The U.S. Preventive Services Task Force, made up of expert appointees who create guidelines for doctors, now recommends routine depression screening for all American teens in an effort to better diagnose and treat nearly 2 million kids who are affected.

About 6 percent of U.S. teenagers are clinically depressed, but most remain undiagnosed and untreated, said the panel. Having determined that detailed, simple questionnaires accurately diagnose depression, the task force wants primary-care physicians and pediatricians to begin screening all teen patients on an annual basis, not just those who appear to be at risk or in crisis.

According to Dr. Ned Calonge, task force chairman, depression is so common, “you will miss a lot if you only screen high-risk groups.” Recommending the use of well-researched questionnaires that focus on depression tip-offs including mood, anxiety, appetite and substance abuse, Calonge and his colleagues stress that since “depression can lead to persistent sadness, social isolation, school problems and even suicide, screening to treat it early is crucial.”

Addressing the fact that some antidepressants have been linked to increased suicidality, the task force stresses that medication alone is not appropriate, and that talk-therapy is vital to successful diagnosis and treatment. Fortunately, childhood and adolescent depression respond well to treatment plans that include medication and talk-therapy.

Recently passed mental health parity laws mandate equal coverage for mental and physical illnesses which guarantees better coverage for children seeking mental health care. This shift in coverage combined with task force recommendations will force pediatricians and family physicians to get more involved in mental health care.

In response to the task force’s report, Dr. Alan Axelson, a Pittsburgh psychiatrist, wrote a report on behalf of the American Academy of Child and Adolescent Psychiatry in which he recommends that pediatricians work closely with child psychiatrists, even sharing office space when possible. The Academy also says insurers should compensate pediatricians for any mental health services they provide.

Because families usually get to know their pediatricians, “having those doctors offer mental health screening can help make it seem less stigmatizing.” Axelson said, adding that “Most pediatricians aren’t trained to do psychotherapy, but they can prescribe depression medication and monitor patients they’ve referred to others for therapy.”

If you have children or teens, check with your family doctor to learn how he screens for depression in young patients.

Anticipate the unexpected.

ALWAYS set up contingency plans just in case.

Examples:

~ If one of us is delayed, we’ll send a text message notifying the others.

~ If we get split up at the mall, here’s the time and place we’ll meet.

~ If you get locked out of the house, get the spare key from (the neighbor, the hiding place…).

~ In case of emergency or disaster, the family will meet at (designated place).

~ If I cannot be reached, here is my emergency contact:

~ Keep a change of clothes, a large towel and water in the car trunk.

~ Store emergency contact person in everyone’s cell phone under “911.”

~ Keep a collar with i.d. tag and phone number on pets.

Pre-planning for challenging times provides a sense of comfort and control, and reduces stress, worry and panic. With a little organization, you will be better equipped to deal with the demands of the moment.

This is the most recent installment in an ongoing series elaborating on 52 proven stress relievers identified by researchers at Texas Woman’s University.

Because Inside Each of Us Is a Wild Thing!

Fall 2009 — Cannot Wait!

A report released by an expert panel convened by the National Institute of Mental Health indicates that myriad biological, psychological, and social factors play a role in the high smoking rates among people with psychiatric disorders.

Analysis of data from the National Comorbidity Study (NCS), a nationally representative survey of psychiatric disorders in the United States, indicated that 41% of people with psychiatric disorders smoke, nearly twice the rate (22.5%) seen in the general population. Their life expectancy is reduced by 20 years.

Additionally, although people with psychiatric disorders make up 26.2% of the U. S. population, they consume 44.3 percent of all cigarettes smoked, and this high smoking rate is partly to blame for increased rates of physical illness and mortality amongst the mentally ill.

Despite these high smoking rates and their obvious health hazards, studies of psychiatric patient care showed that fewer than 25% of outpatients received smoking cessation counseling, and only 1%  of inpatients were assessed for smoking; no treatment plans for these patients addressed tobacco use.

The report says that reasons for these low rates of assessment and treatment include the medical communities acceptance of smoking by psychiatric patients as an individual right and as a method of self-medication and symptom relief.

In order to address the disparities and improve psychiatric patient care and prognoses, the panel identified the following areas for continued research:

* Changes in the hypothalamic-pituitary-adrenal (HPA) axis, a system in the body involved in the response to stress, have been reported in post-traumatic stress disorder (PTSD). The HPA axis is also involved in the development of nicotine tolerance. The interplay of the HPA axis with stress and nicotine may help explain the increased smoking in those with PTSD and other anxiety disorders.

* The possibility that the relationship between depression and smoking is bidirectional: depression increases the risk of smoking, and chronic smoking increases a person’s susceptibility to depression. The same genes may contribute to both. For example, decreased activity of dopamine -a neurotransmitter that is central to the brain’s reward system-is thought to be associated with depression; studies cited by the panel suggest that variants of genes that affect the level of dopamine function can influence the likelihood that someone with depression will smoke.

* As many as 70 to 85 percent of people with schizophrenia use tobacco. According to the panel, psychosocial factors are important in understanding the high rates of smoking people with schizophrenia. Limited education, poverty, unemployment, and peer influence increase smoking risk; the mental health treatment system, in which smoking is not only acceptable but sometimes condoned, is also a contributor.

* Nicotine has effects on some cognitive processes in people with schizophrenia and research has found that variants in the genes for nicotine receptors have been linked to deficits in these processes. The relationships between genes, environment, and smoking in this population are not fully understood.

The panel also identified these issues for future research:

*Improve precision in defining the specific psychiatric disorders of interest in a given study. “Depression,” for example, is used in reference to a number of different conditions. Similarly, clearer definitions of smoking behavior and patterns and progression of use are needed.

* Use longitudinal studies toprovide more complete information on the relative risk, incidence, and course of smoking and various mental disorders.

* Explore the causal links between tobacco use and psychiatric disorders, including possible genetic, neurobiological, psychological, or social factors. The extent to which smoking is used as a form of self-regulation needs to be explored.

* Discover how smoking and other health related factors such as stress, obesity, and limited physical activity contribute to the illness and mortality seen in people with mental disorders.

* Assure adequate sample sizes in smoking cessation trials, and greater emphasis on adapting cessation treatment to various psychiatric populations and in different treatment settings; and research on how tobacco control polices affect psychiatric populations.

With these guidelines in place, psychiatric patients may finally see literal parity on the heels of recent insurance parity; and a mental illness diagnosis will not carry with it a 20-year decrease in life expectancy, as is now the case.

Until now, they didn’t understand why.

Researchers at Loyola University Health System, Maywood, Ill. discovered that depressed patients have higher levels of inflammatory substances in their blood, leading to physiological reactions that, over time, damage the heart.

“The body and the mind are closely connected, and they affect each other. We’ve found that even though patients’ depression gets better within six to eight weeks with treatment, it may take up to six months for the inflammation markers to return to normal,” says Dr. Angelos Halaris, of Loyola University Chicago Stritch School of Medicine.

“The changes caused by the inflammation are like a slow-growing cancer that goes undetected because they cause no symptoms.”

The study found that inflammation from stress alters the structure of blood vessels and activates platelets to form, which increases clotting. As clots clump together plaque forms, ultimately leading to atherosclerosis, a narrowing or hardening of the arteries that could eventually cut off the flow of blood and cause a heart attack or stroke.

“Unfortunately, clots don’t have boundaries,” said Dr. Omer Iqbal, co-researcher at the Stritch School of Medicine. “They can dislodge and travel to the vessels of the heart and cause a heart attack, and they can also reach the brain and cause strokes.”

In light of this new information, patients treated for depression should be routinely screened and monitored for heart disease and excessive stress.

If you’re being treated for depression, know the signs of heart disease and cardiovascular disease, and take precautions to prevent them.

Women using antidepressants appear to have a higher risk of sudden cardiac death, but this doesn’t mean antidepressants are at fault. In fact, the opposite may be true.

One recent study of people with heart failure found that depression was associated with increased mortality but that use of antidepressants was not.

“We suspect that their use is a marker for people with worse depression,” explained Dr. William Whang, an assistant professor of clinical medicine at Columbia University Medical Center in New York City. “The elevated risk seems more specific for antidepressant use, but that use may well be a marker of more severe symptoms.”

The link between depression and heart trouble is physical not psychological, Whang added. “We found that women who had worse depressive symptoms had higher rates of risk factors such as hypertension, diabetes and smoking,” he said.

Whang and his team evaluated data collected from over 63,000 American women in the Nurses Health Study. And while the research team did find a link between depression and heart risk, the incidence of sudden cardiac death was associated more strongly with the use of antidepressant drugs than with symptoms of depression.

Earlier studies linked depression and a higher mortality rate for people who already had heart disease, Whang said. “But this was a group of women without heart disease, and that makes it different,” he noted.

Doctors treating women with depression should take note. “The biggest clinical implication is that management of coronary heart disease risk factors may be especially important for those with depressive symptoms,” he said. “Taking care of those risk factors can modify the risk for coronary disease.”

If you are a woman taking antidepressants, learn the signs and symptoms of heart disease and take the necessary steps to reduce your risk.

Here are a few suggestions from the Federal Government Source for Women’s Health Information:

1. Be physically active

2. Don’t smoke

3. Eat healthy

4. Maintain a normal weight

5. Know your numbers (blood pressure, cholesterol, and triglycerides)

6. Get tested for diabetes

7. Limit alcohol consumption it to no more than one drink a day.

8. Find healthy ways to cope with stress. Talk to your friends, exercise, or write in a journal.

Be proactive. Love yourself. Love your body. You’re worth it.

Lovingly,

Depression is the leading cause of suicide.

Suicide is the third-largest killer of children and young adults between the ages of 10 and 24, and is a growing problem amongst middle aged and elderly adults.

Knowing this, scientists and researchers the world over have devoted time and energy to improving treatment approaches, including studies focused on the efficacy of antidepressant medications.

The news is encouraging.

Common antidepressants reduce the risk of suicide in adults, according to work recently completed and published by Italian scientist Corrado Barbui of the University of Verona.

Barbui and his team reviewed data collected in eight previous studies that included over 200,000 patients. They focused on selective serotonin-reuptake inhibitors (SSRIs), which are the most commonly prescribed class of antidepressants. The team found that the drugs cut suicide risk by more than 40 percent among adults and over 50 percent for elderly people.

Despite the obvious value to adults, researchers still suggest caution when using antidepressants to treat children and adolescents. With this in mind, closer monitoring, such as regular meetings with a therapist or counselor, should be part of the treatment protocol for those under 18.

“Data from observational studies should reassure doctors that prescribing (the drugs) to patients with major depression is safe,” wrote the Italian team.

The news is good indeed.  Depression kills. Treatment works.

Here it is…the latest in a series of stress reduction tips based on research done at Texas Women’s University:

Eliminate or restrict the amount of caffeine in your diet.

I Know! I Know!

Just last Friday I told you about the benefits of coffee, and now I’m telling you to limit or eliminate caffeine.

But let me qualify my statement…

Many people drink 2-3 times the recommended amount of coffee every single day. That is too much!

If you refer back to last Friday’s post, you’ll see that the recommended amount of coffee for optimal health benefits is three to five cups.

That means:

three to five 6- to 8-ounce “cups”

Not 16-ounce mugs

Or 24-ounce ventis

To drink coffee optimally, you must count that single venti as three servings, or in other words, the appropriate amount you should drink in an entire day to save your brain.

Just that one.

No more.

See what I mean?

A New Movie About Life, Love and Being Different

An online acquaintance, Chrysti Hydeck, whose amazing art is available at her Etsy store, The Altered Abbey, introduced me to Phoebe in Wonderland.

The trailer and publicity material are deeply moving. I expect wonder, enchantment and enlightenment from the film itself.

I cannot wait to see it. I will report back when I have.

“It’s not just that it’s okay to be different, but you can actually derive strength from it.”

I am not a coffee drinker, preferring strong black tea with a little soy milk to soften the tannins, but new research may convince me to imbibe once in a while.

A recently released 20-year Finnish study found that among the 1,400 adult subjects, people who drank three to five cups of coffee a day were two-thirds less likely than non-drinkers to develop dementia, including Alzheimer’s disease.

The findings were reported in the Journal of Alzheimer’s Disease and add to a growing mountain of evidence suggesting that coffee drinkers have a reduced risk of developing diseases like Parkinson’s disease, certain cancers and diabetes.

At this time, researchers have not identified exactly what in coffee – antioxidants, caffeine, fiber , or something else  — explains the recent study observations, but you can bet they’ll keep up the studies until they find out.

If, after reading this, you simply must know the details of coffee and all it’s wonders, check out CoffeeScience.org where you’ll find coffee facts, health news, recipes and a whole lot more.

To whet your intellectual appetite in the meantime, here are some coffee facts from the National Coffee Association of The USA’s 2008 Consumption Report:

• 17% of the adult population consumed a gourmet beverage on a daily basis in 2008
compared with 14% in 2007.

• Adults 25-59 led the upswing with 19% of daily gourmet coffee drinkers, an increase of six percentage points from 2007.

• Past year consumption of iced and frozen coffee is up significantly from 2007 levels.

• Coffee drinkers are more likely to feel coffee is healthy, with 49% saying that as opposed to 36% of non-drinkers.

• Sixty one percent said that coffee improves their mental focus versus 48% of non-drinkers and 59% of coffee drinkers say they are more productive versus 47% of non coffee drinkers.

• In 2007, past-day consumption of coffee surpassed that of soft drinks for the first time. While the gap narrowed in 2008, daily consumption of coffee is still directionally higher.

• Consumption of cups per day by consumers age 18-24 continued to trend higher in 2008. Young adults who drank coffee consumed an average of 3.2 cups per day as compared with 3.1 in 2007, a significant increase over 2005’s level of 2.5 cups per day.

• Positive health messages are clear drivers of consumption. Questions posed to consumers about the health benefits of drinking coffee and is coffee good for my health are both up significantly from 2005 to 46% and 36% from 37% and 26% respectively.

Enjoy!