Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

More information on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Aug
24
2013

Pimples And Acne Can Be Caused By Food

For a long time nobody knew why teenagers get acne. But many assumed that it would come from hormonal changes as teenagers grow up. But why then are there some ethnic regions in the world where teenagers do not get acne? In this blog I will present the background that shows that wheat, sugar and dairy products are the culprits. They are not eaten in those regions of our planet where acne does not exist.

Regions where acne does not exist

1. The Kitivan Islanders of Papua New Guinea have no cases of acne in teenagers. They adhere to the old hunter/gatherer diet of no sugar, no alcohol, no wheat and no grains. Instead they eat root vegetables such as sweet potato, yam, taro, tapioca; fruit like papaya, pineapple, banana, mango, watermelon, guava and pumpkin; and also vegetables, coconuts and fish.

2. African Bantus and Zulus: These original African warriors eat a low glycemic diet with no wheat, no milk and no refined sugar or starches. Their teenagers and young adult do not have acne, if they stick to the original tribal diet.

3. Aché hunter/gatherers of Paraguay: a study by researchers from the Colorado State University in 2002 showed that sugar, wheat and other high-glycemic foods were missing in the diet of these native tribes. As a result they have no acne when they consume this type of diet, which is very similar to the Kitivan Islanders of Papua New Guinea.

4. Japan’s Okinawans when sticking to their original diet before 1970 had clear complexion and no pimples (acne). But as this link shows the McDonald’s and other fast foods with too much salt, too much sugar, wheat, deep fried and convenience foods entered the scene after 1970 and the acne rate went up to the American level.

5. The natives of the Purus Valley in Brazil: A dermatological examination of 9955 school children age 6 to 16 showed an acne incidence of only 2.7%. In contrast in Westernized countries the rate of acne is 60 to 80%. The diet in this region is again similar to the other groups already mentioned above.

6. Canadian Inuit before 1950 did not consume dairy products and were acne free. Since then there has been a steady increase of dairy products, soda, beef, and processed foods.

How acne develops

The medical term for pimples or acne is “acne vulgaris”. For years it has been postulated that hormones and medication can cause acne. According to Ref.1 there are several steps that work together in causing acne. The hair follicle and sebaceous gland work as one unit. Male hormones, called androgens play an important role in the development of acne, both in males and females. Testosterone in males is not only produced in testicles, but also in the skin itself. It gets converted by an enzyme, 5-alpha-reductase, into the much more active metabolite dihydrotestosterone. In individuals with hypersensitive receptors in the sebaceous gland this will cause blockage in the sebaceous gland duct and at the same time stimulate the sebaceous gland oil production leading to the formation of a keratotic plug. White heads and black heads are formed this way. Contributing factors are inflammatory substances that are caused by insulin release stimulated by sugar, wheat and starch intake. This stimulates IGF-1 receptors in the skin, which causes growth of the subcutaneous skin layers, which is pushing up from the layer below the skin, kinking the sebaceous gland duct and causing acne pustules (pimples) to form. A skin bacterium, called Propionibacterium acnes (P. acnes), is getting trapped in the pimple causing a local skin infection, which in turn can cause acne cysts and furuncles, particularly in males where there is a family history of acne. High cortisol levels from stress can also be a contributing factor in causing acne. Today’s teenagers are exposed to a lot of stresses from exams, competitive sports and peer pressures.

Females with PCOS (polycystic ovary syndrome) have higher androgen production from ovarian cysts, which results in acne as well.

Both male and female teenagers experience an androgen surge when puberty sets in. If the teenager avoids the additional insulin response, which comes from eating sugar, starch, grain and particularly from consuming wheat and wheat products, the plugging up of skin pores will not occur, meaning these teenagers will be acne free. Some teenagers are also sensitive to milk protein from milk and milk products. In sensitive people whey protein allergy causes the same insulin/skin IGF-1 response described above, which leads to blocking of skin pores. If there is no blockage in the hair follicle, the P. acnes bacteria will stay on the surface of the skin (these bacteria are part of the normal skin flora) and the sebaceous gland secretions flow unimpededly to the surface of the skin keeping  it naturally lubricated. These observations are further confirmed by a study from Malaysia in 2012 showing that a high glycemic load diet with milk and ice cream caused worsening of acne in teenagers of both sexes.

Pimples And Acne Can Be Caused By Food

Pimples And Acne Can Be Caused By Food

Treating acne correctly

A)   Conventional acne treatment

This is a thorny issue, because Big Pharma has a firm hand in the treatment of acne and they are supporting symptomatic treatment of acne rather than treating the cause. There are surface treatment modalities that are supposed to open the skin pores: peeling agents such as benzoyl peroxide. General practitioners often treat the infection with antibiotic pills (tetracycline or erythromycin), but this is not treating the cause, only the super infection that comes from the plugged up skin pores (stasis of sebaceous gland secretions). Another approach is topical application of antibiotic and peeling agent in combination (1% clindamycin and 5% benzoyl peroxide gel), which is applied twice daily (Ref.2). Resistant cases, usually the ones who have a family history of severe acne, have been treated by a skin specialist who has a special license to treat with isotretinoin (Accutane), a vitamin A derivative, which works in many cases, but which can have serious side effects. These include skin dryness, eye dryness, muscle and bone pains, headaches, liver enzyme abnormalities, and instability of mood including depression and causing birth defects in the fetus of a pregnant woman (Ref. 3). In 2009 the manufacturer stopped distributing the drug in the US, because of too many lawsuits regarding damages from the drug.

I am not saying you should ever take this toxic medication. What I am saying is that treating symptoms, but not the cause has led to peculiar drug manufacturing. This drug is now used to treat brain cancer and pancreatic cancer.

B)   Dietary approach to treat acne

There has been a renewed interest in the last 40 years to sort out the connection between dietary factors and acne.

The most straightforward treatment in my opinion is to modify what you eat.

A clinical trial from the University of Melbourne in 2007 showed that a low-glycemic diet reduced the acne lesions by 22% compared to a control group.

Two factors are clear: a low-glycemic diet produces fewer pimples, the stricter the low-glycemic diet is applied, the more effective the treatment will be. Up to 50% reduction in acne lesions were observed among patients with acne who adhered to a strict low-glycemic index diet in just 12 weeks. There is also evidence that milk and other dairy products can contribute to acne, which works through the same mechanism of IGF-1 stimulation mentioned above.

A US study from Boston showed a 22% increase in acne lesions with total milk consumption and increase of 44% after skim milk consumption.

Omega-3-fatty acid supplementation is useful for inflammatory acne in about 2/3 of the cases as this study showed. Here is a patient from this study who benefitted from omega-3 supplementation. The baseline image is seen with inflammatory acne lesions on his cheek. Only 12 weeks after taking 3 Grams of omega-3 supplementation daily his face looked much improved.

Conclusion

There is a lesson to be learnt from the analysis of the regions in the world where acne does not exist and from all these observational studies mentioned. Cutting out wheat, wheat products, grains, sugar, milk and milk products will lead to amazing results regarding acne prevention and improvement of patients who suffer from acne. We have been lulled into believing that medical science will give us a magic pill or magic potion that would solve our complexion problems. As mentioned above one of the “magic pills” (isotretinoin) is so toxic that it is now used for cancer treatments. All along we allowed the food industry to destroy our complexion by inducing an insulin and IGF-1 response that plugged up our skin pores. We can open them up by eliminating wheat and wheat products, sugar, high-glycemic foods as well as dairy products.

More information on acne: http://nethealthbook.com/dermatology-skin-disease/acne-vulgaris/

References

  1. Rakel: Integrative Medicine, 3rd ed., Saunders 2012. Chapter 73 : Acne Vulgaris and Acne Rosacea, by Sean H. Zager, MD
  2. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed., © 2009 Churchill Livingstone.
  3. Cleveland Clinic: Current Clinical Medicine, 2nd ed., © 2010 Saunders.

Last edited Nov. 7, 2014

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Aug
17
2013

Postpartum Depression

Recently there has been a lot of publicity around the topic of postpartum depression (PPD). Typically the reports originate from a case where depression led to catastrophic consequences. It is sad that it often takes a tragedy before a problem like this is publicly more acknowledged. But sadly reports are often one-sided and are missing vital information about preexisting risk factors that are frequently not picked up by the family doctor. There is often denial on behalf of the mother and family, the mother is getting no support from support groups, even though there are such groups. And swift treatment that would be available is often not given. The results are finally making headlines. Once a mother is desperate and deeply depressed (“psychotic depression”) she is capable of killing the baby, herself and others who are close. PPD affects 15% of mothers (Ref.1); a small percentage of them may have postpartum psychosis, which is the most severe form of PPD.

Risk factors for postpartum depression

In Ref. 1 several risk factors are reviewed that can lead to postpartum depression. For instance, a history of a major depressive episode or anxiety attacks during the pregnancy has been found among mothers who developed PPD. However, there may also have been a history of dysphoria (intense feeling of discontent) before her periods in the past; stressful events during the pregnancy or right after birth. Often there is poor social support or a marital conflict. Other factors are low income, young maternal age or immigrant status with deprivation. A lack of support from the partner can also be a major factor.

Up to 85% of women experience postpartum blues within the first 10 days after the delivery of the baby. Symptoms such as mood swings, fatigue, confusion, tearfulness, mild elation and irritability are common during these initial days following her delivery. Progesterone levels following delivery are decreased for at least one month, sometimes up to 3 months. This leads to sleep problems (insomnia), which coupled with the baby crying in the middle of the night causes more sleep disruption. Abnormal brain wave pattern have been documented on women following the birth of a child.

Only 1 in 500 mothers after birth develop what physicians call “postpartum psychosis”, which is a recognized psychiatric emergency.  The symptoms here are extreme mood swings with confusion, poor judgment, disordered thoughts (“delusions”), paranoia (where they think that someone is after them or it is the baby’s fault that they feel that way). Erratic behavior and impaired functioning are also part of this symptom complex. It is this state that needs to be monitored in a psychiatric unit as it is associated with a high suicide and homicide rate. A psychiatrist with experience in treating PPD needs to treat the patient.

Urbanization leads to a lack of support, which is particularly devastating to new mothers who need all the support they can get. This is reflected in a higher percentage of PPD in urban areas versus the percentage of PPD in more rural areas where there is more family support.

 

Postpartum Depression

Postpartum Depression

Hormone changes with postpartum depression

Some people would say that they couldn’t understand why a woman who just had a baby would not be happy and content. Most women are, but if the stress from the pregnancy and from childbearing were too much for the system, there is a point where the hormones are no longer balanced and the coping mechanisms are undermined.

Serotonin concentrations in the brain of women during pregnancy are kept at a higher level due to higher estrogen levels that slow down the degradation of serotonin. Serotonin is the brain hormone that makes you feel good. Estrogens and progesterone are very high during the pregnancy, but this changes right after the baby’s delivery and during the time of recovery in the first few days and weeks. Studies have shown that there was a 15% higher thyroid autoantibody rate in postpartum depression patients when compared to non-depressed postpartum mothers. This was weakly associated with postpartum depression and was responding favorably to thyroid replacement therapy. Progesterone levels were much lower in depressed and nondepressed patients following delivery because with the delivery the placental source of natural progesterone was removed. In a group of patients where progesterone was replaced, no significant improvement of PPD was observed, but they did not explain whether the progesterone replacement was done with bioidentical hormones or synthetic hormones.

Dr. Michael Platt described a case of a postpartum woman who was hypothyroid as well (Ref.2). She responded to hormone replacement with thyroid hormones and progesterone by shedding 60 pounds (she always had a weight problem) over 10 months changing from a size 20 to a size 4. She was able to wean herself off the anti-depressants. In breast feeding women this could be a significant difference as women on bioidentical progesterone can breast feed and will positively influence their breast fed child’s brain development (brain cells have a lot of progesterone receptors, which are stimulated by progesterone).

A recent Canadian study involving pregnant women and women after delivery of their babies showed that there was a significant drop of progesterone levels in saliva samples for several weeks, particularly with breast feeding. The authors explained that the lack of ovulation with a lack of progesterone synthesis in the ovaries was responsible for this. It takes several weeks for most women to regain regular menstrual cycles. It would follow from this that there is room for bioidentical progesterone replacement in the first few months of the postpartum period until the ovaries have resumed their normal cyclical hormone activity.

Conventional treatment for postpartum depression

With baby blues the symptoms are much less severe (compared to PPD) and are starting 2 to 3 days after childbirth, resolving spontaneously within 10 days after delivery. PPD occurs within 3 months following delivery and responds to treatment with antidepressants and psychotherapy such as cognitive behavioral therapy.  Breast feeding needs to be stopped, as it is known that metabolites of the antidepressants end up in breast milk. Typically, a less toxic antidepressant is used like paroxetine (Paxil), otherwise citalopram (Celexa), and fluoxetine (Prozac). In the rare cases where PPD is so severe that psychotic symptoms are present (postpartum psychosis) hospitalization is mandatory (Ref.3). Some of these cases may require electroconvulsive therapy (ECT) and/or lithium treatment for mood stabilization. Thyroid hormone therapy has also shown a beneficial effect in treating antidepressant-resistant cases of PPD (Ref.4).

Alternative treatment of postpartum depression

Although review texts of the treatment of PPD mention that estrogen replacement in postnatal women with PPD was beneficial, there is a warning that this could cause blood clots and anticoagulant measures would have to be combined with this to prevent deep vein thrombosis; suggestions for progesterone replacement were mentioned, which is a treatment modality where blood clots are no danger, but formal trials have not been done, so it is being ignored by most medical professionals. Here is forum of women who have taken postpartum progesterone with positive effects.

Dr. Katherina Dalton published a trial involving 30 PPD patients with a positive response rate of 95% when treated with natural progesterone.

Before treatment patients were suffering from an average of 7.57 symptoms, after the treatment only 2.1 symptoms remained. (Figures with details regarding this study can be found under the above link).

There are many uncontrolled observations like this where natural progesterone creams are incorporated into a holistic approach to treating PPD. Dr. Mercola describes here how useful natural progesterone therapy can be. He also cautions that it should be taken cyclically to mimic nature’s biorhythm to allow progesterone receptors to recover in between treatments.

There are many websites that have useful information about natural progesterone cream treatment for PPD, such as this.

Conclusion

It is common sense that a woman may need natural progesterone following a delivery, because she just got rid of her placenta, which was a virtual progesterone factory protecting her body and the baby’s brain all throughout the pregnancy. Even if a woman decides to only use natural progesterone in a cyclical fashion for 3 to 6 months, the majority of women would not experience the baby blues or PPD. When regular menstrual cycles have been re established, the patient’s own ovarian progesterone production has resumed and progesterone cream is no longer needed until after the birth of  the next child or at the arrival of menopause. Medicine is full of examples where common sense was applied for effective treatment options despite missing randomized studies.

Natural progesterone treatment of PPD is one such example, where intuitively it was tried and it worked in many patients. Whether or not a randomized trial has been done does not concern the progesterone receptors (they just do not like the synthetic versions of progesterone, as they block the receptors leading to progesterone deficiency!).  Natural progesterone treatment can also be combined with traditional treatments of PPD.

More information on postpartum depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/postpartum-depression/

References

1.Teri Pearlstein, MD, Margaret Howard, PhD, Amy Salisbury, PhD and Caron Zlotnick, PhD: “Postpartum depression” : American Journal of Obstetrics and Gynecology – Volume 200, Issue 4 (April 2009)

2. Dr. Michael E. Platt: The Miracle of Bio-Identical Hormones; 2nd edition, © 2007 Clancy Lane Publishing, Rancho Mirage, Ca/USA (p.53-55).

3. Bope & Kellerman: Conn’s Current Therapy 2013, 1st ed.© 2012 Saunders

4. Jacobson: Psychiatric Secrets, 2nd ed. © 2001 Hanley and Belfus

Last edited Nov. 7, 2014

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Jun
15
2013

Electro-Acupuncture Twice As Effective As Conventional Acupuncture

Imagine that you had lower back pain and your doctor said that physically everything was OK. Would you consider traditional Chinese acupuncture? According to Ref. 1 chances are that 70% of patients with back pain will get better with a few visits to an acupuncturist. In 1972 Dr. Ulett’s laboratory at the University of Missouri succeeded in getting the first NIH research grant for the study of acupuncture in the US. During these studies they found remarkable facts, the most important perhaps that electrical stimulation of acupuncture needles resulted in a doubling of the effectiveness of traditional Chinese acupuncture. After extensive research Dr. Ulett stated: ”The ancient practice of traditional Chinese acupuncture is now obsolete” (Ref.1). It is now replaced by the much simpler, but more effective electro-acupuncture using electrical skin pads instead of needles.

The science of electro-acupuncture

In 1958 news came from China that they had done major surgeries with patients being awake and having been made pain free only with the use of electro-acupuncture. In other words no chemical anesthesia was used or else very little was needed to make patients comfortable. Professor Ji-Sheng Han from the Beijing Medical University observed that only electrical stimulation was powerful enough to produce the pain relief that was necessary to allow general surgery. Dr. Han conducted systematic experiments to study the phenomenon of electro-acupuncture and published this in Ref. 2. One of the experiments involved two rabbits where the donor rabbit was anesthetized with electro-acupuncture. Spinal fluid was taken and transferred into a recipient rabbit that had not been further treated. This second rabbit was now rendered pain free to the point where surgery could be performed without pain. Other researchers such as Dr. Pomeranz found that the brain released endorphins in response to electro-acupuncture, powerful morphine-like substances. It was the endorphins that were responsible for making the recipient rabbit of Dr. Han’s experiment pain free. Other experiments of Dr. Pomeranz showed that naloxone, a morphine and endorphin blocker also blocked the analgesic effect previously found by transferring spinal fluid. These lines of experiments also explain why some patients did not respond to electro-acupuncture, as they have a deficiency in the pain control system of their brain lacking endorphin release. Dr. Han did 30 years of experimentation and also observed patients very closely. Dr. Han also investigated the placebo effect and found that this can explain about 30% of healing  However, the remainder of the 70 to 75% response to electro-acupuncture in his opinion was due to the procedure. He was able to explain that traditional Chinese acupuncture points were merely spots on the body where electric currents are picked up easier and transmitted up to the spinal cord and into the brain. They are then switched over in the brain and spinal cord to nerves that go to other areas of the body. This explains how electrical impulses can travel from conducting polymer pads applied over acupuncture points, release neuropeptides in the brain and help the body to heal. Functional MRI studies have confirmed that the brain is stimulated by certain frequencies through electro-acupuncture or traditional Chinese acupuncture to give pain relief.

Electro-Acupuncture Twice As Effective As Conventional Acupuncture

Electro-Acupuncture Twice As Effective As Conventional Acupuncture

These types of studies have also shown that electro-acupuncture produces stronger signals in the brain than traditional Chinese acupuncture.

Beside pain relief many other applications exist for electro-acupuncture. Addiction medicine makes use of electro-acupuncture in weaning people from morphine or heroine etc. It can be used to treat psychiatric illness, particularly depression. It is useful in relieving nausea and vomiting due to chemotherapy with cancer treatments or associated with pregnancy without affecting the pregnancy.

It may also be useful as an adjunct to treating high blood pressure and cardiovascular disease.

One area where clinical hypnosis and electro-acupuncture are coupled is called “conditioned healing” (Ref.1). For instance with posttraumatic stress disorder (PTSD) in returned solders or in rape victims it has been shown that hypnotherapy treatment while using electro-acupuncture for 30 minutes at the same time can be useful in alleviating the symptoms these patients experience.

A few case studies using electro-acupuncture

Here are a few case studies that illustrate the use of electro-acupuncture with regard to patients (cases modified from Ref.1). A treatment consists of a 30-minute session where the patient is either sitting or resting comfortably on an examining table. Treatments initially are often given twice per week until the pain has been reduced to about 50% of the original pain (severity of pain is scored on a 0 to 10 scale right from the beginning). From that point in the treatment program the visits are reduced to weekly sessions. Most clinical problems require three to 12 sessions. If the pain goes away, but returns after a few weeks, repeat sessions can be scheduled, which often lead to pain relief in a shorter time interval than was the case with the original problem. Chronic problems can be treated on an ongoing basis once per month, if there was a clinical response, but the pain reoccurs.

  1. A 53-year-old painter with left shoulder pain, which radiated into the left chest, had problems with painting above his head. His physician did heart studies, but everything was OK. He was told that this was due to a muscle spasm in the shoulder muscles. One electrode was placed over the hoku point (also called LI-4 acupuncture point), which is located over the first interosseus muscle between the thumb and index finger, the other electrode over the area of pain in the left shoulder. Only seven treatments, twice per week for 2 weeks were given, then treatments with weekly intervals were administered. This approach cured his shoulder problems, and he could return to paining.
  2.  A 39-year-old woman came to the office complaining of lower back pain, which radiated into her right leg to the knee area. After tests she was told that she had spinal stenosis with sciatica (irritation of the sciatic nerve). No surgery could be done for this. She was given twelve electro-acupuncture treatments with one electrode placed below her right knee (ST-36 acupuncture point) and another electrode placed over her right lower back over one of the BL acupuncture points. She was almost pain free for about two weeks, but the pain came back after the last treatment. Since then she has been getting ongoing monthly electro-acupuncture visits with about 80% pain relief. Keep in mind that spinal stenosis is a condition for which regular medicine has nothing to offer other than symptomatic pain medication, which she did not want.
  3. A 30-year-old schoolteacher has been suffering from anxiety attacks and agoraphobia (fear of open spaces) for several years. Conditioning with electro-acupuncture (conditioned healing as mentioned above) was used to treat this woman. She received a series of treatments with electro-acupuncture over both interosseus muscles (hoku acupuncture point or LI-4) for 30 minutes during which time she was also listening to a relaxation tape with music in the background and suggestions for self-hypnosis. She was told how to do self-imagery at home. She did this for 10 minutes two or three times per day. Several weeks later she was able to control her anxiety attacks and overcome her fear of open spaces. In the beginning her symptoms were rated as 8 to 10 in severity on a scale from 0 to 10. At the end of the sessions she only had occasional symptoms with a 1 to 2 rating on this scale.
  4. A 50-year-old man with cluster headaches who had been investigated extensively by a neurologist without any other underlying cause was treated with electro-acupuncture. The electrodes were placed on acupuncture points of the head. Within only 4 sessions most of the headaches were gone. After 8 sessions he had no more headaches. However, a few weeks later his cluster headaches returned, but with ongoing monthly treatments he is able to prevent them from recurring. He did not like the side effects of all the pain medications, so he rather goes for his monthly booster electro-acupuncture treatments.

Take-home message regarding electro-acupuncture

Many people never considered traditional Chinese acupuncture for fear of needles. However, extensive research by Dr. Han and Dr. Ulett showed that electro-acupuncture with electrically conducting polymer pads or with EKG pads will replace the acupuncture needles. Not only is this method needle free, but also the weak electrical impulses that are used with electro-acupuncture treatment double the effectiveness of the older acupuncture method.

Many acupuncturists use both methods of acupuncture, but Dr. Ulett who used traditional acupuncture in the past has completely abandoned it and uses electro-acupuncture with the HANS machine instead. It is a complementary medical treatment, which has been authorized by the FDA.

More on pain conditions: http://nethealthbook.com/neurology-neurological-disease/pain/

References

1: George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

2. J.S. Han: “The Neurochemical Basis of Pain Relief by Acupuncture”. Vol. 2. Hu Bei Science and Technology Press, Beijing, 1998 (784 pages).

Last edited Nov. 6, 2014

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Jun
08
2013

Breast Cancer Due To Stress

The medical profession is of the opinion that breast cancer is multi-factorial, where genetics, body weight, hormonal and other factors play a role in causing it (details see Ref. 1). The Wisconsin Longitudinal Study (United States) showed in May 2012 that girls from families of lower socioeconomic status have a higher risk of breast cancer later in life. The study also showed that girls from families with a higher socioeconomic status had a low risk of breast cancer later in life.

The same cohort of women was the subject of another study, which was just published in April of 2013. In this study the question was asked whether stress in career women could cause a higher rate of breast cancer. Using 1957–2011 data showed that 297 of the 3682 White non-Hispanic women of the Wisconsin Longitudinal Study developed breast cancer. Details of the study showed that the peak of the age for breast cancer to develop was around 55 to 65. Women working with the lowest job authority had the lowest rate of breast cancer. High job authority, being the “boss”, was associated with a 1.57-fold (range 1.12 – 2.18-fold) increase in breast cancer. There was also a striking difference between the lengths of job stress exposure, 5 years versus 15 years with both groups, high and low job authority. The lowest risk of breast cancer was for the low stress group of women who worked under these conditions only for 5 years, followed by the same group who had worked there for 15 years. Slightly above that latter group was the breast cancer risk for the 5-year employed high job authority. The highest group of breast cancer risk, rising above all other groups, was the group with high job authority, exposed to this for type of stressful situation for 15 years (see Fig. 1 of the above link). The researchers interpreted their data to say that the majority of the breast cancer risk in these groups of women was due to the stress hormone (cortisol). Minor contributions were thought to be due to the carcinogenic effect of estrogens.

Breast Cancer Due To Stress

Breast Cancer Due To Stress

 

Review of the literature regarding this study

Dr. Lee had been publishing about estrogen dominance for many years (Ref. 2 and 3). When women age, their ovaries do not produce as much progesterone during the luteal phase as in younger years and above the age of 30 to 35 anovulatory cycles are common. During anovulatory cycles ovulation (=release of an egg) does not occur and there is no formation of a corpus luteum that would produce progesterone for 2 weeks. The end result is that there is a lack of progesterone as a woman ages. This has been discussed in detail in Ref. 3. Dr. Lee called this disbalance of estrogen and progesterone “estrogen dominance”. This is one of the important causes of breast cancer as explained in Ref.2. This can be caused by aging, xenoestrogens from exposure to artificial fertilizers, insecticides and cosmetics, but also taking the birth control pill for prolonged periods of time. However, stress by itself can also produce a state of estrogen dominance. Dr. Lee explained (page 180 of Ref. 2) that the cortisol-binding globulin (CBG), which binds both cortisol and progesterone, is a storage form for both of these hormones. As a person is under chronic stress the CBG is increased binding both cortisol and progesterone. This means that less of these hormones are preliminarily available in their free form for body consumption as CBG binding is a storage form for these hormones. The free progesterone, which is the only biologically active progesterone portion, is lowered as a result of stress causing estrogen dominance. If estrogen is not opposed by progesterone, it is cancer causing for breast tissue and the uterine lining, which translates into being at risk for breast and uterine cancer. Only supplementation with bioidentical progesterone cream as described in Ref. 3 will rebalance the hormones (progesterone/estrogen balance) and reduce the cancer risk. The symptoms of estrogen dominance according to Ref. 4 (p. 29) are fatigue, weight gain, less ability to handle stress, headaches, mood swings, loss of sex drive, irregular periods, uterine fibroids, fibrocystic breasts, fluid retention (particularly around the ankles), irritability and depression.

Practical recommendations for women in stressful jobs

Above the age of 35 it is wise to have a saliva hormone test done, checking the levels of 5 hormones (cortisol, DHEAS, estrogen, progesterone and testosterone). This establishes the baseline values for these hormones. The relationship between the levels of these hormones determines whether they are balanced or not. For instance, if the ratio between progesterone and estrogen (divide the level of progesterone by the level of estrogen) is less than 1 in 200 the patient has estrogen dominance (see Ref. 5). You may need to get a naturopathic physician or an A4M physician who is knowledgeable in interpreting these results and treating the patient with bioidentical hormones. Some women may need to start bioidentical hormone replacement at this point if a hormone deficiency is noticed.

In order to counterbalance stress you need to schedule some time for yourself regularly where you can relax, do yoga exercises, meditation, and/or self-hypnosis. Make sure you get enough sleep. Avoid alcohol, if you can as it interferes with a restful sleep, or reduce alcohol to the absolute minimum. Alcohol causes decreased hormone production of both ovaries. It also weakens the adrenal glands contributing to hormone disbalance. Usually the first hormone to show a decline with stress and aging is progesterone. It has to be measured by the saliva test. Ref. 2 and 3 explain why: progesterone is fat-soluble and is transported through the blood in its free form through red blood cells. However, a progesterone blood test measures the serum progesterone level after the red blood cells have been spun down in the centrifuge, which leads to misleading results; only the saliva test gives reliable results in terms of bio-available progesterone levels. Many conservative physicians blindly insist on blood progesterone levels, which will lead to false results. This is why you need a naturopathic physician or A4M physician to help you with the proper interpretation of the test results.

If saliva progesterone levels are low, progesterone cream (bio-identical, as explained below) is applied daily in a concentration that will normalize the levels. Physicians who have been influenced by drug company representatives may suggest to use Provera (or another progestin, which are synthetic hormone substances) as a “supplement”, but this is known from the Women’s’ Health Initiative to cause breast cancer, heart attacks and strokes.

Do the proper monitoring tests with saliva testing and only substitute what is missing with bioidentical hormone creams. Otherwise a low fat, low refined carbohydrate diet, exercise and other good health habits as I have summarized in this link will be very beneficial to prevent stress as a cause of breast cancer. Ref. 6 is also a useful text written for the layperson explaining what to do when stress leads to adrenal fatigue.

References

  1. A review of the causes of breast cancer: http://www.nethealthbook.com/articles/causesofbreastcancer.php
  2. Dr. John R. Lee, David Zava, Ph.D. and Virginia Hopkins: “What your doctor may not tell you about breast cancer”. 2002 Hachette Book Group, New York,NY, USA.
  3. Dr. John R. Lee: “Natural Progesterone”.  2nd edition. Jon Carpenter Publishing, 1999 Charlbury, England.
  4. George Gillson, M.D., Ph.D.: “You’ve hit menopause. Now what? 3 simple steps to restoring hormone balance” 2nd edition, 2004, Rocky Mountain Analytical Corp., Calgary, AB, Canada.
  5.  John R. Lee, M.D. and Virginia Hopkins: “Dr. John Lee’s Hormone Balance Made Simple- The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central Hachette Group USA, New York, NY 10017. Published 2006. Page 57 discusses saliva testing and states: “The healthy ratio of progesterone to estradiol is at least 200 to 1 and can go up to 1,000 to 1 in women using transdermal (delivered through the skin with cream, gels, oils) progesterone.”
  6. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 6, 2014

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Dec
29
2012

Look At The Brain To Avoid Missed Diagnoses and Treatment Failures

Recently I attended a medical conference in Las Vegas. This annual event is organized by the American Academy for Anti Aging Medicine and provides fascinating topics, gives information about the newest diagnostic methods and presents treatment options that reach beyond the borders of conventional medicine. One morning lecture which took place on December 14, 2012 and was given by Dr. Daniel Amen was probably an unforgettable session for the large audience which filled the main auditorium. Dr. Amen is a psychiatrist, and he explained in detail the importance of a correct diagnosis for psychiatric problems. One diagnostic tool is the SPECT scan. It is not just some sophisticated scanning method that shows interesting images of the brain, but it gives detailed information, which area of the brain is affected. As a result a trained specialist will  be able to classify, which treatment option would yield the best result to help the patient who may have a form of depression or other psychiatric disorder. A pill such as Prozac is not the miracle cure for all forms of depression! Through detailed scan information treatment failures can be avoided, which could mean a difference of a patient being able to lead a healthy and productive life as opposed to a patient who could not be helped and who is institutionalized, has hurt others, killed in a rage or has taken his own life.

Look At The Brain To Avoid Missed Diagnoses and Treatment Failures

Look At The Brain To Avoid Missed Diagnoses and Treatment Failures

The SPECT scan depicted here is from a patient who suffered from Lyme disease, but his treating physicians at first did not believe him. It was only after the abnormal SPECT scan on the left that further more sophisticated tests did prove Lyme disease was present and extensive antibiotic treatment cured the lad (normal SPECT scan on the right).

Mental problems can present in frightening ways, as the lecturer presented the case of a young boy who showed behavioral changes that were terrifying to his family. Previously an easy going lad, he turned into a challenge for his family and his teachers. He was bounced from specialist to specialist, and various diagnoses were mentioned, ranging from the statement that he was manipulative and attention-seeking to assuming that he was hyperactive and had a learning disability. The term conduct disorder also came up for discussion. But nothing of that helped to improve the situation. The parents felt like they were losing their child that was on a downhill course and on a destructive path. Finally a SPECT scan did reveal a previously overlooked condition: the boy had a cyst on the frontal lobe of his brain. It looked like a trench that prevented the frontal brain to communicate with the rest of the brain.  He did need surgery in order to remove the enlarging cyst (pull down to see images), which was not an easy surgical procedure. However the scan result led to the identification of the problem, and this patient – in the meantime a young adult – is no longer troubled by psychiatric problems, but holds a job, has good interpersonal relationships and functions like any normal individual of his age group. Overlooked, undiagnosed and not properly treated mental disease robs people of their ability to lead full and productive lives. Patients with mental illness also represent a large number of the prison population.

The lecturer briefly stopped and mentioned that we may have heard of the tragic and unfathomable events in a Connecticut school where 20 children were shot and killed by a 20 year old young man (we all know this now as the Sandy Hook Elementary School shooting in Connecticut). A somber silence settled over the audience. As most of them had been attending conference lectures all morning, they had not heard about the school shooting and would see the shocking details on the news channels only  later that day. For a whole nation December 14, 2012 will be etched into memory as a day of horror, of evil, lives destroyed and hearts broken. For those who listened to the lecture it will be a permanent reminder that mental disorders need effective diagnoses and persistent treatment. Mental illness has been kept behind closed doors in the past, was a source of embarrassment and shame, and denial was common in order to keep a pleasant facade. The consequences can be a source of terrible suffering, which starts with the patient and his family, but as seen a few days ago it reaches into the community and beyond.

More information on mental illness: http://nethealthbook.com/mental-illness-mental-disorders/

Last updated Nov. 6, 2014

May
01
2008

When Kids Are Migraine Sufferers

It is often assumed that migraine headaches are reserved for people with a family history of migraines and that those who are afflicted by those disabling headaches are usually adults. When a child has the symptoms of migraine headaches it is usually a source of grave concern to the parents. Dr. Lewis reported about his findings at a meeting which was sponsored by Rady Children’s Hospital. He has seen many young persons who suffer of headaches and pointed out that the greatest fear of the patient and the parents, is the thought of a developing brain tumor. If a patient has been having headaches for half a year or two years and has had an entirely normal neurological exam, Dr. Lewis can reassure the patient that there is no brain tumor. Breaking the vicious cycle of fear by reassurance often lifts a load of the patient’s back and things may settle down. About 11% of children in the age group of 5 to 15 years have migraine type headaches. The incidence has a peak at 12 years in boys and at 14 years in girls. Migraines have different criteria than headaches: there are at least 5 lifetime attacks that have a least two of the following symptoms: severe aches on both sides of the head, the front or on one side only, throbbing aches, moderate to severe pain that gets worse with activity. At least one symptom of the following has to be present: either light sensitivity, sensitivity to noise, nausea and vomiting. Dr. Lewis reports that proper sleep habits can make a difference. Too little, too much or inconsistent sleep is closely associated with the frequency of migraines. He cited the example of a sixteen year old who started having migraines after school ended at the end of June. She stayed up late and slept till noon. Once she returned to a regular sleep cycle she did a lot better. Eating patterns can play a role too. One of the common stories is the student skipping lunch and developing a headache about an hour later. Other migraine triggers can be sensitivities to certain foods, altitude changes, weather, motion sickness on a trip, excitement, dehydration and learning problems. Dr. Lewis reported that many of the very young patients age 4 to 5 with migraines may have attention-deficit hyperactivity disorder. If the performance problems are addressed headaches will resolve in 80 to 90% of the time. Headaches can also be linked to emotional aspects, peer problems at school, family problems or depression.

When Kids Are Migraine Sufferers

When Kids Are Migraine Sufferers

There is no drug that is officially approved for migraines in children. The medication that has been studied most closely is ibuprofen. A controlled trial of 7.5 mg/kg showed a response of 76 %. Acetaminophen with a dose of 15 mg/kg was studied in patients aged 4 to 16 years. The response was 54%. Neither of those two medications showed any adverse side effect. Sumatriptan nasal spray was well tolerated, showed a 1 hour response of 58%, had no side effects, but a bitter aftertaste. It was also pointed out that in a study oral sumatriptan and placebo scored the same. It is obviously most important to get to the root of the problem and eliminate the triggering factors after which medication can be used. The general consensus is to treat the attacks rapidly and consistently, get the patient back to his or her daily functioning, minimize backup medications and make sure that there are minimal or no adverse side effects.

More information about:

1. Attention-deficit hyperactivity disorder: http://nethealthbook.com/mental-illness-mental-disorders/developmental-disorders/attention-deficithyperactivity-disorder/

2. Migraine headaches: http://nethealthbook.com/neurology-neurological-disease/common-causes-headaches/migraine-headache/

Reference: Presentation at Annual Advances in the Practice of Pediatrics: San Diego 2008; Feb. 22-24, Hilton La Jolla

Last edited November 3, 2014

May
01
2008

Tree Pollen Connected With Mood Disorders

Seasonal affective disorder (SAD) does have its grip on people who react to a lack of sunlight in the winter month. As a result depression in the winter season is not uncommon. Some people just report it as feeling “down” and “tired” or report a lack of energy. Despite all the reports about SA, epidemiological studies have shown that the rate of depression is not the highest in dreary months like January or February but it spikes in the months of April and June. Dr.Teodor Postolache, a psychiatrist at the University of Maryland made a recent presentation at a meeting of the American Acadamy of Allergy, Asthma and Immunolgy delving into the reason for this finding. He compared the exposure of tree pollen which triggers a cytokine release to a tsunami.Virtually no outdoor allergens are present in the winter months, but with the release of tree pollen people who are vulnerable to allergies are exposed to massive amounts of allergens. The released cytokines may affect brain function and behaviour, resulting ultimately in changed cortisol levels and an altered serotonin metabolism. After breathing the cytokines are already released in the nose and they can continue their action in the prefrontal brain area where the centers for mood, anxiety and impulsivity are located. Dr. Postolache and his colleagues confirmed that individuals with a history of allergy and asthma had a 2.5 fold of suicide compared to controls and those with allergic rhinitis had a 1.7 fold higher risk.

Tree Pollen Connected With Mood Disorders

Tree Pollen Connected With Mood Disorders

For the first time it could also be demonstrated that cytokine levels in suicide victims were significantly elevated in the orbitofrontal cortex, the brain area that affects mood. Intranasal corticosteroids in the form of nosedrops can bring significant relief to allergy sufferers, and Dr. Postolache and his team will examine the benefits of intranasal corticosteroids closer  in a clinical study. Whereas systemic corticosteroids have shown a negative impact on mood disorders and depression, the local application of a nasal spray or drops is geared to abolish the pathways from the nose to the brain for the inflammatory cytokines.

More information on seasonal rhinitis: http://nethealthbook.com/ear-nose-and-throat-diseases-otolaryngology-ent/nose-problems/allergic-rhinitis/

Reference: The Medical Post, April 1, 2008, page 1, 34

Last edited November 3, 2014

Apr
01
2008

Short Daily Exercise Helps Chronic Pain Patients

Chronic pain can be an affliction that turns normal living and functioning upside down. Quality of life will be negatively affected, and often depression and anxiety are resulting mental problems. Effective pain relief is crucial, but often there are undesirable side effects to pain medication, and the patient will explore other avenues that bring a measure of relief. Amy Burleson, Psy.D. of the Cleveland Clinic’s chronic pain rehabilitation program found that chronic pain patients were physically deconditioned due to chronic pain and a chronic lack of physical activity. Depression and other mood disorder also were very common. A 10 minute exercise program was added to the treatment of a group of 28 patients who suffered of various chronic pains: back pain, fibromyalgia, neuropathy and migraines. Patients started a simple routine of walking on a treadmill, starting with a low speed of 1 mile per hour and increasing the speed every few minutes, till they walked at a speed of 3 miles per hour, a speed which was manageable for all patients. After 3 weeks patients found that their physical endurance had increased. They also experienced less depression and anxiety. Even more remarkable was the fact that the patients’ pain perception had diminished.

Short Daily Exercise Helps Chronic Pain Patients

Short Daily Exercise Helps Chronic Pain Patients

Likert scale scores which were used in the assessment of pain perception showed a drop from 7.32 in the beginning of the program to 2.75 at 3 weeks. It is obvious that even mild exercise has benefits for patients with chronic pain: the overall well being receives a noticeable boost through an approach that has no pharmacological impact, no side effects and has no high cost of health care.

More information on the right dose of exercise: http://nethealthbook.com/health-nutrition-and-fitness/fitness/right-dose-exercise/

Reference: Pain Medicine, Volume 9, Issue 1, Page 88-141 (January/February 2008)

Last edited November 3, 2014

Mar
01
2007

Depression Increases Stroke Risk

Strokes have been observed mainly in the aging population, and various lifestyle factors play a role in the risks. It is generally well known that smoking is one of them. High blood pressure that is left untreated will have a stroke as a consequence. Even though in the past the development of a stroke was more commonly seen in older patients, it has become something to be reckoned with for patients that are middle aged.
While some risk factors are the same in all the age groups, researches scrutinized the age group under 65 for additional risk factors. The one that stands out is depression.
Margaret Kelly-Hayes Ed.D. and her colleagues evaluated data from the Framingham Heart Study, looking at 4,120 participants aged 29-100 years who were followed for 8 years. In the course of their research they checked for symptoms of depression by administering the Center for Epidemiological Studies Depression Scale (CES-D). If patients were taking medication for depression they were included in the study. In participants under 65 with depressive symptoms the stroke risk was found to be four times higher than in the population of the same age group without depressive symptoms.

The findings were commented on by Dr. Francisco Javier Carod-Artal, of the Sarah Hospital in Brasilia, Brazil. He found that a growing body of evidence suggests that biological mechanisms underlie a bidirectional link between depression and many neurological illnesses. Mood disorders can influence the development of disease.

Depression Increases Stroke Risk

Depressed patients 4 times more at risk of getting stroke

Pinpointing exactly why depressive symptoms are increasing the risk for strokes is a challenge. Dr. David Spiegel from Stanford (Cal.) University was interviewed and he believes that the problem is environmental as well as biologic. People who are depressed may smoke more, avoid social contact, may lack self care and neglect taking blood pressure medication.
In any event it is important to treat depression, and to take care of all the known steps in stroke prevention.

More information about:

1. Stroke prevention: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/stroke-prevention/

2. Depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

Reference: MD Consult News, January 29, 2007

Last edited November 2, 2014