Depression: The Common Cold of Mental Illness
Donna, a 35-year-old bank officer, used to look forward to her seven-year-old son’s soccer games, but lately,it just doesn’t seem worth the effort. She’s lost 12 pounds in the last two months because she just doesn’t feel like eating. Once decisive and efficient, she has trouble concentrating and making decisions. “All I want to do during the day,” she says, “is sleep, but then I wake up in the middle of the night and can’t fall back asleep.”
Although she doesn’t know it, Donna is experiencing clinical depression. As one of the most common forms of psychological disorder, depression costs Americans up to 35 billion dollars a year in lost productivity, medical expense, and destroyed careers, as well as untold numbers of family breakups.
According to the National Foundation for Depressive Illness, between 35,000,000 and 40,000,000 Americans are likely to be affected by serious depression during their lives. It is the seventh or eight leading cause of death in the U.S., and the third leading cause of death among adolescents and young adults.
Yet despite the widespread debilitation that it causes, less than 30% of those suffering from depression or manic depression are aware that they have a disease, much less a treatable physical one. Tim Obermeyer, 41, a Dallas restaurant manager, said, “I knew that there was no real reason why I should feel bad, yet the feelings of worthlessness persisted. I thought I was having a mid-life crisis. It wasn’t until a friend of mine pulled me aside and told me that he thought I was depressed that I ever realized that (depression) might be the problem.”
The good news is that eighty to ninety percent of those afflicted can be successfully treated. There is a growing consensus among scientists that depression is a core disruption of normal brain chemistry and can be treated as such. Clinical depression is an illness caused by an imbalance of chemical transmitters in the brain called serotonin and norepinephrine.
In some instances, depression can be triggered by life stresses. Sometimes a significant loss can trigger unresolved grief for other losses that have been experienced. In such cases, a therapist can help guide the depressed patient through any childhood issues that may still be affecting him or her. Recent research suggests that people who are genetically predisposed to depression (e.g. have a parent with a history of depression) are more vulnerable to developing depression in response to a life trauma, such as divorce or the death of a close friend or family member.
According to Dr. Sarita Uhr, a psychiatrist in private practice in Richardson, “In many cases, a combination of talk therapy along with antidepressant treatment is more effective than either used alone.” It is common for people to have a therapist for “talk therapy” and a psychiatrist who handles the medical part of the treatment.
So how can you tell if you’re experiencing a clinical depression or just a depression resulting from the normal ups and downs of life? Dr. Uhr says, “Everyone experiences occasional periods of feeling down from time to time. However, if you feel depressed every day for two weeks, experience difficulty falling asleep or staying asleep, have a change in your appetite, and a low sex drive, you may be clinically depressed.”
Many of the symptoms of clinical depression, such as loss of sleep, appetite, and sex drive, are responsive to anti-depressant medication. The newest weapons in the fight against depression are a generation of specific antidepressants called the SSRIs or serotonin reuptake blockers, which increase the levels of serotonin in the brain. Examples of the SSRIs include Prozac, Paxil, and Zoloft. They have become the new first-line treatment for depression. Their most common side effects include diarrhea or nausea, headache, insomnia, agitation and difficulty reaching orgasm.
For proper diagnosis of depression and administration of antidepressant medication, consult a physician. The majority of people who are treated with antidepressant medication respond favorably, and most are able to resume their normal activities and lifestyle during and after treatment. Many people find regular counseling useful as well.
For more information, call the National Foundation for Depressive Illness, Inc. at 800-248-4344 for nationwide referral lists of university medical centers and physicians who specialize in the treatment and for patient support groups.
Are You Depressed?
I feel downhearted, blue, and sad.
I don’t enjoy the things I used to.
I feel that others would be better off if I were dead.
I feel that I am not useful or needed.
I am losing weight.
I have trouble sleeping through the night.
I am restless and can’t keep still.
My mind isn’t as clear as it used to be.
I get tired for no reason
I feel hopeless about the future.
Rating your responses: If you agree with at least five of the statements, including either item 1 or 2, and if you have had these symptoms for at least two weeks, professional help is strongly recommended. If you answered “yes” to statement 3, get help immediately.
–National Foundation for Depressive Illness Inc.
Self-Help For Depression
Note: The following suggestions may be useful as supplements to a course of medical treatment prescribed by a physician, but are not intended to replace it. If you suspect you may be depressed, make an appointment with a medical professional.
Get outside at least once a day for a walk by yourself.
Light exercise of any kind can be very helpful.
Don’t fight the depression–try to accept it as an illness.
If your appetite is low, eat small nutritious snacks and have other people cook for you, if possible.
Delay any big decisions about work, marriage, or money until you feel better.
Don’t trust your memory–take notes and make lists.
Avoid being home alone for long periods of time–the depressive thoughts can get worse when no one is around.
If you have to do some work, do it in the afternoon or early evening. Energy and interest are usually best at these times.
–Mood Disorder Association
The Mystery of Hepatitis C
When Mary White*, 42, was told 11 years ago by her doctor that she had elevated liver levels, she shrugged it off as a minor problem that was probably caused from “drinking too much.” Five years ago, when she went to donate blood for her back surgery, she was told that she carried hepatitis C antibodies. She was asked if she had ever had a blood transfusion or done IV drugs. Because the answer was no to both questions and she had no symptoms, she says, “I blew it off.” Two years ago, when she went to the doctor for her annual checkup, she was told she had hepatitis C.
Mary’s experience, unfortunately, is not uncommon. According to the Hepatitis International Foundation, each year, about 28,000 Americans contract hepatitis C, an RNA virus which is a common cause of inflammation of the liver. Although the disease affects almost four million Americans in the U.S., many people are unfamiliar with it. Originally called non-A non-B hepatitis, the virus was discovered in the mid-1970’s, but it wasn’t until 1989 that a test for identifying its specific antibodies became available.
The World Health Organization estimates that there are approximately 100 million chronic HCV persons worldwide who are at risk for progressive liver disease. About 70% to 80% of all carriers will develop chronic liver disease, regardless of whether or not they have symptoms.
Although the virus is found in blood, it is not yet clear whether semen or saliva can actually transmit HCV. It may be transmitted by using razors, needles, toothbrushes, nail files, tattooing, body piercing, or acupuncture needles used by an infected person. All people with HCV are potentially infectious.
With so many people chronically infected with the HCV, Hepatitis C is probably the single most important cause of chronic liver disease, cirrhosis, and liver cancer in the Western world. It is currently the major indication for liver transplantation in the U.S.
Mary White was lucky. After beginning treatment, she is currently free of symptoms and shows no early signs of cirrhosis or cancer. She says, “I have side effects from the interferon, but mostly just headaches and muscle aches the day after the injection…my doctor tells me that we won’t know for sure if I am a responder until after 12 months, but my blood tests look pretty good.”
Symptoms of HCV
One of the most insidious things about hepatitis C is that many people who are infected with the virus have mild or no symptoms. The most frequent complaint is fatigue. Other symptoms can include nausea, poor appetite, fever, headaches, muscle aches, and weight loss. There may or may not be jaundice (yellowing of the skin and eyes).
The incubation period varies but averages about seven to eight weeks. An infected person’s liver test may range from being elevated to being normal for various lengths of time. Even if an infected person has a normal liver test, he or she may carry the virus and can transmit the disease to others. After being infected, there are three possible scenarios that may occur: you may go on to clear the virus from your body; you may become a healthy carrier; or you may experience chronic hepatitis, which can cause long-term liver damage.
Often an asymptomatic patient will learn of his or her hepatitis infection through a routine physical examination or while donating blood. It is frequently detected only by elevated liver enzyme tests. Diagnosis of the hepatitis C virus can be determined with a simple and specific blood test that detects antibody against HCV. It’s important to realize, however, that this test is not part of a routine physical, and you must specifically request it from your physician in order to receive it.
If the initial test if positive, a second test will be performed to confirm the diagnosis and measure the level of liver enzymes. Unfortunately, few people are able to completely clear the virus from their blood. Over 80% of the cases reported each year become chronic, where liver enzyme levels remain elevated for at least six months after the initial acute infection.
Living With HCV
Currently, there is only one specific treatment for chronic Hepatitis C: Interferon. Interferon is a genetically engineered form of a naturally-occurring protein that is usually administered by injection. Because it frequently causes side effects such as headache, fever, fatigue, and depression, HCV patients must be assessed carefully and monitored frequently during treatment.
Although there is presently no proven alternative to Interferon as the primary treatment of chronic HCV, some patients have experienced success by practicing a holistic lifestyle and utilizing supplemental therapies that strengthen the immune system. According to Prescription for Natural Healing by Dr. James Balch (Avery Publishing Group, 1997), all B vitamins are essential for normal liver function. Dr. Balch recommends taking 50-100 mg of vitamin B complex three times daily with meals. The book also recommends a number of herbs that may be beneficial, including milk thistle, burdock, dandelion, and black radish.
If you have HCV, it’s important to learn how to pace yourself and rest when you feel tired. Try to maintain a positive attitude, get moderate exercise, and eat a well-balanced diet. Avoid all fats, sugar, and highly processed foods, and eliminate alcohol from your diet.
To reduce your risk of contracting HCV, be sure to clean up blood spills with household bleach. Use care when handling anything that may have the blood of an infected person on it such as razors, scissors, nail files, etc. Although it is believed that HCV is transmitted only occasionally through sexual contact, always practice safe sex using a latex condom.
* Mary White is not her real name.
Are You At Risk?
People who are most at risk of acquiring hepatitis C include anyone who has had a blood transfusion before 1990, IV drug users, hermodialysis patients, those with tattoos, people who have unprotected anal sex, and those with multiple sex partners. Body-piercing and cocaine snorting also are risk factors. However, an estimated 10% of partners have no identifiable history of exposure to the virus. If you have concerns about hepatitis C, discuss with your doctor whether or not you should have the diagnostic test.
For referrals to specialists in your area, contact the Hepatitis Foundation International at (800) 891-0707.
Search for a Cure
Can you imagine not being able to recognize the spouse that you’ve spent the last 30 years of your life with? Or not being able to remember the names of your children? Sadly, it’s happened to people who have Alzheimer’s disease. And there are currently more than four million Americans who suffer from it, including former President Ronald Reagan.
Alzheimer’s disease (AD) is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking, and behavior. While it may strike when a person is in his or her forties, it is most common in older Americans, afflicting 10 percent over the age of 65, and as many as 50 percent of those over 85. And as the American population continues to age, that number is expected to increase to about 14 million Alzheimer’s victims by 2030.
The disorder usually has a gradual onset, with early symptoms such as difficulty remembering certain events and performing familiar tasks. The Alzheimer patient may also experience confusion, personality change, behavior change, impaired judgment, and difficulty finding words, finishing thoughts, and following directions. Ginny Chambers,74, remembers all too clearly the symptoms that her husband, Jay displayed during an eight-year battle with Alzheimer’s. She says, “It started with odd little things…he was always such a perfectionist about changing his clothes, and then one day he wouldn’t let me wash them. He wanted to wear them all the time…We’d been going to the same church for 30 years, and he wouldn’t recognize his friends there anymore. He’d go up to people who looked familiar and talk to them, and then he’d ask me later, ‘Who was that in the gray suit?’…Eventually, he became totally incapacitated. I had to bathe and change him. The last six months of his life, he would smile at me, but he didn’t talk at all.”
Diagnosis of Alzheimer’s
According to Julia Lothrop, M.S., assistant professor in the department of gerontology and geriatric services at UT Southwestern Medical Center at Dallas and director of the Education Core activities for the Alzheimer’s Disease Center, “A clinical diagnosis of AD is made by first eliminating other possible conditions such as depression, metabolic changes, nutritional deficiencies, adverse drug reactions, and stroke.” Alzheimer’s is now known to be characterized by a specific set of physiological changes in the brain. Nerve fibers surrounding the hippocamus, the brain’s memory center, become tangled, and information is no longer carried properly to and from the brain. Alzheimer patients have been found to lack the brain chemical acetylcholine, which is involved in the processing of memory by the brain.
In addition, Dr. Roger Rosenberg, director of the Alzheimer’s Disease Center at UT Southwestern and professor of neurology and physiology, notes that researchers studying AD are now finding a number of genetic mutations related to chromosomal abnormalities.Because the disease seems to run in families, researchers believe that there may be a genetic factor.
Ongoing Research Continues
Although there is currently no treatment available to stop or reverse the mental deterioration characteristic of AD, there is real hope on the horizon. There are currently several experimental drugs being studied for the treatment of Alzheimer’s disease at study sites nationwide. The Alzheimer’s Disease Center (ADC) at UT Southwestern evaluates people for Alzheimer’s disease at its Harry Hines Boulevard location and at satellite clinics across Dallas. It is one of only 28 centers in the U.S. to receive funding from the National Institutes of Health for research on Alzheimer’s.
Dr. Myron Weiner, vice chairman for clinical services for the Department of Psychiatry, director of UT Southwestern’s Alzheimer’s Disease Center’s Clinical Core, and holder of the Harbin Chair for Alzheimer’s Disease Research, says, “We are encouraged by the number of new medications being developed for Alzheimer’s…Although only two drugs are currently approved for use in the U.S. (Cognex and Aricept), two additional drugs, Exelon and metrifonate, are expected to be approved by the FDA soon for use in the U.S.–possibly as early as this year.”
Exelon was approved for use by the Swiss government in August of 1997 based on a study of more than 3,300 European and American Alzheimer’s sufferers. Compared with those taking a placebo, those taking Exelon retained their memories longer and were better able to handle activities of daily living. The other promising new drug, metrifonate, acts similarly to Cognex and Aricept. All three are cholinesterase inhibitors, agents that slow the breakdown of acetylcholine, a neurotransmitter crucial to cognitive functioning. In a 26-week study of metrifonate with more than 400 participants with diagnoses of mild to moderate Alzheimer’s, those taking the placebo deteriorated significantly, but those taking metrifonate did not, except for some minor cognitive loss at the end of the six-month trial.
Other research to date has revealed a number of interesting clues, many which point to nutritional deficiencies. For example, people with Alzheimer’s tend to have low levels of vitamin b12 and zinc in their bodies, which are important in cognitive functioning.Levels of antioxidant vitamins A and E and the carotenoids also tend to be low. Many researchers also believe that beta-amyloid, which is produced in virtually every cell in the body as a result of the degeneration of tissue, may be a key player in the disease.
Although all of these findings offer hope, science does not yet have a conclusive answer on what can be done to prevent the mental deterioration. Even diagnosis of the disease is not a precise science. Right now, there is no single laboratory procedure or biochemical marker that can definitely confirm the disorder in a living person.
However, many researchers are becoming cautiously optimistic that in the not-too-distant future, new treatments should be able to delay the onset of the disease, and to slow the debilitating mental deterioration that it causes. According to Lothrop, “There are a number of health care professionals who are predicting that in the 21st century, it will become a reasonably manageable chronic illness.”
Is it Alzheimer’s or Normal Memory Loss?
As they age, many people worry that their forgetfulness is a sign of Alzheimer’s disease. According to Doris Svetlik, administrative director of UT Southwestern Medical Center’s clinic for Alzheimer’s, “Some families often assume elderly relatives are developing Alzheimer’s disease when they fail to remember a conversation or lose their car keys. Some memory loss due to lack of concentration is normal for all of us. But persistent confusion and memory loss interfering with normal, routine activities can indicate a medical disorder, and a thorough medical evaluation should be sought.”
A good example of the difference between dementia and forgetfulness is the following: if you don’t remember where you put your glasses, that is forgetfulness; if you do not remember that you wear glasses, that may be sign of dementia.
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Providing One-Stop Care for Cancer Patients
It’s everyone’s worst nightmare: you walk into your doctor’s office one afternoon for a routine physical, feeling fine, and you’re told that you have cancer. Hard to believe, but it happened to Eugene (Gus) Mussett, a 58-year-old industrial trainer from Allen, Texas, just over two years ago, when a urologist first diagnosed him with prostate cancer. “It was the biggest shock I ever had,” he recalls.
Unfortunately, Gus’s experience is far from unique. According to the American Cancer Society (ACS), prostate cancer is the No. 2 cancer killer of men in America (after lung cancer). More than 185,000 new cases of prostate cancer in the United States are discovered each year, and about 39,000 men die from the disease annually.
Since prostate cancer is often asymptomatic in its early, curable stages, it’s important for men to be aware they are at risk. The ACS recommends that all men over the age of 50 ask their doctors about having a PSA (Prostate Specific Antigen) blood test and a digital rectal exam annually. Although researchers are uncertain what causes prostate cancer, there are certain risk factors linked to the disease, including age, diet, and genetic links. Because of this, men in high-risk groups such as African-Americans and men with family members who have had prostate cancer should talk to their physicians about starting the screenings even earlier, in their 40s. The earlier the diagnosis, the better the odds for successful treatment.
As soon as he was diagnosed, Gus began exploring his options. “I immediately starting trying to figure out what the best methods of treatment were and what was available,” he says. Through research and referrals, he soon discovered the Arlington Cancer Center right in his own backyard of North Texas. With the motto of “Practically everything a cancer patient needs, under one roof,” the Center completes over 200 outpatient treatments daily-more than 55,000 a year-for nearly every type of cancer. Lab Director Kathy Ferguson says, “We have people come here from all over the world. It’s not unusual to have people from 8 to 10 states and two countries represented here in a day.”
What’s attracting that international crowd is a staff of leading physicians, Ph.Ds, nurses, technologists and therapists that provide comprehensive cancer treatment in a compassionate, personalized atmosphere. Arlington’s range of services includes autologous bone marrow and stem cell transplantation; chemotherapy; brachytherapy, or radioactive seeding; breast cancer treatment; diagnostic radiology; radiation therapy; a prostate seeding program; an onsite pharmacy; and three laboratories, including a bone marrow lab that tests, processes and stores patients’ bone marrow.
“Nobody wants to be treated for cancer, but if you have it, this is a good place to be. We have excellent doctors and caregivers. We try to make it as easy as possible on our patients and provide everything they need right here,” Kathy says. “…When you’ve got cancer, you don’t want to run around town to five different places to try to get your prescription filled.”
Arlington is one of only a few treatment centers nationwide using a computer system for three-dimensional reconstruction and analysis of diagnostic images, which results in more clearly-defined tumors and enhanced diagnostic accuracy. Kathy says, “We have the ability to diagnose earlier than ever before. There’s been a huge improvement in the specificity and the increased number of protocols available for diseases.”
Arlington’s approach to fighting cancer involves a multi-disciplinary program. In Gus’s case, a combination of hormone, radiation, and implant therapy was used over the course of several months. He experienced virtually no side effects from his treatment, which he attributes to the expertise of the staff and the specificity of the equipment used to limit radiation to the tumor area, which minimized damage to the healthy surrounding cells. At his last checkup, he was symptom-free, and his PSA registered well within the safe range. “I’m as normal as anyone can be,” he says.
Today, Gus’s aftercare involves a physical every three months to monitor his PSA level and ensure that he remains in remission. Looking back, he says that it was the staff at Arlington that made the experience as positive as possible under the circumstances.“It was a lot easier to go through because of the people involved. If the people around you are up, it’s a whole lot easier to do disagreeable things,” he says. “Everyone is extremely professional, knowledgeable, and efficient, but it doesn’t feel like a hospital atmosphere. I’ve never run into anyone there who wasn’t smiling, who wasn’t willing to stop and answer your questions. You’re not just someone going through the system on a conveyor belt: they know you by name. I don’t know how they do it.”
Kathy agrees that there’s something special going on at Arlington Cancer Center. “We have a very unique staff. The people that work here love this facility and their patients, and it shows…Anybody can have high-tech. Not everyone can give these patients the love and support they receive here,” she says.
For more information on Arlington Cancer Center, check out their website at http://www.acctx.com. The website for the American Cancer Society is at http://www.cancer.org.