How Depression Affects Sex


woman in bed

Depression can have a profound impact on sexual relationships. It can hamper our ability to feel emotionally secure with our partner, and it can rob us of our desire for and enjoyment of sexual connection.

Some of the most common problems that depression can cause:

Lack of pleasure – Depressed people don’t find pleasure in things they used to, including engaging in a sexual relationship that they previously really enjoyed.

Increased emotional sensitivity – When things go wrong in a sexual relationship, as they are bound to do from time to time, depressed people may misinterpret these temporary changes as due to their own inadequacies…which often leads them to avoid sex further.

Low energy – Fatigue can be a major symptom robbing them of sexual energy.  Depression may result in too little or too much sleep, and even a great deal of rest doesn’t revive vitality to the person. Desire is often compromised by tiredness and sexual functioning too can decline. The energy to pleasure a partner may feel impossible to muster.

Difficulty with bonding – People living with depression often struggle to feel worthy of love. This can lead their partners to feel frustrated that they can’t break through with their efforts to love and their invitations into the enlivening sexual relationship.

If you live with depression, there are some steps you can take to improve your sex life:

Consider a medication change – Ironically, the medication that is most often prescribed to alleviate depression is a class of drugs that often severely impact sex. For both genders, these drugs, called selective serotonin reuptake inhibitors (SSRIs), can reduce sexual desire and inhibit orgasm. For men, an SSRI may also impact their erections. No one should go off medication without a doctor’s supervision, if you’re on an SSRI and it’s affecting your sex life, you may want to consult a psychiatrist to see if other drugs are possible.

Work on the depression itself – To help understand and heal the roots of your depression, it may be helpful to work with a psychotherapist. Doing psychological work can help stabilize your mood and may even help you get off medication. Therapy organizes the complex feelings of depression, allowing a person to mentally understand there are concrete action steps that will help. The psychotherapist’s empathy and understanding is internalized as comfort, which lays a new foundation for mood stability. And the steadfast relational experience in therapy helps a person form more secure attachments in the rest of their relationships.

Visit a sex therapist with your partner – Going to sex therapy with your partner may alleviate misunderstandings about the sexual process and increase a person’s confidence about their technique. Sex therapists know sex is a physical process that enhances a person’s attachment to their partner and can suggests ways to increase the sexual intimacy for relationship. Most often, sex therapists help couples resolve the power struggle between them that is played out on the sexual realm. This resolution increases security in the partnership eliminating a frequent contributing source of depression.

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Is a Clinical Trial Right for Me?


woman looking at doctor

Making the decision to sign up for a clinical trial can be complicated.

When 45-year-old James learned that, despite surgery and chemotherapy, his colon cancer had recurred, he found himself faced with a difficult choice: try the standard of care again (the same chemo he had just gotten, which had not been wiped out the cancer), or sign up for a clinical trial and get an investigational chemotherapy regimen.

James felt overwhelmed having to make such a decision. “When I was first diagnosed, the doctors told me what to do and I did it, but now I have to decide what to do! It feels unfair that I have to make this decision, how am I supposed to know what to do?”

Though clinical follow very strict guidelines to make sure the trial is safe and ethical, clinical trials are, by definition, investigational, meaning that the outcome is not certain. For patients like James this uncertainty can be very difficult to deal with: “I already don’t know why my cancer is back or how long I will live (cancer prognosis anxiety), so why would I do a clinical trial when I don’t even know if it will work?”

Patients decide to participate in a clinical trial, and work on tolerating the uncertainty, for a variety of reasons. Some sign up because there is no other evidence based therapy that is proven to work for their cancer situation (tumor type and stage-how far it has spread). Some patients are motivated by a desire to be part of the search for the cure, the ultimate goal of cancer research, getting rid of cancer all together. And others participate because they want to gain access to medication that may not be available otherwise, new drugs that are yet to be approved by the Food and Drug Administration or yet to be sold on the open market or paid for by insurance companies.

For James, this third reason was enough for him to want to participate in the clinical trial instead of repeating the chemotherapy regimen he had already been through. “I would rather try something that may work then hope that the old way works the second time. I just don’t have faith that the old chemo will work for me now.”

James did have to work hard to control his worry related to the clinical trial outcome. In some ways, the actual participation in the clinical trial itself was therapeutic. Being part of a clinical trial meant that he came into the cancer center on a more regular basis, and saw a specifically trained group of clinical trial researchers each time. “I like meeting with my trial team, they follow my labs really closely, they all know my story and they really pay close attention to all my symptoms.” James did have extra paperwork to complete for the trial, but he was able to do that in the mornings so that his afternoons were free to spend time with his kids. Having the investigational medication cost covered by the clinical trial was also reassuring to James. “By participating in this trial I know that I am helping medical researchers understand and fight cancer, and it does feel good to know the trial is paying for the medication!”

For as upbeat as James was most of the time, he still struggled with worry about his cancer progressing (cancer prognosis anxiety) and how much time he had left. James accepted the reality of his cancer being advanced, and that he could only stay in the clinical trial until the cancer progressed (then he would likely return to old chemotherapy medications or consider palliative hospice care), but he still wanted to be able to live as fully as possible while he could. “I am young, and if I worry about cancer all the time then I won’t be able to really live my life. I have to find a way to hang out with my kids and get my work done without cancer worry all the time.” James developed a plan for managing his cancer prognosis anxiety, and it really helped him live in the moment, appreciate and even enjoy each day a bit, even while he was in the clinical trial for colon cancer.

Here are some of the things that helped James:

1. Stay informed. You can find information about medical research all over the country at clinicaltrials.gov.

2. Know your team and pick a point person. The point person is who you call with questions or symptoms while you are being treated with the investigational medication.

3. Remind yourself that by participating in the clinical trial you are contributing to the cure for cancer and thus helping countless other people.

4. Remind yourself that you have access to medications in a clinical trial that you would not otherwise receive.

5. Pay attention to self-care. Good sleep habits, time for relaxation and gentle exercise, healthy foods all help manage side effects of cancer and treatment.

6. Put cancer away every day. Make time for life (friends, family, pets, work) and try to put cancer away (“I will think about this, deal with this, later” – even if for 1 hour at a time).

A Brain Scientist Who Studies Alzheimer’s Explains How She Stays Mentally Fit


If you like sudoku, go ahead and play. But staying sharp means using many parts of your brain.

 

As a specialist in Alzheimer’s prevention, Jessica Langbaum knows that exercising her mental muscles can help keep her brain sharp.

But Langbaum, who holds a doctorate in psychiatric epidemiology, has no formal mental fitness program. She doesn’t do crossword puzzles or play computer brain games.

“Just sitting down and doing Sudoku isn’t probably going to be the one key thing that’s going to prevent you from developing Alzheimer’s disease,” she says.

Instead of using a formal brain training program, she simply goes to work.

“My job is my daily cognitive training,” says Langbaum, the associate director of the Alzheimer’s Prevention Initiative at the Banner Alzheimer’s Institute in Phoenix.

And that’s true of most working people. “While you’re still in the work force you are getting that daily challenge of multitasking, of remembering things, of processing information,” she says.

Langbaum offers that perspective as someone who has spent years studying the effects of brain training programs, and as someone who has seen Alzheimer’s up close.

“My grandfather was diagnosed with mild cognitive impairment when I was in graduate school getting my Ph.D.,” she says. “That transitioned into full-blown Alzheimer’s dementia.”

So Langbaum began to ask herself a question: “How can I in my career help ensure that we aren’t suffering from the disease when we reach that age?”

And she realized early on that puzzles and games weren’t the answer because they tend to focus on one very narrow task. The result is like exercising just one muscle in your body, Langbaum says. That muscle will get stronger, but your overall fitness isn’t going to change.

The brain training programs used in research studies are more promising and much more demanding. “They’re hard,” says Langbaum, who tried them herself while she was part of a groundbreaking study on the effects of brain training.

In the study of about 2,800 people age 65 and older, most spent more than five weeks doing exercises that tested memory, reasoning or speed. Two of the interventions, reasoning and processing speed, helped a bit even 10 years later, Langbaum says.

“They delay the onset of cognitive impairment,” she says. “They keep your brain working at the same level longer, compared to people who did not receive those same cognitive training interventions.”

But it remains unclear whether brain training can also prevent or delay Alzheimer’s. And more recent research suggests that social interaction may be a better form of mental exercise than brain training.

“People who have a lot of social interactions, particularly in mid-life, have a lower risk of Alzheimer’s dementia in later life,” Langbaum says. “There’s something about being around people that’s helpful for our brains.”

Langbaum’s in good shape on the social front. Between her family, her two kids, her colleagues at work, and her friends, she says, the social areas of her brain get a vigorous daily workout.

So brain training isn’t for Langbaum. But it may be useful for people who are out of the workforce and more isolated, she says.

And she has some advice for anyone looking for a way to keep their brain healthy.

“If you like crossword puzzles, do them,” she says. “But try something new. And trying something new that brings you enjoyment is key. Don’t do it if you don’t like it.”

FDA Clears Omadacycline (Nuzyra) for Two Infections


The US Food and Drug Administration (FDA) has approved omadacycline (Nuzyra, Paratek Pharmaceuticals) for treatment of adults with community-acquired bacterial pneumonia (CABP) and acute skin and skin structure infection (ABSSSI).

The FDA’s Antimicrobial Drug Advisory Committee recommended in favor of omadacycline for CABP and ABSSSI in August, as reported by Medscape Medical News.

Omadacycline is a modernized tetracycline with broad-spectrum activity that is designed to overcome tetracycline resistance.

It is approved for CABP caused by Streptococcus pneumoniae, Staphylococcus aureus (methicillin-susceptible isolates), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

It is also approved for ABSSSI caused by Staphylococcus aureus (methicillin-susceptible and -resistant isolates), Staphylococcus lugdunensis, Streptococcus pyogenes, Streptococcus anginosus grp. (includes S anginosus, S intermedius, and S constellatus), Enterococcus faecalis, Enterobacter cloacae, and Klebsiella pneumoniae.

In three global phase 3 studies involving about 2000 adults, omadacycline met all primary and secondary efficacy outcomes designated by the FDA and the European Medicines Agency and was generally safe and well tolerated, the company notes in a news release.

Omadacycline comes in intravenous and oral formulations, offering clinicians the ability to start treatment in a healthcare facility and complete treatment at home, potentially reducing hospitalizations and costs.

It is also the first and only once-daily IV and oral antibiotic approved to treat both CABP and ABSSSIs in nearly 20 years, according to the company.

Paratek expects omadacycline to be available in the first quarter of 2019.

According to the US Centers for Disease Control and Prevention, each year, an estimated 2 million people in the United States develop an antibiotic-resistant infection; such infections kill at least 23,000 people a year. The main bacteria causing CABP, Streptococcus pneumoniae, is responsible for 1.2 million infections and 7000 deaths, while ABSSSI is responsible for more than 750,000 hospitalizations, the company notes in the release.

“Treating pneumonia and skin infections has become increasingly complex as existing antibiotic therapies sometimes have reduced efficacy as resistance continues to grow. This reality makes it increasingly challenging to provide safe and effective treatments to patients,” Keith Kaye, MD, director of clinical research, Division of Infectious Diseases, University of Michigan, Ann Arbor, said in the release. “There continues to be a need for novel antibiotics with both IV and oral formulations, such as Nuzyra, to help physicians stay ahead of the evolving resistance landscape.”

Omadacycline was given priority review and had fast-track and qualified infectious disease product (QIDP) designations. QIDP designation is given to antibacterial products that treat serious or life-threatening infections under the Generating Antibiotic Incentives Now (GAIN) title of the FDA Safety and Innovation Act.

Time to destigmatise mental health issues


75 percent of LGBT+ teens said they recently felt depressed and 67 percent had heard negative remarks from family members

So many people who struggle with illnesses such as anxiety or depression carry with them connected burdens. They carry the fear that loved ones will pull away or fail to understand. They carry the shame that comes from struggling in a society in which people are pressured to always be performing at their best, without any vulnerabilities showing through. And they carry a painful silence, where it can feel like there’s no safe way to express the simple difficulty of getting through the day.

In the United States, while we are getting better at talking about mental health, we still fail in many ways when it comes to these conversations. That’s a serious problem for all of us, but it can be especially harmful for young people, particularly LGBT+ youth.

For individuals dealing with mental illness, it can be a wrenching, unmooring experience. For young people, it can be especially shattering, because they may have never seen their way through it before. Because of the silence and stigma that surround these topics, they may not think they know anyone who has. And for LGBT+ youth, who are likely already facing daunting challenges, they can feel particularly isolated.

But the truth is, many people have or will experience some kind of mental health condition in their lifetimes – most commonly depression or anxiety, but also potentially a more serious illness such as schizophrenia. One in five adults and youth will experience mental illness this year. And in the LGBT+ community, the numbers can be even higher.

To be clear, this has nothing to do with being LGBT+ and everything to do with how society treats the LGBT+ community. As the National Alliance on Mental Illness explains, we face health issues just like everyone else, but they’re compounded due to prejudice and other biases.

In our recent survey of more than 12,000 LGBT+ teenagers, the Human Rights Campaign Foundation saw in stunning detail the difficult challenges these youth face.

Seventy-seven percent of LGBT+ teens surveyed report recently feeling down of depressed. Only 26 percent of youth say they always feel safe in their school classrooms, and 67 percent have heard negative remarks about LGBT+ people from someone in their family. In addition, many youth in our community face the multiple stressors of racism and anti-LGBTQ discrimination. A high majority of LGBT+ youth of colour have personally experienced racism, and almost 90 percent have seen racism impact the lives of someone close to them.

While we are making inroads into addressing the issues, there clearly remains significant work to do. In addition to celebrating and focusing on compassion and inclusion, as a society we must acknowledge that many of us are struggling, and we must recognise that it’s a struggle we do not carry alone. Young people need to know that mental health challenges are not a result of weakness or a character flaw, nor tied to one’s sexual orientation or gender identity.

As a culture, as a community, and especially as adults we must take seriously the work to destigmatise this issue. If we can, and if it feels safe to do so, let’s talk about what we’re doing for our mental health. Let’s be a little more open about past or current struggles. Let’s show compassion with ourselves and others, and let’s acknowledge that mental health is just like any other aspect of health – it takes maintenance, it is complex and there will be aspects outside of our control.

And let’s eliminate once and for all the devastating, isolating myth that individuals struggling with mental illness are each struggling with it alone.

 

A brain scan could help reveal if a person is a suicide risk


“We examine brain activation patterns that occur while people are thinking about suicide-related and emotional concepts,” David Brent, a professor in the department of psychiatry at the University of Pittsburgh, told Digital Trends. “We then use machine learning to identify the words and activation patterns associated with those words that best discriminate between suicidal and non-suicidal individuals.”

The ability to accurately scan someone to quickly determine whether they might pose a suicide risk may still be a way off, but the researchers’ previous work does at least suggest this is a possibility. In a study carried out last year, they demonstrated that it is possible to use this technology to tell whether a person is considering suicide based on the way they think about death-related topics. The new NIMH grant will help take this work forward.

“The first study was relatively small, had no non-suicidal psychiatric participants, and was cross-sectional,” Brent continued. “This study will be larger, [and] will repeat the procedure to see if fluctuations in neural signatures are related to fluctuations in suicidal ideation, and see how we can predict future suicidal behavior. In addition, we will be developing and testing a peripheral measure that we hope will correlate with neural findings, but can be used in a clinician’s office without needing to do fMRI.”

Ultimately, the researchers are hoping to establish a more objective way to assess suicide risk, rather than having to rely on self-reporting. They also believe that this work will be able to reveal more about the ways in which suicidal people think about death, which could be used to more precisely guide psychotherapy.

Half of all mental illness begins by the age of 14


An invigilator monitors pupils during a GCSE mathematics exam at the Harris Academy South Norwood in south east London, March 2, 2012   REUTERS/Luke MacGregor

Mental illness can strike anyone at any time in their life. In fact, more than 350 million people across the world – of all ages and from all communities – suffer from depression. But half of all mental illness begins by the age of 14, according to the World Health Organization (WHO). And it is that shocking statistic which is the focus of this year’s World Mental Health Day.

 

The good news is we are learning to better understand and deal with mental health issues. Here are some key developments.

 

Early intervention

While half of all mental illness begins by the age of 14, most cases go undetected and untreated.

Teenagers and young adults have many changes to deal with, including changing schools, leaving home and starting university or a new job. This can lead to stress and apprehension. In some cases, if not recognized and managed, these feelings can lead to mental illness.

In some countries, the formative years of a child’s life have been dominated by conflict and upheaval, leaving these young people particularly vulnerable to mental distress and illness.

 

In terms of the burden of disease among adolescents, depression is the third leading cause, while suicide is the second leading cause of death among 15-29 year olds. Harmful use of alcohol, drugs and eating disorders are also cause for concern.

Despite this troubling picture, the WHO says there is a growing recognition of the importance of helping young people build mental resilience at an early age. Parents and teachers can help young people build life skills that help them cope with everyday challenges at home and school. More schools are launching initiatives such as mindfulness and meditation, and some provide psycho-social support.

This does however require investment from governments. And that investment needs to work in tandem with programmes to raise awareness, helping peers, parents and teachers know how to support their friends, children and students.

Mental Health Facts in the US

Image: National Alliance on Mental Illness

The role of genetics

Research has shown that 30-40% of the risk for both depression and anxiety is genetic and 60-70% is due to environmental factors, according to the National Institute for Health Research.

 

Now, the NIHR and King’s College London are calling for 40,000 people diagnosed with depression or anxiety to join what they say will be the largest ever database of volunteers.

The researchers plan to explore the genetic factors behind the two most common mental health conditions – anxiety and depression.

 

“It’s a really exciting time to become involved in mental health research, particularly genetic research which has made incredible strides in recent years – we have so far identified 46 genetic links for depression and anxiety,” explains Dr Gerome Breen of King’s College London.

“By recruiting 40,000 volunteers willing to be re-contacted for research, the study will take us further than ever before. It will allow researchers to solve the big unanswered questions, address how genes and environment act together and help develop new treatment options.”

 

Technology and the brain

 

Conventional wisdom suggests that spending too much time online is in some ways detrimental to the human brain and mental health.

And there is a growing body of scientific work pointing to the dangers of a digital lifestyle. For example, neuroscientist Adam Gazzaley has written a book The Distracted Mind: Ancient Brains in a High-Tech World which explores how internet-connected devices degrade our attention, and have implications for mental health and stress levels in the workplace.

 

However, many scientists also believe that technology can be harnessed to address mental health issues, and there has been a proliferation of apps aimed at wellbeing.

For example, the Happify app promises to reduce stress and anxiety by providing happiness games and activities. The basic principle is that you can change and modify the brain by training it as if it were a muscle – a theory called neuroplasticity. By adopting new thinking habits, its users can overcome negative thought patterns and learn to cope with everyday stresses.

 

The app already has 3.5 million users, and claims to help people with schizophrenia, clinical depression and chronic illnesses.

There is also growing scientific evidence that points to the success of online therapy.

In the UK, the National Institute for Health and Care Excellence which provides national guidance on improving healthcare, has approved the use of online cognitive behavioural therapy (CBT).

 

CBT is one of the well-established talking therapies, but now scientists recognize that it is sometimes easier for people to open up to a machine rather than a human being. CBT is also notoriously expensive and time-consuming, so technology may also allow for treatment to become more widely available.

 

A policy priority

 

World leaders have recognized the importance of mental health and well-being by including it in the Sustainable Development Agenda, which was adopted at the UN’s General Assembly in September 2015.

As part of Goal 3, world leaders have committed to the “prevention and treatment of noncommunicable diseases, including behavioural, developmental and neurological disorders, which constitute a major challenge for sustainable development”.

The then Director-General of the WHO, Dr Margaret Chan, explained the significance of the decision, saying it will help the world achieve greater fairness.

 

“The inclusion of noncommunicable diseases under the health goal is an historic turning point. Finally these diseases are getting the attention they deserve,” she says.

Specific goals include reducing premature mortality from noncommunicable diseases by one third by 2030 and strengthening the prevention and treatment of substance abuse including narcotic drug and alcohol use.

 

It is through this type of ongoing commitment, as well as the growing awareness of mental health issues, that progress can be made.

Today is World mental health day


Today is World mental health day

World mental health day

 

raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. Talk about mental health issues and what more needs to be done to make mental health care a reality for people worldwide.

Good mental health is paramount but it’s often undervalued. Also, the seriousness of conditions can be underplayed or even stigmatized. Today, let’s work together to encourage good mental health practices & breakdown stigmas.

What Is HEMLIBRA®?


HEMLIBRA is a treatment for people with hemophilia A with or without factor VIII inhibitors

HEMLIBRA is a prescription medicine used for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults and children, ages newborn and older, with hemophilia A with or without factor VIII inhibitors.

  • Hemophilia A is a bleeding condition people can be born with where a missing or faulty blood clotting factor (factor VIII) prevents blood from clotting normally.
  • HEMLIBRA is a therapeutic antibody that bridges clotting factors to help your blood clot.
  • HEMLIBRA can reduce all bleeds (whether treated or not), and the number of treated bleeding episodes, including joint bleeds, spontaneous bleeds, and target joint bleeds.

HEMLIBRA is not a cure for hemophilia.

What is the most important information I should know about HEMLIBRA?

HEMLIBRA increases the potential for your blood to clot. Carefully follow your healthcare provider’s instructions regarding when to use an on-demand bypassing agent or factor VIII, and the dose and schedule to use for breakthrough bleed treatment. HEMLIBRA may cause serious side effects when used with activated prothrombin complex concentrate (aPCC; FEIBA®), including thrombotic microangiopathy (TMA), and blood clots (thrombotic events). If aPCC (FEIBA®) is needed, talk to your healthcare provider in case you feel you need more than 100 U/kg of aPCC (FEIBA®) total.

How HEMLIBRA is thought to work

HEMLIBRA is thought to bridge activated factor IX (9) and factor X (10) to restore the function of missing activated factor VIII (8) to help your blood clot.

FIXa=activated factor IX (9); FX=factor X (10).

HEMLIBRA offers steady and consistent levels between doses, so there’s no need to adjust dosing based on activities

HEMLIBRA has a half-life of 4 weeks*

Treatment will begin with a loading dose once weekly for 4 weeks to increase the levels of HEMLIBRA in your blood. When the loading dose is complete, you will take a maintenance dose, which helps HEMLIBRA levels in your blood remain steady. Your healthcare provider will decide how often you should take your maintenance dose, which can be once weekly, once every 2 weeks, or once every 4 weeks.

Lower levels of HEMLIBRA in blood were expected in children less than 6 months old.

*After multiple subcutaneous injections, the amount of time estimated for the body to clear half of HEMLIBRA from the blood is 4 weeks.

What is HEMLIBRA?

HEMLIBRA® is a prescription medicine used for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults and children, ages newborn and older, with hemophilia A with or without factor VIII inhibitors.

What is the most important information I should know about HEMLIBRA?

HEMLIBRA increases the potential for your blood to clot. Carefully follow your healthcare provider’s instructions regarding when to use an on-demand bypassing agent or factor VIII, and the dose and schedule to use for breakthrough bleed treatment. HEMLIBRA may cause the following serious side effects when used with activated prothrombin complex concentrate (aPCC; FEIBA®), including:

  • Thrombotic microangiopathy (TMA). This is a condition involving blood clots and injury to small blood vessels that may cause harm to your kidneys, brain, and other organs. Get medical help right away if you have any of the following signs or symptoms during or after treatment with HEMLIBRA:
    • confusion
    • weakness
    • swelling of arms and legs
    • yellowing of skin and eyes
    • stomach (abdomen) or back pain
    • nausea or vomiting
    • feeling sick
    • decreased urination
  • Blood clots (thrombotic events). Blood clots may form in blood vessels in your arm, leg, lung, or head. Get medical help right away if you have any of these signs or symptoms of blood clots during or after treatment with HEMLIBRA:
    • swelling in arms or legs
    • pain or redness in your arms or legs
    • shortness of breath
    • chest pain or tightness
    • fast heart rate
    • cough up blood
    • feel faint
    • headache
    • numbness in your face
    • eye pain or swelling
    • trouble seeing

If aPCC (FEIBA®) is needed, talk to your healthcare provider in case you feel you need more than 100 U/kg of aPCC (FEIBA®) total.

Before using HEMLIBRA, tell your healthcare provider about all of your medical conditions, including if you:

  • are pregnant or plan to become pregnant. It is not known if HEMLIBRA may harm your unborn baby. Females who are able to become pregnant should use birth control (contraception) during treatment with HEMLIBRA.
  • are breastfeeding or plan to breastfeed. It is not known if HEMLIBRA passes into your breast milk.

Tell your healthcare provider about all the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, or herbal supplements. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I use HEMLIBRA?
See the detailed “Instructions for Use” that comes with your HEMLIBRA for information on how to prepare and inject a dose of HEMLIBRA, and how to properly throw away (dispose of) used needles and syringes.

  • Stop (discontinue) prophylactic use of bypassing agents the day before starting HEMLIBRA prophylaxis.
  • You may continue prophylactic use of factor VIII for the first week of HEMLIBRA prophylaxis.

What should I know about lab monitoring?
HEMLIBRA may interfere with laboratory tests that measure how well your blood is clotting and may cause a false reading. Talk to your healthcare provider about how this may affect your care.

The most common side effects of HEMLIBRA include: redness, tenderness, warmth, or itching at the site of injection; headache; and joint pain.

These are not all of the possible side effects of HEMLIBRA. Speak to your healthcare provider for medical advice about side effects.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use HEMLIBRA for a condition for which it was not prescribed. Do not give HEMLIBRA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about HEMLIBRA that is written for health professionals.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

Please see the HEMLIBRA full Prescribing Information and Medication Guide for Important Safety Information, including Serious Side Effects.

Arthritis Tied to Higher Risk for Anxiety, Depression


More than one fifth (22%) of adults with arthritis have anxiety, and 12% report depression, a national survey shows. Overall, 10.3 million adults with arthritis reported symptoms of anxiety, depression, or both.

Symptoms of anxiety and depression were much more likely among younger adults, patients with chronic pain or other chronic comorbidities, and those who could not work or who had disabilities.

“The high prevalence of symptoms of anxiety and depression among adults with arthritis warrants awareness, screening, and subsequent treatment of these conditions. Health care providers can refer patients to mental health professionals and self-management education programs, and encourage physical activity to reduce anxiety and depression symptoms and improve quality of life,” the authors write.

Dana Guglielmo, MPH, from the Division of Population Health Promotion, Centers for Disease Control and Prevention, and the Oak Ridge Institute for Science and Education, Tennessee, and colleagues report their findings in an article published online October 4 in Morbidity and Mortality Weekly Report.

The researchers analyzed data from 93,442 participants who completed the 2015-2017 National Health Interview Survey to estimate the national prevalence of clinically relevant symptoms of anxiety and depression among adults aged 18 years and older with arthritis.

Approximately half of the participants (n = 46,742) were randomly chosen to complete the Adult Functioning and Disability supplement during the study. Patients were considered to have arthritis if they responded “yes” to the question, “Have you ever been told by a doctor or other healthcare professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”

The survey supplement included questions about anxiety and depression symptoms. Respondents were classified as having these symptoms if their symptoms occurred daily or weekly and if the intensity of their symptoms was “a lot” or “in between a little and a lot” the last time they occurred.

“These definitions identified adults whose symptoms would likely meet Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic criteria and also would be clinically managed, which are referred to in this report as ‘clinically relevant,’ although these definitions are not clinical diagnoses,” the researchers explain.

Age-standardized prevalences of anxiety and depression symptoms were 22.5% (95% confidence interval [CI], 20.8 – 24.3) and 12.1% (95% CI, 10.8 – 13.4), respectively, among those with arthritis, compared with 10.7% (95% CI, 10.2 – 11.2) and 4.7% (95% CI, 4.4 – 5.0) among those without arthritis.

Symptoms were more likely among women than men; among respondents who were unemployed, unable to work, or disabled compared with adults who were employed; and among those who identified as lesbian, gay, bisexual, or “other” than among participants who identified as heterosexual.

In addition, higher symptom prevalences were seen among adults who reported chronic pain and arthritis-attributable activity limitations and increased with the number of chronic comorbidities, increasing psychological distress, and worsening self-rated health. Symptom prevalences were also higher among those who currently smoked cigarettes compared with those who had never smoked.

By contrast, symptoms were less likely among those with higher educational and income-to-poverty ratios. Symptom prevalences were lower among those who reported engaging in aerobic physical activity compared with inactive adults.

Patients with arthritis who had anxiety symptoms (44.3%; 95% CI, 40.4 – 48.3) were less likely to take medications than those with symptoms of depression (57.7%; 95% CI, 52.4 – 62.9). Just over one third (34.3%; 95% CI, 30.3 – 38.1) of patients with anxiety symptoms and 42.8% (95% CI, 37.7 – 48.1) of those with depression symptoms reported speaking with a mental health professional during the past 12 months.

Previously published research has shown an association between arthritis and poorer adherence to treatment for depression, and a survey from 2000-2001 found that almost 1 in 5 patients with arthritis and major depression said they had considered suicide during the past year.

Among patients with both arthritis and chronic pain, 31.2% reported symptoms of anxiety, and 18.7% reported symptoms of depression. The authors point to a possible link between chronic pain and anxiety or depression, which may make physical and mental health management more difficult for patients with arthritis.

Clinic-based rheumatic disease studies found that both anxiety and depression were associated with poorer response to treatment and decreased quality of life, yet only half of patients with a mental health condition receive treatment, according to the National Institute of Mental Health. “[T]he current analysis suggests that treatment prevalence among adults with arthritis might be similar or lower, especially for anxiety,” the authors write.

Multifaceted Approach Needed

“Successful treatment approaches to address anxiety and depression among adults with arthritis are multifaceted and include screenings, referrals to mental health professionals, and evidence-based strategies such as regular physical activity and participation in self-management education to improve mental health,” the authors explain.

Noting that mental health conditions and arthritis have been previously identified as two of the three greatest causes of work disability among adults aged 18 to 64 years, the authors say, “concerted efforts to improve arthritis and mental health outcomes could help reduce work disability.”

The prevalence of anxiety and depression among adults with arthritis highlights an unmet need that clinicians can address, they continue. Patients with chronic pain conditions such as arthritis should receive integrated care, including screening for mental health problems and education on self-management.

In addition, clinicians can refer patients with arthritis to evidence-based programs such as the Chronic Disease Self-Management Program, which has demonstrated ongoing reductions in depression, fatigue, and pain, as well as increases in aerobic activity and improved self-efficacy and self-rated health.

Physical activity “can be as effective as medication or therapy for anxiety and depression,” the authors write, and even patients who get less than the recommended amount of physically active can still derive physical and mental health benefits.

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