The Suicide Epidemic

There is an epidemic of suicide in the US, most recently the hanging deaths of two celebrities–Kate Spade and Anthony Bourdain. Suicide rates have gone up all over the country, by more than 30% in many states since 1999. Suicide is now the tenth leading cause of death in adults, nearly 45,000 in 2016. The vast majority of people who kill themselves are white and more than three-quarters are men. States with lax gun laws have higher suicide rates. Each day, 20 military veterans kill themselves.

These are the facts–what can we do about them? The CDC reports that more than half of those who commit suicide do not have a known mental health problem. But we do know that there are many factors contributing to suicide, including relationship and financial problems, substance abuse, and chronic health problems. It is hard to maintain a positive outlook facing the many problems in the world today–overpopulation, climate change, and economic inequality.

Antidepressants are not the answer. As I wrote in a previous post, the evidence that they are effective is slim, especially for people with mild to moderate depression. In fact, there is research showing that antidepressants such as Paxil, Zoloft, and Effexor actually increase suicide attempts, especially in adolescents and young adults. And the recent report that one-third of adults take medications that can cause depression makes me wonder if Kate Spade or Anthony Bourdain were victims of one or more of these drugs.

On the other hand, there is growing evidence that several non-drug treatments for depression can be effective. There are more details about each of these in my book, but here is a summary:

-Cognitive Behavioral Therapy (CBT) is just as effective as antidepressants, without danger of side effects
-Exercise can decrease depression as much as psychological or pharmacological therapies and is more long-lasting
-A dietary pattern characterized by a high intakes of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and low intakes of animal foods was associated with a decreased risk of depression.
-Omega-3 fatty acids found in fatty fish, nutritional supplements, the herb St. John’s wort, massage, yoga, acupuncture and homeopathy have all been shown effective for depression in research studies.

So why aren’t more people taking advantage of these healthier approaches to depression? One reason is that health insurance and Medicare do not cover them and people must pay for them out-of-pocket. But like many other chronic health problems, it is often easier to take a pill than make positive lifestyle changes.

The New Shingrix Vaccine

MY TAKE: As with any new drug or device, it is best to wait a year or two to find out if there are any unexpected adverse effects.

Shingrix, the new shingles vaccine, is all the rage among the over-50 set. It is hard to drive by a Walgreens without seeing a sign advertising that it is available. As you may know, shingles occurs when the same varicella zoster virus that causes chickenpox becomes reactivated in later life. In most people older than 50, shingles virus is dormant in the nervous system, and a person’s risk for shingles rises sharply after age 50.

The previous shingles vaccines, Zostavax, was made from a live, inactivated virus while Shingrix uses a protein on the surface of the virus. Shingrix also contains two adjuvants to boost the immune response, one of which has not been used in humans before now.

PROS of Shingrex–

-Provides 80-90% protection against shingles with two doses, compared to 50-60% from one dose of Zostavax
-Appears to last longer than Zostavax

CONS of Shingrex–

-Requires two shots 2-6 months apart instead of just one
-Has more side effects- 75% of people reported pain at the injection site, 17% with reactions severe enough to prevent normal activities. Also, about 1 in 10 people reported systemic effects such as muscle pain, fatigue, headache, shivering, fever, or gastrointestinal illness.
-More expensive- can cost up to $300, not always covered by Medicare or insurance.

What bothers me the most is that the CDC panel evaluating Shingrix split 8-7 over whether to recommend it above Zostavax, a highly unusual lack of consensus. Several panel members advocated collecting safety data on Shingrix for a year or two before endorsing it over Zostavax. One member noted that the adjuvant in Shingrix that boosts the immune response “has never been out in the real world before.” So waiting a year or two before getting the vaccine seems prudent.

As for me, I’ll take my chances without either vaccine. There are several homeopathic remedies that have an impressive track record in treating shingles, should I get it. But infections more often occur when the immune system is weak and shingles is probably no exception. Eating a healthy diet, exercising, getting enough sleep, and dealing effectively with stress should make you less susceptible to getting shingles.

Should You Take Statins?

Cholesterol is only one of several factors that affect the risk of heart disease. Others include high blood pressure, smoking, lack of exercise, family history, poor diet, and being overweight or obese. One study estimated that 80 percent of heart disease could be prevented by changes in three lifestyle factors- diet, exercise and smoking. And yet the medical establishment remains focused on cholesterol levels and taking statins.

When I was in medical school, a total cholesterol below 240 mg/dL was considered acceptable, but over the years that was lowered to 220 and then to 200 by various advisory groups. In 2004, new guidelines that made LDL cholesterol the primary factor in deciding to prescribe statins were so stringent that millions more Americans were prescribed these drugs. Subsequently, it was reported that all but one of the nine members of the panel that wrote the guidelines had received funding from statin manufacturers.

A consortium of heart organizations came out with yet a new set of guidelines in 2013, based on your risk of heart attack in the next ten years, determined by an online calculator. You should take a statin, they advised, if your risk is 7.5 percent or more. Using the results of the online calculator, upwards of 70 million Americans, including almost everyone over age sixty-five, should be taking these drugs. Fortunately, a recently revised calculator (https://sanjaybasu.shinyapps.io/ascvd/) dials back the number of people advised to take statins.

Missing from these advisories is any consideration of the dangers of taking statins:

-One in five patients taking statins have side effects, with muscle pain being the most common.
-The FDA has issued safety announcements cautioning statin users about memory problems, diabetes, and liver function.
-Acute memory loss is four times more common in statin users in the first days of treatment.
-People taking statins have nearly a 50 percent higher risk of developing type 2 diabetes.
-Other side effects include cataracts, liver and kidney damage, fatigue, and mood disorders.

If you have had a previous heart attack or stroke and/or if you have a 20 percent risk of having one in the next ten years using the new calculator, you should consider taking a statin if you are not able to reduce your ten-year risk using lifestyle methods alone. In people with familial hypercholesterolemia, a genetic defect causing high levels of LDL cholesterol, statins are usually recommended. These people can also lower their risk of heart disease, as well as the dosage of statins needed, by diet, exercise, and smoking cessation.

While it is easier to take a pill, most of us could take a thirty-minute walk three times a week, up our intake of fruits and vegetables to five servings daily, and cut down on highly refined carbohydrates. Losing weight and stopping smoking are more difficult but can be done with proper motivation. Given the choice, what would you do? Change your lifestyle or take a pill? As the evidence of serious side effects from statins continues to grow—diabetes, cataracts, muscle damage, even dementia—the risk benefit equation tilts dramatically toward not taking them at all.