The area of the brain involved in forming new memories, known as the hippocampus, seems to shrink in people with recurring depression, a new study shows.

Australian researchers say the findings highlight the need to spot and treat depression when it first develops, particularly among young people.

Ian Hickie, who co-directs the Brain and Mind Research Institute at the University of Sydney, led the study. His team looked at the neurology of almost 9,000 people from the United States, Europe and Australia. To do so, they analyzed brain scans and medical data for about 1,700 people with major depression, and almost 7,200 people who didn't suffer from depression.

The researchers noted that 65 percent of the participants with major depression had suffered recurring symptoms.

The study, published June 30 in the journal Molecular Psychiatry, found that people with major depression, particularly recurring forms of the condition, had a smaller hippocampus. This part of the brain was also smaller among participants diagnosed with depression before they reached the age of 21.

Many young people diagnosed with depression go on to develop recurring symptoms, Hickie's team noted.

RELATED: Depression as a Risk Factor for Dementia

Recurrence seemed key: About a third of participants had had only one episode of major depression, and they did not show any reduction in the size of their hippocampus compared to non-depressed people.

According to the researchers, that suggests that it is recurring depression that takes a toll on brain anatomy.

The take-home message: Get depression diagnosed and treated before brain changes can occur, the Australian team said.

"This large study confirms the need to treat first episodes of depression effectively, particularly in teenagers and young adults, to prevent the brain changes that accompany recurrent depression," Hickie said in a university news release.

According to co-researcher Jim Lagopoulos, "these findings shed new light on brain structures and possible mechanisms responsible for depression."

"Despite intensive research aimed at identifying brain structures linked to depression in recent decades, our understanding of what causes depression is still rudimentary," Lagopoulos, who is an associate professor at the institute, said in the news release.

The study couldn't prove cause-and-effect, however, and the study authors say that more research could help explain if the brain changes are the result of chronic stress, or if these changes could help spot people who are more vulnerable to depression.

The active ingredient in "magic mushrooms" may help patients with tough-to-treat depression, a new study suggests.

Twenty patients received psilocybin -- the psychoactive compound in a group of mushrooms that cause hallucinations. Nineteen who completed the study showed improvement in their depression symptoms for up to five weeks after treatment, according to the researchers at Imperial College London.

None had responded to traditional depression treatment, they noted.

"We have shown for the first time clear changes in brain activity in depressed people treated with psilocybin after failing to respond to conventional treatments," said study leader Robin Carhart-Harris, head of psychedelic research at Imperial.

However, his team emphasized that patients with depression should not try to self-medicate with magic mushrooms. While these results are promising, the study was small and did not include a comparison group of patients who did not receive psilocybin, they noted.

Still, brain scans before and after treatment suggest psilocybin may reset the activity of brain circuits that play a role in depression.

"Several of our patients described feeling 'reset' after the treatment and often used computer analogies," Carhart-Harris reported in a college news release. One said he felt like his brain had been "defragged" like a computer hard drive, and another said he felt "rebooted," the researcher added.

RELATED: Depression May Hasten Death in Years After Heart Diagnosis

"Psilocybin may be giving these individuals the temporary 'kick-start' they need to break out of their depressive states, and these imaging results do tentatively support a 'reset' analogy. Similar brain effects to these have been seen with electroconvulsive therapy," Carhart-Harris said.

Larger studies are needed to see if this positive effect can be reproduced in more patients, said study senior author David Nutt.

"But these initial findings are exciting and provide another treatment avenue to explore," said Nutt, director of neuropsychopharmacology in the division of brain sciences.

He added that a trial scheduled to start early in 2018 will test the psychedelic drug against a leading antidepressant.

For this latest study, patients received two different doses of psilocybin, one week apart.

In recent years, promising results have emerged from a number of clinical trials testing the safety and effectiveness of psychedelics in patients with conditions such as depression and addiction.

"Psilocybin can be a promising agent for depression," said Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital, in Glen Oaks, N.Y. "For decades, there has been suspected benefit of psychedelic agents for the treatment of psychiatric and neurological disorders."

However, he said, the clinical trials to date have been very small, and without a placebo arm for comparison. He agreed that replication in larger studies is warranted.

The study was published Oct. 13 in the journal Scientific Reports.

Helicopter parents, take note: A mother has a better relationship with her child if she respects the youngster's need for independence at a young age, a new study suggests.

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Mothers who allowed children more freedom at age 2 were viewed more positively by their children later in childhood, according to the University of Missouri study.

The study included more than 2,000 mothers and their children. The researchers observed how much the mothers controlled the children's play at age 2 and then interviewed the children at fifth grade to assess how they felt about their mothers.

"When mothers are highly controlling of small children's play, those children are less likely to want to engage with them," Jean Ispa, co-chair of the department of human development and family studies, said in a university news release.

Respect for independence is important both for children's growth and for creating positive parent-child relationships, she said. "We found that mothers who supported their children's autonomy were regarded more positively by their children than mothers who were highly directive," she said.

RELATED: Being a Good Parent Without Judging Other Parents

"Mothers who are very directive when their children are toddlers often tend to still be controlling when their children enter adolescence," Ispa noted.

Mothers with small children mostly use physical controls, she said, but when children are older these directives become more verbal and psychological -- not allowing kids to speak their mind, for instance. "It's not surprising that their children begin to view them in a negative light," Ispa said.

The findings, published online recently in the journal Social Development, don't mean that parents should not establish and enforce rules or offer advice, Ispa said. She noted that behavioral rules -- such as teaching children to check for cars before crossing the street -- did not have a negative impact on mother-child relationships.

It was psychological control -- such as inducing guilt or telling children what to think and feel, or to play in certain ways -- that damaged mother-child relationships, the study found.

"Many times, parents think that employing these controlling behaviors is the 'right way' to raise children, but our research shows that really does not work," Ispa said.

"Allowing children age-appropriate levels of autonomy to make safe decisions is very good for kids, and they usually will make wise decisions when they have been taught about safe choices as well as consequences," she added.

"A good place for parents to start would be to have open discussions and allow their children to express their own points of view," she suggested. "When giving children instructions, explain reasons for decisions rather than simply saying, 'Because I said so.' "

Risky behaviors such as reckless driving or sudden promiscuity, or nervous behaviors such as agitation, hand-wringing or pacing, can be signs that suicide risk may be high in depressed people, researchers report.

Other warning signs may include doing things on impulse with little thought about the consequences. Depressed people with any of these symptoms are at least 50 percent more likely to attempt suicide, the new study found.

"Assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications," study lead author Dr. Dina Popovic, of the Hospital Clinic de Barcelona, in Spain, said in a news release from the European College of Neuropsychopharmacology (ECNP).

The findings were scheduled for presentation Saturday at the ECNP's annual meeting in Amsterdam.

One expert in the United States concurred with the findings.

"It has long been known that those patients with depression who also experience anxiety and/or agitation are more likely to attempt or complete suicide," said Dr. Donald Malone, chair of psychiatry and psychology at the Cleveland Clinic. "These symptoms can also be a clue that the underlying diagnosis is bipolar depression (manic depressive disorder)," he added.

In the study, Popovic's team looked at more than 2,800 people with depression, including nearly 630 who had attempted suicide. The researchers conducted in-depth interviews with each patient, and especially looked for differences in behaviors between depressed people who had attempted suicide and those who had not. Certain patterns of behavior began to emerge, the study authors said.

"Most of these symptoms will not be spontaneously referred by the patient, [so] the clinician needs to inquire directly," Popovic said.

She and her colleagues also found that "depressive mixed states" often precede suicide attempts.

RELATED: What Suicidal Depression Feels Like

"A depressive mixed state is where a patient is depressed, but also has symptoms of 'excitation,' or mania," Popovic explained. "We found this significantly more in patients who had previously attempted suicide, than those who had not. In fact, 40 percent of all the depressed patients who attempted suicide had a 'mixed episode' rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide."

The researchers reported that the standard criteria for diagnosing depression spotted only 12 percent of patients with mixed depression. In contrast, using the new criteria identified 40 percent of these patients, Popovic's team said.

"This means that the standard methods are missing a lot of patients at risk of suicide," she said.

Malone agreed that a "mixed state" can heighten odds for suicide.

"This study appropriately cautions caregivers to pay particular attention to suicide risk when treating patients with mixed states," he said.

"Bipolar patients are at higher risk of suicide in general when compared with non-bipolar depression, even when not in a mixed state," Malone said. Drug treatments for bipolar depression "also can differ significantly from those of unipolar depression," he added. "In fact, antidepressants can worsen the situation with bipolar patients."

According to Malone, all of this means that "accurate diagnosis is essential to deciding on effective treatment."

Dr. Patrice Reives-Bright directs the division of child and adolescent services at South Oaks Hospital in Amityville, N.Y. She said that the "more commonly known risk factors for suicide include hopelessness, history of previous attempts and recent loss or change in one's life."

However, the impulsive and risky behaviors outlined in the new study can "also increase the likelihood of someone who is depressed to act on thoughts to end his or her life," Reives-Bright said.

She agreed with Malone that "identifying these symptoms of a mixed state is important when assessing mood symptoms and selecting treatment options for the patient."

Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal. However, according to Popovic, one strength of the new study is that "it's not a clinical trial, with ideal patients -- it's a big study, from the real world."

More than 800,000 people worldwide die by suicide every year, and about 20 times that number attempt suicide, according to the World Health Organization. Suicide is one of the leading causes of death in young people.

Drinking Tea for Diabetes: Green Tea or Black Tea?

When it comes to drinking tea for diabetes, Steinbaum says benefits are tied to all teas, but that green tea is the clear winner. "For one, when you drink green tea for diabetes, you will get a higher level of polyphenols than you would get in black,” she explains. It’s the polyphenols in fruits and vegetables that give them their bright colors. So, having more color means that green tea is richer in polyphenols. “Of the black teas, the more orange the color, the higher the polyphenols,” she adds.

    "Green tea is good for people with diabetes because it helps the metabolic system function better."

Suzanne Steinbaum, DO

Besides its color, green tea also contains higher polyphenol levels because it's prepared from unfermented leaves, "so it is really pure,” Steinbaum says. Black tea, on the other hand, is made from leaves that are fully fermented, which robs it of some nutrients. “Plus, some black tea varieties can have two to three times more caffeine than green, which isn’t good in excess,” she says.

Polyphenols: Beyond Drinking Tea for Diabetes

The benefits of tea are clear. But besides tea, a number of foods high in polyphenols also can help prevent and manage type 2 diabetes. “The fruits highest in polyphenols are berries, grapes, apples, and pomegranates — because of their rich color,” Steinbaum says. Broccoli, onions, garlic, tomatoes, eggplant, and spinach are also good sources, as are cranberries, blood oranges, blackberries, blueberries, raspberries, strawberries, rhubarb, lemons, limes, and kiwis. “We know red wine contains resveratrol, which is a polyphenol — the highest concentration is in Bordeaux,” Steinbaum says.

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.

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It's unclear what causes binge eating disorder.

Like other eating disorders, BED is probably caused by a combination of genetic, psychological, and social factors.

Some risk factors for binge eating disorder include:

• A history of anxiety or depression
• A history of dieting (especially in unhealthy ways, such as skipping meals or not eating enough food each day)
• Painful childhood experiences, such as family problems

Symptoms of Binge Eating Disorder

People with binge eating disorder have frequent bingeing episodes, typically at least once a week over the course of three months or more.

Binge eating episodes are associated with three or more of the following:

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts of food when you're not feeling hungry
• Eating alone, because you feel embarrassed about how much you're eating
• Feeling extremely disgusted, depressed, or guilty after eating

Some people also display behavioral, emotional, or physical characteristics, such as:

• Secretive food behaviors, including hoarding, hiding, or stealing food
• Feelings of anger, anxiety, worthlessness, or shame preceding a binge
• Feeling disgusted with your body size
• A strong need to be in control, or perfectionist tendencies

Binge Eating Disorder Treatment

If you have binge eating disorder, you should seek help from a specialist in eating disorders, such as a psychiatrist or psychologist.

There are several treatments available for BED. Treatment options may include:

For a hypoallergenic beauty product to plump up your lashes, Van Dyke suggests Almay Thickening Mascara. It's affordable, available at mass-market stores, and a great beauty product to avoid skin allergy reactions. Almay products go through rigorous testing to avoid allergens and irritants and maintain the brand's reputation for hypoallergenic beauty products, says Van Dyke. "It is hard to beat Almay for dermatologist-approved makeup, particularly around the eye," she adds.

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He single-arm  is a classic exercise, but it's not always done correctly. You'll often see people rocking their entire upper bodies on the move, putting their lower back at risk for injury and not getting the most out of the row.

That's where this TRX row comes in, because it forces you to keep near-perfect form. It's an exercise that will keep you honest on all your single-arm rows, and combined with a at the end that's also on the , it makes a perfect finishing move to a pull-day workout.

The New York Times published an article “Should Athletes Eat Fat or Carbs?” last week which was based on a study that shows a diet comprised of 85 percent fat can help improve overall performance for ultra-endurance athletes more than the traditional high-carbohydrate diet considered best for athletes. And by fat, they mean good fats that come from foods like nuts, avocados, and extra-virgin olive oil — not your cheeseburgers and French fries. But before you throw all your healthy eating rules out the window, it’s important to note that this recommendation is not for most of us — these recommendations for real athletes. We’re talking about people who exercise for a living — think NBA players, Olympic swimmers, or professional marathoners.

Let’s be honest: Most of us don’t run more than two marathons a week or work out at all hours of the day, so this way of eating is not recommended, even for high school and college players and people who exercise regularly. However, this information certainly brings into question traditional thinking and, as so often with these studies, leaves us wondering if this type of eating could benefit other types of athletes or moderately active people. We’ll need to continue to watch the research for more answers.

It’s important to remember that carbohydrates are an essential part of a healthy, well-balanced diet and provide fuel for your workouts in the form of glycogen, which is stored in the liver and muscles. Fat, however, must be broken down into fatty acids before it can be used as fuel, and only endurance athletes who vigorously exercise throughout the day are able to use up all their glycogen stores before their bodies start using fat. A ketogenic diet, like the ones the article reviews with 85 percent of the diet from fat, forces your body to use fat more readily as an energy source. This is referred to as a ‘ketoadaption’ and takes several weeks to achieve.

Still, it’s not a good idea to overdo it on carbohydrates or fat for all your meals. Fats should only comprise 20 to 30 percent of your total daily calorie intake per meal (think two slices of avocado). Carbohydrates should make up 40 to 50 percent of your meal, and sources of good carbohydrates include vegetables, fruits, legumes, and whole grains. Government experts have offered suggestions for the 2015 Dietary Guidelines, (due to be published in the fall) which encourage Americans to cut down on meat, added sugars, and starchy, high-carb foods and include more fruits, vegetables, whole grains, and healthy fats into their diets.

“The move toward reducing the amount of carbohydrates recommended for the general public is because most of us are not active. We sit too much! When we don’t move, or if we move for only an hour a day, we’re not utilizing all the carbohydrates we are eating, and therefore we continue to gain weight and increase our risk for chronic diseases. For the most part, we are moving too little and eating too much and especially carbohydrates because they are easy, available, and taste good,” says Maureen Namkoong, MS, RD nutrition and fitness director at Everyday Health.

There’s a place for good carbohydrates and fats in a balanced diet. Good carbohydrates and fats give you energy, may help you lose weight, and promote cardiovascular health. But too much of a good thing can be bad — and this is true for fats and carbs, too.

No one thinks they could be in this situation, but here's advice from safety experts if it happens.

Thursday, April 03, 2014

The headlines appear with unnerving frequency about mass shootings somewhere in the United States -- at a movie theater, a shopping mall, a school, a sporting event. Yesterday, a shooting tragedy took place at the Fort Hood military base in Texas, the second at this site since November 2009.

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Precisely how often mass shootings have occurred depends somewhat on interpretation. The Congressional Research Service, which defines a mass shooting as one that takes place in a relatively public place and results in four or more deaths, not including the shooter, identified 78 such shootings in the United States from 1983 to early 2013. A report by researchers at Texas State University, done after the killings at Sandy Hook Elementary School in Connecticut, used different parameters and identified 84 mass shootings from 2000 to 2010 by people whose main motive appears to have been mass murder.

Though the precise number of mass casualty shootings may be hard to determine, there's no disagreement that people today need to think about their safety whenever they go out in public, said Dennis Krebs, a retired captain and paramedic with the Baltimore County Fire Department and author of "When Violence Erupts, A Survival Guide for Emergency Responders" and the "Special Operations Mission Planning Field Guide." 

“If you at least think about what you would do if you were confronted with such a situation, it gives you an edge,” Krebs said. 

Life-Saving Tips in the Event of a Mass Shooting

Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University, said that people don’t need to panic or even fear going to public places to avoid mass casualty shootings. He does agree with Krebs though: In 2014, it’s worth giving some thought to how to protect yourself during a mass shooting. 

What you can do if faced with a mass shooting depends greatly on the situation and your physique and physical capabilities, Dr. Redlener noted. “If you’re small and alone or with your 1-year-old or your 14-year-old, it’s going to be different,” he said. “Everything about survival guidelines is dependent on the details of the particular situation.” 

However, experts in public safety do have advice on how to protect yourself and your loved ones in the event of a mass shooting.

Pay attention to your surroundings. No matter where you go, "be aware of your environment," Redlener said. "If you see something that looks suspicious or out of place, or you notice an unusual gathering of people, you can begin taking action prior to the event occurring." By being aware, you may be able to avoid the scene and not walk into trouble. “Situational awareness is something that police officers and the military are taught and trained to do,” he said. When you go to a mall or a movie, know where the nearest exits are. 

RELATED: Media Exposure to Traumatic Events Can Be More Stressful Than Being There

Flee if you can. If you’re caught in a mass shooting, “you want to get outside of the building as quickly as you possibly can," Krebs said. A lot of people freeze, but "that's the last thing you want to do,” he said. Urge any people you're with to come with you, but don’t waste precious time trying to persuade them to get out while you can. 

"If you see something... suspicious or out of place...you can begin taking action prior to the event."

Irwin Redlener, MDTWEET

David Reiss, MD, a San Diego psychiatrist, said that some training in the martial arts can help prepare you to deal with your body’s natural fight-or-flight response and not be paralyzed when faced with traumatic events from which you should flee. “To be aware of that response and have some training in dealing with it can be useful without going overboard,” he said. 

Leave your belongings behind. Drop whatever stuff you have with you -- packages, luggage, purse, or backpack. It will make your exit easier. Nothing is more important than your life, Krebs said. Video of the mass shooting at the Los Angeles airport in November 2013 showed people fleeing with their suitcases, but, as Krebs said, "there's nothing in that piece of Samsonite that’s worth your life." 

If you can’t run, hide. “You want to be in an area that allows you to be protected from the gunman or further mischief by the armed perpetrator,” said Stephen Hargarten, MD, MPH, professor and chairman of emergency medicine and director of the Injury Research Center at the Medical College of Wisconsin. Lock and barricade the doors to your hiding place. In one recent mass shooting at a mall, a store clerk was able to protect some shoppers by hitting the button for a gate in front of the store, sealing everyone inside, Krebs said. 

Once in hiding, be quiet. Shut off your cellphone. Instinct may tell you to keep it on and try to call for help, but a ringing phone could be dangerous if it attracts the shooter's attention, Krebs said. Call 911 for help only if and when it’s safe to do so. 

Try to avoid confronting the shooter. According to the U.S. Department of Homeland Security, taking any action against the shooter should be a last resort -- something you do only if your life is in imminent danger. But, if there's no other option, yell, act aggressively, or look around for something that might work as a weapon. 

Afterwards, exit carefully. Once the shooting has stopped and you are able to leave the building, go out with your hands up. Drop whatever you are carrying. “Police may not have a description of the suspect they’re after," Krebs said, "and if you come running out the door with something in your hand, you could end up getting hurt." 

Disaster Preparedness With Children 

Parents with young children should follow the same advice that flight attendants give passengers: Take care of yourself first because, if you don’t, you won’t be able to help your children, Dr. Hargarten said.

Before you're faced with a traumatic event, talk with your children about the best ways to handle such situations. What you say will depend on their age, but whatever you say, try not to frighten them unnecessarily. Emphasize that in an emergency situation like that, they would need to follow your directions, no questions asked. If you have to scream at your children, it could attract the attention of the shooter. 

As part of your family's disaster preparedness plan, decide where to meet if you get separated in an emergency -- even if it's a place you've been many times before. 

Dr. Reiss said you can’t anticipate mass casualty shootings and should not spend your days fretting over what you would do if you were caught up in one. “If you expect emergencies every moment of your day, it will ruin your life,” he said. It’s best to give it some thought but not let it overwhelm you

Get the inside scoop on Mohs surgery, the most popular treatment option for basal and squamous cell carcinomas.

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.

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 list price of these newer drugs is upwards of $14,000 a year per patient.Getty Images
Are new medicines for people with out-of-control cholesterol wildly overpriced? It's a question that's sparking debate among consumers and providers of care.

Now, researchers at the University of California, San Francisco (UCSF) report that the price of these drugs -- called PCSK9 inhibitors -- would have to be slashed by a whopping 71 percent to be deemed cost-effective.

PCSK9 inhibitors are a relatively new class of medicines for treating patients whose LDL (bad) cholesterol isn't well-controlled on statins or who cannot tolerate statins. Lipitor (atorvastatin) and Crestor (rosuvastatin) are examples of first-line statins doctors typically prescribe to patients with high cholesterol.

The UCSF team didn't question whether these new medicines are effective in reducing heart attacks and strokes.

"These are super awesome drugs, they really work," said study co-author Dr. Kirsten Bibbins-Domingo.

But the price is "far in excess" of what would be considered a reasonable cost for the clinical benefit they provide, added Bibbins-Domingo, a UCSF professor of medicine, epidemiology and biostatistics.

The list price of these newer PCSK9 drugs is upwards of $14,000 a year per patient.

Dr. Kim Allan Williams, who was not involved in the study, is past president of the American College of Cardiology. He said some doctors have a difficult time with such studies because they compare patients' lives and "events" — such as heart attack and stroke — versus dollars spent on these medicines.

The new study doesn't change his view of the value of the PCSK9 inhibitor class.

"No one's giving those drugs unless the patient is incapable of getting to the target [level of LDL cholesterol]," said Williams, who is chief of cardiology at Rush University Medical Center in Chicago. "You're only going to use it for a situation where you have no choice."

RELATED: 8 Foods That Can Cause High Cholesterol

Because the study is based on list prices, not what patients actually pay, it's also "difficult to analyze the cost-effectiveness when [you] don't know exactly what the cost is," Williams added.

He said he's had patients with copays of $380 a month and others who had zero copays because the cost was completely covered by insurance. He worries, though, that poor patients may not be offered the same access to these medicines.

The CSF researchers designed the study to find out how much bang for the buck these drugs actually provide.

Their study updates a prior cost-effectiveness analysis using current list prices as well as results of a recent clinical trial. That trial demonstrated the clinical effectiveness of Repatha (evolocumab), one of two PCSK9 inhibitors approved by the U.S. Food and Drug Administration, in reducing the risk of heart attack and stroke.

Based on a simulation involving 8.9 million adults who would meet trial criteria, adding PCSK9 inhibitors to statins would prevent 2.9 million more heart attacks and strokes compared with adding Zetia (ezetimibe), another type of medication that blocks the production of cholesterol by the liver.

But the PCSK9 inhibitor class is not cost-effective based on a threshold of $100,000 for each life year gained, the study authors contend. They found that you would have to spend $450,000 per year to get one extra year of life per year.

"The price would have to be between $4,000 and $5,000 [per year] for it to be cost-effective," said Bibbins-Domingo. "If you look in other countries, in Europe, for example, that is in fact where this drug is priced."

Dr. Josh Ofman, senior vice president of global value, access and policy at Amgen Inc., the maker of Repatha, took issue with the findings. "We think that their model is deeply flawed," he said.

The study was based a 3 percent per-year rate of heart attacks and strokes, while other studies use much higher rates — more than three times higher — based on "real-world" data, Ofman said. The study is modeling a population that's not having many heart attacks and strokes, he said.

Ofman also questioned the threshold for determining cost-effectiveness that the UCSF researchers used. He said other organizations use a minimum of $150,000 per quality-adjusted life-year saved.

As for the price differential between the United States and Europe, Ofman cited many factors, from government price controls to how those countries price these drugs.

Amgen isn't alone in its criticism of how these medicines are valued. Earlier this month, several national provider and payer groups raised concerns about how the PCSK9 inhibitors are valued in a letter to the nonprofit Institute for Clinical and Economic Review, which assesses the value of new medicines.

More than a dozen organizations, including the National Forum for Heart Disease & Stroke Prevention, the American Pharmacists Association Foundation and the American Society for Preventive Cardiology, signed the letter citing concerns ranging from the types of patients that could benefit from these drugs to the importance of preventing heart attacks and strokes — not just deaths.

"The big controversy about all these types of analyses is what we're willing to value a patient's year of life at," Ofman said.

The new study was published in the Aug. 22/29 issue of the Journal of the American Medical Association.

October is Breast Cancer Awareness Month, an annual campaign to raise awareness of breast cancer risks, the value of screening and early detection, and treatment options available to women and men who are diagnosed with one of the many forms of breast cancer. More than 249,000 people in the United States are diagnosed with invasive breast cancer every year, and nearly 41,000 die from the disease.

Over the years, a loop of pink ribbon has come to symbolize breast cancer awareness, and today the image of a pink ribbon can be found emblazoned on thousands of products, from apparel to dishware to office supplies. But there's more to awareness than just wearing pink.

This week marks the second anniversary of my writing this blog.  It’s a good chance to remember why I write the blog, what it has meant to me, and to think about what’s ahead.  I originally wanted to write because the original site, HealthTalk.com, helped me immensely with their psoriasis web content.  I especially enjoyed the various topics presented in the monthly webcast.   By writing I believed I could bring my own story and perspective to the discussion of how to live with and treat psoriasis.  At that time I also felt down about many aspects of my life, including psoriasis.  With no end in sight managing this disease I wondered if anything good could be redeemed from the experience.  If I could help one other person feel like they are not alone in battling psoriasis, if anyone could benefit from my trial and errors with medications, or if caregivers could understand the different dimensions of living with psoriasis then writing would be worth it.  Finally, I wanted a community I could share the struggles with and how better to find one than to help create one?

A new study cast doubts on the existence of seasonal depression -- a mood disorder linked to reduced sunlight in the winter months.

This form of depression -- known as seasonal affective disorder (SAD) and recognized by the mental health community for nearly 30 years -- "is not supported by objective data," the new study claims.

Depression comes and goes, said study lead researcher Steven LoBello. If someone experiences depression in the fall and winter, "it doesn't mean that seasonal changes have caused the depression," added LoBello, a professor of psychology at Auburn University at Montgomery, Ala.

For the study, LoBello and colleagues used data from a telephone survey of more than 34,000 U.S. adults asked about depression and then gathered information on time of year, latitude and more when measuring depression.

LoBello noted the study found no evidence that symptoms of depression were season-related and said, "If this seasonal pattern of depression occurs at all, it may be fairly rare."

Dr. Matthew Lorber, acting director of child and adolescent psychiatry at Lenox Hill Hospital in New York City, also said that seasonal affective disorder may not be a "legitimate diagnosis."

Big drug companies, Lorber said, pushed to have SAD recognized as a standard diagnosis. "It then allowed them to market to a new population to use their medications. That was a motivating factor in creating this disorder," said Lorber, who wasn't involved in the new study.

LoBello thinks the seasons have no place in the diagnosis of depression, and he would like to see these criteria discontinued.

His reasoning? Assuming a cause that isn't accurate may lead patients to pursue treatments that won't deliver relief, LoBello said.

According to the new report, published Jan. 20 in Clinical Psychological Science, seasonal affective disorder was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- the bible of psychological diagnosis -- in 1987.

RELATED: Why Depression Is Underreported in Men

LoBello isn't the first to explore the validity of this diagnosis.

Kelly Rohan, an associate professor of psychology at the University of Vermont, has done her own research on seasonal depression and found "no season differences in reports of depressive symptoms."

"I certainly did not argue that this means SAD does not exist," she said. "However, only a minority of depression cases are actually SAD."

So, how come other research has found that a significant percentage of the public suffers from this condition? (The American Academy of Family Physicians says up to 6 percent of U.S. adults have winter depression, and as many as one in five have mild SAD symptoms).

It all depends on how the studies are done and how the questions are asked, Rohan said. "Also, SAD depressive symptoms tend to be less severe than in nonseasonal major depression and mood tends to be back to normal in the spring and summer," she said. "So when you take all the depressed people in this sample -- including the minority that claims to be SAD -- and look at seasonal differences in their depression scores, I am not surprised that it is a wash."

For the study, LoBello and colleagues used the 2006 Behavioral Risk Factor Surveillance System. The 34,000-plus respondents had been asked about the number of days they felt depressed in the past two weeks. The researchers matched these responses with the location of each person and the day, month, latitude and amount of sun exposure when interviewed.

People who responded to the survey in the winter months, when sunlight exposure was low, had no greater levels of depressive symptoms than those who responded to the survey at other times, the researchers said.

In addition, the researchers found no evidence for seasonal differences in mood when they zeroed in on more than 1,700 participants with clinical depression.

Carolyn Jacob, MD, director of Chicago Cosmetic Surgery and Dermatology, doesn’t just treat patients with psoriasis — she manages her own. Dr. Jacob has been living with psoriasis since she was 14 years old.

Jacob’s psoriasis primarily affects her scalp and nails, both of which can be tough to hide. “I hated it when I had scalp involvement, which would show flakes on my clothing and itch constantly,” Jacob says.

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Embarrassed about her nail psoriasis, Jacob used to paint them a color that would mask her symptoms. The National Psoriasis Foundation says that about half of all people with psoriasis will have symptoms affecting the nails, which can include changes in color, thickening of the nails, separation of the nail, and the formation of pits or holes.

An Accessible Skin Care Routine

For healthy skin, Jacob knows she has to keep her skin clear and moisturized as much as possible. She uses CeraVe cleanser, available at many drugstores. “It adds ceramides to the skin, which help to rebalance the natural moisturizing factor in your skin,” she says. She follows that up with CeraVe lotion.

Other daily psoriasis treatment tips that Jacob offers her patients and practices herself include:

• Cleanse and moisturize your skin just once daily to avoid drying.
• Use a soft cloth or your hands to lather up with cleanser; never use a loofah on skin that’s actively flaring because the rubbing and scratching could worsen symptoms.
• If you have psoriasis on your face, Jacob advises against using harsh toners because they can be aggravating.
• During the frigid Chicago winters, Jacob switches to a cream or moisturizing cream from a lighter lotion because it’s more hydrating for thirsty winter skin.
• For scalp psoriasis, she recommends over-the-counter favorites like Neutrogena T/Gel, DHS tar shampoos, or those containing salicylic acid (her personal pick is Neutrogena T/Sal.) For something stronger, she likes Clobex, a steroid shampoo that you can get with a prescription from your dermatologist.

When Jacob’s psoriasis flares, she turns to a prescription Avène product called Akérat cream because it contains exfoliators and softeners to soothe the skin.

Daily Psoriasis Treatment Starts from the Inside Out

Jacob knows that psoriasis and its treatments are more than just skin deep. She sticks to a healthy, balanced diet to help keep inflammation down and her symptoms in check. She eats salmon and walnuts for the omega-3 fatty acids, which can help reduce inflammation and promote better heart health. Jacob also takes omega-3 supplements for an extra boost. “They are great for inflammatory conditions, especially psoriasis, and they help balance cholesterol levels and improve your skin texture,” she explains. The heart-healthy supplements can prove particularly beneficial since people with psoriasis have a 58 percent greater chance of suffering a major cardiovascular event like a heart attack, according to the National Psoriasis Foundation.

Stress is also a trigger for psoriasis, so Jacob tries to keep it in check, particularly by exercising. With twin toddlers and a busy schedule, she has to make time to work out. How does she fit it in? “I get up early to exercise so it is done for the day,” she says. It’s a prudent strategy that’s backed by a study from the August 2012 issue of Archives of Dermatology, which found that women who engaged in regular vigorous exercise were less likely to develop psoriasis.

Another of Jacob’s secrets: avoiding alcohol. “It makes stress worse and makes psoriasis worse,” she says. The National Psoriasis Foundation notes that alcohol can interfere with psoriasis treatments and causes side effects when combined with many psoriasis medications. Plus, alcohol can change the way you perceive and manage your stress, according to the National Institute on Alcohol Abuse and Alcoholism.

Find What Works for You

Jacob’s psoriasis is now well controlled with biologic medications, and she says her skin, scalp, and nails stay pretty healthy. Her best advice? Work with your dermatologist to find the right treatment for you.

“The availability of biologic medications was life changing — to not have to deal with other messy medicines that do not work well, to not itch, and to have normal nails is wonderful,” she says. “This type of treatment makes me feel like a normal person again!”

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.”

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.

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.