prozacOnly Most Depressed Benefit From Antidepressants

Books such as 'Prozac Nation' bear witness to the fact that antidepressant medications are among the most widely prescribed and taken drugs in the United States, and worldwide. Now a meta-analysis published in this week's JAMA raises the question of who really benefits from such medications.

Antidepressant Drug Effects and Depression Severity pooled data from 6 studies and included 718 adult patients. Information on depression severity was gleaned using the Hamilton Depression Rating Scale, a more quantitative, objective measure of how badly someone is affected by their depression than either reports by the patient or clinical impressions. The researchers found that the people who received the most benefit from antidepressant medications were those who were more depressed to begin with. Those with only mild or moderate depression didn't gain the same relief or any relief at all. It therefore appears that only those with severe depression should really use these drugs.

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blood-clot1-300x225Clotting Risk Higher, Persists Longer Than Anyone Knew
 
It's no surprise to anyone that blood clots form more commonly following surgery, and plenty of strategies are in place to make sure they don't. Medicalese for this is venous thromboembolism or VTE, with two forms, DVT or deep vein thrombosis, and PE or pulmonary embolism, the usual suspects. But now a huge study in the British Medical Journal has shown that the risk of blood clot formation is much higher and lasts longer than was previously suspected: Duration and Magnitude of the Postoperative Risk of Venous Thromboembolism in Middle Aged Women: Prospective Cohort Study.

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santaOverweight, Sedentary, and Suffering Sleep Deprivation

Santa embodies a plethora of poor choices when it comes to health, an article entitled "Santa Claus: a public health pariah?" in the most recent issue of the British Medical Journal asserts. In view of the fact that Santa is more recognized than that other icon of popular culture, Ronald McDonald, and may also leverage his considerable notoriety toward the furtherance of public good, Rick and I agree that Santa should change some aspects of his gig. In keeping with the season, we focus our attention on this problem in this week's podcast.

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picblood1Keeping Blood Sugar Low May Not Help
 
In a classic 'if a little is good, more is better' manner, the medical establishment has for years touted tight blood sugar, or glucose, control as the best means of avoiding the complications of diabetes. Surprise! Now it's turning out that like so many areas of medicine, this one size fits all approach doesn't work. A study in this issue of Annals of Internal Medicine, Comorbidity Affects the Relationship Between Glycemic Control and Cardiovascular Outcomes in Diabetes, concludes that whether tight glucose control is effective or not depends on the presence of other health issues, so-called 'comorbidities.'

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headacheSevere Headache May be Treated With Oxygen

Headaches seem to be a common human condition, with almost everyone having suffered one at some point in life. In the spectrum of headaches, the most severe form is known as 'cluster' headaches. Clusters are characterized by excruciating pain behind or around one eye, tearing, drooping of the eyelid, runny nose and other symptoms. More men than women get them, with women who do describing the pain as "worse than childbirth." No surprise, then, that cluster headaches are one cause of suicide.

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061124-hiv_virusHIV Vaccine Provides Modest Benefit

The quest for an effective vaccine against HIV resembles a search for the Holy Grail. That's what I quip on this week's podcast, and while the phrase is tired and shopworn, in this case it fits. We've known about the cause of AIDS for decades now, the virus continues to kill tens of thousands annually, and although we have very effective drugs that keep the virus in check they are too expensive to offer much solace to much of the world's HIV infected population. In this week's NEJM, a glimmer of hope is reported: Vaccination With ALVAC and AIDVAC to Prevent HIV-1 Infection in Thailand.

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img_CPR_heartsaverShould IV Drugs be Given During Out-of-Hospital Cardiac Arrest?

For many years folks who study survival related to heart attacks experienced out of the hospital have lobbied for allowing emergency medical technicians (EMTs) to administer a range of drugs as well as other interventions. The clear goal is to improve a person's chances of making it to the hospital alive, where hopefully treatment will result in long term survival. Now a study done in Norway seems to conclude that use of the most common medication, epinephrine, does not result in any benefit to these folks and may actually result in harm. That's in this week's Journal of the American Medical Association: Intravenous Drug Administration During Out-of-Hospital Cardiac Arrest.

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mammogram_womanReduced Need for Mammography

Unless you've been living under a slimy rock this week, you know that the US Preventive Services Task Force has changed the screening guidelines for breast cancer. Instead of annual mammograms for all women over the age of 40, the guidelines are now tailored to reflect when the risk for developing breast cancer increases, and that's largely after menopause. Incidentally, right when the risk for the real killer in the room, heart disease, also rises. Here's the link to the recommendations, published in Annals of Internal Medicine: Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement.

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Gall_BladderWill Statins Soon be Added to Municipal Water Supplies?

Yet another benefit has been added to the list related to the use of statins - those medications intended primarily to reduce cholesterol in the blood. Why reduce cholesterol? Because high cholesterol is associated with a host of nasty consequences: narrowing or blockage of blood vessels and subsequent clot formation, heart attacks or strokes among them. Now what else is good about statin use? Turns out long term use of statins results in fewer folks forming gallstones and requiring surgical removal of their gall bladder. That's in the current issue of JAMA: Statin Use and Risk of Gallstone Disease Followed by Cholecystectomy.

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Humhrt2The Final Word on Bypass Surgery?
 
Coronary artery bypass surgery, abbreviated CABG and pronounced like the vegetable, is necessary when someone's coronary arteries, those that supply the heart muscle itself with blood, become so extensively blocked that they must be replaced. The traditional way to do this is to crack open the patient's chest, harvest blood vessels from elsewhere in the body (yet another controversy we'll leave alone for today) and stitch them into place on the heart, thereby bypassing the blocked vessels.

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