Myths and facts about antidepressants

Millions of people suffer from depression, anxiety, and other mental health conditions. Selective serotonin reuptake inhibitors (SSRIs) can improve a wide variety of these conditions, making these drugs some of the most widely used. Although often positive, the benefits of these medicines can also be a cause of concern to many people. Health, Body and Mind takes a deeper look

Millions of people suffer from depression, anxiety, and other mental health conditions. Selective serotonin reuptake inhibitors (SSRIs) can improve a wide variety of these conditions, making these drugs some of the most widely used. Commonly prescribed SSRIs include Prozac (fluoxetine), Celexa (citalopram), Luvox (fluvoxamine), Zoloft (sertraline), Paxil (paroxetine), and Lexapro (escitalopram).

SSRIs work by blocking a receptor in the brain that absorbs the chemical serotonin. Serotonin is known to influence mood, but the exact way SSRIs improve depression isn't clear. SSRIs have the power to mildly influence mood, outlook, and behavior. Although often positive, these same benefits can also be a cause of concern to many people. Will taking an SSRI change you into someone else?

Alternative therapies for depression

There is no evidence that any alternative treatment is effective for treating moderate to severe depression. For some people, however, they may be used as an addition to other treatments -- providing relaxation, relief from depressive symptoms, and helping you cope with some of the causes of depression such as grief, anxiety, changing roles, and even physical pain. If you have depression and are considering using an alternative form of therapy, it is important to seek the advice of your healthcare provider.

What is alternative therapy?

A health treatment that is not classified as standard western medical practice is referred to as "alternative" or "complementary". Alternative therapy encompasses a variety of disciplines that include everything from diet and exercise to mental conditioning and lifestyle changes. Examples of alternative therapies include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others.

All medicines have side effects, and depression treatments are no exception. Although generally well-tolerated, antidepressant drugs affect each person differently. Understanding the reality behind SSRI myths can help you know what to expect, if you're taking these medicines.

SSRI myth or fact: It's right to ask questions about possible interactions between your medicines. Although no drug is 100 percent safe for everyone, SSRIs are among the safest. Rarely do SSRIs interact or cause problems with other medicines.

One important exception: SSRIs can cause dangerously high blood pressure when taken with monoamine oxidase (MAO) inhibitors. These medicines are rarely used, and include Marplan, Nardil and Selegiline. Demerol, a very commonly used pain medication in hospitals after surgeries, has also been reported to cause dangerously high blood pressure when used along with an SSRI.

The antibiotic Zyvox (linezolid) acts similarly to an MAO inhibitor, and also should not be taken with SSRIs.

Bottom Line: SSRIs are safe to take with almost all medicines. Ask your doctor or pharmacist to be sure.

Taking an SSRI will change my personality: It's true that taking an SSRI changes the chemistry inside your brain. This causes subtle changes in the way you feel, act, and behave. But you just might like the new you. In one of the few studies measuring personality changes in response to antidepressants, those taking SSRIs felt more emotionally stable, outgoing, trusting, and assertive, and less hostile. SSRIs are approved by the FDA for anxiety or depression that's severe enough to interfere with normal functioning in life. In that case, you could argue, maybe a minor personality makeover is worth a try.

Bottom Line: Treating depression with SSRIs, therapy or both may mean making changes to who you are.

SSRIs are addictive: SSRIs do not cause addiction in the way cocaine, tobacco, or heroin do. After a period of exposure to SSRIs, however, the brain does adapt and get "used to" the medicine. For this reason, you shouldn't stop taking an SSRI suddenly without talking to your doctor. After completing treatment, the SSRI dose is tapered and stopped, and the brain readjusts.

Bottom Line: SSRIs aren't addictive, but they shouldn't be stopped abruptly either- to avoid bothersome but not necessarily dangerous features of serotonin withdrawal syndrome.

If I Start an SSRI, I'll have to take it forever: Most people take SSRIs for a limited period of time. General treatment guidelines for depression suggest treatment for at least several weeks after symptoms have improved. Depression, however, returns periodically in many people. The same is true for many other conditions that SSRIs treat. For this reason, a doctor may recommend long-term treatment as prevention against future episodes or exacerbations of symptoms.

Taking an SSRI will make me fat: People react to different SSRIs in different ways. Some people taking SSRIs put on pounds -- while relatively fewer people stop overeating and lose weight. In one typical study, about 17 percent of people taking an SSRI gained enough weight that it bothered them.

An SSRI will stop me from feeling anything: Some people report a general dulling of emotion while taking SSRIs. On the other hand, people whose emotions are shut down by depression describe finally being able to feel again. These are difficult effects to study and are not followed by the FDA or reported by drug manufacturers. Again, different SSRIs may create different effects in different people.

Bottom Line: Taking an SSRI can change how you experience emotions. If an antidepressant creates unpleasant feelings, you should discuss it with your doctor.

--www.webmd.com

Pakistan National Health Accounts:
Why they are crucial

The poor performance of our health system and resultant poor health of our people are related to the lack of a system that creates accountability. Without sound evidence on health care financing we have no way of knowing what is working or how to improve health care services. Now the government of Pakistan has recently initiated work on a National Health Accounts (NHA) system for the benefit of country

 By Muhammad Ashar Malik

The Government of Pakistan recently initiated work on a National Health Accounts (NHA) system for the country, the creation of a comprehensive set of data on the flow of funds into a health care system in a country, their sources and the way that they are used. Most countries in the region have such accounts and these are considered essential for the rational management of the health sector. NHA can classify financial data by function (for example, amounts spent on preventive versus curative medicine), by budget head (for example, salaries, medicines, equipment and buildings, etc.) and by source, such as the Federal Ministry of Health, other government departments, state-owned enterprises, private insurance plans, households and the like. These accounts are capable of providing sound evidence on health care spending in the country.

The poor performance of our health system and resultant poor health of our people are related to the lack of a system that creates accountability. Without sound evidence on health care financing we have no way of knowing what is working or how to improve health care services. This is exactly what has been happening for last very many years.

We have information on the poor performance of Pakistan's health system but have little understanding of how the system works financially or how it can be improved. Many argue that health problems in Pakistan are due to low expenditure on health care, urban biases in resource allocation, low spending on preventive programmes, fewer funds for medicines and supplies, high out-of-pocket expenditure on health care and financial allocation-expenditure gaps. Many of these claims may turn out to be completely or partially correct but there is a possibility that many may also be absolutely wrong. NHA, with the support of performance data, can unearth such facts which could lead to the complete revamping of some of the health care programmes and projects in the country. Analysis based on NHA data may well recommend a re-orientation of the health care delivery system in Pakistan.

Ministries of Health in other South Asian countries such as India, Bangladesh, Nepal, and Sri Lanka have already carried out a few rounds of National Health Accounts. Similarly neighbouring countries Iran and China have also been producing National Health Accounts for a period of time. Pakistan, on the other hand, is still lagging behind in this important activity of national importance.

The government should be lauded for this long-overdue step. FBS will lead the initiative that will provide evidence that can be used by the Ministry, and this will certainly lead to greater accountability in the health sector. However, as NHA is a core activity of the health sector, the more active involvement of the Ministry of Health and academia will be highly beneficial both in terms of quality and ownership.

This is evident from the experience of many countries where NHA has been a regular feature of health ministries' own plans of action or where a cell has been established within the ministry itself e.g. Health Economics Unit in Bangladesh and the National Health Accounts Cell in India.

Childhood obesity may be levelling off

Latest data suggests that the number of overweight kids may be levelling off. However, experts caution there's still much to be done to improve the health of children because the number of youngsters who are overweight today is still triple what it was in the 1960s and 1970s

In what may be the first good news in the battle against obesity among children, researchers report that the latest data suggest that the number of overweight kids may be levelling off. However, experts caution there's still much to be done to improve the health of children because the number of youngsters who are overweight today is still triple what it was in the 1960s and 1970s.

"The rates are still very high. But this study suggests there may be some cause for optimism as the rate appears fairly level over eight years," said study author Cynthia Ogden, an epidemiologist at the National Centre for Health Statistics.

"After 25 years of extraordinarily bad news about childhood obesity, there is a glimmer of hope. But it's much too soon to know whether rates have truly levelled off," said Dr David Ludwig, director of the Optimal Weight for Life programme at Children's Hospital Boston.

"Even if they have levelled off, the prevalence is at such high levels that unless we do something, unless we redouble our efforts, this generation is in store for a shorter and less healthful life than their parents," Ludwig said.

Using height and weight data from the U.S. National Health and Nutrition Examination Survey (NHANES), the researchers calculated the body-mass index (BMI) for 8,165 children between the ages of two and 19. The data used for the study was collected in 2003-04 and again in 2005-06.

The researchers found no statistical difference between the two time periods, and so combined them into one. Between 2003 and 2006, 31.9 percent of children had a BMI higher than the 85th percentile for their gender and age. A BMI above the 85th percentile means a child is at risk of being overweight.

Slightly more than 16 percent of the children had a BMI at or above the 95th percentile, indicating they were overweight. And 11.3 percent had a BMI at or above the 97th percentile, indicating these kids were significantly overweight.

When the researchers compared this data to data from as far back as 1999, they found no statistically significant differences in the prevalence of overweight children.

The study didn't look at factors that might be contributing to the trend, according to Ogden.

Ludwig said the numbers may have something to do with all the attention that has been paid to the problem of childhood obesity. But, he added, there still needs to be much more focus given to the problem at an international level.

"We need a comprehensive national strategy. We need to regulate junk food ads to kids, we need better school lunch funding, better funding for regular physical education in schools and after-school activities, and we need improved insurance reimbursement for obesity prevention and treatment services," he said.

"It's much too soon to tell if there's a true plateau or if this is just a temporary lull. Without major declines in prevalence, the health toll will continue to mount," Ludwig said.

--www.msn.com

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Health update
Vitamin D status not associated with lower prostate risk

Men with a high blood concentration of vitamin D don't have a reduced risk of prostate cancer, National Cancer Institute researchers report. Previous laboratory studies had suggested that high doses of vitamin D may decrease prostate cancer risk, but epidemiological studies of that association have yielded mixed results. In this new study, researchers compared blood concentrations of vitamin D of 749 prostate cancer patients and 781 men without the disease. The blood samples were collected at the start of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, and all the prostate cancer cases included in this study were diagnosed one to eight years after collection of the blood samples. Increased vitamin D concentrations weren't associated with a statistically significant difference in prostate cancer risk.

Dialysis catheter placement makes little difference in infection risk

There's little overall difference in infection risk if a catheter for dialysis is inserted into a neck vein or an upper leg vein in critically ill patients, French researchers report. Currently, it's widely believed the neck catheter is less likely to cause infection than the leg catheter. The researchers compared rates of bacteria growth on catheters (catheter colonisation) at the time of their removal and rates of catheter-related blood stream infections. The patients were randomly selected to have the catheter inserted in the neck (jugular) vein or the leg (femoral) vein. Catheter colonisation occurred at a rate of 40.8 per 1,000 catheter-days among patients in the femoral group and a rate of 35.7 per 1,000 catheter-days among those in the jugular group. Catheter-related bloodstream infection occurred in three of 324 (0.9 percent) of patients in the femoral group and in five of 313 (1.6) percent of patients in the jugular group. This was not a statistically significant difference. The study authors said that the findings are "inconsistent with the widely accepted convention to avoid femoral catheterisation to prevent the risk of catheter-related infection."

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