and arthritis.

It has been shown before that women are more prone to depression than men, but the reasons are not known, Roane said.

Data for the report were gathered from the U.S. National Health and Nutrition Examination Surveys. The findings were published online Feb. 13 in the CDC’s NCHS Data Brief.

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Copyright © 2018 HealthDay. All rights reserved.

SOURCES: Debra Brody, M.P.H., division of Health and Nutrition Examination Surveys, National Center for Health Statistics (NCHS), U.S. Centers for Disease Control and Prevention; David Roane, M.D., chairman, psychiatry, Lenox Hill Hospital, New York City; Feb. 13, 2018, U.S. Centers for Disease Control and Prevention’s NCHS Data Brief, online

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    Medical Definition of Kratom Written by Our Doctors

    Kratom: a botanical (plant) preparation that has been described by marketers to offer relief from pain, depression, and anxiety as well as to treat addiction to opioid drugs. Kratom is a plant found in Thailand, Malaysia, Indonesia, and Papua New Guinea. It has also been used as a drug of abuse, an alternative to opioid drugs because it can produce similar effects, with similar risks of addiction and death.

    In November 2017, the US Food and Drug Administration (FDA) issued an advisory about the health risks of kratom, citing reports of at least 36 known deaths associated with the use of kratom-containing products. An updated communication by the FDA in February 2018 confirmed the evidence suggesting that kratom has properties of an opioid drug and strengthened the warnings about its use. There also have been reports of kratom being laced with other opioids like hydrocodone. The use of kratom is has been linked to serious complications such as seizures, liver damage and withdrawal symptoms. Kratom use has been linked to 44 deaths between 2011 and 2017.

    There are currently no FDA-approved uses of kratom. In the 2018 update, the FDA states, “Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids. There is no evidence to indicate that kratom is safe or effective for any medical use.”

    Kratom is regulated as a controlled substance in 16 countries and is also banned in several US states.




    Nerve Pain: Symptoms, Causes, and Treatment Options


    FDA. “Statement from FDA Commissioner Scott Gottlieb, M.D. on FDA advisory about deadly risks associated with kratom.” Nov 17, 2017.
    <https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584970.htm>

    FDA. “Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse.”
    <https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htm>

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      Photodynamic Therapy (PDT) Costs, Side Effects & Recovery

      What is photodynamic therapy (PDT)?

      Photodynamic therapy (PDT) is a medical treatment that utilizes a photosensitizing molecule (frequently a drug that becomes activated by light exposure) and a light source to activate the administered drug. Very thin superficial skin cancers called actinic keratoses and certain other types of cancer cells can be eliminated this way. Acne can also be treated as well. The procedure is easily performed in a physician’s office or outpatient setting. PDT is also referred to as blue light therapy.

      PDT essentially has three steps. First, a light-sensitizing liquid, cream, or intravenous drug (photosensitizer) is applied or administered. Occasionally, a photosensitizing molecule that is already part of the body can be activated. Second, there is an incubation period of minutes to days. Finally, the target tissue is then exposed to a specific wavelength of light that then activates the photosensitizing medication. The mechanism by which tissue is destroyed seems to depend on the presence of activated oxygen molecules.

      Steps:

      1. application of photosensitizer drug
      2. incubation period
      3. light activation

      Although first used in the early 1900s, PDT in the modern sense is a new, evolving science. Current PDT involves a variety of incubation times for different the light-sensitizing drugs and a variety of light sources depending on the target tissue. The basic premise of PDT is selective tissue destruction.

      At present, the primary limitation of available PDT technology for skin is the depth of penetration of the light and ability to target cells within 1/3 of an inch (approximately 1 cm) of the light source. Therefore, tumors or atypical growths must be close to the surface of the skin for PDT to work.

      PDT is currently used in a number of medical fields, including oncology (cancer), dermatology (skin), cosmetic surgery, ophthalmology, and oral medicine.

      In oncology, PDT is FDA approved for non-small cell lung cancer, esophageal cancer, and precancerous changes of Barrett’s esophagus. Its use is also being further investigated through clinical trials in general oncology for conditions including cancers of the cervix (mouth of uterus), prostate gland, brain, and peritoneal cavity (the abdominal space that contains the stomach, liver, and internal organs).

      Levulan stick (photosensitizer medication)

      Levulan stick (photosensitizer medication)

      In dermatology, PDT with the photosensitizer Levulan Kerastick (20% delta-aminolevulinic acid HCl) is used for the treatment of very early, thin skin cancers called actinic keratoses (AK). The initial approval was specifically for the treatment of actinic keratosis of the face and scalp with application of the photosensitizer followed by a timed exposure to a special blue light source. PDT has also used for acne, rosacea, thin nonmelanoma skin cancers, sun damage, enlarged sebaceous glands, wrinkles, warts, hidradenitis suppurativa, psoriasis, and many other skin conditions. It is not used to remove moles or birthmarks.

      Application of Levulan to the face

      Application of Levulan to the face

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        Picking a New Primary Care Doctor

        News Picture: Picking a New Primary Care DoctorBy Julie Davis
        HealthDay Reporter

        Latest Prevention & Wellness News

        THURSDAY, Feb. 8, 2018 (HealthDay News) — There are times in life when you need to pick a new doctor, or primary care provider.

        A primary care provider is your health gatekeeper, offering wellness visits, evaluating problems and suggesting specialists when necessary.

        There are different types of providers to choose from, such as internists; family practitioners who care for adults as well as children; and, for women, ob-gyns or obstetrician-gynecologists. Board-certification in one of these areas indicates a high level of training.

        These tips from the U.S. National Library of Medicine will help you find the right professional for you.

        First, put together a list of prospects from many sources. Start with your health insurance provider to know who’s in your network. Ask relatives and others you trust — for example, your dentist or eye doctor — then do a web search through your state medical association and national nonprofit health organizations.

        You want to select someone you’ll feel comfortable with because, ideally, he or she will be involved in your care for a long time. You might request an office or phone interview to get to know a potential provider. Considerations can range from bedside manner, treatment style and a focus on prevention, to location and convenient office hours.

        Create a list of what’s most important to you:

        • Do you want a bedside manner that’s friendly or formal?
        • Should the doctor’s focus be on prevention or helping you manage a chronic condition?
        • Do you prefer an approach to treatment that’s conservative or aggressive?
        • Do you want to be an active partner in the patient-doctor relationship?
        • Would you like the doctor to be easy to reach and communicate with via email?

        Your answers to these questions will help you find the right health care match.

        Bonus tip: Should you have a non-life-threatening health problem before you find a new health care provider, locate the nearest urgent care center. This type of facility can save time and money compared to a traditional emergency room.

        MedicalNews
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          Asthma Drug Tied to Nightmares, Depression

          News Picture: Asthma Drug Tied to Nightmares, DepressionBy Serena Gordon
          HealthDay Reporter

          THURSDAY, Sept. 21, 2017 (HealthDay News) — The asthma medication Singulair (montelukast) appears linked to neuropsychiatric side effects, such as depression, aggression, nightmares and headaches, according to a new review by Dutch researchers.

          But experts aren’t yet ready to pull the plug on this class of medication.

          “In our study, we give prescribing physicians the advice to be alert for signs and symptoms for allergic granulomatous angiitis [a rare complication associated with the drug] and for severe neuropsychiatric symptoms,” said study lead author Dr. Meindina Haarman.

          “The doctor still decides whether or not to treat the patients with montelukast,” said Haarman, from University Medical Center Groningen in the Netherlands.

          Dr. Matthew Lorber is a psychiatrist at Lenox Hill Hospital in New York City. He cautioned against discontinuing the medication in children with asthma, a lung disease that inflames and narrows the airways.

          “Ultimately, asthma can be a life-threatening condition in children and cannot be ignored, so I do recommend to parents that their children continue with these lifesaving medications,” Lorber said.

          “It is just very important to monitor for these risks, and it is vital that doctors warn parents about these risks before their children start these medications so they know what to be on the lookout for,” Lorber added.

          Singulair is an asthma and allergy medication, available as a pill or as dissolvable granules, taken once daily. It’s part of a class of drugs called selective leukotriene receptor antagonists, according to Haarman. Other medications in this class include zafirlukast (Accolate) and zileuton (Zyflo and Zyflo CR).

          Since 2009, the U.S. Food and Drug Administration has required these drugs to carry a warning that they are associated with neuropsychiatric side effects, such as agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression and insomnia. Suicidal thinking and behavior (including suicide), and tremor are also possible side effects.

          The current study used two databases to see how prevalent these types of side effects were in children and adults taking Singulair. One was the Netherlands Pharmacovigilance Center Lareb, which reported more than 300 adverse side effects after taking Singulair.

          The second was a global database called VigiBase, maintained by the World Health Organization to monitor adverse side effects from medications. This database, which includes more than 120 countries, contained almost 18,000 reports of adverse events after taking Singulair.

          The odds of depression were nearly 7 times higher in kids and adults taking Singulair. The odds of aggressive behavior were 30 times higher in children taking the drug, researchers found.

          The odds of thinking about suicide were 20 times higher and the odds of nightmares were more than 22 times higher in adults and kids taking the drug, with children especially prone to nightmares, the study showed. The risk of headaches was twice as high in people taking Singulair.

          The study authors acknowledge it’s hard to tease out a cause-and-effect relationship. For example, having asthma has been linked to a higher risk of depression, so is the effect from the disease or the treatment?

          Still, Haarman said, “For certain neuropsychiatric symptoms [such as] nightmares, the relatively high reported odds ratio indicates a strong relationship between montelukast and the symptom. But for other side effects this relationship is not that clear.”

          But, she continued, “No exact pathophysiological explanation has been found yet for the increased risk of neuropsychiatric problems in both children and adults treated with montelukast.”

          Dr. Gina Coscia is an allergist, immunologist and pediatric pulmonologist with Northwell Health in Great Neck, N.Y.

          “Singular is used in a select group of patients with asthma whose symptoms are inadequately controlled on inhaled corticosteroids. It is typically an adjunctive therapy and is useful because it can limit the amount of steroids a patient receives,” she explained.

          “If your physician thinks that your child’s asthma is inadequately controlled or if your child has exercise-induced asthma, montelukast might be a beneficial treatment,” Coscia said. But, she added, “It is imperative to be conscious of any behavioral changes or nightmares, and if these occur, call your physician promptly.”

          Haarman said adults should also reach out to their physicians if they experience any unusual side effects while taking these medications.

          Merck — the manufacturer of Singulair — did not respond to a request for a comment.

          The study’s findings were published Sept. 20 in Pharmacology Research and Perspectives.

          MedicalNews
          Copyright © 2017 HealthDay. All rights reserved.

          SOURCES: Meindina Haarman, M.D., University Medical Center Groningen, the Netherlands; Matthew Lorber, M.D., psychiatrist, Lenox Hill Hospital, New York City; Gina Coscia, M.D., allergist, immunologist and pediatric pulmonologist, Northwell Health, Great Neck, N.Y.; Sept. 20, 2017, Pharmacology Research and Perspectives

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            Definition of Peritoneal

            Peritoneal: Having to do with the peritoneum.

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              Many Migraine Sufferers Given Unnecessary Opioids, Study Finds

              News Picture: Many Migraine Sufferers Given Unecessary Opioids, Study FindsBy Amy Norton
              HealthDay Reporter

              FRIDAY, Aug. 25, 2017 (HealthDay News) — Too many people with migraines are prescribed potentially addictive opiate painkillers, while too few may be getting recommended medications, a new study suggests.

              Researchers found that of nearly 2,900 Americans who visited the doctor for migraine relief, 15 percent were prescribed opioids such as oxycodone (OxyContin or Percocet) or hydrocodone (Norco, Vicoprofen).

              That’s despite the fact that the drugs should really be used only as a “last resort,” said study lead researcher Dr. Larry Charleston IV.

              Opioids are not only less effective than recommended migraine drugs, they’re also risky, said Charleston, an assistant professor of neurology at the University of Michigan Medical School.

              Repeated opioid use, he explained, can actually lead to more frequent, or even chronic, migraines. And by now, it’s no secret that the drugs have the potential for abuse and addiction.

              “We have a huge problem with opioids in the U.S.,” Charleston said.

              Dr. Lauren Natbony treats migraine patients at Mount Sinai’s Center for Headache and Pain Medicine in New York City.

              She said that the most common cause of chronic migraine is medication overuse — including opioids. The painkillers should only be used in “rare circumstances,” Natbony said — such as for certain patients who simply cannot tolerate “migraine-specific” medications.

              The 15 percent figure in this study is “way too high,” said Natbony, who wasn’t involved in the research.

              Migraines are intense headaches that typically cause throbbing pain on one side of the head — along with sensitivity to light and sound, and sometimes nausea and vomiting.

              They’re also common, affecting about 12 percent of Americans, according to the U.S. National Institutes of Health.

              Treatment guidelines say that people with migraines should first try general painkillers — such as acetaminophen (Tylenol), naproxen (Aleve), ibuprofen (Advil, Motrin) — or migraine-specific medications called triptans. Those include drugs such as sumatriptan (Imitrex, generics) and rizatriptan (Maxalt, generics).

              People with more severe or more frequent migraine attacks may need preventive medications. Those include certain blood pressure drugs, such as metoprolol (Lopressor, Toprol) and propranolol (Inderal), and anti-seizure drugs like topiramate (Qudexy, Topamax) and valproate (Depacon).

              The current findings are based on a federal survey. The survey tracks trends in office-based medical care across the United States.

              Charleston’s team focused on U.S. adults who visited the doctor for migraine treatment between 2006 and 2013. They were representative of 50 million office visits nationwide, the researchers said.

              White, black and Hispanic patients were prescribed similar rates of opioids for migraines, the study found.

              Meanwhile, 39 percent of patients were not prescribed any “abortive” medication — meaning a drug that eases a migraine attack in progress. A similar percentage (just over 40 percent) received no preventive medications.

              The researchers had no information on the severity or duration of patients’ headaches, according to Charleston. So it’s not clear how often they should have been prescribed medication.

              But, Charleston said, when patients were prescribed abortive or preventive medications, they were often “low-quality.” That meant drugs that did not fall in the “Level A” category set by the American Academy of Neurology — based on evidence of their effectiveness.

              For example, triptans (sumatriptan/Imitrex, rizatriptan/Maxalt) and dihydroergotamine (Migranal, which comes as a nasal spray or injection) would be considered Level A abortive treatments. In this study, only 19 percent of patients received such Level A drugs, while 27 percent were prescribed at least some lower-quality abortive medication.

              According to Natbony, it’s hard to know what to make of those findings. There could be reasons that some patients received drugs that were not in the Level A category, she said.

              The bottom line for patients, she said, is to “advocate for themselves.”

              Ask whether you are on the best medications for your head pain, Natbony advised — and if you’re prescribed an opioid, question it. “Don’t assume it’s OK because a doctor is prescribing it,” she said.

              It’s unclear why so many patients in this study were on opioids, according to Charleston.

              About half had seen their primary care doctor, while between one-fifth and one-quarter visited a neurologist.

              It’s possible, Natbony said, that many of those doctors lacked education in migraine treatment. Even some neurologists, she noted, may be less-informed if they don’t specialize in headache management.

              “It’s not clear where the breakdown is happening,” Natbony said.

              Whatever the reasons, she said that migraine patients who are unsatisfied with their care should get a second opinion — if possible, with a headache specialist.

              That may not always be easy, though. There’s roughly one headache specialist for every 86,000 migraine sufferers in the United States, Charleston said.

              Findings from the study were published recently in the journal Cephalalgia.

              MedicalNews
              Copyright © 2017 HealthDay. All rights reserved.

              SOURCES: Larry Charleston IV, M.D., assistant professor, neurology, University of Michigan Medical School, Ann Arbor; Lauren Natbony, M.D., assistant professor, neurology, Center for Headache and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City; June 26, 2017, Cephalalgia, online

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                Keratitis Types, Symptoms & Infection Treatment

                What are the causes of keratitis?

                Keratitis, the eye condition in which the cornea becomes inflamed, has many potential causes. Various types of infections, dry eyes, abnormalities of the eyelids, injury, and a large variety of underlying medical diseases may all lead to keratitis. Some cases of keratitis result from unknown factors.

                What are the risk factors for keratitis?

                Major risk factors for the development of keratitis include any break or disruption of the surface layer (epithelium) of the cornea.

                The use of contact lenses increases the risk of developing keratitis, especially if hygiene is poor, improper solutions are used to store and clean the lenses, or if contact lenses are worn improperly or in the presence of persistent irritation.

                A decrease in the quality or quantity of tears predisposes the eye to the development of keratitis.

                Disturbances of immune function through diseases such as AIDS or the use of medications such as corticosteroids or chemotherapy also increase the risk of developing keratitis.

                What are the different types of keratitis?

                Keratitis can be classified by its location, severity, and cause.

                If keratitis only involves the surface (epithelial) layer of the cornea, it is called superficial keratitis. If it affects the deeper layers of the cornea (the corneal stroma), it is called stromal keratitis or interstitial keratitis. It may involve the center of the cornea or the peripheral part of the cornea (that portion closest to the sclera) or both. Keratitis may affect one eye or both eyes.

                Keratitis may be mild, moderate, or severe and may be associated with inflammation of other parts of the eye. Keratoconjunctivitis is inflammation of the cornea and the conjunctiva. Kerato-uveitis is inflammation of the cornea and the uveal tract, which consists of the iris, ciliary body, and choroid.

                Keratitis may be acute or chronic. It may occur only once or twice in an eye or be recurrent. It may be limited in its effects on the eye or be progressive in its damage. It may involve one eye (unilateral) or both eyes (bilateral).

                The various causes of keratitis may result in different clinical presentations, so defining the location, severity, and frequency of the condition can often assist in pinpointing the exact cause. Other helpful facts in establishing the cause of keratitis can include demographic information such as the age, sex, and geographic location of the patient. A medical history, social history, and a review of all symptoms are often useful as well in finding the cause of keratitis.

                Infection is the most frequent cause of keratitis. Bacteria, viruses, fungi, and parasitic organisms may all infect the cornea, causing infectious or microbial keratitis.

                • Bacteria most frequently responsible for keratitis include Staphylococci, Hemophilus, Streptococci, and Pseudomonas. If the front surface of the cornea has been damaged by a small scratch and the surface is not intact, almost any bacteria, including atypical mycobacteria, can invade the cornea and result in keratitis. Ulcerations of the cornea may occur, a condition known as ulcerative keratitis. Before the advent of antibiotics, syphilis was a frequent cause of keratitis.
                • Viruses that infect the cornea include respiratory viruses, including the adenoviruses and others responsible for the common cold. The herpes simplex virus is another common cause of keratitis. It typically produces a dendritic keratitis, which is a defect in the surface of the cornea in a tree-branching configuration. Worldwide, the incidence of HSV keratitis is about 1.5 million, including 40,000 new cases of related blindness each year. The herpes zoster virus (VZV or varizella-zoster virus, the virus responsible for chickenpox and shingles) may also cause keratitis, particularly when shingles involves the forehead. The U.S. Centers for Disease Control and Prevention (CDC) has recently described adult patients with conjunctivitis and keratitis resulting from the Zika virus.
                • Fungi such as Candida, Aspergillus, and Nocardia are unusual causes of microbial keratitis, more frequently occurring in people who are immunocompromised because of underlying illnesses or medications. Fusarium keratitis, a type of fungal infection, occurs primarily in contact-lens wearers. Bacterial co-infection can complicate fungal keratitis.
                • Contact-lens wearers are also susceptible to Acanthamoeba keratitis caused by an amebic parasite. “River blindness,” or onchocercal keratitis, is another parasitic infection of the cornea, rarely seen in developed countries, but very common in the Third World.

                Physical or chemical trauma is a frequent cause of keratitis. The injury may become secondarily infected or remain noninfected. Retained corneal foreign bodies are frequent sources of keratitis. Ultraviolet light from sunlight (snow blindness), a tanning light or a welder’s arc, contact-lens overwear, and chemical agents, either in liquid form splashed into the eye or in gases in the form of fumes can all result in noninfectious keratitis. Chemical injury or contact lens-related keratitis often causes superficial punctate keratitis, in which the examiner notices myriads of injured surface cells on the affected cornea.

                Disturbances in the tear film may lead to changes in the corneal surface through drying of the corneal epithelium. This type of keratitis is usually superficial and is known as keratitis sicca. If the eyes are extremely dry, the surface cells may die and form attached filaments on the corneal surface, a condition known as filamentary keratitis. Inability to close the eyelids properly can also lead to corneal drying, a condition termed exposure keratitis. This can occur in Bell’s palsy, which is a facial nerve weakness sometimes associated with Lyme disease.

                Disorders of the eyelids or eyelashes may also cause keratitis. If the lower eyelid is turned inward, a condition known as entropion, eyelashes will rub against the cornea. Lashes growing in the wrong direction may also cause surface damage to the cornea.

                Allergies to airborne pollens or bacterial toxins in the tears may also cause a noninfectious type of keratitis. Autoimmune diseases create a similar appearance, often affecting the periphery of the cornea, termed marginal keratitis or limbic keratitis. People with rheumatoid arthritis or other immune disorders may develop marginal corneal ulceration with thinning of the cornea.

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