JustCare

Tag: Anxiety

  • Are weight-loss drugs a modern-day miracle?

    Are weight-loss drugs a modern-day miracle?

    Pretty much everywhere I turn, there’s a new story about the benefits of weight-loss drugs beyond helping people lose weight. It’s still early days, and many weight-loss drugs are extremely expensive. But, if you believe the stories, weight-loss drugs can treat heart conditions, can reduce overall health care spending and, can even treat depression and dementia, reports Simar Bajaj for the New Scientist.

    For now, Medicare covers weight-loss drugs mainly for people with diabetes. They are super expensive, driving up insurance premiums considerably, and there’s a lot we still don’t know about them. Still, what’s coming out about their benefits seems nothing short of a miracle.

    Some former alcoholics and drug addicts appear to lose their desire for alcohol and drugs when they take a semaglutide, a weight-loss drug, such as Wegovy and Ozempic. Their depression and anxiety fade away. So, can their addiction.

    Today about six million Americans take a weight-loss drug or GLP-1 medicine. Before long, it is projected that five times that number–30 million–Americans will be on a semaglutide. These drugs enable people to drop between 15 to 20 percent of their body weight.

    Back in February, Epic, which keeps Americans’ medical records, determined that people who took a GLP-1 were considerably less likely to suffer from depression and anxiety than others.  An earlier study arrived at similar findings. 

    Time will tell before we know for sure whether weight-loss drugs deliver all these findings. For now, it seems that the findings make sense. People who are overweight are more prone to depression. If they lose weight after taking a GLP-1, it’s more than likely that it will benefit them mentally as well as physically. For most of us, it feels good to lose weight.

    Some scientists believe there’s more to the story. GLP-1s are produced in the brain as well as the gut. So when you take a GLP-1 drug, you could be benefiting your brain directly, improving cognitive functions and emotional control. Indeed, in a small study of people who did not lose weight from a GLP-1, the researchers still saw improvements to their moods, and they experienced fewer depressive symptoms.

    GLP-1s have been found to increase blood flow in the brain as well as to keep nerve cells from dying as quickly as they otherwise do. They bring more glucose to the brain. As a result, the brain can function better. For these reasons, in small studies, GLP-1s have also been found to be responsible for less brain shrinkage in people with Alzheimer’s and to slow the progression of the disease.

    Again, these are early days. The good news is that these weight-loss drugs seem to have myriad benefits. And, for now, they also appear to come with few risks. But, if we know anything, it’s that what’s good for your health today might be found to come with serious side effects tomorrow.

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  • Mental health care is unaffordable for one in four Americans with anxiety and depression

    Mental health care is unaffordable for one in four Americans with anxiety and depression

    Researchers at Johns Hopkins found that 25 percent of adults with anxiety and depression in the US cannot afford to pay their mental health care bills, keeping them from receiving psychiatric care. Medical debt doubled the likelihood that people would either go without treatment or delay treatment for mental conditions, according to the research findings published in the JAMA Network. Mental health parity continues to be a dream.

    Nearly one in five households in the US carry medical debt, making it hard to get treatment for mental conditions when needed. Medical debt is prevalent among Americans with anxiety and depression.

    More than eight percent of Americans have not paid their medical bills of $250 or more. Overall, Americans in debt often face poor health outcomes and struggle to pay for their daily needs, including food and housing. Having health insurance does not help them.

    Sadly, not even half of adults with a mental disorder get treatment for it in the US. It’s expensive, even with insurance. And, psychiatrists tend not to accept insurance. So, out-of-pocket costs for mental health treatment can be exceptionally high.

    The researchers surveyed nearly 28,000 adults. Insured Americans with high deductible health plans were most likely to forego or delay mental health treatment.

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  • Marijuana appears to offer several benefits…and risks

    Marijuana appears to offer several benefits…and risks

    Sanjay Gupta writes for CNN.com about his change of heart on the benefits of marijuana, notwithstanding its risks. In traveling the world, Gupta spoke directly to people for whom marijuana was the only treatment that offered relief. He also learned that the proportion of older adults using marijuana in the US is growing more rapidly than any other age cohort.

    Gupta is clear that marijuana is not a cure-all. But, for example, it sometimes can prevent seizures in children. Still, it does not work to offer relief to everyone. What’s worse, marijuana can contribute to falls, which often land older adults in the emergency room.

    Until 1996, cannabis was illegal in every state for all purposes. Today, marijuana is legal in 38 states as well as the District of Columbia. Some of the remaining states make it a crime to possess marijuana, even for medicinal purposes. The federal government still treats marijuana as a “Schedule 1 substance,” with no accepted medical use and a likely chance of abuse.

    Apparently, federal law notwithstanding, many older adults use marijuana daily to address sleep issues, pains, anxiety and depression. They tend to like it better than anti-depressants, opioids and sleeping pills.

    Marijuana could reduce the number of prescription drugs older adults take. Today, three in 10 older adults take at least five prescription drugs daily.

    Gupta says that our bodies actually produce cannabis and have cannabinols receptors. Our endocannabinoid system balances our body, but it weakens as we age. That’s why older adults tend to struggle more with sleep and pain and mood.

    If you are thinking that you’d like to try cannabis, Gupta suggests you start with a low dose and take it slowly. There are more than 100 cannabinols, so we don’t generally have a good idea of how any particular cannabis you take will affect you. All we know is that it could give you a very good night’s sleep.

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  • Who should take ketamine for depression?

    Who should take ketamine for depression?

    Everywhere I turn these days, someone is talking up ketamine and its ability to treat mood disorders. David Dodge reports for The New York Times on the risks and benefits of using ketamine when other treatments for depression fail. Who should take ketamine?

    What is ketamine? Ketamine is an anesthetic–a pain reliever. It is not like other anti-depressants that increase your serotonin levels. Rather, it affects glutamate, which is a neurotransmitter that is a factor in regulating mood.

    How do you take ketamine? Ketamine can be taken as a nasal spray, in a tablet or through an IV.

    What is the setting for taking ketamine and its side effects? People usually spend an hour or two in ketamine sessions, in a doctor’s office or clinic, where they are being closely monitored.

    How long does it take for ketamine to work? What’s impressive about ketamine is that some people who have been suffering from depression for prolonged periods feel complete relief right after taking it. Many people are said to see their symptoms go away or recede in less than two months. But, some people may have to continue taking it for a prolonged period to keep symptoms at bay.

    What types of mood disorders does ketamine treat? Some ketamine trials are showing that ketamine is able to treat many different serious mood disorders that other drugs are not able to treat. Ketamine has been shown to treat obsessive compulsive disorder, social anxiety disorder and major depressive disorder. It is still unclear who benefits most from ketamine.

    How does ketamine make you feel? People might feel euphoric, sleepy, dissociated from the world. They also might feel dazed and/or nauseous for many hours. Some feel that they are in a catatonic state. In large doses, ketamine can cause paranoia, thoughts of suicide, chest pain and high blood pressure.

    Who should take ketamine? The jury’s out on this question as of now. There is no data on its long-term effects. Several ongoing clinical trials around the world will provide more data. Since it can have serious side effects–although experts say they are rare–some say that only people with severe mood disorders should take ketamine. Others believe that it could be an alternative to traditional treatments for depression and anxiety.

    Who should not take ketamine? People with heart conditions should not take ketamine except in special situations. If they do, they should be monitored while they take the ketamine because it can increase their blood pressure and heart rate.

    How does ketamine compare with other treatments for depression? Unlike other treatments for depression, which can take several weeks to take effect, ketamine works quickly.

    Is ketamine addictive? It’s still unclear. But, some experts worry about potential for abuse.

    Can your doctor prescribe ketamine? Yes. The Food and Drug Administration has not approved it to treat depression and anxiety. But, the FDA has approved it for other purposes, so your doctor can prescribe it for off-label use.

    How much does ketamine cost? At a clinic, ketamine can cost between $400 and $800 for each session. At home, the cost can drop to $120 a session. Your health insurance generally will not cover its cost.

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  • For your mental health, feed your brain

    For your mental health, feed your brain

    The New York Times reports on nutritional psychiatrists who advise people to eat as little processed foods, meat and dairy products as possible in order to ease anxiety and mild depression. Instead, for your mental health, they recommend a rainbow of natural foods, including lots of fresh fruits and vegetables. Is it possible that how you feel turns on what you eat?

    Dr. Drew Ramsey, a nutritional psychiatrist, recommends eating oysters because they have vitamin B12 and omega-3 fatty acids. According to some studies, B12 can keep your brain from shrinking. And, you are at risk for suicide and depression without adequate omega-3 fatty acids. Keep in mind, however, that there is no good evidence to suggest taking B12 or omega-3 fatty acids in supplement form has any health benefit. Moreover, Cochrane.org, the gold star for analyzing the research data, says the evidence is not conclusive that eating omega-3 fatty acids treats depression.

    Dr. Ramsey also believes that eating unhealthy foods contributes significantly to depression. Americans eat a lot of calories but do not eat a lot of micronutrients found largely in fruits and vegetables that help our brains to thrive. We need to eat between 12 and 16 ounces of fruit and between 16 and 24 ounces of vegetables every day. Yet, just 10 percent of adults eat that much fruit and vegetables.

    To treat depression, Dr. Ramsey appreciates that talk therapy can be beneficial, as are prescription drugs in many cases. He and others believe that supplementing those treatments with whole foods can be invaluable. In addition to fruits and vegetables, they recommend fatty fish, whole grains and legumes. Foods high in phytonutrients promote the generation of new brain cells and reduce the risk of harmful inflammation.

    There are a few studies to support Dr. Ramsey’s view. One 2016 study of 12,000 Australians found that those who ate more fresh fruits and vegetables were happier and had a greater sense of well-being than those who did not do so. A 2017 study of 422 young adults from the US and New Zealand had similar findings. Canned fruits and vegetables did not deliver the same results.

    A 2017 randomized-controlled trial also showed that a 12-week Mediterranean diet improved people’s moods and reduced their anxiety levels. The Mediterranean diet apparently delivers good gut bacteria. And, good gut bacteria has been found to help process serotonin, a mood elevator.

    Dr. Lisa Mosconi, who directs the Women’s Brain Initiative at Weill Cornell in New York City, has found, based on imaging studies, that people who eat Mediterranean diets typically have brains that look younger and are more active metabolically than people who do not. These people may have a lower risk of dementia.

    In short, it appears wise to pay attention to what you feed your brain. Your brain needs a lot of nourishment; it consumes more energy than any other organ in your body. Avoiding processed and fried foods is a good beginning. It may improve your mood and make you feel better.

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  • Don’t overlook marijuana-prescription drug interactions

    Don’t overlook marijuana-prescription drug interactions

    Middle-aged and older adults are increasingly using marijuana. As these groups tend to take more medications, marijuana-drug interactions are overlooked.

    When I think of a typical marijuana user, I admit I tend to stereotype. I see a young person, at home or with friends, smoking a large joint and having a good time. I don’t picture a grandma toking. Yet new research indicates that older people, in fact, are using cannabis more and more.

    A new study found that the number of middle-aged and older adults using marijuana is on the rise. The analysis, based on the National Survey on Drug Use and Health, found that about 9% of adults between 50 and 65 had used cannabis in the last year, and about 3% of those 65 and older had. In 2013, those figures were, respectively, 7% and 1.4%.

    Laws allowing for marijuana use – either recreationally or for medical purposes – are on the rise and can explain the increase. There is some medical evidence that marijuana can be used for a variety of medical conditions, such as pain, nausea from chemotherapy, multiple sclerosis, epilepsy and seizures, and this may also help to explain the increase in the older population.

    Why Worry?

    So what’s the big deal, you might ask? Since older people tend to take multiple medications, there is a risk of marijuana potentially interacting with those drugs and undermining their effectiveness. Yet because marijuana research is limited in the US, thanks to strict restrictions from the government, it’s hard to know exactly what those impacts are.

    If older individuals – or any people, for that matter – are using marijuana for medical purposes, hopefully their doctors are aware of the medications being taken. However, if you are using marijuana and your doctors don’t know, you should tell them as soon as possible. They may be aware of potential marijuana-drug interactions.

    Despite the lack of research on marijuana-drug interactions, there are certain classes of drugs that don’t mix well with cannabis. Because marijuana is very calming on the body, taking drugs that have sedating effects is a big no-no. For example, taking benzodiazepines such as Valium (diazepam) and Xanax (alprazolam), which are used for anxiety and insomnia, or muscle relaxants can lead to central nervous system depression. The same goes with using cannabis and alcohol.

    Cannabidiol (CBD), one of the chemicals found in marijuana, is a big culprit for problems. Why? It can inhibit an enzyme in the liver that is used to break down medicines. When this happens, the medication ends up staying in the body longer, which can enhance the effects of drugs. CBD can even slow the breakdown of statin medications, used to lower cholesterol. That can increase the chances of side effects associated with statins, such as muscle pain.

    There is also evidence that marijuana can impact the effectiveness of antidepressants. This is because marijuana may speed up metabolism of the antidepressant in the body. As a result, a person may need higher doses in order to get the same effect from the antidepressant.

    More research is needed not only on the benefits and risks of marijuana as a medical treatment, but on cannabis-drug interactions. The trend in older people using marijuana makes the research all the more urgent. It’s time for the federal government to loosen restriction of cannabis research.

    This article was originally published in medshadow.org

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  • Beware of anxiety drug interactions with other meds

    Beware of anxiety drug interactions with other meds

    Drugs such as Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam) are some of the most-prescribed medicines – more than 133.4 million such prescriptions were filled in the US in 2014. As with any medication, drug interactions can occur if you take a benzo with another medication, and in certain cases, may be life-threatening.

    With benzos, there are two areas of concern. The first is that interactions might increase the effects of the drug, which can result in oversedation, accidents and/or overdose. The second is that interactions could decrease the amount of a benzo in the bloodstream of a patient who has been on the drug for a long time, which can result in withdrawal symptoms, the most severe being seizures and death. Here are three drug classes that can have dangerous interactions with benzodiazepines.

    1. Opioids

    Opioids such as OxyContin (oxycodone), morphine, and Vicodin (hydrocodone) are painkillers. Katy LaLone, MD, a consulting psychiatrist with A Resilient Space Psychiatry Consultants in Cleveland, says combining benzos with “other sedative medications, especially opioids, can cause cardiorespiratory depression,” putting patients at risk of overdose and death. In fact, 75% of benzodiazepine-related deaths also involve an opioid. This combination is so dangerous that the FDA issued a black box warning in 2016 about prescribing the two drug classes together.

    Dr. LaLone has even seen overdoses in patients who are on stable doses of the two drugs after developing a “compromised cardiorespiratory status, such as the flu or undiagnosed sleep apnea.” She adds, “overdose is almost always accidental.”

    2. Insomnia drugs

    Prescription drugs that treat insomnia, known as “Z-drugs” have a mechanism of action similar to benzos. These drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). Dr. LaLone sees the combination of benzos and Ambien quite frequently in her clinical practice, usually in patients receiving prescriptions from more than one doctor. Patients are often prescribed benzodiazepines for anxiety and a “Z-drug” for insomnia, not realizing the drugs are similar in action.

    She notes this “dangerous combination can cause amnestic episodes (blackout spells),” and she almost never prescribes the 2 drug classes together except in special cases. A 2017 study looking at emergency room visits for adverse events from benzos and/or “Z-drugs” found that the combination of the 2 drug classes led to a 4-fold risk for serious outcomes.

    3. Proton Pump Inhibitors (PPIs)

    These drugs, such as Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole), are used to treat acid reflux. They can increase blood levels of benzodiazepines by interacting with the same liver enzymes that clear them from the body. This can result in worsening side effects of benzodiazepines including confusion, sedation, dizziness, falls and impaired driving.

    The most common offenders are Prilosec and Nexium. Mary Hall, a retiree living in North Carolina, was prescribed Prilosec by her doctor while taking clonazepam. She said, “The clonazepam started to build up, and I started feeling stoned like I was taking more doses of a benzo. I actually had to skip my night dose of the clonazepam and stop taking the Prilosec after three days.” She also developed a “horrible headache” that lasted for several days. She notified her doctor, and he was unaware of the potential interaction. . . .

    How to Avoid Dangerous Interactions?

    There are numerous ways you can protect yourself from dangerous drug interactions involving benzos. Dr. LaLone recommends that you only take medications that are prescribed to you, and take them only as prescribed. Second, obtain your prescriptions from one physician and pharmacy, and have regular doctor visits to assess your medication regimen. Third, exercise caution with use of other sedating medications, especially opioids. And finally, inform your doctor of all medications you are taking, including over-the-counter medications and supplements.

    It is also important to know that if you are considering stopping a benzo after being on it for a long time, it should be tapered to avoid the risk of severe withdrawal, which can result in seizures and even death.

    This article was excerpted from and originally published on Medshadow.org.

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  • Anxiety about health and finances growing

    Anxiety about health and finances growing

    If you’re feeling anxious about your health and finances, you are not alone. The American Psychiatric Association (APA) just released a poll revealing that Americans are especially anxious about their health and safety. Americans are also extremely anxious about their ability to pay their bills. Overall, anxiety is on the rise, particularly among baby boomers, pre-retirees and retirees.

    More than one thousand adults from across the country participated in the APA poll this past March. Megan Brooks reports for Medscape that they rated their anxiety in these five areas: health, safety, finances, relationships, and politics. Anxiety levels overall are five points higher than last year. Anxiety levels for baby boomers are up seven points from last year, more than any other group. Millenials have the highest anxiety levels of any group. And, the biggest area of anxiety overall is in the area of paying bills.

    The APA president, Anita Everett, MD said: “This poll shows US adults are increasingly anxious, particularly about health, safety, and finances. That increased stress and anxiety can significantly impact many aspects of people’s lives, including their mental health, and it can affect families. . . .  It highlights the need to help reduce the effects of stress with regular exercise, relaxation, healthy eating, and time with friends and family.”

    For help planning ahead for your care needs, pick up The Ten Should-Do’s for Your Health, Purse and Peace of Mind, Chapter One of Aging, Schmaging, a forthcoming book by Diane Archer.

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