8 Things You Can Start Doing Now to Look Younger

2 / 9   Use the Right Skin Care Products

When shopping for skin care products, there are three powerful ingredients you should look for to maintain youthful-looking skin, says Robinson. One, check the label for a serum containing antioxidants like vitamin C (Robinson likes Elizabeth Arden Prevage Anti-Aging Daily Serum), which will help brighten your skin; two, add retinoids, which increase cell turnover and stimulate collagen renewal, to your routine; and three, start using an alpha hydroxy acid exfoliator to remove the top layer of dead skin cells (Robinson is a fan of Peter Thomas Roth Un-Wrinkle Peel Pads, which are gentle enough to be used daily). 

8 Things You Can Start Doing Now to Look Younger


1 / 9   Who Says You Have to Look Your Age?

When it comes to how old you are, age really is just a number. In 2014, researchers at the International Institute for Applied Systems Analysis published a study stating that there are a lot more factors that should go into determining age than how long you’ve been alive. There are plenty of super-simple things you can do to keep your complexion healthy and radiant regardless of what birthday you most recently celebrated. Andrea Robinson, the former head of beauty for Ralph Lauren and Tom Ford and the author of “Toss the Gloss: Beauty Tips and Tricks for Women 50+”, shares her insider knowledge on what anti-aging products really work, makeup tips that are guaranteed to make you look younger, and more.

 

Welcome to HealthTalk Blog

For those of you who’ve been with HealthTalk for some time, my name is probably familiar. I’m the founder of this health education company that creates and publishes free audio programming on the latest treatments and quality of life innovations for chronic illnesses such as multiple sclerosis, psoriasis, asthma and various types of cancer.

And also, more recently, I’m a patient treated successfully for chronic lymphocytic leukemia.

Quite frankly, I stumbled into the healthcare arena by accident some 20-plus years ago. And I’m glad I did, because I’ve become fascinated with the improvements to treatment and patient care over the years.

And it may have saved my life.

When I was diagnosed with CLL in 1996, I had been doing this for more than a decade. I carefully researched my options and found a doctor at the M. D. Anderson Cancer Center who recommended what was then an experimental treatment (today, it’s the standard of care). Now I’m in molecular remission.

At HealthTalk, I’m responsible for partnering with advocacy groups and major hospitals (including M. D. Anderson) and I still host many programs, including the upcoming Crohn’s webcast on November 10.

Getting back to my broadcasting roots, I also just launched a radio program called This blog will feature my perspective on the news of the day and other interesting nuggets of useful knowledge that I come across in my work exploring the world of patient empowerment.

This is a very exciting time in medicine. I hope you’ll join me as we travel down the path toward better care together.

only am I not alone, but I am connecting in a significant and meaningful way

only am I not alone, but I am connecting in a significant and meaningful way

DIY Beauty Solutions

Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.
Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

DIY Beauty Treatments for Every Skin Problem

  • 1 / 7   DIY Beauty Solutions

    Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

    Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

  • 2 / 7   Problem: Hyperpigmentation and dark spots

    Solution: Fresh lemon juice and a red onion


    Lemon juice and red onions are naturally acidic, and when combined together, they create a gentle-yet-effective at-home alternative to dark spot and hyperpigmentation treatments that are often formulated with harsh chemicals.

    For best results, Michael Lin, MD, a board-certified dermatologist in Beverly Hills, California, suggests blending ¼ of a red onion with freshly squeezed lemon  juice before applying it to the desired area with a Q-tip. After 10 to15 minutes, wash off the homemade treatment with a mild cleanser.

  • 3 / 7   Problem: Dry, calloused hands and feet

    Solution: Almond milk and coffee grounds


    For a smoothing hand and foot scrub, Lin suggests combining almond milk with leftover coffee grounds from your morning roast. Almond milk is rich in antioxidants and vitamin E, which helps protect skin from free radicals that can damage cells and break down collagen. Coffee grounds, on the other hand, offer exfoliating benefits that help reveal radiant skin. “Using a caffeine scrub helps to stimulate cells and elastin, and temporarily firm the skin,” says Lin. 

    Combine 2 cups of almond milk and the coffee grounds in a bowl, then scrub the formula in circular motions on your hands and feet.

  • 4 / 7   Problem: Dull skin

    Solution: Peppermint tea


    Using topical treatments isn’t the only way to achieve gorgeous, glowing skin. In fact, radiant skin can be attained from the inside out by drinking a generous cup of peppermint tea. Dallas-based celebrity aesthetician Renee Rouleau advises her celebrity clients to drink a cup of the minty stuff before red carpet events.  

    “Peppermint tea is known to boost blood circulation, giving skin a vibrant glow,” says Rouleau, adding that peppermint can also help decrease stress. 

  • 5 / 7   Problem: Uneven skin tone and UV damage

    Solution: Strawberries and honey


    Strawberries in particular are jam-packed with vitamin C and are a natural source of salicylic acid, which is often found in anti-acne treatments to help clear skin and keep flare-ups at bay. When paired with honey, which has anti-bacterial benefits, they create a powerful at-home alternative to a store-bought mask. 

    Mash together three strawberries and 1 Tbsp. honey and apply the mixture. Wash off the mask with warm water after 15 minutes.

  • 6 / 7   Problem: Dry, frizzy hair

    Solution: Coconut oil


    As the weather gets warmer, your hair can become dry, frizzy, and completely unmanageable. Because of its moisturizing benefits, coconut oil is highly effective when it comes to nourishing hair and battling frizz. 

    For a hydrating hair treatment, New York City stylist Nunzio Saviano, owner of Nunzio Saviano Salon in New York City, recommends working a tablespoon of liquefied coconut oil through your hair post-shampoo. Leave the oil in for five to 10 minutes and rinse it out with chilly water, which will also help close the hair cuticle and seal in moisture, fighting frizz.

  • 7 / 7   Problem: Product buildup

    Solution: Apple cider vinegar

    Product buildup (sometimes confused for dandruff) is residue left behind on your hair and scalp by shampoo, mousse, hairspray, and other styling products. Additionally, dirt, natural oils, and hard water mineral deposits can build up on your hair shaft, leaving locks dull and weighed down. For a quick at-home fix, celebrity colorist Kyle White recommends a five-minute apple cider vinegar treatment.

    “Apple cider vinegar is an effective clarifying

5 Reasons Why Skin Cancer Surgery Isn’t So Scary

Veva Vesper has dealt with more than her fair share of skin cancer in the last 25 years. The 69-year-old Ohio resident has had more than 500 squamous cell carcinomas removed since the late 1980s, when the immunosuppressant medication she was taking for a kidney transplant caused her to develop them all over her body — everywhere from the corner of her eye to her legs. 

While Vesper’s story is unusual, skin cancer is the most common cancer in the United States. In fact, it’s currently estimated that one in five Americans will get skin cancer in his or her lifetime.  

Mike Davis, a 65-year-old retired cop, and like Vesper, a patient at The Skin Cancer Center in Cincinnati, Ohio, has a more familiar story. Earlier this year, he had a basal cell carcinoma removed from his left ear — the side of his face most exposed to UV damage when driving on patrol. 

The buildup of sun exposure over your lifetime puts you at greater risk for developing basal and squamous cell skin carcinomas as you age. Both Vesper and Davis had Mohs surgery, the most effective and precise way to remove the two most common types of skin cancer. 

DIY Beauty Treatments for Every Skin Problem

Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

7 Quick Fixes to Look More Attractive

One look at the billion dollar anti-aging industry and it's no surprise we find youth beautiful above all else. But skin isn't the only indicator of it — the size of your eyes is, too. "Women with baby-like features such as large, widely-spaced eyes are typically judged to be most attractive," says Viren Swami, PhD, author of The Psychology of Physical Attraction,who cites cross-cultural study data from African-American, Asian, Hispanic, and Taiwanese participants.

The quickest and easiest way to maximize your eyes is to sketch a line on the top lash line using a smoky shade, and then smudge the shadow with a brush or your fingertip to soften and blend, says Tina Turnbow, a celebrity makeup aritst.

11 Struggles Every New Runner Understands

I've never been one of those people. You know the kind, the ones who wake up in the morning or lace up in the evening and "go for a run."

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I've always been envious of my roommates, who can sneak in a jog with ease and carry on with their day, as if they had done something casually simple like taking the trash out. So, I made a vow to give running another chance. After all, the exercise has been shown to make you happier, reduce your risk for disease and even increase longevity.

While group classes and long walks will probably always be more my speed, I did find that I was enjoying running more than I ever did in the past. However, that doesn't come without a few hiccups. Below are a handful of struggles all new runners can probably relate to.

Getting winded in the first few minutes.

Probably one of the most discouraging elements of getting into a running routine is realizing that you're not as in shape as you thought you were. I continuously find myself doing more walking or jogging than actual running. But just because you need those intermittent breaks doesn't mean you aren't a runner. In fact, research shows that walking intervals during your run can help you maintain your overall pace.

Two words: Sore. Muscles.

The second-day pain is real. If you're experiencing those achy muscles, try one of these post-run remedies. Just make sure you're checking in with your body as you establish your routine. A little soreness is OK, but if the pain is more intense you may have sustained a running-related injury.

 

 

Feeling overwhelmed by the copious amount of races.

Color runs, beer runs, zombie runs, princess half marathons... the list is seriously endless. However, there are some perks to picking a race. Signing up for one helps you set a goal as you get into a routine, plus there's an opportunity to turn it into a social event by participating with your friends.

If your goal is to become a marathon runner (and props to you!), there are also some benefits there: Research shows consistent long-distance running can improve cardiovascular health and lower the risk for other organ disorders, the Wall Street Journal reported.

The jolting agony of waking up at 6 a.m.

My sleepy brain is constantly telling me my bed feels better than running (and often, the bed wins). If you need a little extra motivation, try one of these hacks to help you jumpstart your morning workout.

The boredom.

Part of the reason I never got into a routine in the first place was because the exercise itself seemed extremely dull to me (the treadmill is my arch-nemesis). Once I discovered more running-path options, I started to have more fun. However, that's not to say that I don't get a little bored sometimes — and that's OK.

Note: If you still just can't get excited by the process most of the time, you may want to try a more entertaining workout option instead. Exercise should be engaging, not mind-numbing.

Trying to find your perfect route.

Finding your favorite place to run is like finding a good apartment: It feels elusive until one day you hit the lottery. Whether you're into lush scenery or a skyline, it's important to find the routes that work for you in order to make the exercise entertaining.

The joy of picking out new workout clothes.

Sleek tanks! Compression pants! Neon shoes!

Running toward (multiple) "finish lines."

If you've ever uttered to yourself just one more pole, you're not alone. In fact, picking out an arbitrary finish line on your run can improve your performance. Research shows those who stare at a target in the distance go faster and feel less exertion than those who don't concentrate on anything, The Atlantic reported.

 

 

Bargaining with yourself on your run.

If you run five more blocks, you can binge-watch Scandal when you get home, I tell myself. Chances are I'd probably do it anyway — but at least it encourages me in the moment.

Creating a playlist that will consistently keep you motivated.

No, a simple music-streaming app won't do when your lungs are on fire and your legs feel weak. You need that one specific song that will inspire you to keep going (shout out to all my Shake It Off comrades). If you're looking for a playlist to spice up your run, check out some of these.

Eating Well As You Age

Looking in the mirror for changes as you age? A healthy diet helps to ensure that you'll like the reflection you see. Good nutrition is linked to healthy aging on many levels: It can keep you energized and active as well as fight against slowing metabolism and digestion and the gradual loss of muscle mass and healthy bone as you age.

Making healthy diet choices can help you prevent or better manage chronic conditions such as high blood pressure, high cholesterol, and diabetes. It's never too late to adopt healthier eating habits.

Strategies for Healthy Eating as You Age

Replace old eating habits with these healthy approaches:

  • Eat every three or four hours. “This keeps energy levels high and keeps appetite hormones in check to avoid overeating,” says Kim Larson, RD, of Total Health in Seattle and a spokesperson for the Academy of Nutrition and Dietetics.
  • Eat protein at each meal. Aim for 20 to 30 grams to help maintain muscle mass. Choose fish at least twice a week as a source of high quality protein. Other good sources of protein include lean meat and poultry, eggs, beans, nuts, and seeds.
  • Choose whole grains. Replace refined flour products with whole grains for more nutrients and fiber.
  • Choose low-fat dairy. Cutting out the saturated fat may help lower your risk for heart disease.
  • Learn about portion sizes. You may need to scale back on the serving sizes of foods to control your weight.
  • Choose nutrient-rich whole foods over empty calories. Whole foods are those closest to their natural state. Empty calories are typically processed foods with added salt, sugar, and fat. For example, snack on whole fruit instead of cookies.
  • Eat a “rainbow” of foods. “Eat five to seven servings of fruits and veggies each day to keep antioxidants like vitamins A, C, and E high,” Larson says. Choosing fruits and vegetables of different colors provides your body with a wide range of nutrients. According to research published in the May 2012 issue of the Journal of the American Geriatric Societyexercise coupled with higher fruit and vegetable intake led to longer lives. Fruits and veggies also fill you up with fiber, which cuts down on snacking and helps control weight, Larson says.
  • Choose healthy cooking techniques. Try steaming, baking, roasting, or sautéing food rather than frying it to cut back on fat.
  • Cut down on salt. If you’re over 51, national recommendations are to eat less than 1,500 milligrams of salt per day. Look for low-sodium foods and season your meals with herbs and spices rather than salt.
  • Stay hydrated. “Dehydration can cause irritability, fatigue, confusion, and urinary tract infections,” Larson says. Be sure to drink plenty of water and other non-caffeinated liquids throughout the day.
  • Ask about supplements. You may have changing nutrient needs as you get older and might benefit from vitamins B12 and D, calcium, and omega-3 fatty acid supplements, Larson says. Ask your doctor or a dietitian for guidance.

Overcoming Challenges to Healthy Eating

Eating a healthy diet can be complicated by changes you may face as you age, such as difficulty eating or a limited budget. There are strategies you can try to solve these common challenges:

  • If you've lost your appetite or sense of taste: Try new recipes and flavors — adding spices, herbs, and lemon juice can make foods more appealing. If you take medication, ask your doctor if appetite or taste changes are side effects and if switching to another drug might help.
  • If you have a hard time swallowing or chewing: Choose foods that are moist and easy to eat, such as nutritious soups made with beans and vegetables, Larson says.
  • If affording groceries is difficult: Shop from a list — careful planning can help you make the healthiest and most cost-effective food choices. Use coupons or shop on days when discounts are offered. Buying fruits and veggies when they’re in season and frozen produce in bulk can also help control expenses.
  • If you have trouble preparing meals: Consider buying healthy prepared or semi-prepared meals or at least pre-cut ingredients to cut down on energy-draining prep time.

Larson believes in the importance of enjoying your food. Make healthy-diet changes step by step and have fun experimenting to find new tastes and cooking styles. Eat slowly and pay attention to the experience. “Create a pleasant eatingenvironment," she says. "Sit by a window and enjoy every bite.”

What You Need to Know About Hyperpigmentation

Even small skin traumas like a pimple or bug bite can leave you with complexion-busting dark spots. “This is one of the most common ailments that patients come to see me about,” explains Jeanine Downie, MD, director of Image Dermatology in Montclair, New Jersey. “It’s an annoying condition that affects all skin types, but the good news is that it’s fairly easy to treat.”

Find out how Dr. Downie helps patients treat and avoid marks on their complexions.

Everyday Health: What causes hyperpigmentation?

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Jeanine Downie: Any trauma or inflammation to the skin — either from acne, pimples, bug bites, or simply a bump, cut, or scratch — disrupts the surface layers where you have melanin, responsible for skin’s color. As the skin heals, it leaves behind residual pigmentation and dark spots.

 

 

 

EH: Is there anything you can do to prevent it?

JD: Unfortunately, if you’re prone to these dark spots, it’s tough to prevent them. Still, picking or scratching at an irritation will further traumatize the area, so hands off! You’ll also want to be vigilant about wearing sunscreen. As your skin gets darker, so will those hyperpigmented areas — it’s not like a tan is going to even out the color. Obviously, daily sunscreen wear is a must anyway, but this is just one more reason to protect your skin from UV rays.

EH: What steps can you take to treat it?

JD: The sooner you start taking care of your wound, the better it’ll look once healed. I recommend keeping the wound covered, especially if the skin is broken, and applying a topical healing ointment.

 

 

For large cysts or cuts, you may even want to see your dermatologist for a treatment plan. Once the pimple or cut has healed, apply 2% hydroquinone cream, which is available over-the-counter, or 4% hydroquinone, available by prescription from your doctor.

If the topical creams don’t quite do the trick, talk to your dermatologist about chemical peels or laser treatments to completely eliminate more stubborn discoloration.

EH: Is hyperpigmentation more common in people with darker complexions?

JD: No matter your skin color, everyone is susceptible to hyperpigmentation. Still, those with darker complexions seem to hold on to those spots for much longer because they have more melanin in their skin. It also means those hyperpigmented areas are going to be darker and more visible as well. Pregnancy and certain medications can increase your body’s production of melanin, and lead to hyperpigmentation as well.

6 Ways to Prep Your Skin for Summer

Scheduling vacation plans and buying a new swimsuit will mentally prepare you for summer, but your skin may need some help getting ready, too. For gorgeous, smooth skin you'll feel ready to bare, you need to take a few simple steps. Try this head-to-toe refresher to take your skin out of hibernation.

1. Reveal Glowing Skin

Regular exfoliation can be a part of a healthy skin regimen no matter the season; as long as your skin is not sensitive, exfoliation can help you achieve smooth, healthy-looking skin that makes you look more glowing and youthful. “But it must be done with care,” says Doris Day, MD, a dermatologist in New York City. “The goal is to lift off the outer layer of skin cells that are ready to be sloughed off without stripping the skin.”

 

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Brushes, polishing cloths, and scrubs offer easy ways to smooth away rough spots. Rotating cleansing brushes work by physically buffing off the dead skin cells. Exfoliating cloths, microdermabrasion kits, and scrubs with granular ingredients also operate the same way. “For the body, look for a scrub that contains coarse particles that dissolve over time, like sugar, so you don’t irritate the skin,” says Dr. Day.

Products that chemically exfoliate the skin contain ingredients such as glycolic, salicylic, or polyhydroxy acids that cause the skin to shed its outer layer and reveal the newer layer.

2. Remove Hair Without Irritation

If your summer forecast calls for sunny days at the beach or poolside, you may be putting some effort into removing unwanted hair. But once you rip off the wax strip, it’s also important to care for the skin that’s newly exposed to the elements.

Give your skin some time to recover before rolling out your beach towel or getting active outdoors. “I advise clients to stay out of the sun or heat for at least 48 hours after any hair-removal process,” says Cindy Barshop, owner of Completely Bare spas. “Follicles are vulnerable to irritation, and skin may be sensitive due to any heat or friction from lasers, waxing, or shaving.”

Since most of us don’t plan our hair removal that far in advance, buffer your tender skin with an oil-free sunscreen, wait for it to dry (about 5 minutes), and dust on some talc-free baby powder, says Barshop. To prevent ingrown hairs, it’s helpful to wear loose-fitting clothing and use an after-waxing product that contains glycolic and salicylic acids, which team up to prevent dead skin cells from causing bothersome bumps.

 

 

3. Fight UV Rays With Food

All the work you put into making your skin look good won’t be worth it unless you guard it from the sun’s damaging rays, which are strongest during the summer. Surprisingly, you can protect yourself from the inside, too. “In addition to usingsunscreen, eat cooked tomatoes every day if you know you’re going to be in the sun,” says Jessica Wu, MD, assistant clinical professor of dermatology at USC Medical School. According to research, cooked tomatoes are rich in lycopene, an antioxidant that helps fight the effects of UV rays such as redness, swelling, and blistering from sunburn. If you plan to spend a lot of time outdoors, you may benefit from consuming tomato sauce, grilled tomatoes, or even Bloody Marys. “This doesn’t replace sunscreen, but the habit could give you additional protection if you can’t reach your back and miss a spot,” Dr. Wu adds.

4. Clear Up Body Breakouts

It’s no better to have acne on your body than on the face, especially in the heat, when hiding and covering up isn’t an option. The approach to treating acne on the back, chest, and elsewhere on the body is the same as treating facial acne: “Exfoliate regularly, don’t pick, and treat with effective ingredients,” says Day.

Washing with products that contain salicylic acid helps slough off the dead skin cells; a treatment product with micronized benzoyl peroxide can also help by penetrating the skin and killing off the bacteria that cause acne.

If your skin is sensitive, investing in an acne-treating blue light tool may be worth the cost. “You simply wave the light wand over skin for five minutes daily and it helps kill bacteria,” says Leslie Baumann, MD, a dermatologist in Miami. If you have severe body acne, see a dermatologist.

5. Erase Cellulite

First, the good news: Some products may be able to smooth out the undesirable dimples and unevenness of cellulite. The bad news: They won’t get rid of cellulite forever. The smoothing and toning effect, like many good things in life, is fleeting. Still, it may be worth slathering on a toning body lotion to make your skin look and feel tighter for a day at the beach or a special event.

“Products that contain caffeine and theophylline temporarily dehydrate fat cells,” says Dr. Baumann. “However, it’s the massage and the application of the cream that does the work.” The best course of action long-term is to exercise regularly, coupled with targeted massage, suggests Baumann.

Another way to hide cellulite is to apply a fake tan. Take advantage of the newest self-tanners, which have come a long way from the strong-smelling streaky creams or sprays of yesteryear. “There has been so much progress in the formulations — the colors are natural, there’s no streaking, and the scent is so much better,” says Day.

6. Treat Your Feet

If you’ve stuffed your feet inside boots all winter, they probably could use a little TLC for sandal weather. Jump-start your program with a salon pedicure, or if you’re short on time, you can heed Day’s DIY tip, which will help soften feet while you sleep. First, remove thicker skin with a foot file. Apply a rich emollient cream or ointment, then cover the feet in plastic wrap and cotton socks. Leave on overnight. Repeat every day until you achieve smooth skin, then once a week to maintain soft skin.

7 Healthy Habits of the 2016 Presidential Candidates

The New Hampshire primary's in full swing, and if there’s one thing all the presidential hopefuls can agree on, it’s that running for office is the ultimate endurance challenge. They’re canvassing across the country with little time to exercise or sleep, and it doesn’t help that at every stop they’re tempted by unhealthy foods like pizza, pork chops, and pies. So how do the presidential candidates stay healthy and keep their energy levels up during the grueling primary season? Read on to find out!

What Is Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is an illness that can result in muscle weakness or loss of muscle function in parts of the body.

In people with Guillain-Barré syndrome (pronounced GHEE-yan ba-RAY), the body's own immune system attacks the peripheral nervous system.

The peripheral nervous system includes the nerves that connect the brain and spinal cord to the limbs. These nerves help control muscle movement.

GBS Prevalence

Guillain-Barré syndrome is a rare disease.

The Centers for Disease Control and Prevention (CDC) estimates that about 1 or 2 out of every 100,000 people develop GBS each year in the United States.

Anyone can get GBS, but the condition is more common in adults than in children, and more men than women are diagnosed with GBS each year.

Causes and Risk Factors

Doctors don't know what causes Guillain-Barré syndrome.

Many people with GBS report a bacterial or viral infection (such as the flu) days or weeks before GBS symptoms start.

Less common triggers for GBS may include:

  • Immunizations
  • Surgery
  • Trauma

Guillain-Barré syndrome is not contagious — it cannot spread from one person to another.

Types of GBS

There are several types of Guillain-Barré syndrome, which are characterized by what part of the nerve cell is damaged.

The most common type of GBS is called acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

In AIDP, the immune system mistakenly attacks the protective nerve covering that helps transmit nerve signals from the brain to other parts of the body.

Guillain-Barré Syndrome Symptoms

The first symptoms of Guillain-Barré syndrome often include feelings of tingling or weakness in the feet and legs. These feelings may spread to the arms and face.

The chest muscles can also be affected. Up to a quarter of people with GBS experience problems breathing.

In very severe cases, people with GBS may lose all muscle function and movement, becoming temporarily paralyzed.

Signs and symptoms of Guillain-Barré syndrome may include:

  • Pricking or tingling "pins and needles" sensations in the fingers, toes, ankles, or wrists
  • Muscle weakness that starts in the legs and spreads to the upper body
  • Unsteady walking
  • Difficulty with eye or facial movements (blinking, chewing, speaking)
  • Difficulty controlling the bowels or bladder
  • Rapid heart rate
  • Difficulty breathing

Carbohydrates: Your Diet's Fuel

Before you feast on chicken and boycott carbs, take a closer look at the U.S. Food Pyramid.

Carbohydrates are highlighted as an important part of ahealthy diet, and not banned by any means. Your body needs a wide variety of foods to function and stay healthy.

"Carbohydrate is one of the macronutrients that we need, primarily for energy," says Sandra Meyerowitz, MPH, RD, a nutritionist, online nutrition coach, and owner of Nutrition Works in Louisville, Ky.

While fats and protein are also necessary for energy, they're more of a long-term fuel source, while carbohydrates fulfill the body's most immediate energy needs. "It's your body's first source of energy — that's what it likes to use," adds Meyerowitz.

Prescription Drugs That Cause Depression

Some prescription drugs can cause or contribute to the development of depression and other mood disorders.

What do certain asthma, acne, malaria, and smoking-cessation prescription drugs have in common? Answer: Their possible side effects include depression or other mood disorders.

Depression as a side effect of prescription drugs is widespread and increasingly gaining attention. The medications that contribute to drug-induced depression might surprise you. For example, an asthma medication, Singulair (montelukast), is prescribed to help people breathe more easily, but its side effects may include depression, anxiety, and suicidal thinking, according to a research review published in Pharmacology in 2014.

“In 2009, Merck added psychiatric side effects as possible outcomes with Singulair, including tremor, depression, suicidality — suicidal thinking and behavior — and anxiousness,” says J. Douglas Bremner, MD, researcher and professor of psychiatry and radiology at Emory University School of Medicine in Atlanta.

Drugs With Depression as a Side Effect

Dr. Bremner has published studies on the possible relationship between the use of retinoic acid acne treatments and the development of depression. One of the drugs within this category is Accutane (isotretinoin), the oral treatment for severe acne that has been associated with psychiatric problems, including depression.

“The original brand-name version of isotretinoin, Accutane, was taken off the market in 2009, although it continues to be marketed as Roaccutane in the U.K., Australia, and other countries," Bremner notes. "In the U.S. there are three generic versions available that have also been associated with reports of depression and suicide, Sotret, Claravis, and Amnesteem."

RELATED: Are You Getting Hooked on Anxiety Medications?

The full list of drugs that could cause depression is a long one. British researchers found 110 different medications between 1998 and 2011 that were associated with increased depression risk, according to a report published in BMC Pharmacology and Toxicology in September 2014.

Besides isotretinoin and montelukast, drugs that can cause or contribute to the development of depression or other mood symptoms include:

Lariam (mefloquine), used to treat malaria. Depression, anxiety, and psychosis are among the side effects of this medication, according to an article in Medical Science Monitor in 2013 that explored the chemical cascade behind mood changes.
Chantix (varenicline), used to stop smoking. The Food and Drug Administration (FDA) lists hostility, anxiety, depression, and suicidal thoughts as possible side effects of this medication.
Inderal (propranolol hydrochloride) and other drugs in the beta-blocker class, used to treat high blood pressure. Research on beta-blockers and depression suggests that some, but not all, of the medications in this class can contribute to depression, according to a report in the February 2011 issue of the Journal of Clinical Psychopharmacology.
Contraceptives. Contraceptives including those delivered by vaginal ring or patch could lead to depression in some people, according to research published in the Cochrane Database of Systematic Reviews in 2010.
Corticosteroids. Some people who take corticosteroids experience side effects such as depression, anxiety, and panic attacks, among other symptoms, according to a review of research published in Rheumatology International in 2013.
Interferon-alpha. As many as 40 percent of people using this immunologic medication may experience depression, according to a 2009 report in Dialogues in Clinical Neuroscience.
Interferon-beta. The link between this immunologic medication and depression is debated, but researchers reporting in Therapeutic Advances in Neurologic Disorders in 2011 note that depression is a concern for those who take it, in part because of their underlying conditions.
Nonnucleoside reverse transcriptase inhibitors. These HIV medications may increase the risk for depression, according to research published in the September 2014 issue of HIV Medicine. Arimidex (anastrozole) and aromasin (exemestane). Both of these long-term breast cancer therapies may contribute to depression, according to the FDA.
Vigabatrin. This anticonvulsant may cause depression, irritability, and psychosis, notes a review of studies in Acta Neurologica Scandinavica in 2011.
The FDA investigates drugs that have many reports of depression symptoms as a side effect. It requires what are called black-box warnings to be clearly printed on medications, like isotretinoin, that have been linked to depression and suicidal behavior, among other serious health threats. Make sure you read the information pamphlets that come with your prescription medications (and ask your pharmacist if you don’t understand what they say). You can stay on top of any news about their side effects by setting up a news alert on Google.

You can get the latest drug safety information on the FDA website.

Also, pay attention to how you feel. Though you may be taking medications that seem unrelated to mood, let your doctor know if you have symptoms such as sadness, difficulty sleeping, hopelessness, sleep changes, or thoughts of suicide.

“If you suspect your medication may be causing depression or similar problems, talk with your doctor and, if necessary, consult with a psychiatrist,” Bremner advises. The good news is that drug-induced depression usually clears up once you stop taking the medication.

Are Your Drugs Causing Depression?

It can be challenging to figure out whether your depression is related to taking a prescription drug, but here are some indicators:

Timeline. Drug-induced depression is defined as depression that appears within a month of starting or stopping a medication, according to the American Society of Health-System Pharmacists (ASHP). The society also advises that other conditions that might cause depression have to be considered in figuring out whether medication is the contributing factor. Bremner found in his research that the timeline varies from weeks to a month or two.
Dose-response relationship. With some drugs, depression symptoms may get better as the dose is reduced or worse as it is increased. This is usually a clear indicator of a relationship.
If you are uncertain about whether your changes in mood or energy are drug symptoms, talk with your doctor. Screening tools and questionnaires can reliably identify depression. You can also send information about your experiences to the FDA.

Prescription Drug-Induced Depression Treatment

In severe cases, people taking prescription drugs have developed depression leading to suicidal behavior. Because of this risk, don’t ignore or try to wait out feelings of depression, even if you believe they are only a prescription drug side effect. Talk with your doctor about these options to correct the situation:

Switching to an alternative treatment. If an equally effective medication that does not have depression as a side effect exists, the easiest option is to switch prescription drugs.
Getting a psychiatric evaluation. This may be recommended in any case to make sure you do not have an underlying psychiatric condition that has gone undiagnosed. People with a history of depression may have a worse response to some medications. An antidepressant might be prescribed in order to help manage depression symptoms.
Talk therapy will not work in this case, says Bremner, because the problem is chemically based. You will need prescription medication to address the depression if you cannot stop taking the drugs that are causing it.

If you think your depression symptoms are linked to a prescription drug you’re taking, talk with your doctor right away, get screened for depression, and find a better way to manage both your health issues and your mood.

10 Winter Foods for Depression

1 / 11   Boost Your Mood With Seasonal Bounty
It’s winter, and depending on where you live, it could be very cold and gray, with sunshine in short supply. The winter doldrums plus holiday high anxiety make this season especially stressful and depressing for many people. But you might be able to eat your way to a better mood. Load your plate with these winter foods for depression to lift your spirits.

7 Dietitian-Approved Pumpkin Spice Foods You'll Love

1 / 8   Healthy Treats to Celebrate the Season

Fall means beautiful foliage, back-to-school time, and, you guessed it, pumpkin spice everything. From lattes to hummus (yes, you read that right), there’s no shortage of pumpkin spice-flavored products on the market. The problem is that many of these foods are laden with fat and sugar. A grande pumpkin spice latte with whipped cream at Starbucks, for example, contains a whopping 50 grams (g) of sugar and 380 calories — enough for a whole meal! Then there’s the pumpkin muffin from Dunkin’ Donuts, which weighs in at 550 calories and 24 g of fat.

The good news is you don’t have to steer clear of foods with pumpkin: They contain even more potassium than bananas, which means they can help lower blood pressure and decrease the risk of stroke and heart disease. Plus, a study published in February 2014 in the International Journal of Clinical Oncology found that consuming foods rich in beta-carotene — like pumpkins — is associated with a decreased risk of colon cancer, and a study published in 2004 showed that it may also reduce risk of prostate cancer.

To help you get into the spirit of the season — without widening your waistline — try these dietitian-approved pumpkin spice treats!

9 Best and Worst Milks for Your Heart

1 / 10   Not All Milks Are Alike

The milk aisle is changing, and has a growing number of options for what to pour on your cereal or drink down as a late-night snack. But what do the newer types of milk mean for your heart health if you have high cholesterol? Old-fashioned cow’s milk, for example, is loaded with calcium and vitamins A and D, which are all good for your heart and overall health. But the saturated fat in whole milk — and even in 2 percent milk — may counteract those health benefits. When you're trying to get to healthy cholesterol levels, you'll want to limit the amount of saturated fat in your diet.

Alternative milks can provide similar nutritional benefits if you're lactose intolerant, allergic to certain proteins in cow’s milk, vegan, or simply prefer something other than cow's milk. “People choose a milk based on tolerability and taste — in addition to health beliefs,” says Deborah Krivitsky, RD, director of nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital in Boston. “Each milk will provide different pluses and minuses.”

Many Under 40 May Not Need Regular Cholesterol Checks: Study

Many adults under 40 may not need to have routine cholesterol screenings, a new study suggests.

To come to this conclusion, the researchers looked at the real world implications of two conflicting sets of guidelines on cholesterol testing.

One, from the American College of Cardiology/American Heart Association (ACC/AHA), says that all adults older than 20 should have a cholesterol screening. They also suggest a repeat test every four to six years.

The other guidelines come from the U.S. Preventive Services Task Force, a government-funded, independent panel of medical experts. They say many adults can go longer before their first cholesterol test -- until age 35 for men, and age 45 for women.

The exception would be people with a major risk factor for heart problems -- such as high blood pressure, smoking or a family history of early heart disease.

Those patients can start cholesterol testing at age 20, the task force adds.

The new findings support the "more targeted" approach the task force uses, according to lead researcher Dr. Krishna Patel, of Saint Luke's Health System in Kansas City, Mo.

Why? The study, Patel explained, tried to estimate the impact of the two different guidelines in the "real world."

To do that, the researchers used data on 9,600 U.S. adults aged 30 to 49 who were part of a government health study.

The study team found that among nonsmokers with normal blood pressure, very few were at heightened risk of suffering a heart attack in the next 10 years. That means very few would be considered candidates for a cholesterol-lowering statin -- even with elevated LDL (so-called "bad" cholesterol) levels.

"So, screening cholesterol early doesn't bring much actionable information," Patel said. "If we're not going to treat, there's no point in doing it."

The study was published May 15 in the Annals of Internal Medicine.

Others disagreed with Patel's point.

The point of screening younger adults is not so doctors can put them all on statins, said Dr. Neil Stone, one of the authors of the ACC/AHA guidelines.

Instead, there are two central reasons, Stone explained.

One is to spot younger adults who may be heading down a path toward heart disease later in life.

Once they know their LDL is high, they and their doctors can have an "all-important discussion" about diet and lifestyle changes, said Stone, who is also professor of medicine at Northwestern University's Feinberg School of Medicine in Chicago.

READ MORE: 9 Things Dietitians Wish You Knew About High Cholesterol

The other reason is to catch cases of familial hypercholesterolemia, a genetic condition that causes very high LDL levels (above 190 mg/dL), he said.

People with the condition have a much higher-than-average risk of heart disease, and often develop it at a young age.

Because of that, the condition should be treated with statins, according to the ACC/AHA.

There is "strong and compelling evidence," Stone said, that catching the condition in younger adults makes a difference.

Dr. Paul Ridker, who wrote an editorial accompanying the study, had a similar view.

"Familial hypercholesterolemia is a common disorder, and it's easy to detect," said Ridker, of Brigham and Women's Hospital in Boston. "Why delay something as simple and inexpensive as a cholesterol test?"

Plus, he said, catching even "run-of-the-mill" high LDL is important.

"Knowing about it early in life can be a good motivator to make lifestyle changes," Ridker said.

What if a young adult has healthy LDL levels? Ridker said he'd be "fine" with that patient forgoing further tests until later in life.

For her part, Patel agreed that a one-time check, to catch familial hypercholesterolemia, is a wise move for young adults. But she questioned the value of repeat testing.

According to Stone, the ACC/AHA guidelines say it's "reasonable" to repeat cholesterol testing every four to six years. "It's not mandatory," he noted.

But people's lives, and heart disease risk factors, change as they move through adulthood, Stone said. So, a periodic cholesterol check can be useful when it's done as part of a "global risk assessment" where doctors look at blood pressure, smoking habits and other major risk factors for heart disease.

Motivating younger adults to get those risk factors under control is critical, according to Stone. "We know it's a big deal if you can have optimal risk factor [control] by age 45 or 50," he said.

In the study, very few people were at elevated risk of heart attack -- as long as they didn't smoke or have high blood pressure. ("Elevated" meant a greater than 5 percent chance of having a heart attack in the next 10 years.)

In the absence of those two risk factors, only 0.09 percent of men younger than 40 were at elevated risk of heart attack. And only 0.04 percent of women younger than 50 were.

But smoking, in particular, changed everything: Among male smokers in their 40s, one-half to three-quarters were at elevated risk of a heart attack.

"Smoking had a huge effect," Patel said. Smokers, she stressed, should "definitely" have their cholesterol tested -- and, more importantly, quit the habit.

Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

Teens and E-cigarettes

In Figure 2 Teen e-cig users are more likely to start smoking.
30.7 percent of e-cig users started smoking within 6 months while 8.1 percent of non users started smoking. Smoking includes combustible tobacco products (cigarettes, cigars, and hookahs).

6 Detoxifying Vegetable Soup Recipes for the New Year

Bone broth was the hipster darling of 2015 food trends, but if healthy eating is one of your resolutions, just sipping on broth isn’t going to cut it. It’s a new year, and 2016 is all about doubling down on fruits and veggies in the most delicious way possible. Sure, salads pack in a lot of produce, but broth-based soups may be the most satisfying — and warming! — route to healthy eating this winter. If you’ve been mainlining gingerbread and peppermint bark for the past two weeks, a detoxifying veggie soup is the perfect way to usher in a healthier new year, one satisfying slurp at a time. Here are five recipes that’ll give your resolutions staying power all month long:

The Calming Power of Nature

Spending time in nature eases depression, and could be a good supplement to medicine and therapy.

Remedies for depression abound, from medications to psychotherapy, or talk therapy. Having a range of treatment options is a good idea because no single treatment works equally well for each of the millions of U.S. adults with depression. Now researchers say a new therapy, proven to relieve depression, should be added to the mix as a supplement to established treatments. It's called nature.

Interacting with nature can have replenishing effects for those with depression, says Ethan Kross, PhD, associate professor of psychology at the University of Michigan and one of many experts who has studied the nature-depression link.

A little dose of nature helps us all recharge, but it may have special benefit for those who are depressed. "It seems that, from our work, the restorative effect of nature seems to be stronger for individuals diagnosed with depression," says Marc Berman, PhD, assistant professor of psychology at the University of Chicago. That might be because they feel mentally fatigued, and being in nature re-energizes them. However, Dr. Berman has a strong caveat: "We're not arguing that interacting with nature should replace clinically proven therapies for depression," he says. Nor should those with clinical depression try to treat themselves.

RELATED: How to Create a Depression Treatment Plan

However, Berman and others say, interactions with nature could serve as a very effective supplemental treatment.

What Nature-Depression Research Shows

Among the studies finding nature helps with depression:

Adults with depression who took a 50-minute walk in a natural setting for one research session and then a 50-minute walk in an urban setting for another research session were less depressed and had better memory skills after they took the nature walk.
Adults who moved to greener urban areas, compared to less green, had better mental health during follow-up three years after the move.
Those who took group nature walks reported less depression, less stress, and a better sense of well-being than those who didn't take nature walks, according to a study that looked at more than 1,500 people in a walking program.
Being outdoors and in nature boosts vitality, which experts define as having physical and mental energy. Those with depression often report fatigue and decreased energy. Researchers found the energy-boosting effect of nature was independent of the physical activity or social interaction experienced while outdoors.
How Nature Works Its Magic

The phenomenon of how nature helps improve depression is still being analyzed fully, Dr. Kross says.

One possibility, Berman says, is that interacting with nature helps due to the attention-restoration theory. "We have two kinds of attention," he says. "One is top-down (also called directed), the kind we use at work." Directed attention can be depleted fairly quickly, as you can only focus and concentrate for so long.

Another type of attention is bottom-up, or involuntary. "That's the kind automatically captured by things in the environment, such as lights or music." Involuntary attention is less susceptible to depletion. "You don't often hear people say, 'I can't look at this waterfall any longer,'" Berman says.

Why does nature hold this special effect? In a natural environment, we can choose to think or not, Berman says, and this choice is believed to help us rest our brains. You can then pay attention later, when you need to. "It is giving people more ability to concentrate, which is a big problem for those with depression," Berman says. Nature provides an effective setting for resting our brains, unlike urban settings. Even in the most peaceful urban environment, you have to pay attention to such things as traffic and stoplights.

Nature's replenishing effect is fairly instantaneous, Berman says. So if you're depressed and having an especially bad day, a quick dose of nature might help.

However, Berman cautions that anyone with clinical depression needs to be under a doctor's care, with supervision of all their treatments.

12 Ways to Ease Seasonal Depression

1 / 13   Seasonal Depression: Common But Treatable
If shorter days and shifts in weather zap your energy and make you feel blue, you’ve got classic symptoms of a seasonal mood disorder. Seasonal affective disorder (SAD) is a form of seasonal depression triggered by the change in seasons that occurs primarily in winter. Why do some people get SAD? Experts aren’t certain, but some think that seasonal changes disrupt the circadian rhythm: the 24-hour clock that regulates how we function during sleeping and waking hours, causing us to feel energized and alert sometimes and drowsy at other times.

Another theory is that the changing seasons disrupt hormones such as serotonin and melatonin, which regulate sleep, mood, and feelings of well-being. About 4 to 6 percent of U.S. residents suffer from SAD, according to the American Academy of Family Physicians, and as many as 20 percent may have a mild form of it that starts when days get shorter and colder. Women and young people are more likely to experience SAD, as are those who live farther away from the equator. People with a family history or diagnosis of depression or bipolar disorder may be particularly susceptible.

"It is important to treat SAD, because all forms of depression limit people's ability to live their lives to the fullest, to enjoy their families, and to function well at work," says Deborah Pierce, MD, MPH, clinical associate professor of family medicine at the University of Rochester School of Medicine and Dentistry in Rochester, New York. Here are a few SAD treatment options you might want to consider.

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Talk Therapy May Help Depressed Teens Who Shun Antidepressants

Cognitive behavioral therapy can help boost mood without drugs.

Depressed teens who refuse antidepressants may benefit from counseling, a new study suggests.

The study included more than 200 teens who were unwilling to take medication to treat their depression. The researchers found that those who tried a type of short-term "talk therapy" -- known as cognitive behavioral therapy (CBT) -- were more likely to recover than those who didn't.

"High numbers of adolescents experience depression, as many as 10 to 15 percent each year -- and up to one in five by age 18," said lead researcher Greg Clarke. He is a depression investigator at the Kaiser Permanente Center for Health Research in Portland, Ore.

"Unfortunately, most of these depressed teens are not treated. As few as 30 percent get specific depression care," he said.

In many cases, depressed teens refuse to take antidepressants, "often because of side effect concerns," Clarke said. These include warnings going back to 2004 about suicidal thoughts and behavior related to antidepressant use, the researchers said. Other common side effects from antidepressants include weight gain and fatigue.

"Offering brief cognitive behavioral therapy is an effective alternative," Clarke said. The small to moderate benefits found in this trial may be tied to reduced need for psychiatric hospitalization, the researchers noted.

The report was published online April 20 in the journal Pediatrics.

Simon Rego is director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City. He said that depressed teens can benefit from talk therapy offered by pediatric and family practices.

Teen depression is usually identified in primary care and is increasingly treated there, he said. But as many as 50 percent of teens with depression turn down medications, and of those who start antidepressants, as many as 50 percent fail to keep taking them, Rego said.

"Integrating cognitive behavioral therapy into primary care would present adolescents with depression with a non-medication treatment that would be easily accessible, brief and cost-effective," Rego explained.

According to the Anxiety and Depression Association of America, cognitive behavioral therapy can cost $100 or more per hour. "Some therapists or clinics offer therapy on a sliding scale, which means that charges fluctuate based on income," the association says. Not all insurance plans cover cognitive behavioral therapy.

RELATED: 7 Antidepressant Side Effects

For the study, Clarke and his colleagues conducted a five- to nine-week program in which counselors used cognitive behavioral therapy techniques to help teens identify unhelpful or depressive thinking and replace those ideas with more realistic, positive thoughts.

The program also helped patients create a plan to increase pleasant activities, especially social activities, Clarke said.

Between 2006 and 2012, the researchers randomly assigned 212 teens with major depression to receive either the weekly cognitive behavioral therapy or other care for depression, which could have included school counseling or outside therapy. All the teens, who were aged 12 to 18, had either refused antidepressants or stopped taking them, the study authors said.

On average, teens who tried cognitive behavioral therapy recovered seven weeks faster (22.6 weeks versus 30 weeks) than teens who didn't, the investigators found. In addition, the teens who used cognitive behavioral therapy were less likely to require psychiatric hospitalization, the findings showed.

Recovery was defined as having no or minimal symptoms of depression for eight weeks or more. Symptoms included feelings of hopelessness, loss of interest in friends and activities, changes in sleep and appetite, trouble concentrating and feelings of worthlessness or excessive guilt.

After six months, 70 percent of teens in the cognitive behavioral therapy program had recovered, compared with 43 percent of teens not in the program, the researchers reported.

Some benefits were still associated with cognitive behavioral therapy after one year, although the gap between the two groups of teens had tightened, Clarke said.

7 Healthy Habits of the 2016 Presidential Candidates

The New Hampshire primary's in full swing, and if there’s one thing all the presidential hopefuls can agree on, it’s that running for office is the ultimate endurance challenge. They’re canvassing across the country with little time to exercise or sleep, and it doesn’t help that at every stop they’re tempted by unhealthy foods like pizza, pork chops, and pies. So how do the presidential candidates stay healthy and keep their energy levels up during the grueling primary season? Read on to find out!

Can the Anesthetic Ketamine Ease Suicidal Thoughts?

A small study found that the drug worked quickly in people with major depression.

Low doses of the anesthetic ketamine may quickly reduce suicidal thoughts in people with long-standing depression, a small study suggests.

By the end of three weeks of therapy, most of the 14 study volunteers had a decrease in suicidal thoughts and seven ended up not having any such thoughts, the researchers found.

To get into the study, patients had to have had suicidal thoughts for at least three months, plus persistent depression. "So, the fact that they experienced any reduction in suicidal thinking, let alone remission, is very exciting," said lead researcher Dr. Dawn Ionescu, an instructor in psychiatry at Harvard Medical School in Boston.

Despite these results, many mysteries still remain about the drug, Ionescu said. For example, "we don't know yet how the drug works," she said. "In addition, we do not know if the doses of ketamine being used for depression and suicide will lead to addiction -- more research is needed in this area."

The study used only intravenous ketamine, but oral and intranasal doses may also work, she added.

Whether ketamine might ever become a standard therapy for depression and suicidal thoughts is also up in the air. "That is something we need to investigate," Ionescu said.

All of the study volunteers were being treated for major depressive disorder on an outpatient basis. They had all been experiencing suicidal thoughts for three months or more, and were resistant to other treatments, the researchers said. Eleven of the 14 volunteers were female, and their mean age was 50 years.

Ketamine, which is primarily an anesthetic, had been shown in other studies to quickly relieve symptoms of depression, Ionescu said.

For the study, two weekly intravenous infusions of ketamine were given over three weeks. The first three doses of ketamine were five times lower than typically given when the drug is used as an anesthetic. After initial treatment, the dose was increased.

RELATED: How to Create a Depression Treatment Plan

Patients were checked before, during and after treatment, and every other week during three months of follow-up. Assessments included measurement of suicidal thinking, in which patients were asked how frequent and how intense their suicidal thoughts were, the study authors said.

Of the seven patients who stopped having suicidal thoughts, two continued to be free of both thoughts of suicide and symptoms of depression during the three-month follow-up, the findings showed.

No serious side effects from the drug were seen, the researchers said.

"The most common side effects are an increase in heart rate and blood pressure, and changes in the way people perceive their environment. For example, some people will dissociate and feel like their environment looks different or that parts of their body look different. Generally, the side effects are mild and only last for one to two hours," Ionescu said.

Two patients dropped out of the study. One dropped out because of the drug's side effects, and the other had a scheduling conflict, the researchers said.

All of the patients knew they were getting ketamine. The researchers are now finishing up a study in which some patients received the drug and others got a placebo.

Drugs currently used to treat suicidal thinking include lithium and clozapine, but these drugs can have serious side effects requiring careful monitoring of blood levels. Electroconvulsive therapy can also reduce suicidal thoughts, but its availability is limited and it can have serious side effects, such as memory loss, the researchers explained.

Cognitive behavioral therapy, a type of "talk" therapy, can also be an effective treatment for suicidal thinking, but may take weeks to months to be effective, the study authors pointed out.

Dr. Ami Baxi is director of adult inpatient services in the department of psychiatry at Lenox Hill Hospital in New York City. She said, "Ketamine, often used as an anesthetic in medicine, has been recently shown to cause a rapid antidepressant effect and reduce suicidal thoughts in patients with treatment-resistant depression."

However, this study has many limitations, she added. First, it was a very small study and "only two of the 14 patients were able to maintain this reduction three months after the infusion," Baxi said.

Second, patients knew they were receiving ketamine, "leaving them exposed to a possible placebo effect," she explained.

Baxi agreed this is a promising study, but it's too early to know the effects of ketamine on suicidal thinking. "Additional studies remain essential to enhance our knowledge on the psychiatric benefits of ketamine," she said.

The report was published in the May 10 online edition of the Journal of Clinical Psychiatry.

Expert Panel Recommends Questionnaire to Help Spot Depression

Part of your next visit to your family doctor's office should be spent filling out a questionnaire to assess whether you're suffering from depression, an influential panel of preventive medicine experts recommends.

What's more, people concerned that they might be depressed could download an appropriate questionnaire online, fill it out ahead of time and hand it over to their doctor for evaluation, the panel added.

In an updated recommendation released Monday, the U.S. Preventive Services Task Force urged that family doctors regularly screen patients for depression, using standardized questionnaires that detect warning signs of the mental disorder.

If a patient shows signs of depression, they would be referred to a specialist for a full-fledged diagnosis and treatment using medication, therapy or a combination of the two, according to the recommendation.

These questionnaires can be self-administered in a matter of minutes, with doctors reviewing the results after patients fill out the forms, said Dr. Kirsten Bibbins-Domingo, vice chair of the task force.

"This could be a checklist that patients fill out in the waiting room, or at home prior to the visit," she said. "The good thing is we have many instruments, measures that have been studied for screening for depression."

About 7 percent of adults in the United States currently suffer from depression, but only half have been diagnosed with the condition, said Bibbins-Domingo, who is a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco.

"We know that depression itself is a source of poor health," she said. "It leads people to miss work, to not function as fully as they might, and we know it is linked and associated with other types of chronic diseases."

It makes sense that family doctors perform front-line screening for depression, since they are more likely than a mental health professional to come across a person with undetected symptoms, said Michael Yapko, a clinical psychologist and internationally recognized depression expert based in Fallbrook, Calif.

"Only about 25 percent of depression sufferers seek out professional help, but more than 90 percent will see a physician and present symptoms and signs that could be diagnosed," said Yapko, who is not on the task force.

The panel has recommended regular depression screening for adults since 2002, but their guidelines currently urge doctors to ask two specific questions that provide a quick evaluation of a person's mood. The questions are, "Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"

The updated recommendation expands doctors' options for depression screening, adding commonly used questionnaires like the Patient Health Questionnaire, or PHQ-9.

The PHQ-9 is a list of 10 questions that focus on problems that a person might have experienced during the past two weeks, including poor appetite, low energy, sleep problems and a lack of interest in doing things.

"These are not instruments that diagnose depression," Bibbins-Domingo noted. "They give clinicians the first indication of something that should be followed up on."

RELATED: 10 Drug-Free Therapies for Depression

Yapko said that someone who wanted to could lie on the questionnaires and avoid having their symptoms detected, but he added that in his experience it's not a very likely scenario.

"When you have people who are suffering who genuinely want help, they're happy to give you as accurate a portrayal as they can give you," he said. "Generally speaking, the people seeking help want help and they want to do their best in filling these things out. That's what makes the test worthwhile."

The task force is an independent, volunteer panel of national experts that has been issuing recommendations on preventive medicine since 1984.

Yapko and Bibbins-Domingo said depression screening shouldn't eat into a doctor's time, since patients can fill out and score the questionnaires on their own.

Instead of wasting time reading magazines in the waiting room, patients "could be filling out an inventory that is self-administered, self-scored and wouldn't take any physician time at all," Yapko said.

Patients also could download and fill out a depression questionnaire at home and hand it in when they go to the doctor, but Yapko said patients should make sure they're using the form their doctor prefers.

"Which of the many inventories and questionnaires a doctor might wish to use is a matter of personal and professional judgment," he said. "So, a doctor would need to specify which form to obtain online and the patient would then need to remember to bring it in, not always easy when depression negatively affects your memory. Easier to have the form in the office and have them fill it out in the waiting room."

Yapko added that it's important that doctors who screen for depression follow up by referring patients to a mental health professional, rather than trying to diagnose and treat depression themselves.

"When physicians get a diagnosis of depression, their most immediate thing to do is prescribe an antidepressant," Yapko said, noting that more than 70 percent of antidepressants are prescribed by non-psychiatrists. "Only a minority of people walk out of a doctor's office with a referral to a mental health professional, a fact which drives me a little crazy."

Recognizing an Addiction Relapse

Treatment and recovery from an addiction to drugs or alcohol are steps in a lifelong journey. Unfortunately, 40 to 60 percent of drug addicts and almost half of all alcoholics will eventually go through a substance abuse relapse.

If someone dear to you has been in addiction treatment, it is important for you to be able to recognize if that person is relapsing as early as possible. This way, the problem can be addressed before it spirals out of control. Just because your loved one relapses does not mean that their addiction treatment has failed, however; it just means that the current treatment regimen probably needs to be reevaluated.

Addiction Relapse: Obvious Signs

"Most of the time the signs are so obvious," says Thomas Kosten, MD, Jay H. Waggoner chair and founder of the division of substance abuse at Baylor College of Medicine in Houston.

According to Dr. Kosten, the following are common indicators of a drug or alcohol addiction relapse:

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  • Alcohol is missing from the house.
  • Bottles of alcohol are found around the home.
  • Your loved one comes home obviously intoxicated.
  • Money is missing from bank accounts or stolen from friends or family member.
  • Medicine is missing from the house.

 

 

Addiction Relapse: Early Indicators

 

 

There are also signals from the addict that a relapse is just around the corner, when steps can be taken to prevent the relapse or at least address it in its earliest stages. Your loved one may exhibit the following emotions and behaviors:

  • Anxiety
  • Anger
  • Impatience
  • Extreme sensitivity
  • Moodiness
  • Not wanting to be around people
  • Refusing help
  • Not complying with treatment recommendations
  • Problems with sleeping
  • Appetite changes
  • Reminiscing about the past
  • Lying
  • Seeing friends that they've used drugs or alcohol with in the past
  • Talking about relapse

Addiction Relapse: Stepping in

When you suspect that your loved one has relapsed, Kosten says the best thing to do is tackle the issue head-on. He suggests that you start the conversation in the following way:

  • First, say to your loved one, “I think you’re using.”
  • If the person admits he is using again, then say, “We need to do something about this."
  • Kosten suggests that at this point you start setting limits by saying something such as, "Unless you get help, you will have to leave the house."

If your loved one is showing signs of an impending relapse but hasn’t yet relapsed, Kosten says that it is important to confront him first. Otherwise it is very unlikely that you are going to be able to convince him to get back into addiction treatment. Then you should encourage him to continue with treatment, talk to an addiction counselor or sponsor, and practice good self-care — that is, get enough sleep, eat well, and take steps to relieve stress.

If the addict refuses to talk with a professional or you feel that you need anaddiction expert to help you learn how to confront him, contact your local Council for Alcoholism and Drug Abuse. Or if you have access to the person’s doctor, addiction counselor, or sponsor, speak to that person about how you might deal with the situation.

Moving Just 1 Hour a Week May Curb Depression Risk

Career couch potatoes, take heart: Just one hour a week of any kind of exercise may lower your long-term risk for depression, new research suggests.

The finding comes from a fresh analysis of a Norwegian survey that tracked exercise habits, along with depression and anxiety risk, among nearly 34,000 adults.

After a closer look at the data, a team of British, Australian and Norwegian analysts determined that people who engage in just an hour of exercise per week -- regardless of intensity level -- face a 44 percent lower risk for developing depression over the course of a decade than those who never exercise at all.

"The key finding from this study is that doing even a small amount of regular exercise seems to protect adults against future depression," said study author Samuel Harvey.

"This was not a case of more is better; the vast majority of the mental health benefits of exercise was realized when individuals moved from doing no regular activity to 1 or 2 hours per week," Harvey explained.

"Also, the mental health benefits were there regardless of the intensity of the physical activity," he added. "There is great evidence that there are many physical health benefits to more regular exercise, but the mental health benefits leveled out after 2 hours."

RELATED: 7 Common Myths About Depression

Harvey is an associate professor with the School of Psychiatry at the University of New South Wales, in Sydney, Australia. "The important point here is that any type of physical activity -- even just walking -- had similar levels of mental health benefits," he concluded.

The original survey was launched between 1984 and 1986. In that timeframe, participants (who were about 45 years old, on average) underwent physical exams, and filled out lifestyle and medical questionnaires. Mental health assessments were also completed.

The Norwegian pollsters conducted a follow-up survey between 1995 and 1997 among roughly two-thirds of the original participants.

About 7 percent of those tracked through 1997 had developed depression, while about 9 percent had developed clinical levels of anxiety, the findings showed.

Exercise did not appear to have any impact on anxiety risk. But investigators found that, regardless of gender or activity intensity, regular exercise lasting at least an hour per week was linked to a lower risk for developing depression over time.

The study authors calculated that roughly 12 percent of the depression cases might have been prevented if those who had become depressed had previously routinely engaged in one hour of low-intensity activity a week.

Exercising more than one hour per week did not, however, appear to substantially decrease depression risk even further; the lion's share of the protective impact appeared to max out at the one-hour mark.

But as to how and why such a minimal amount of regular exercise might help stave off depression, the study team wrote that "the bulk of the observed protective effect remains unexplained." And the study did not prove a cause-and-effect relationship between exercise and lower risk of depression.

Harvey and his colleagues reported their observations in the Oct. 3 issue of the American Journal of Psychiatry.

Simon Rego, chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said that "there are probably many mechanisms at play that could explain how this works. But it doesn't have the same effect on anxiety, so we just don't know yet exactly what's happening."

However, Rego added, "What we do know is that what they've identified is a very low bar of entry. We're talking about just an hour of activity a week. And it doesn't have to be vigorous or intense. You don't need to go out to a spin class or sign up for a running club. This could just be getting people who aren't moving much to just increase their daily walking habit. That's all."

So, he explained, "while we don't have all the definitive answers yet, this is a very promising finding because this is something many people may find easy to do."

Diabetis

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News From AAN: Correction on Tysabri/PML Blog (last of paper)

Last week we posted a blog about the risks of PML for patients taking Tysabri, based on news from the American Academy of Neurology (AAN) meetings which took place earlier this month. In the comments section, Chris asked that we check our facts and report back.

Well, once again, your commitment to the Life With MS Blog community has paid off.

I jotted off a quick e-mail to the Public Affairs department for Biogen/Idec and waited… and waited… and got nothing. Because, however, of the active participation of our community the conversation was noted and I got an e-mail asking if we needed any assistance directly from the senior manager for international public affairs.

I am not happy that I was wrong, but I am happy to know that we can get the correct information out to you today.

I had reported that Alfred Sandrock, MD, PhD, of Biogen/Idec, presented findings from the company’s study on progressive multifocal leukoencephalopathy (PML) in patients using Biogen/Idec’s MS drug, Tysabri. I was mistaken in my assessment of “immunosuppressive” (IS) therapy in the list of risk factors for PML.

Risk factors for PML include:

More than two years on Tysabri
Prior immunosuppressant therapy
Positive serology for JC virus infection
According to Biogen, immunosuppessants, in the context used by Dr Sandrock are limited as:

“A prior IS would be considered mitoxantrone, azathioprine, methotrexate, cyclophosphamide, mycophenolate, cladribine, rituximab, and chemotherapy (not otherwise specified).”

Not included, as you can see, are any of the other MS disease modifying therapies (DMT) or even corticosteroids like Solu-Medral or Prednisone — which is normally considered an IS drug, but not for the case of the PML warning.

The original press release that I received on the topic was incomplete and I apologize for the misunderstanding.

As a side note, I took advantage of the conversation to request more information on the companies rational in keeping the patent on the JC Virus assay test that I also mentioned in that same blog post. I’ll update you on that conversation as soon as it happens.

Once again, your voice was heard by the people who have the answers and I think we’ve cleared up the misunderstanding. Thank you all for your continued involvement in our community. It makes a big difference in the lives of so many!

Wishing you and your family the best of health

 

Herbal remedy isn't regulated, and can have side effects and serious drug interactions.

Herbal remedy isn't regulated, and can have side effects and serious drug interactions.

St. John's wort is a popular herbal therapy for depression, but a new Australian study highlights the fact that "natural" does not always equal "safe."

Using reports filed with Australia's drug safety agency, the researchers found that adverse reactions to St. John's wort were similar to those reported for the antidepressant fluoxetine -- better known by the brand name Prozac.

Those side effects included anxiety, panic attacks, dizziness, nausea and spikes in blood pressure, the researchers reported in the July issue of Clinical and Experimental Pharmacology and Physiology.

"It's concerning to see such severe adverse reactions in our population, when people believe they are doing something proactive for their health with little risk," lead researcher Claire Hoban, of the University of Adelaide, said in a university news release.

Research has shown that St. John's wort can help ease mild to moderate depression. But the fact that it works also means there is a risk of side effects, said Dr. Samar McCutcheon, a psychiatrist at Ohio State University Wexner Medical Center in Columbus.

"Even if the bottle says 'natural' or 'herbal,' it still has ingredients that are active in your body," said McCutcheon, who was not involved in the study.

It has long been recognized that St. John's wort can have significant side effects and interact with certain medications, McCutcheon pointed out.

But many consumers may not know that, she noted, largely because dietary supplements are not regulated in the way that drugs are.

"I definitely think this [lack of awareness] is still an issue," McCutcheon said. "People think St. John's wort is safe because they can buy it at a health food store."

In the United States, dietary supplements do not have to be studied for safety and effectiveness before they reach the market.

"Plus," McCutcheon said, "you're relying on companies to make sure these products include the ingredients they're supposed to, and keep out ingredients that they shouldn't."

The situation is similar in Australia, and many consumers there are unaware that supplements are largely unregulated, according to Hoban's team.

RELATED: 7 Supplement Risks Every Woman Should Know About

The researchers based their findings on doctors' reports to Australia's national agency on drug safety. Between 2000 and 2013, there were 84 reports of adverse reactions to St. John's wort, and 447 reports on Prozac.

But since those are voluntary reports, they do not reflect the actual rate of side effects from either therapy, according to the researchers. And, Hoban said, bad reactions to St. John's wort are particularly likely to go unreported, since the herb is often not even considered a drug.

According to McCutcheon, it's important for people with depression symptoms to see a health professional before self-medicating with St. John's wort. "That will help ensure you have the right diagnosis," she said.

If your symptoms are actually part of a different disorder, St. John's wort may be ineffective -- or possibly even risky. For example, McCutcheon said that in people with bipolar disorder, the herb might fuel a manic episode.

But possibly the biggest concern, she said, is the potential for St. John's wort to interact with commonly used medications.

The herb can dampen the effectiveness of birth control pills, blood thinners and heart disease drugs, along with some HIV and cancer drugs, according to the U.S. National Center for Complementary and Integrative Health.

What's more, it can interact with antidepressants. It's not clear exactly how St. John's wort works, McCutcheon said, but it's thought to boost levels of the brain chemical serotonin -- which is how the most commonly used antidepressants work.

"If you use the two together, you run the risk of having too much serotonin," she said. And that raises the risk of a potentially fatal condition called serotonin syndrome, whose symptoms include confusion, tremors, diarrhea and a drop in body temperature.

Some side effects of St. John's wort are caused by the herb itself, such as skin rash that's worsened by sunlight, said Dr. John Reed, director of inpatient services at the University of Maryland's Center for Integrative Medicine in Baltimore.

But the main concern is still its potential for interacting with other medications, he said. "Compared with other herbs, St. John's has more drug interactions," Reed explained. "So if you're using it, don't take other medications unless it's under medical supervision."

He added that anyone on any medication should do some homework before starting an herbal product. "Go online and do a search for drug interactions. Ask your pharmacist or doctor," Reed advised.

"Unfortunately," he said, "this type of information [on drug interactions] doesn't have to be printed on product labels."

The bottom line, according to McCutcheon, is that people with depression should talk to their providers about any supplements they take, or want to take. And those providers, she said, should be willing to have nonjudgmental discussions.

"I want all my patients to be comfortable enough to bring up anything with me," McCutcheon said.

A Diet for Better Energy

Complex carbs are key for sustained energy throughout the day, while too many sugary snacks can lead to energy crashes. Find out which foods you need for round-the-clock energy.

 

Juggling the responsibilities of work, life, and family can cause too little sleep, too much stress, and too little time.

Yet even when you're at your busiest, you should never cut corners when it comes to maintaining a healthy diet. Your body needs food to function at its best and to fight the daily stress and fatigue of life.

Energy and Diet: How The Body Turns Food Into Fuel

Our energy comes from the foods we eat and the liquids we drink. The three main nutrients used for energy are carbohydrates, protein, and fats, with carbohydrates being the most important source.

Your body can also use protein and fats for energy when carbs have been depleted. When you eat, your body breaks down nutrients into smaller components and absorbs them to use as fuel. This process is known as metabolism.

Carbohydrates come in two types, simple and complex, and both are converted to sugar (glucose). “The body breaks the sugar down in the blood and the blood cells use the glucose to provide energy,” says Melissa Rifkin, RD, a registered dietitian at the Montefiore Medical Center in the Bronx, N.Y.

Energy and Diet: Best Foods for Sustained Energy

Complex carbohydrates such as high-fiber cereals, whole-grain breads and pastas, dried beans, and starchy vegetables are the best type of foods for prolonged energy because they are digested at a slow, consistent rate. “Complex carbohydrates contain fiber, which takes a longer time to digest in the body as it is absorbed slowly," says Rifkin. Complex carbs also stabilize your body’s sugar level, which in turn causes the pancreas to produce less insulin. This gives you a feeling of satiety and you are less hungry.”

Also important in a healthy, energy-producing diet is protein (preferably chicken, turkey, pork tenderloin, and fish), legumes (lentils and beans), and a moderate amount of healthy monounsaturated and polyunsaturated fats (avocados, seeds, nuts, and certain oils).

“Adequate fluids are also essential for sustaining energy,” says Suzanne Lugerner, RN, director of clinical nutrition at the Washington Hospital Center in Washington, D.C. “Water is necessary for digestion, absorption, and the transport of nutrients for energy. Dehydration can cause a lack of energy. The average person needs to drink six to eight 8-ounce glasses of water each day.”

Energy and Diet: Foods to Avoid

 

Simple carbohydrates, on the other hand, should be limited. Ranging from candy and cookies to sugary beverages and juices, simple carbs are broken down and absorbed quickly by the body. They provide an initial burst of energy for 30 to 60 minutes, but are digested so quickly they can result in a slump afterward.

You should also avoid alcohol and caffeine. Alcohol is a depressant and can reduce your energy levels, while caffeine usually provides an initial two-hour energy burst, followed by a crash.

Energy and Diet: Scheduling Meals for Sustained Energy

 

“I always recommend three meals and three snacks a day and to never go over three to four hours without eating something,” says Tara Harwood, RD, a registered dietitian at the Cleveland Clinic in Ohio. “If you become too hungry, this can cause you to overeat.”

Also, try to include something from each food group at every meal, remembering that foods high in fiber, protein, and fat take a longer time to digest.

Even if life is hectic, it’s important to make wise food choices that provide energy throughout the day. Your body will thank you.

 

Plastics Chemical Tied to Changes in Boys' Reproductive Development

When expectant mothers are exposed to plastics chemicals called phthalatesduring the first trimester, their male offspring may have a greater risk of infertility later in life, a new study suggests.

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Boys exposed to the chemical diethylhexyl phthalate (DEHP) may be born with a significantly shorter anogenital distance than those not exposed to these chemicals. Anogenital distance is the distance between the anus and the genitals. A shorter anogenital distance has been linked to infertility and low sperm count, the researchers explained.

"We saw these changes even though moms' exposure to DEHP has dropped 50 percent in the past 10 years," said lead researcher Shanna Swan, a professor of preventive medicine and obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City.

"Therefore, we have not found a safe level of phthalate exposure for pregnant women," she contended.

Swan said that this study cannot prove that these boys will have fertility problems as adults or that DEHP causes these problems. However, animal studies have implicated the chemical in male reproductive problems. Based on the data from this study, Swan believes there is a strong association between exposure to DEHP and fertility in human males.

DEHP is used to soften plastics. Most exposure results from eating foods that pick up the chemical during processing, Swan said.

RELATED: 10 Toxic Household Items You Should Throw Away Now

 

 

"Since food is the largest source of DEHP for consumers, it is difficult for pregnant women to minimize exposure," she said. "Eating unprocessed food will likely help. However, eliminating DEHP from food really has to be done by food producers."

The chemical is also found in medical tubing and in a variety of products, including flooring, wallpaper, lacquers and personal care products, Swan said.

The report was published Feb. 19 in the journal Human Reproduction.

For the study, Swan's team collected data on almost 800 pregnant women and their infants.

Specifically, the researchers found that exposure in the womb to three types of DEHP was associated with a significantly shorter anogenital distance in boys, but not in girls.

A group representing the chemical industry took issue with the study, however.

In a statement, the American Chemistry Council (ACC) stressed that the study only examined one type of phthalate, not all versions of the chemical. And it said that phthalates are "one of the most widely studied family of chemicals in use today."

The ACC added that DEHP "is known to break down into its metabolites within minutes after it enters the body. Information collected by the Centers for Disease Control and Prevention over the last 10 years indicates that, despite the fact that phthalates are used in many products, exposure from all sources combined is extremely low -- much lower than the levels established as safe by scientists at regulatory agencies."

 

 

But another expert says phthalate exposure may not be benign. Dr. Kenneth Spaeth, director of the Occupational and Environmental Medicine Center at North Shore University Hospital in Manhasset, N.Y., said, "virtually everyone in the U.S. experiences continual exposure to phthalates."

And, a number of studies have tied the chemicals with changes in developing fetuses. "Phthalates, in particular, have been shown in both human and animal studies to interfere with normal fetal development," he said.

This study supports what has been demonstrated before, that phthalate exposure in the first trimester is linked to male reproductive development, Spaeth said. "This study is an important step forward in establishing this effect because the study included a much larger number of individuals than prior studies and helps identify one particular agent, DEHP, as an important contributor to this effect," he said.

Additionally, this study shows the importance of exposure in the first trimester as a critical window for the effect of phthalates on the male reproductive system. "On the whole, given these features, the authors have contributed important information about the public health risk posed by phthalates," Spaeth suggested.

Depression Among Doctors: A Growing Problem

Long shifts of on-the-job training, and caring for patients in life-or-death situations, is enough to wear a person down. And it does.

Close to one-third of medical residents (doctors out of medical school and in training) experience depression, according to a new study published online in JAMA. The risk starts on the first day of residency training, when the probability that a doctor will become depressed more than quadruples compared to those not in residency.

“This is remarkable considering how patients often don’t report their depression because of the social stigma that’s attached to it,” says study author Douglas A. Mata, MD, MPH, a resident physician himself at Brigham and Women’s Hospital and a clinical fellow at Harvard Medical School in Boston.

“We also found that the number of depressed residents might be going up — that is, the prevalence of physician depression might be getting worse with time,” adds Dr. Mata. “It’s certainly not getting any better, so we’ve got a public health crisis on our hands that isn’t being talked about enough.”

Depression among doctors in training has been studied extensively over the years, so this study looked at what the research shows as a whole. Mata and his colleagues searched four databases of medical research for all relevant studies from 1963 through September 2015.

They found 31 studies that assessed depression at one point in time, and 23 long-term studies. Together, the studies involved more than 17,500 doctors and showed that 29 percent of them had depression or symptoms of depression. Most of the studies relied on self-reporting, but their methods also differed significantly.

In studies using a nine-question survey to assess depression symptoms, about one in five medical residents (21 percent) had depression. Studies that used another depression measure doubled that, to 43 percent of doctors experiencing depression at some point in their residency.

How Stressful Work Conditions Boost Depression Risk

“Doctor training has a deluge of risk factors for depression,” Mata says. “Many residents spend all their waking hours working like crazy, so their relationships with friends and family go on the back burner, making them feel isolated. Also, constant lack of sleep, combined with ‘time zone changes’ take a toll on the mind and body.”

What Mata means by time zone changes is the effect of being on overnight call every third or fourth night, which is much like taking transatlantic flights twice a week and dealing with the resultant jet lag. Worse, residents must often relocate to new cities each year, where they may lack essential support systems, he says.

“They may have tens of thousands of dollars of debt hanging over their heads as well, since the United States places the financial risks and burdens of training on the students themselves, not on the public health system they’re training to serve,” adds Mata. “To top it all off, they’re responsible for the care of ill patients, and they’re exposed to some mentally traumatic scenarios in the process.”

Is Patient Safety at Risk?

Depression among MDs appears strongly linked to the start of residency training, when the percent of doctors with depression jumped 16 points in the study, putting them at 4.5 times greater risk of depression once residency has begun.

“As clinicians, we’re used to treating others, but we’re often bad at taking care of ourselves,” Mata says. “Doctors need to pay more attention to their own mental well-being, and to that of their colleagues.”

Not doing so could have serious ramifications for patients, points out Victor Fornari, MD, chief of the division of child and adolescent psychiatry at Long Island Jewish Medical Center in Manhasset, New York.

RELATED: 5 Things Psychologists Wish Their Patients Would Do

“Depressive symptoms and depression may interfere with attention and focus,” says Dr. Fornari, who was not involved in the study. “Depression in resident physicians may also interfere with the development of the doctor-patient relationship. Patients may experience their depressed resident physicians as less engaged or less interested in their care.”

And attempting to counteract that impression could potentially make the situation worse, suggests Mata. “The doctors who care the most may overextend themselves to give their patients more empathy, which puts them at a higher risk for depression,” he says.

At the same time, sleep deprivation during residency contributes to depression and possible medical mistakes, he says.

“Sleep deprivation has been linked to a high risk of needle-stick injuries and exposure to bloodborne pathogens,” Mata says. “Depression has also been linked to more medical errors. Depressed doctors report more anxiety about making mistakes, whether or not they actually do.”

How Thanking Your Doctor May Help

While patients should not necessarily worry about their doctors’ health and safety, Mata says, they can help in small ways.

“Just tell your doctors ‘thank you’ and make sure they understand what they mean to you,” he says. “That goes a long way.”

But such kindnesses will not solve a problem that appears to be worsening. The study found that prevalence of depression among residents increased by half a percent each year, though the authors note the rise could relate to increased awareness of depression among docs.

Recognizing the problem is the first step. Residents also need support and mentoring, and modified work hours, which is already occurring in many institutions, Fornari says.

“Part of medical training is encouraging the resident physician to regulate their own self-care in an effort to learn how to manage their stress and ask for assistance with depression,” Fornari says.

Mata would like to see a proactive model rather than the current reactive one, which relies on residents to identify their own depression and seek help. Year-long resilience-based programs that teach coping skills from the first day of residency would be an important measure, he says.

“Widespread depression among doctors will inevitably cause good docs to work fewer hours and even leave the field,” Mata says, adding that the situation may even dissuade people from entering the medical field. “This has broad social implications for the health of our population as a whole.”

Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

10 Ways to Make Your Treadmill Workout Safer

With the news of SurveyMonkey CEO David Goldberg's accidental death on a treadmill, we are reminded that there are risks to exercise, particularly when using gym equipment. Because a treadmill is powered by a motor, rather than self-propelled, accidents can happen, especially when people lose their balance. Injuries can include bruises, sprains, broken bones, concussions, and sometimes, even death. 

While the Consumer Products Safety Commission reported over 24,000 emergency room visits associated with treadmills in the United States in 2014, deaths are rare. That said, it's important for people to know their physical limits and keep safety in mind when using a treadmill.

An Expert's Guide to Sneezin' Season

Allergy sufferers should prepare for a particularly 'nasty' spring, New York sinus specialist says.

This could be a bad spring allergy season and people with allergies need to be prepared, an expert warns.

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"With the crazy up and down weather, some parts of the country could see worse allergy-provoking conditions. There is likely to be a pollen superburst this season, so sufferers should get ready," Dr. Jordan Josephson, a sinus specialist at Lenox Hill Hospital in New York City, said in a hospital news release.

"It promises to be a nasty spring," he added.

It's crucial to deal with allergy symptoms immediately, according to Josephson.

"Allergies left untreated can cause sinus swelling leading to chronic sinusitis. Allergies can also affect your digestive tract. Gastroesophageal reflux disease (GERD) can be a direct response of the allergic response. So allergies can seriously affect your quality of life. Just ask any allergy or sinus sufferer," he said.

 

 

Dr. Punita Ponda is assistant chief in the division of allergy and immunology at Northwell Health in Great Neck, N.Y. She suggested that if you know you have spring allergies, start taking allergy medication at least one to two weeks before the start of allergy season. Then continue taking it throughout the season, she noted in the news release.

RELATED: 9 Seasonal Allergy Signs You May Be Overlooking

 

 

Josephson outlined a number of other ways to keep your allergy symptoms under control, including: staying indoors as much as possible between 10 a.m. and 4 p.m., when pollen counts are highest; using your air conditioner, which cleans and dries the air; keeping doors and windows closed; and using an air purifier.

After being outdoors, remove your clothes and wash them immediately. Keep pollen-exposed clothes separate from clean clothes. You should also take a shower after being outside in order to remove pollen from your skin and hair, he suggested.

In addition, irrigate your sinuses daily to flush out pollen. And take antihistamines, but try to avoid decongestants.

Giving the 'Green Light' to Migraine Relief

A new study sheds light -- literally -- on a potential means of easing migraine pain.

Researchers in Boston exposed 69 migraine patients to different colors of light. They found that while blue light exacerbated headache pain, a narrow spectrum of low-intensity green light significantly reduced light sensitivity.

In some cases, this green light also reduced migraine pain by about 20 percent, the researchers found.

They noted that migraine headache affects nearly 15 percent of people worldwide, and a frequent symptom of migraine is light sensitivity, also known as photophobia.

"Although photophobia is not usually as incapacitating as headache pain itself, the inability to endure light can be disabling," study author Rami Burstein, of Beth Israel Deaconess Medical Center in Boston, said in a medical center news release.

RELATED: Home Remedies for Headache Treatment

"More than 80 percent of migraine attacks are associated with and exacerbated by light sensitivity, leading many migraine sufferers to seek the comfort of darkness and isolate themselves from work, family and everyday activities," he added. Burstein directs the medical center's Comprehensive Headache Center.

Two experts said the treatment may have merit.

"Certainly Dr. Burstein's work suggests that more research should be done, as this is a potentially beneficial new avenue for treatment," said Dr. Noah Rosen, who directs Northwell Health's Headache Center in Great Neck, N.Y.

He pointed out that "light therapy has been used successfully in other conditions such as certain dermatologic issues and seasonal affective disorder [SAD]."

Dr. Gayatri Devi is a neurologist at Lenox Hill Hospital in New York City.

He said the success in some patients with light therapy "implicates the thalamus -- a brain 'relay station' between the sensory organs, including the eyes and the cortex of the brain -- as the area where migraine-related photophobia is amplified."

For his part, Burstein said he's now trying to develop an affordable light bulb that emits narrow-band green light at low intensity, as well as sunglasses that block all but the narrow band of green light.

Rosen stressed, however, that more study may still be needed.

"In general, it seems a safe treatment but one that is limited by cost, access and whether its use on a regular basis would decrease disability," he said.

The findings were published May 17 in the journal Brain.

Vitamin D