Monthly Archives: October 2013

Could you be almost depressed?

Psycological Health

Could you be almost depressed?

2013-10-28

By Shelley Carson, Special to CNN

Man behind a window
Man behind a window

Editor’s note: Shelley Carson is an associate of the Department of Psychology at Harvard University. She’s the co-author of “Almost Depressed: Is My (or My Loved One’s) Unhappiness a Problem?“

Consider whether the following questions describe you or someone you love:

Are having trouble enjoying things in life that used to be fun?

Do you find that you are constantly irritable and overreacting to petty incidents? Are you are regularly finding excuses to avoid spending time with friends or family?

Does it seem like you’re “just going through the motions” and barely getting through the day? Do you feel overstressed and believe there is no way you can ever catch up with what you have to do?

If any of these questions rings true, you may be almost depressed. And you are not alone. Research suggests that as many as 12 million people in the United States may be suffering from low-grade depression symptoms that are not severe enough to warrant clinical treatment.

Almost depression is not a mental disorder. It is a state of low mood that can leave you exhausted and de-energized, keeping you from savoring life and working at your peak performance level. It is a gray area of mood problems that lies on a continuum between the ups and downs of normal mood, and full-blown major depression.

(You may wonder how you can tell if your mood symptoms put you in the almost depressed range, or if they are serious enough to be considered major depression. If you are thinking about death or suicide, have lost a significant amount of weight because of appetite changes, or have feelings of hopelessness or extreme guilt, or if you believe your symptoms may be severe enough possibly to warrant a diagnosis of major depression, please contact a mental health professional.)

At Harvard Medical School, we have been investigating the effects that almost depression and other subclinical conditions can have on an individual’s quality of life. People who are almost depressed report a number of issues, including lower job satisfaction, lower satisfaction with their marriage and other personal relationships, more anxiety issues, less control over their lives and lower overall well-being than people who do not fall into the almost depressed range.

In fact, on some of these measures, people who are almost depressed report feeling worse off than people who actually fall into the clinically depressed range. Clearly, even though almost depression does not rise to the level of a diagnosable mental disorder, it is nevertheless associated with a substantial amount of distress and suffering.

There is also another more serious problem: Research indicates about 75% of cases of low-grade depression will devolve into full-blown major depression if they are not recognized and arrested.

Major depression is a deadly disorder. People who are depressed have four times the risk of heart disease and almost six times the risk of dying after a cardiac event than people who are not depressed.

People who are depressed also have between nine and 16 times the risk for suicide than people who are not depressed.

It is therefore vitally important to recognize the symptoms of almost depression in yourself and your loved ones, and to take steps to reduce the suffering it causes.

There are a number of things you can do to combat almost depression that have been shown to be effective in randomized clinical trials (the gold standard of treatment testing). Here is a list of some these “evidence-based” steps:

Make sure you are getting enough exercise. The minimum amount for treating depression is 30 minutes of continuous aerobic exercise (70% to 85% of maximum heart rate) plus a 10-minute warm-up and cool-down period three times a week.

Integrate activities you have found pleasurable in the past into your weekly calendar. Even if you feel that you no longer enjoy them, such activities will increase the activation of the pleasure centers in your brain. As your symptoms resolve, you will regain pleasurable feelings.

Use creative outlets to express your negative feelings. You don’t need experience or talent to express yourself creatively, so paint, write or play music. Expressive creative work reduces depressive symptoms.

Manage your stress level. Stress has negative effects on both the brain and the body and can be a major source of depressive symptoms.

Challenge the way you think. Our moods are dependent not upon what happens to us in our lives, but in how we interpret what happens. Changing your interpretation has been shown to reduce depressive symptoms.

Increase your level of mindfulness. Mindfulness training and practice is an effective way to keep depression at bay.

Reduce the power you give to your “inner critic.” Often the negative and critical things we say to ourselves lead to feelings of depression and powerlessness.

Increase your social support circle. Having a strong social support system is a known protective factor against depression.

Improve your self-care. Poor nutrition and poor sleep habits can augment feelings of depression. In some cases, specific nutritional supplements can work wonders.

The steps that work for you will be dependent upon your specific signs and symptoms, the severity of your symptoms and your personality. If one step doesn’t work, do not give up.

There are many pathways to wellness, and with patience you will find the way that works for you.

You don’t have to be almost depressed. You can take charge of your symptoms and make your way out of the gray shadows and into the full light of good mental health.

How Sweden’s New Text Message Plan Is Saving Cardiac Arrest Victims

Behaviour

How Sweden’s New Text Message Plan Is Saving Cardiac Arrest Victims

Trained volunteers receive notifications in order to shave crucial minutes off emergency response times.

By using text messages, the city of Stockholm, Sweden is getting emergency responders to cardiac arrest victims faster.

Here’s how it works. Volunteers who are trained in CPR are added to a network called SMSlivräddare, (or SMSLifesaver). When a resident dials 112 (the equivalent of 911 in the states), a text message is sent to all CPR volunteers who are within 500 meters of the person needing emergency care. This way, a volunteer may get to the patient faster than an ambulance.

The likelihood of survival from cardiac arrest drops 10% for every minute it takes first responders to arrive. CPR administered by bystanders has been found to significantly increase the likelihood of survival, but not everyone feels comfortable doing it, or even knows how.

SMSlifesavers is run by Stockholm South General Hospital and the Karolinska Institute and currently has 9,600 registered volunteers. According to Quartz, there are about 200,000 Swedes who have undergone CPR training and could participate.

SMSlifesavers’ spokesperson, Dr. Mårten Rosenqvist, told Quartz that traditional ambulance services have trouble reaching cardiac arrest victims in teh Stockholm area due to lack of vehicles, traffic and other patient duties.

New Definition of “Full-Term” Pregnancy Presents Other Problems

Reproductive Health

New Definition of “Full-Term” Pregnancy Presents Other Problems

2013-10-23

By @ProfEmilyOsterOct. 22, 2013

Big news for women who are 38 weeks pregnant: you are no longer considered “full term.” The American College of Obstetricians and Gynecologists (ACOG) announced today that they would introduce a new classification system for the end of pregnancy.  Previously women who were 37 to 41 weeks pregnant were all considered “Full Term” and women 42+ weeks “Post-term”.  The new classification system calls for four groups:  “Early Term” (37-38 weeks), “Full Term” (39-40 weeks), “Late Term” (41 weeks) and “Post-term” (42+weeks).

I know, that’s a lot of terms. But the big change here is to separate out the 37 to 38 week period and acknowledge that, for most babies, this isn’t the ideal time to be born. Evidence has been piling up that babies born in this period do worse than babies born at 39 or 40 weeks. One very recent paper shows babies at 37 to 38 weeks are more likely than those born later to need time in the NICU, mechanical ventilation and IV fluids. But as induction and scheduled C-sections have become more common, the share of babies born at 37 or 38 weeks has risen from 17% in 1983 to 27% in 2009. Many of these deliveries are elective and driven, at least in part, by the perception by women (or their doctors) that things are ready to go at 37 weeks. The push to reduce these early-term deliveries has been going on for years.

This change in wording could make a big difference in practice. Early term births are expensive because of their added complications and by explicitly distinguishing them it makes it easier for insurers to refuse to cover elective births in this period. The problem, however, with having a strict guideline like this is that sometimes people start to treat it the cutoff itself as meaningful.

It is worth reflecting back on why this change is even necessary.  The idea that 37 weeks is “full term” is intended to be descriptive.  As pregnancy moves forward, the baby becomes more developed.  Among the last organs to develop are the lungs, and usually this happens by 37 weeks, so calling 37 weeks “full term” is simply an acknowledgement of this. But women, and their doctors, can start to think that when you move from 36 weeks 7 days pregnant to 37 weeks 0 days pregnant there is a magic switch which means your baby is ready.  This is obviously not the case.

This is illustrative of a broader issue, in medicine and elsewhere, with any kind of sharp rule-like cutoff.  In one example, researchers have shown that as a result of drawing the cutoff for very low birth weight at 1500 grams, babies born right below 1500 grams of weight actually have better outcomes than those right above, because they are given extra treatment.  Again, there is nothing biologically special about 1500 versus 1499.  The cutoff is descriptive, and when it’s treated as a rule, odd things happen. The same issues come up in finance, closer to my own field, when looking at lenders who used sharp cutoffs in credit scores in deciding who to lend to.  There is nothing special about a credit score of 620 compared to 619, and when you treat it like there is, you can get into trouble.

The worry, of course, to return to the babies, is that what is happening here is we are replacing one rule with another. The new guidelines fix one issue, but could lead doctors (in theory) to be too cautious about delivery in 37 or 38 weeks when medically warranted. It could also lead them to be too gung-ho about delivery as soon as you hit 39 weeks. The best case would be if women and their doctors took these terms as they are intended— as descriptive guidelines, not rules—and got better about letting nature take its course unless there is a medical reason not to.  If that happens, this truly will be a major change, and not just for the women at 38 weeks.

 

Pregnant woman holding belly
Pregnant woman holding belly

Deep-Voiced Men Make Bad Mates: Study

Behaviour

Deep-Voiced Men Make Bad Mates: Study

2013-10-22

By @youselessOct. 17, 2013

Smiling couple talking on bed in modern home
Smiling couple talking on bed in modern home

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Men with deeper voices have an advantage in attracting women, but mostly if they’re looking for a fling, new research suggests.

Researchers at at McMaster University in Ontario, Canada have previously reported on the link between the depth of a guy’s voice and his attractiveness to women. They also figured that guys with lower voices, and hence probably more testosterone, were more likely to cheat (they were right). What they couldn’t work out was why women preferred the men who were probably going to be cads. So they went back to the audiotape.

In the new study — which may also provide some insight into why Isaac Hayes songs are forever a popular choice for the boudoir — researchers had women listen to men’s voices and asked them first if they thought the speaker was a faithful sort of guy. Then they were asked if they fancied the owner of the voice for a long or short-term relationship. The deep-voiced men were chosen more often for short term relationships, but mostly by certain sorts of women—those who had already expressed a belief that a bass voice often led to fishy behavior.

“Differences in the strength of women’s preferences were accounted for by whether or not they thought the voices belonged to a cheater,” says Jillian O’Connor, a postdoctoral fellow in the Department of Psychology, Neuroscience and Behaviour at McMaster, who was this study’s (and the prior one’s)  lead author. “Women who thought that men with lower pitched voices were cheaters liked them for short-term flings.”  The scientists defined “short-term relationship” more towards the one-night-stand than the May to December fling.

The women who didn’t associate a deep pitch with infidelity tended to prefer those guys for long term relationships. The authors surmised that some women have come to adaptively understand that more macho guys are more likely to cheat — and have thus learned to avoid macho-sounding guys for serious life partnering.

For deep-voiced males, fear not. The study was pretty small, just 87 women, and it didn’t use actual tones. The voices the women heard came from the same guy with his pitch digitally deepened or heightened. Which means the findings probably aren’t conclusive enough to cross off any baritones from anybody’s list of eligible bachelors, even if biology were destiny.

Study: Predicting Whether a Partner Will Cheat Could Be Gender-Specific

The lure for a deep voice for females may have something to do with the woman’s biology too. “Some of my other research has found that women who have more attractive faces have stronger preferences for lower pitched men’s voices,” says O’Connor. “But that was not examined in this study.” Looks like men are not the only ones who respond to siren songs.

Study: Breast Milk Sold Online Can Get Your Baby Sick

Behaviour

Study: Breast Milk Sold Online Can Get Your Baby Sick

Donated or sold breast milk contains bacteria and sometimes salmonella

By Eliana Dockterman @edocktermanOct. 21, 2013

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A small marketplace for breast milk has sprouted online, but a study published Monday confirms what health professionals suspected: Internet breast milk is often tainted.

The study, published in Journal of Pediatrics, found that breast milk donated or sold on two popular websites was often contaminated with high levels of bacteria that could make a child sick, including salmonella. Sixty-four percent of the samples were contaminated with staph, 36 percent with strep and almost 74 percent had so much bacteria that they would have failed the Human Milk Banking Association’s criteria, the Associated Press reports.

Recent research has found that breast milk protects infants from infections, so doctors have been encouraging new mothers to breast-feed rather than use formula. But not all women can do so — couples who have adopted, mothers who have mastectomies and women who simply cannot produce enough milk are forced to rely on donated or purchased breast milk.

Some turn to breast milk banks, where the Human Milk Banking Association screens donors. But banks prioritize premature infants with medical complications, and do not hold enough milk for healthy infants whose mothers simply cannot lactate.

In 2011, there were more than 13,000 postings on the four leading milk-sharing sites, the AP reports.

Reproductive Medicine’s Gift: 5 Million Babies

Reproductive Health

Reproductive Medicine’s Gift: 5 Million Babies

2013-10-21

Methods like IVF have brought 2.5 million babies into the world in the last six years alone

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About 5 million babies have been born with the help of advanced reproductive medicine since 1978, a medical group said Tuesday.

The International Committee for the Monitoring of Assisted Reproductive Technology, which represents fertility groups, unveiled the estimate at a reproductive medicine meeting in Boston. So-called Assisted Reproductive Technology (ART) includes fertility treatments like in vitro fertilization, among others.

“The number of babies born through ART is now about the same as the population of a U.S. state such as Colorado, or a country such as Lebanon or Ireland,” Richard Kennedy, a committee board member, said in a statement. “This is a great medical success story.”

According to group’s calculations, the number of ART babies grew rapidly over the last few decades. By 1990, there had been an estimated 90,000 births worldwide with the help of ART; by 2000, 900,000 births; and by 2007, 2.5 million births.

More than half of the 5 million ART babies were born in the last six years.

Don’t Let Them Smell You Sweat: You’ll Seem Untrustworthy

Behaviour

Don’t Let Them Smell You Sweat: You’ll Seem Untrustworthy

2013-10-14

By

 

Urghhh, bad smell.
Urghhh, bad smell.

There’s a reason why you should never let ‘em see — or smell — you sweat. You appear not just less confident, but less competent and less trustworthy as well.

It’s not exactly a revelation, but it is sobering — women are judged differently based on their sweat, according to a new study published in PLOS ONE. Experts in the field of perspiration have broken sweat down into three types: sweat from exercise, sweat in response to heat, and sweat from stress. Each is driven by a slightly different body process — exercise and heat sweat come from the body’s eccrine glands, which pump out clear, odorless water on the surface of the skin that is tinged with a bit of salt (these are the glands responsible for damp foreheads and clammy palms and feet). Stress sweat, however, comes from the more hirsute regions of the body — think scalp, armpits and groin — and is saturated with fats. Those aren’t odoriferous per se, but they serve as food for the bacteria that blanket the skin, and it’s those bugs that emit the hallmark BO signalling sweat under pressure.

And according to scientists from Monell Chemical Senses Center, that odor also affects how people perceive the sweatee. While previous work suggested that people changed their emotional reactions toward others based on their odor, the latest study found that people may also judge others on their compatibility and trustworthiness according to their scent.

The researchers asked 44 female participants to provide samples of underarm sweat at the start of the study, and under three different conditions — after exercising on a stationary bike for 15 minutes, after stressful events that the scientists created, and after the same stressful events but treated with an antiperspirant. The anxiety-producing exercises included preparing a speech for five minutes, doing mental math problems for five minutes, and five minutes of public speaking. Secret provided its Clinical Strength antiperspirant and funded the study, but did not influence its design or data, according to the scientific team.

The researchers then asked 120 male and female volunteers to smell the various sweat samples while watching videos of the women who provided the samples as they went about their daily duties at home, in the office or in a childcare setting. The evaluators rated the women they saw on how stressed or confident they appeared. Those who smelled samples of untreated stress sweat were significantly more likely to say the women to whom the samples belonged were more stressed than those who smelled the treated sweat. What’s more, men were more likely to see the stress-sweating women as less confident, trustworthy and competent when they were asked about those characteristics.

Although the researchers only looked at women for this study, the authors say that prior research showed that inhaling the body odors from men under stress also induced anxiety in female subjects.

The scientists say this is the first study to link sweat odor to social perceptions, so it’s too early to say whether perspiration odor in all societies would have the same effect on trust and competence measures. The American culture places a premium on smelling fresh and on masking body odors, but other societies may not place as much value on hiding natural emanations. So in the U.S., the results could be a boon not just for deodorant and antiperspirant manufacturers, but for video conferencing ventures as well. The next time you’re nervous about a speech or a presentation, you might consider finding ways to not let them smell you sweat.

Transgender Showed Evolutionary Benefits in Ancestral Societies

Behaviour

Transgender Showed Evolutionary Benefits in Ancestral Societies

2013-10-09

By

 

Close-up of a couple holding hands in field
Close-up of a couple holding hands in field

A new paper published in the journal Human Nature finds that transgendered men were often seen as an asset in some societies.

Among hunter-gatherer communities, the social investments that transgender males made to their groups may have helped to sustain the transgender orientation into modern societies, say researchers led by Doug VanderLaan of the Centre for Addiction and Mental Health in Canada.

VanderLaan and his colleagues studied 146 non-transgendered societies and 46 transgender societies in both current and older hunter-gatherer societies, and found that transgender men were considered useful to their communities as extra help in supporting the family, whether by maintaining households or by contributing to the raising of children. Those benefits provided an evolutionary advantage to the societies in which they belonged, allowing them to survive and remain healthy, and that in turn provided the opportunity for transgender attributes to continue into future generations, despite the fact that many transgender males did not have biological children of their own. Not surprisingly, this effect was strongest in communities in which both male and female contributions to the health of a family — in the form of emotional, social as well as financial and political support — were considered equally important. In these communities, discrimination against homosexual activity was rare, the authors report.

In fact, that condition was critical to the positive societal contributions of the transgender males. In order for the contributions of these men to benefit the community, they had to be accepted by its members. And that remains true today — people who identify as transgender, or with any other sexual orientation for that matter, become most productive if they can contribute their time and energy to a community that accepts and welcomes their support.

Social Attitudes About Sexual Orientation May Not Be As Open As Previously Thought

Behaviour

Social Attitudes About Sexual Orientation May Not Be As Open As Previously Thought

By

 

Back of woman in t-shirt in 2008 Gay and Lesbian Pride Parade in Toronto, Canada
Back of woman in t-shirt in 2008 Gay and Lesbian Pride Parade in Toronto, Canada

We like to think we’re a progressive society that is accepting of all sexual orientations, but the latest survey shows anti-gay sentiment is higher than we think, and current methods for assessing attitudes about sexuality are not as accurate as they should be.

In a study published in the National Bureau of Economic Research, scientists found that current methods may not accurately capture both the size of the lesbian, gay, bisexual and transgender (LGBT) population as well as attitudes toward them.

Overall, it’s hard to measure sexual orientation and opinions about sexual orientation because of persistent biases toward more socially acceptable responses. Researchers have found this trend even in computer-generated surveys where responses are anonymous.

So a team from Ohio State University and Boston University compared these survey techniques to another strategy that provided even more privacy and anonymity to participants, by guaranteeing that even the researchers could not connect the volunteers to their answers. Among the 2,516 U.S. volunteers who were randomly assigned to answer questions about their sexuality using one or the other survey method, those taking the more veiled survey were 65% more likely to report a non-heterosexual identity themselves and 59% more likely to report having a same-sex sexual experience than those using the standard survey technique.

The veiled method also revealed more people with anti-gay sentiment than among those taking the other type of survey. The participants were 67% more likely to disapprove of an openly gay manager at work and 71% more likely to admit that it was acceptable to discriminate against people who are lesbians, gay or bisexual.

“Comparing the two methods shows sexuality-related questions receive biased responses even under current best practices, and, for many questions, the bias is substantial,” the authors write.

Did the enhanced anonymity lead to more truthful responses? The researchers aren’t sure, but previous studies revealed that when responses are blinded, people do tend to express attitudes and opinions that are more raw and closer to their true beliefs. The scientists also can’t explain why those who were questioned under the more veiled technique were more likely to admit to both non-heterosexual orientation or experiences as well as more bias against them. While they suspect the two trends are independent of each other, it’s possible that the results also reveal something deeper about sexuality and social acceptance — or lack thereof — of LGBT identities.

The last word on hormone therapy?

Reproductive Health

The last word on hormone therapy?

2013-10-07

 

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When Janice hit menopause, she had terrible night sweats and hot flashes, but she was scared to undergo hormone replacement therapy.

Janice (who asked that her full name not be used for privacy reasons) had heard this treatment might be dangerous to her heart, and worried about risking her health.

It’s a concern many women have shared over the past decade since the benefits of hormone replacement therapy have been called into question. A large study called the Women’s Health Initiative (WHI) was instrumental in casting doubt on these hormones.

Tuesday, scientists from the WHI released what they say is the definitive study on the safety of hormone replacement therapy (HRT).  The bottom line: It’s OK for most healthy women who have just entered menopause to take hormones for a short period of time, but the researchers do not recommend it for long-term use. The results are published in this week’s Journal of the American Medical Association.

Background

Hormone replacement therapy is used to replace estrogen and other female hormones that are no longer produced after menopause. For decades, doctors thought HRT was good for women’s hearts and prescribed it, in part, to prevent heart disease.  About 40% of menopausal women used these hormones.

In the 1990s, more than 27,000 women were enrolled in a clinical trial through the WHI. Scientists wanted to find out if HRT really prevented heart disease and other chronic diseases.  But in 2002, a major part of the trial using two kinds of hormones (estrogen plus progestin) was suspended.  Researchers found some of the participants had serious health problems, including an increased risk of coronary heart disease, breast cancer and stroke. Two years later, the remainder of the clinical trial, involving women who had hysterectomies and were on only one hormone (estrogen), was also shut down due to health concerns.

When the WHI study was suspended, it received a lot of attention, both in the medical world and in the media. Many doctors stopped prescribing oral HRT.  Today only about 10% to 15% of menopausal women still take them, experts say.

The study

For this study, scientists looked back at 13 years of research on the WHI participants. The main message is: Most menopausal women should not use long-term hormone therapy for the purpose of preventing heart disease or other chronic diseases, says Dr. JoAnn Manson, one of the principal investigators of the WHI trial and Chief of Preventive Medicine at Brigham and Women’s Hospital in Boston, Massachusetts.

The WHI research found older women taking HRT are at a higher risk of blood clots, stroke and, in some cases, heart attacks.

But for most healthy women who are beginning menopause and suffering severe symptoms such as hot flashes and trouble sleeping, HRT can be a good option.

“It’s very likely that the quality of life benefits will outweigh the relatively small risk of having an adverse event,” Munson says.

However, Munson adds, women who have a history of heart disease or breast cancer may want to avoid HRT.

Some observers hope this study will put to rest the debate over HRT.  Over the years, some doctors have been critical of the way information from the WHI HRT trials has been interpreted.

“There are some risks and there are some benefits, but the risks in the grand scheme of things are not nearly as great as they have been portrayed,” said Dr. Holly Thacker, director of the Cleveland Clinic Center for Specialized Women’s Health in Cleveland, Ohio.

“Many of my patients still fear them, out of proportion to the data. This result helps put them into perspective once again and ought to be reassuring to women with average risk,” says Dr. Nanette Santoro, chair of the Department of Obstetrics and Gynecology at the University of Colorado in Aurora, Colorado.

About 15% to 20% of women in early menopause have moderate to severe symptoms and might benefit from taking HRT, according to Manson. Health care providers now often prescribe lower doses of oral HRT or potentially safer options such as the hormone patch, gels or vaginal creams.

For Janice, talking to her doctor put her mind at ease.

“My doctor explained the pros and cons of hormone therapy, assuring me that for me it was a good option,” says Janice. “My night sweats are pretty much gone.”