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.

Do Antidepressants Really Work?

There was much brouhaha in the news last week about a new study claiming that once and for all the debate about anti-depressants was over. Headlines proclaimed that “It’s official – antidepressants work“, “Study proves anti-depressants are effective“, and “Antidepressants work. Period.” But what did the study really find?

The analysis looked at the first 8 weeks of treatment from 522 placebo-controlled studies of patients with major depressive disorder (MDD). This is a type of severe depression that occurs in an estimated 3 percent of the US population over age twelve. Researchers reported that all antidepressants were more effective than placebo but the results were mostly modest. The dropout rate was 2-4 times greater in those taking the medications compared to placebos.

The study did not include people with the more common types of mild to moderate depression, which comprise 75 percent of people taking antidepressants, nor did it evaluate the efficacy of these drugs for more than 8 weeks. Other studies have reported that exercise and cognitive behavior therapy are just as effective as anti-depressants, without the risk of side effects. In fact, in the long-term, patients using exercise have a much lower relapse rate than those taking drugs.

Other critics of this study have pointed out that many of the studies in the analysis were unpublished and had not been through a rigorous peer-review process and that 80 percent of the studies reviewed were funded by pharmaceutical companies. Finally, some of the authors of the analysis reported consulting fees from companies that manufacture the very drugs they were studying.

So what did we learn from this study? There is a modest benefit in taking anti-depressants for the approximately 3 percent of people with severe depression for the first 8 weeks of treatment. Maybe. Does this study provide a definitive answer about the usefulness of anti-depressants in the vast majority of people who are taking them? Not by a long shot.

More information on non-drug treatments for depression as well as the dangers and side effects of anti-depressants can be found in my book, Do You Really Need That Pill? Now available for pre-order at https://www.amazon.com/Really-Need-That-Pill-Overmedication/dp/1510715649

New Studies on Preventing Alzheimer’s

The Alzheimer’s Association estimates that one in eight people over age sixty-five has this disease and that the number will triple by 2050 to 16 million people. This would take a huge toll on our health care system, as well as on each family that would be burdened financially and emotionally dealing with their loved one. All of us, especially those approaching their “golden years,” want to do everything possible to avoid this fate.

Two new studies offer simple ways to prevent or treat what is called cognitive impairment, mild to moderate memory problems that can be early signs of dementia. The first study assigned participants with early memory impairment to either listen to music or to meditate for 12 minutes each day for three months. At the end of that time, both groups showed significant improvements in tests measuring memory and thinking ability. These gains were maintained or improved after another three months. Easy to do, cost-effective, and without side effects, these are activities that most of us can do on our own. (Journal of Alzheimer’s Disease, January 18, 2017)

You probably know that keeping active mentally is one way to prevent dementia. A recently-published study followed elderly people (ages 74-82) for four years to see how various activities affected their memory and thinking ability. Out of the 1929 people who were mentally normal at the beginning of the study, 456 developed cognitive impairment. Those who reported playing games, doing crafts, using a computer, or participating in social activities 1-2 times a week had a significantly lower risk of developing this problem than those who did them only 2-3 times a month. My bridge partner will be happy to hear this. (JAMA Neurology, January 30, 2017)

Finally, a provocative new study suggests that those people who develop high blood pressure late in life—age 80 or beyond—have a significantly lower risk of dementia. This is compatible with several other studies that found more cognitive impairment in seniors with a systolic blood pressure (the top number) below 130 and better mental functioning in those with values above 160. The authors of the new study theorize that higher blood pressure is needed in the elderly to force adequate blood flow to the brain due to age-associated hardening of the arteries. (Alzheimers Dement, January 17, 2017) On the other hand, high blood pressure earlier in life is thought to contribute to dementia, due to damage of the arteries leading to the brain.

There is also research linking many common drugs—statins, acid-reflux drugs, anti-histamines, tranquilizers, anti-depressants—with mental impairment and dementia. More about that in my book, coming June, 2018.

The Top Five Drugs To Avoid

While researching my book, Do You Really Need That Pill?, I came upon many drugs that can cause more harm than good. But there are five specific types that I think most people should avoid, due to their questionable effectiveness and potential side effects. Many of these are blockbusters heavily advertised by Big Pharma. Of course, there are people who actually need these drugs, but they are few and far between.

My book covers these drugs in much greater detail and I will focus on each one more specifically in a later post. But for now, here is the nitty gritty on the top five types of drugs to avoid, if you can:

Statins (Lipitor, Zocor, Crestor) are prescribed to lower cholesterol. Current guidelines advise that nearly everyone over age 65 take them but there is little evidence that they actually prevent heart disease in people without risk factors or a previous heart attack or stroke. One out of every five people taking them experiences muscle damage and they can double the risk of diabetes. Statins have also been associated with memory loss, dementia, and impaired liver function.

Acid Reflux Drugs (Nexium, Prilosec, Prevacid) were approved by the FDA to be taken for only 2 weeks, yet many people take them for months or even years. They suppress stomach acid, which prevents the body from absorbing essential nutrients such as calcium, iron, and Vitamin B12. This leads to such problems as anemia, depression, bone fractures, and dementia.

Osteoporosis drugs (Fosamax, Reclast) are unnecessary for the vast majority of women who take them. There is little evidence that they strengthen bones or prevent hip fractures and there are several dangerous side effects. Exercising, getting plenty of calcium and Vitamin D in your diet, and avoiding excess alcohol and caffeine are better ways to improve your bone health.

Anti-depressants (Prozac, Paxil, Zoloft, Effexor) are effective in as few as one out of seven people with mild to moderate depression. Side effects include sexual dysfunction, suicide, bleeding disorders, and diabetes. Psychotherapy, exercise, meditation, yoga, and alternative therapies such as acupuncture and homeopathy can alleviate depression.

Opioid pain relievers (morphine, codeine, OxyContin, Vicodin, Percocet) caused more than 30,000 overdose deaths in 2017 despite research showing they are no more effective than over-the-counter pain pills like ibuprofen. Another nearly 30,000 deaths were attributed to synthetic opioids such as fentanyl. Because of their potential for addiction, the FDA now recommends that prescriptions for opioids be limited to seven days.