Yes, You Are Lovable With Depression and Anxiety


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If you worry that your anxiety or depression will limit your chances for relationships, you’re not alone. Many people are concerned that having a psychological condition—especially a chronic one—might make them unattractive to other people. How am I going to find friends or a partner when I’m dealing with depression or anxiety? Who’s going to want to sign up for this?The fear of rejection can make you think that your only option is to hide your condition – that if you tell the truth, people will leave. But, most people aren’t looking for perfection from you—they want honesty. Honesty is the foundation of relationships and true intimacy. And rather than your struggles being a deal breaker, the person likely will recognize them as a single aspect of who you are.

I’ve heard many of my patients describe their relief to find that dating partners were not put off when they acknowledged their condition. Partners who are familiar with anxiety and depression may understand the strength it takes to keep going. They might even live with these conditions themselves, given how common they are.

But what if they’re not accepting of you – what if, for them, it is a deal breaker? It’s true that not everyone will have a positive response to mental health conditions. But if this happens, or has happened to you already, remember that other people’s choices do not define you. If someone can’t see past your struggles, that says a lot more about who they are than it says about you. And just because that one particular person was not comfortable with your condition doesn’t mean that everyone will have the same response.

Still, when someone reacts negatively to you, it hurts. For many people, this kind of rejection can trigger automatic thoughts, like I’ll always be alone, that may feel true in the moment but are not based in reality. Watch out for related thoughts that might pop up in this area, such as:

  • Being anxious and depressed means I’m unlovable.
  • I don’t deserve to be happy.
  • Love is for other people; it won’t ever happen for me.
  • I’m too broken to ever be loved.
  • Nobody wants me around.
And perhaps the most disturbing thought of all: No one would miss me if I died. This belief is common among those thinking about ending their own lives, and is patently false. Don’t believe it—more people than you realize love and appreciate you, and would be devasted if you ended your life. The people who care about you need you, just as you are. (If you do have suicidal thoughts, please reach out for help: call the National Suicide Prevention Lifeline at 800-273-TALK or text 741741 to connect with a counselor at Crisis Text Line)As with any problematic thoughts, start by recognizing them as thoughts that may or may not be true. Then share them with someone who cares about you and knows you well. They’ll be able to point out where you’re being too hard on yourself. If you haven’t already, also seek out the support of a qualified professional—someone who can work with you not only on the symptoms you’re having but on any harsh self-judgments.

Going through anxiety or depression or any other psychological condition doesn’t make you unlovable—it makes you human. And we love the person who trusts us enough to show us their humanity. Chances are there are people right now who are more willing to love you than you even know. Why not let them?

Major Study Finds Pregnancy Issue Actually Linked to Autism, And It’s Not Vaccines


It’s a common but erroneous belief among anti-vaxxers that if a pregnant woman gets jabbed, she puts her unborn child at risk of autism.

This couldn’t be further from the truth. Instead, a growing body of research suggests that when a mother goes unvaccinated, that is when she truly leaves her child vulnerable.

A new study of nearly 1.8 million children in Sweden has found that the risks for autism and depression are significantly higher if your mother was hospitalised with an infection during pregnancy.

The results build on a nascent but burgeoning idea that specific infections, when contracted during pregnancy, can harm a developing brain, boosting the risk of psychiatric disorders coming on later in life, including conditions such as bipolar disorder, schizophreniadepression, and autism.

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This new study, however, paints a much broader stroke. Instead of revealing one or two bad infections, the authors found that the results remained the same whether or not the hospitalisation was due to severe infections – like influenza, meningitis and pneumonia – or much more mild UTIs.

In other words, it isn’t necessarily a specific virus, but infection in general that appears to be causing these problems, and it seems to be the case even when the affliction can’t reach the fetal brain.

“The results indicate that safeguarding against and preventing infection during pregnancy as far as possible by, for instance, following flu vaccination recommendations, may be called for,” says Verena Sengpiel, an expert in obstetrics and gynaecology at the University of Gothenburg.

Drawing on data from the Medical Birth Register for almost 1.8 million children, born in Sweden between 1973 and 2014, the authors tallied how many of their mothers had been hospitalised with an infection during their respective pregnancies.

The researchers then tracked these children and their mental health through the inpatient register until 2014, when the oldest ones were turning 41.

Statistical analysis of the data revealed a worrying link between a child’s mental health and their mother’s immune system.

While the study did not find an increased risk of schizophrenia or bipolar disorder, the authors did find that when a pregnant woman goes to the hospital for an infection, her child is more likely to seek hospital treatment for depression and autism later on in life.

In fact, among these children, the increased risk was 79 percent for autism and 24 percent for depression.

“Overall, we found evidence that exposure to maternal infection during fetal life increased the risk of autism and possibly of depression in the child,” the authors write.

“Although the individual risk appears to be small, the population effects are potentially large.”

As fascinating as it is, the study is only observational, so it can’t tell us exactly how a maternal infection would impact a child’s developing brain.

Nevertheless, recent studies on animal models have suggested that these infections might be causing an inflammatory reaction in the nervous system, altering gene expression in the brain and changing its architecture.

The thing is, many of these studies also note there are a multitude of genetic factors at play, so the answer to this puzzle could be highly complex.

“Our results cannot exclude the possibility of increased risk for psychopathologic conditions as a result of a dual “hit”: an inflammatory fetal brain injury on a background of genetic susceptibility,” the authors of the new study write.

More research will be needed before we can say for sure what is going on. In the meantime, however, the best thing a pregnant mother can do is stay healthy and adhere to the best medical advice out there. Getting all your vaccinations is a good start.

Source: JAMA Psychiatry.

FDA Approves Esketamine Nasal Spray For Hard-To-Treat Depression


Spravato, the brand name for esketamine, a newly approved option for treatment-resistant depression.

Janssen Pharmaceutica

 

The Food and Drug Administration approved the first drug that can relieve depression in hours instead of weeks.

Esketamine, a chemical cousin of the anesthetic and party drug ketamine, represents the first truly new kind of depression drug since Prozac hit the market in 1988.

The FDA’s decision came Tuesday, less than a month after a panel of experts advising the agency voted overwhelmingly in favor of approval.

“There has been a long-standing need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition,” said Dr. Tiffany Farchione, acting director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research, in a press release about the decision.

“This is potentially a game changer for millions of people,” said Dr. Dennis Charney, dean of the Icahn School of Medicine at Mount Sinai in New York. “It offers a lot of hope.”

Esketamine works through a mechanism different from those of drugs like Prozac, Charney said. And that is probably why studies show it can often help people with major depressive disorder who haven’t been helped by other drugs.

“Many of them are suicidal,” Charney said. “So it’s essentially a deadly disease when you haven’t responded to available treatments and you’ve been suffering for years if not decades.”

Charney was part of the team that first showed two decades ago that ketamine could treat depression. He also is named as co-inventor on patents filed by the Icahn School of Medicine relating to the treatment for treatment-resistant depression, suicidal ideation and other disorders.

Esketamine, developed by Johnson & Johnson, will be administered as a nasal spray and be used in conjunction with an oral antidepressant. It will be marketed under the brand name Spravato. The FDA has approved it for patients who have failed to respond adequately to at least two other drugs.

That means about 5 million of the 16 million people in the U.S. with major depression might benefit from esketamine, said Courtney Billington, president of Janssen Neuroscience, a unit of Johnson & Johnson.

But esketamine presents some challenges because of its similarities to ketamine. In high doses, both drugs can cause sedation and out-of-body experiences. And ketamine, often called Special K in its illicit form, has become a popular party drug.

So Johnson & Johnson is taking steps to make sure esketamine will be used only as intended, Billington said.

“Spravato will not be dispensed directly to a patient to take at home,” he said. “It will only be available in approved and certified treatment centers.”

Patients will inhale the drug under supervision at these centers once or twice a week. And they will receive a dose that is unlikely to produce side effects such as hallucinations.

“The amount of active ingredient that’s in this product, it’s at a very, very low dose,” Billington said.

Even so, the FDA, according to its press release, is requiring a warning label that says patients “are at risk for sedation and difficulty with attention, judgment and thinking (dissociation), abuse and misuse, and suicidal thoughts and behaviors after administration of the drug,”

Esketamine’s approval comes as more and more doctors have begun administering a generic version of ketamine for depression. Generic ketamine is approved as an anesthetic, not as an antidepressant. Even so, doctors can legally prescribe it for off-label medical uses.

And as a growing number of studies have shown ketamine’s effectiveness against depression, ketamine clinics have sprung up around the United States. These clinics often administer the drug in an intravenous infusion that can cost more than $500 per treatment.

Many doctors who have become comfortable offering ketamine for depression probably won’t switch to esketamine, said Dr. Demitri Papolos, director of research for the Juvenile Bipolar Research Foundation and a clinical associate professor at Albert Einstein College of Medicine.

For the past 10 years, Papolos has been prescribing an intranasal form of ketamine for children and adolescents who have a disorder that includes symptoms of depression.

“I’m very pleased that finally the FDA has approved a form of ketamine for treatment-resistant mood disorders,” Papolos said. He said the approval legitimizes the approach he and other doctors have been taking.

But he hopes that doctors who are currently using ketamine continue to do so. “It’ll be a lot less expensive and a lot easier for their patients [than esketamine],” he said.

And animal studies show it’s possible that old-fashioned ketamine is a more potent antidepressant than esketamine, Papolos said.

Esketamine “may not be as effective as a generic that any psychiatrist or physician can prescribe without restrictions,” Papolos said.

Johnson & Johnson said the wholesale cost of each treatment with esketamine will range from $590 to $885, depending on the dose. That means twice-weekly treatments during the first month will cost centers that offer the drug at least $4,720 to $6,785. Subsequent weekly treatments will cost about half as much.

The drugmaker says those figures don’t include administration and observation costs.

Food GOLD: Turmeric is just as effective as 14 pharma drugs but suffers from NONE of the side effects


Image: Food GOLD: Turmeric is just as effective as 14 pharma drugs but suffers from NONE of the side effects

What if you could replace all the pills in your medicine cabinet with just one herb? Depending on what you take and why, that may be possible with turmeric. Its main component, curcumin, boasts enough health-enhancing properties to keep pharmaceutical execs up at night.

In fact, this herb is so powerful that it has been at the heart of more than 12,000 peer-reviewed biomedical studies. Researchers have found more than 800 different therapeutic and preventive uses for curcumin. Here is a look at just a few of the drugs to which it compares favorably, as outlined by Green Med Info.

Metformin (for diabetes)

Diabetes numbers continue to climb as Americans grapple with obesity, and that means more and more people are taking Metformin – and taking on its scary risks as well. However, a study in the journal Biochemistry and Biophysical Research Community found that curcumin has value in treating diabetes; it is between 500 and 100,000 times more powerful than Metformin when it comes to activating AMPK, which raises glucose uptake. Studies have also shown that it has a 100 percent efficacy rate in preventing those with pre-diabetes from developing full-fledged diabetes.

Lipitor (for cholesterol)

A 2008 study revealed that curcumin compares favorably to atorvastatin, which you may know as Lipitor, when it comes to dealing with the endothelial dysfunction behind atherosclerosis while reducing inflammation and oxidative stress. Other studies have shown that it can impact triglyceride levels, LDL cholesterol, and total cholesterol. While most of the studies so far have been done in animals, it is believed that it could have the same effect in humans, although the right levels have yet to be established.

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Prozac (for depression)

A study in 2011 found that curcumin compares favorably to the antidepressants fluoxetine (Prozac) and imipramine when it comes decreasing depressive behavior. Best of all, it doesn’t carry the serious side effects that Prozac does, which include sleep problems, tremors, headaches, nausea, a lower sex drive, and suicidal ideation. In addition, it’s well-tolerated by patients.

Researchers believe it works on depression by inhibiting monoamine oxidase, the enzyme that has been linked to depression when it’s present in high amounts in the brain. It also raises levels of calmness-inducing serotonin and dopamine.

Oxaliplatin (for chemotherapy)

A study published in the International Journal of Cancer looked at curcumin’s effects in stopping colorectal cell lines from proliferating. The researchers discovered the herb compared favorably to the chemotherapy drug oxaliplatin. Other studies are underway exploring the impact curcumin has on various types of cancer after animal studies showed it could help prevent illnesses like skin, stomach and colon cancer in rats.

Anti-inflammatory medications

Curcumin is also great for inflammation, which is at the root of many chronic illnesses today such as cancer, metabolic syndrome, Alzheimer’s disease, degenerative diseases, and heart disease. A study published in Oncogene identified it as an effective alternative to drugs like ibuprofen, aspirin and naproxen given its strong anti-inflammatory effects, fighting inflammation at the molecular level. Meanwhile, in a study of patients with rheumatoid arthritis, curcumin worked even better than anti-inflammatory drugs.

Curcumin is so effective at addressing such a vast array of conditions that it’s hard to discuss it without sounding like you’re exaggerating. However, turmeric is truly “food gold” and it’s something well worth making a conscious effort to consume more of. You might not be ready to clean out your entire medicine cabinet, but that doesn’t mean you can’t start adding this spice to your food. It pairs well with a variety of dishes, soups, salads, stews, and smoothies; consuming turmeric with fats is ideal, and make sure you add a pinch of pepper to boost its bioavailability.

Sources for this article include:

GreenMedInfo.com

NaturalNews.com

VeryWellHealth.com

DISTURBING report finds that 20 million American schoolchildren have been prescribed antidepressants


Image: DISTURBING report finds that 20 million American schoolchildren have been prescribed antidepressants

In many ways the world is a far more complex, difficult place to live in now than it was 20 or 30 years ago. Social media places children under increasing pressure – and at an ever decreasing age – to look perfect, have limitless “friends” and lead apparently perfect lives. Many parents work longer hours than in previous decades, leaving them with little time and energy to spend with their kids. And children are under immense pressure to perform academically and on the sports field.

In previous years, kids could generally be found playing outside with their friends or chatting to them on the phone, but modern society leaves children isolated from one another, spending more time with virtual “friends” than real-life ones. Many spend most of their time online, hardly ever venturing outside.

This toxic mix of external pressures and isolation can leave children, particularly those struggling through adolescence, feeling depressed and confused. The solution for many parents and healthcare professionals is to simply prescribe them antidepressant medications like selective serotonin reuptake inhibitors (SSRIs). This “solution” is so widely favored, in fact, that a disturbing report by the Citizens Commission on Human Rights found that around 20 million American schoolchildren have been prescribed these dangerous drugs.

Antidepressant use in children rises sharply in seven years

Antidepressant medications are, in fact, not recommended for children under the age of 18, but you would never know that if you were to judge by the way doctors hand out prescriptions for these drugs like candy.

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According to the Daily Mail, a study recently published in the European Journal of Neuropsychopharmacology, which studied antidepressant use in children under the age of 18 in five western countries, found that there was an alarming increase in the number of prescriptions for these drugs between 2005 and 2012.

In Denmark, prescriptions for children increased by 60 percent; prescription numbers soared more than 54 percent in the United Kingdom; in Germany, they rose by 49 percent; the United States saw a 26 percent increase; and there was a 17 percent increase in antidepressant prescriptions for children in the Netherlands during that period.

This is shocking because a 2016 study published in the respected British Medical Journal, which evaluated the mental health of 18,500 children prescribed antidepressant medications, found that not only are the benefits of these drugs “below what is clinically relevant” (i.e. they don’t work), but children taking them are twice as likely to exhibit suicidal or aggressive behaviors than children who do not.

The study also found that the drug manufacturers are not only aware of this fact but that they actively try to hide the risks by labeling suicidal thoughts and suicide attempts as “worsening of depression” or “emotional liability” rather than admitting that they are side effects of the medication.

“Despite what you’ve been led to believe, antidepressants have repeatedly been shown in long-term scientific studies to worsen the course of mental illness — to say nothing of the risks of liver damage, bleeding, weight gain, sexual dysfunction, and reduced cognitive function they entail,” warned holistic women’s health psychiatrist, Dr. Kelly Brogan, writing for Green Med Info. “The dirtiest little secret of all is the fact that antidepressants are among the most difficult drugs to taper from, more so than alcohol and opiates.

“While you might call it ‘going through withdrawal,’ we medical professionals have been instructed to call it ‘discontinuation syndrome,’ which can be characterized by fiercely debilitating physical and psychological reactions. Moreover, antidepressants have a well-established history of causing violent side effects, including suicide and homicide. In fact, five of the top 10 most violence-inducing drugs have been found to be antidepressants.”

This doesn’t mean that our children need to be left to struggle through depression and isolation without any help, however. Experts recommend family, individual and other therapies, lifestyle changes including exercise and dietary changes, and spending more time outdoors with family and friends as healthy, side-effect-free ways to help kids cope.

Learn more about the dangers of antidepressant drugs at Psychiatry.news.

Sources include:

GreenMedInfo.com

Independent.co.uk

DailyMail.co.uk

ScienceDaily.com

Scientists Find Fluoride Causes Hypothyroidism Leading To Depression, Weight Gain, and Worse


The tables are finally starting to turn in regard to the perception that the world has of water fluoridation following the release of at least two reputable studies over the past three years documenting the adverse health effects caused by the chemical.

Researchers from the University of Kent, a public research university based in the United Kingdom, conducted the latest and considerably groundbreaking study on the health effects potentially caused by adding fluoride to the public’s water.

After studying data obtained from nearly every medical practice in England, scientists found that fluoride may be increasing the risk for hypothyroidism, or an underactive thyroid, a condition in which the thyroid gland fails to produce enough hormones, resulting in symptoms such as fatigue, obesity and depression.

Published in the Journal of Epidemiology and Community Health, the study included the largest population ever analyzed in relation to the adverse health effects caused by water fluoridation.

Recent UK study includes the “largest population ever studied in regard to adverse effects of elevated fluoride exposure”

After collecting data from 99 percent of England’s 8,020 general medical practices, researchers found that the locations with fluoridated water were 30 percent more likely to have high levels of hypothyroidism, compared to areas with low, natural levels of the chemical in the water.

This means that up to 15,000 people could be suffering from depression, weight gain, fatigue and aching muscles, all of which could theoretically be prevented if fluoride were removed from the water, according to The Telegraph.

“Overall, there were 9 percent more cases of underactive thyroid in fluoridated places,” reports Newsweek, which also notes that 10 percent of England’s water is fluoridated compared with nearly 70 percent of America’s.

The science paper also compared the fluoridated city of Birmingham with the city of Manchester, which refrains from fluoridating, and found that doctor’s offices in Birmingham were nearly twice as likely to report high levels of hypothyroidism.

The new report has some experts questioning their stance on water fluoridation.

“The study is an important one because it is large enough to detect differences of potential significance to the health of the population,” said Trevor Sheldon, a medical researcher and dean of the Hill York Medical School who has published numerous studies in this field.

Sheldon, who in the past supported fluoride, admits that the “case for general water fluoridation” is no longer clear.

New fluoride study contradicts last year’s report by Public Health England that states fluoride is “safe and effective” for improving dental health

Released in March of last year, Public Health England’s report states that “there is no evidence of harm to health in fluoridated areas,” and no differences were found between fluoridated and non-fluoridated areas in regard to rates of hip fractures, osteosarcoma (a form of bone cancer), cancers overall, Down’s syndrome births and all other recorded causes of death.

New research, however, suggests that the spike in the number of cases of hypothyroidism in areas such as the West Midlands and the North East of England is “concerning for people living in those areas.”

“The difference between the West Midlands, which fluoridates, and Manchester, which doesn’t was particularly striking. There were nearly double the number of cases in Manchester,” said the study’s lead author Stephen Peckham.

Women 15 times more likely to develop underactive thyroid

“Underactive thyroid is a particularly nasty thing to have and it can lead to other long term health problems. I do think councils need to think again about putting fluoride in the water. There are far safer ways to improve dental health.”

Hypothyroidism is particularly a cause for concern for women, as they’re 15 times more likely than men to develop the condition. Previous studies suggest that fluoride inhibits the thyroid’s ability to use iodine, which is an essential mineral for a healthy thyroid, the master gland in the human body.

 

Sources:
http://www.newsweek.com
http://jech.bmj.com
http://www.telegraph.co.uk
https://www.gov.uk

Depression Linked to Shortage of a Single Naturally Occurring Chemical


Depression plagues about 300 million people worldwide, and as scientists learn more about the condition they are realizing it’s far more complex than we once thought. This year alone, a new type of depression was identified, and scientists uncovered about 80 genes that might determine why some people are more susceptible than others. Fortunately, these discoveries are also showing us how to better treat depression. A paper released in July took a step in a new direction by identifying a naturally occurring chemical linked to depression that could be a key target for future drugs.

The paper, released in Proceedings of the National Academy of Sciences, focused on acetyl-L-carnitine (ALC), which usually is involved in converting food into energy. Led by Stanford University professor of psychiatry and behavioral sciences, Natalie Rasgon, Ph.D., this study was among the first to show that low levels of ALC are linked to depressive states in humans. Rasgon established this connection by collecting life history details and blood samples from a diverse sample of participants ranging from 20 to 70 years old.

Depression
A future drug that targets ALC might provide a new avenue for depression treatment 

Rasgon compared the blood samples of 45 healthy controls and 71 participants who suffered from either moderate or severe depression and found that those with depression had significiantly lower levels of ALC in their blood. Importantly, she also found that those with the lowest levels of ALC tended to have the most severe symptoms, developed depression later in life, and reported experiencing little relief when they adhered to traditional treatment.

In a previous interview with Inverse, Rasgon speculated that dips in ALC could partially explain patterns of depression that emerge in individuals who had experienced neglect, poverty or other trying circumstances during childhood.

“We’ve known that people who experienced childhood adversity subsequently experience worse overall health, cognitive performance, and are at risk for depression when they reach mid-life,” Rasgon said. “This study mechanistically addresses the link between adversity and depression because of the low ALC levels. This is speculative, but it could decrease the body’s capacity to tolerate stress.”

Rasgon emphasized that while it might be tempting to try to treat low ALC levels with a supplement (ALC supplements are easy to find), she doesn’t think that restoring ALC levels with external sources is the answer. She believes that supplementation could “just derail the potential efficacy of a drug” that may be developed in the future.

“At this point, we want to be very careful in specifying what we’ve achieved: We have found a new biomarker for depression, and it has significant potential for finding a new molecular target for drugs,” Rasgon said.

Instead, it’s best to look at ALC as a target for some future treatment that might provide solace to millions of people in years to come.

Largest Ever Clinical Study on Vitamin D Shows We’re Wrong About a Crucial Benefit


We are still in love with vitamins a century after they were discovered, with half the US and UK population taking a supplement.

Vitamin D – the sunshine vitamin – is the favourite and is believed to have the most proven benefits.

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Governments, including the UK government, have said that the evidence for vitamin D’s health benefits is so overwhelming that every adult should take it as a supplement for at least six months of the year.

It was first used to cure rickets in Victorian children living in urban poverty and is now routinely given to prevent and treat brittle bone disease (osteoporosis) and fractures.

It has been associated with a reduced risk of over a hundred common diseases in observational studies, ranging from depression to cancer.

The largest ever clinical study on the benefits of vitamin D in preventing fractures has been reported in the BMJ, with over 500,000 people and around 188,000 fractures from 23 cohorts from many countries.

As vitamin D levels are strongly influenced by genes, the researchers used genetic markers for vitamin D blood levels (called Mendelian randomisation or MR) to avoid the normal biases of observational studies, such as confusing cause and consequence of disease and the effects of other related health behaviours (so-called “confounders”).

 

The results showed no association between vitamin D levels over a lifetime and the risk of fracture. This latest study contradicts the UK government’s recent view, but not a host of earlier clinical trials.

In 2014, a review and meta-analysis of 31 vitamin D supplement trials found no effect on all fractures. Much of our strong belief in the benefits of vitamin D came from studies of supplements in care homes in the 1980s, which were never replicated and were probably flawed.

In a more recent meta-analysis of 33 randomised trials of over 50,000 older adults, supplementation with calcium or vitamin D had no effect on the incidence of fractures. There were also no clear benefits on muscle strength or mobility.

So, if all the data points to vitamin D failing to prevent fractures, why worry about all the people with low blood levels of the vitamin? Vitamin D deficiency has become a modern epidemic with a fifth of the UK and US populations reported to have low levels. Will they be more susceptible to other diseases and cancer?

No consensus on deficiency

There is little agreement on what vitamin D deficiency is. Deficiency levels are arbitrary with no international consensus and confusion caused by different units in the US. A “normal” level can vary from 50 to 80 nanomole per litre of blood, but recent studies suggest 30nmol is quite enough.

While clinical deficiency (<10nmol) is often clear cut, wrongly labelling millions of people as vitamin D deficient causes stress and over-medicalisation. Most people assume calcium and vitamin D are safe, and the more you take the better. My clinical practice changed when studies showed calcium supplements, as well as being ineffective against fractures, may cause heart disease. Prescriptions are now dropping.

Vitamin D is fat soluble, so high levels can build up in the body. While recommendations for supplements are usually with modest doses (10 micrograms or 400 international units (IU)), these will inevitably be overdone by some people taking other sources in cod liver oil tablets or in fortified milk, orange juice or bread. More worrying, people increasingly buy high-dose supplements of 4,000-20,000IU on the internet.

Patients with very high vitamin D blood levels (over 100nmol) are becoming routine in my clinic and elsewhere, and toxic overdoses are increasingly being reported. Several randomised trials have shown that patients with high blood levels or taking large doses of vitamin D (above 800IU) had an unexpected increased risk of falls and fractures. Vitamin D is far from safe.

It can no longer be recommended for use in other conditions; the vast majority of the positive published studies in 137 diseases were reviewed as spurious. It was widely believed that vitamin D supplements prevented cardiovascular disease, but meta-analyses and large-scale genetic MR studies have ruled this out.

Pseudo-disease

We have created another pseudo-disease that is encouraged by vitamin companies, patient groups, food manufacturers public health departments and charities. Everyone likes to believe in a miracle vitamin pill and feels “they are doing something”.

Vitamin D, despite its star status, would not be called a vitamin today, as the doses needed are too large, the body can synthesise it from skin, and it is a steroid precursor. Instead of relying on this impostor, healthy people should get vitamin D from small doses of sunshine every day as well as from food, such as fish, oil, mushrooms and dairy products.

We should also trust that thousands of years of evolution would cope with a natural drop in vitamin D levels in winter without us snapping our limbs. About half the population take vitamins daily, despite zero benefits, with increasing evidence of harm. The worldwide trend of adding unregulated vitamins to processed food has now to be seriously questioned.

While vitamin D treatment still has a rare medical role in severe deficiency, or those bed bound, the rest of us should avoid being “treated” with this steroid for this pseudo-disease and focus on having a healthy lifestyle, sunshine and importantly save your money and energy on eating a rich diversity of real food.

Montelukast’s Underrecognized Adverse Drug Events


The US Food and Drug Administration (FDA) first alerted healthcare professionals (HCPs) about a possible association between the use of leukotriene inhibitors and neuropsychiatric events in 2008 and added information to product labels in 2009. The reported events included agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor. While the precaution was extended to all agents in this class (montelukast [Singulair®], zafirlukast [Accolate®], and zileuton [Zyflo®]), particular concern has been raised about montelukast due to its widespread use in both adult and pediatric patients for multiple indications. Montelukast is approved for the chronic treatment of asthma, acute prevention of exercise-induced bronchial constriction, and relief of both perennial and seasonal allergic rhinitis symptoms. Singulair is approved in adults and children 6 months of age and older. Continued concerns about suicidality and neuropsychiatric events with montelukast were again raised at a recent FDA Pediatric Advisory Committee (PAC) meeting in September 2014. Medscape spoke with Sally Seymour, MD, and Erika Torjusen, MD, MHS, both at the Center for Drug Evaluation and Research in the Division of Pulmonary, Allergy, and Rheumatology at the FDA, about the advisory committee meeting, concerns with these agents, and the implications for HCPs.

Medscape: Can you briefly review the concerns presented at the advisory committee meeting about these agents?

Dr Seymour: On September 23, 2014, montelukast [Singulair] was discussed at the PAC meeting as part of a routine pediatric safety review conducted after a drug has new pediatric labeling.

During the open public hearing, a parent who represented numerous groups wanted to raise awareness of the potential for neuropsychiatric events with montelukast. The speaker stated that, despite the FDA’s communication efforts and information in the product label, many physicians are not aware or do not communicate the risk for neuropsychiatric events to patients.

As part of the discussion, the committee reviewed the current montelukast labeling regarding the risk for neuropsychiatric events. Members wanted HCPs to be cognizant of the association with neuropsychiatric events and consider discontinuing montelukast if they occur. The PAC recommended a communication directed at HCPs to raise awareness of the association of neuropsychiatric events. This Medscape interview is a result of the committee’s recommendations.

Medscape: In addition, the committee heard about the available objective data regarding montelukast and neuropsychiatric events. Could you summarize those data? What do we know about these adverse events, what they look like, how acutely they occur, and the populations in which they occur?

Dr Seymour: At the PAC meeting, we briefly summarized the FDA’s previous review of this safety issue. In 2008-2009, we reviewed available data (postmarketing and clinical trial data) to evaluate the risk for neuropsychiatric events with leukotriene modifiers: montelukast, zileuton, and zafirlukast. During this review of spontaneous postmarketing reports, we noted a variety of neurologic or psychiatric adverse events associated with use of these products. Reports included: agitation, aggressive behavior or hostility, anxiousness, depression, disorientation, disturbance in attention, dream abnormalities, hallucinations, insomnia, irritability, memory impairment, restlessness, somnambulism, suicidal thinking and behavior (including suicide), and tremor. Some of these reports appeared to be consistent with a drug-induced effect. Events were noted in both adults and children, and the onset of events varied.

Based upon these data, the FDA required the manufacturers to add information to the product labels. All of these labels now have a warning/precaution about the risk for neuropsychiatric events.

Medscape: This was a pediatric advisory committee meeting. Were all of these events reported in children, or are adults also experiencing these adverse events?

Dr Seymour: We have reports of children and adults experiencing these types of events. We especially want to reach out to HCPs taking care of children because montelukast is approved for children down to 6 months of age, and detecting these events in children may be more challenging. Small children can’t report side effects, and young children or teenagers may experience changes in behavior or mood that can be mistakenly attributed to a normal phase of development. Therefore, parents and practitioners need an increased level of awareness about the risks of montelukast in these age groups.

Medscape: Are these adverse events reversible with drug discontinuation, and is there a time frame in which they are likely to occur?

Dr Torjusen: The most common adverse events are typically not serious. These events are generally reversible with cessation of therapy. In terms of timing, we have reports following initiation of montelukast and after chronic use.

Medscape: You noted that the committee made a determination that more outreach and strengthening of prescriber warnings was warranted. Were there any other committee recommendations? For example, will there be any requirement to manufacturers to conduct any further studies?

Dr Torjusen: Based on the testimony provided during the open public hearing, the PAC recommended potential strategies for increasing awareness of the neuropsychiatric events that may occur with montelukast. Possibilities raised by the committee included labeling changes, education of providers, and consideration for further studies. The PAC recommendations can be found on our website.

Dr Seymour: When the FDA completed its initial review in 2009 and required the companies to update the product labeling, we did not require clinical trials to further evaluate this issue. Because this is a known safety issue, the FDA does not think that changes to the prescriber information or clinical studies are warranted at this time. The PAC noted that the patient labeling was clear.

Medscape: Given that this is a class-wide concern, should all leukotriene inhibitors be avoided in patients who experience these symptoms in response to one agent? Or is it worth a clinician trying another drug in the same class if it was felt it was really indicated?

Dr Torjusen: Based on the data available, this does appear to be a class effect and is the reason the labeling change was applied to all of the drugs in the class of leukotriene inhibitors. Therefore, if a patient experiences neuropsychiatric symptoms while on one leukotriene inhibitor, we would recommend that they avoid other drugs in the class.

Medscape: Why do you think this now 5-year-old safety issue is not well known by prescribers?

Dr Torjusen: That is a good question. It is possible that awareness of the association between montelukast and neuropsychiatric events has faded. HCPs are inundated with new products and new safety information, and keeping up with all of this can be a challenge. In addition, the types of events experienced are highly variable. Detecting these events in children and young adults can be particularly challenging. Young children may be less able to articulate these experiences, and parents may unknowingly attribute symptoms to be part of developmental changes. Therefore, reminders of important safety concerns may be necessary at times for both patients and providers.

Medscape: What are the key take-home messages for clinicians who are prescribing this class of drugs?

Dr Torjusen: The key take-home message is for HCPs to be aware of the risk for neuropsychiatric events with the use of montelukast. Providers should inform their patients and families that these types of side effects are a possibility with these medications, and they should follow up with their patients after initiation of therapy.

Patients should also notify their HCPs if side effects occur, and HCPs should consider discontinuing therapy if patients develop neuropsychiatric symptoms.

Medscape: Are there resources for patient education that clinicians can and should use?

Dr Torjusen: Certainly, clinicians can always refer to the product label for montelukast [Singulair], which provides safety information for the product. In addition, the patient prescribing information provides useful information on the product, including side effects.

Information about the FDA’s review of the safety issue can be found on the FDA website.

Serious adverse events should also be reported to the FDA MedWatch or by calling the FDA at 1-800-FDA-1088. Patients and HCPs who want more information about specific products can go to the FDA website or contact the FDA [1-888-INFO-FDA].

4 Potential Depression Fighting Actions You Can Take


Depression can make your world different in so many ways. This disorder can make people feel sluggish, emotional (anger and sadness), frightful, and unmotivated. The very signs and symptoms of depression make taking action to fight the disorder extremely difficult.

There are different forms of depression, but the two most common are Major Depressive Disorder and Persistent Depressive Disorder (PDD), also known as dysthymia.

According to the Anxiety and Depression Association of America:

  • Major Depressive Disorder is the leading cause of depression related disability in the US for those between the ages of 15 to 44, and affects over 16 million people per year.
  • PDD is a shorter-term depression that affects over 3 million people in the US annually with the average age of the disorder being around age 31.

According to a psychiatrist in Indianapolis Indiana, “taking action is one of the most important things you, or someone you know with depression can do to fight this often-debilitating disorder. There are also health reasons beyond mental health to take action, like decreasing dementia risk.”

What actions can you or a loved one take? Here are a few potential depression-fighting actions you can employ to ease the grappling hold of the disorder.

  1. Take Action And Fight Depression By Getting Active

Research points to the importance of getting active. By starting with just five minutes of exercise and slowly increasing to 20 minutes over time could have a big impact, according to a study explained in Harvard Health.

Depression can drop energy levels significantly, making anything active seem like a chore. However, staying inactive can feed depressed feelings and cause other health issues as well.

There are several needs for someone who feels depressed, and depression treatment can be a culmination of different action tactics and medication. The main goal is to start taking action through activity.

  1. Do Not Stay Isolated To Avoid People And Events

Similar to taking an active stance against depression, you should never stay isolated and avoid people and events that you may have once enjoyed the company of or doing.

“Simple human interaction can make a big difference in battling depression,” Dr. Richard Honaker, Chief Medical Advisor for Your Doctors Online said. “Sometimes discussing things with a friend or family member can offer relief.”

Placing yourself in a social setting can also be helpful. There are plenty of local events you can find online to connect with people with similar interests, or make a point of going to a few events, like dinner parties in your own social circle.

Remember, you do not need to let depression, and the associated signs and symptoms define you as a person.

  1. Get Back Into Old Hobbies You Once Loved

One of the worst things about depression is that the disorder can make you lose interest in old activities and hobbies you once loved. It could be swimming, painting, even sitting silently in a park watching passers by. However, to fight depression, it is time to take back those activities.

This may be challenging at first, since you may not really feel that great about those old hobbies. But this is when action to be active comes into play. Really force yourself to do those old activities.

One of the best ways to do this is to schedule the activity with a friend or family member, so they can hold you accountable if you try to skip out when the day arrives. Try it out for a week or two, and if you simply still feel uninterested, it is just fine to find a new hobby to change your perspective.

  1. Talk To A Professional About Your Depression

You can’t do it alone! This is a very vital fact that many people with depression do not understand, because of their disorder. If everyone with depression could fix himself or herself, we wouldn’t have millions still suffering from it. This makes seeking out and talking to a professional a must.

In Conclusion . . .

The first step to depression treatment is action. This is of course easier said than done, but it is a vital step. From stepping out of isolation to talking about feelings with a professional, the above steps are actions that offer no guarantee.

The fight against depression is often long, but getting started soon is optimal. Do not let depression define you, and always remember that you are never alone. There are millions of people living with this disorder with joy in their lives.

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