Recovery Michigan

Scientists say they have settled one of medicine's biggest debates after a huge study found that anti-depressants work.

The study, which analysed data from 522 trials involving 116,477 people, found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills.

But it also showed big differences in how effective each drug is.

The authors of the report, published in the Lancet, said it showed many more people could benefit from the drugs.

There were 64.7 million prescriptions for the drugs in England in 2016 - more than double the 31 million in 2006 - but there has been a debate about how effective they are, with some trials suggesting they are no better than placebos.

The so-called meta-analysis, which involved unpublished data in addition to information from the 522 clinical trials involving the short-term treatment of acute depression in adults, found the medications were all more effective than placebos.

However, the study found they ranged from being a third more effective than a placebo to more than twice as effective.

Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: "This study is the final answer to a long-standing controversy about whether anti-depressants work for depression.

The most effective:

• agomelatine
• amitriptyline
• escitalopram
• mirtazapine
• paroxetine

The least effective:

• fluoxetine
• fluvoxamine
• reboxetine
• trazodone

"Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin."

However, Prof Pariante said the paper did not improve understanding of how to help patients who had treatment-resistant depression and who were not helped by taking any of the 21 tested drugs.

However, heavy drinking is more robustly linked to an increased risk of dementia. This appears to be for a number of reasons.

Firstly, when alcohol is broken down in the body, it produces acetaldehyde, which is toxic to brain cells. Heavy drinking can also lead to thiamine deficiency and, eventually, Wernicke-Korsakoff syndrome, which negatively impacts brain function.

Alcohol misuse is associated with other factors that can influence brain function, such as epilepsyand head injuries. On top of this, alcohol consumption raises the risk of vascular dementia due to its effect on the vascular system as a whole — for instance, it increases blood pressure.

Although the above factors adequately explain why alcohol abuse and dementia may be linked, the exact size and scale of the issue is not clear.

Across the same time period, there were almost 1 million people diagnosed with alcohol use disorders, most of whom had an alcohol dependency diagnosis, too. According to the study authors, alcohol use disorder was "defined by the chronic harmful use of alcohol or alcohol dependence."

Of the dementia cases, around 3 percent were directly attributed to alcohol. But when the team looked at only the early-onset dementia cases, the percentage was much higher.

Even when looking at all types of dementia, alcohol appeared to play a larger part than previously thought. Overall, alcohol use disorders were associated with a threefold increase in the risk of all types of dementia. And importantly, they were found to be the most significant modifiable risk factor for dementia.

When alcohol-related brain damage was excluded, alcohol use disorders still doubled the risk of vascular and other dementias. Even when adjusting the data for confounding variables, the link remained significant.

Inflammation is a word we are hearing more and more. Studies show that inflammation may be the root cause of many diseases in the body.

The body responds to stress by creating an inflammation. For example, if you catch a cold, your body may become fevered. Your body is heating up to try to get rid of the virus. But if we stayed in that inflammatory state all the time, it could cause damage in other ways inside the body; problems like aging too quickly, infections, skin conditions, digestive issues, cancer, arthritis and so much more.

Inflammation can be caused by:

· Food sensitivities

· An imbalance of bacteria in the gut

· Toxins from the environment or food we eat

· Lifestyle

· Stress.

"To date, opioid-tapering research reports on costly and largely inaccessible inpatient programs or resource-intensive structured outpatient opioid reduction programs," Darnall told MedPage Today. "We tested a community-based, voluntary opioid tapering approach that any prescriber can implement with limited to no resources, just some basic training in methodology."

To lessen withdrawal symptoms, physicians decreased opioid doses up to 5% for up to two dose reductions in the first month. In months 2 to 4, patients were asked to reduce doses by as much as 10% per week, with increments tailored to each patient. Physicians monitored patients with close clinical follow-up at least once a month, adjusting doses as needed.

After 4 months, researchers administered follow-up surveys. Of 82 patients, 31 did not complete the 4-month survey and were considered to have dropped out of the study. Depression negatively correlated (P=0.05) and baseline marijuana use positively correlated (P=0.04) with completing the study.

To confirm results of the 51 patients who finished the study, researchers reviewed medical records, periodic urine tests, and the state Prescription Drug Monitoring Program (PDMP), and found no aberrations in compliance or prescriptions.

At baseline, the median daily MME of study completers was 288 mg and they had a median of 6 years of opioid use. Pain intensity was 5 out of 10 on a numeric pain rating.

After 4 months, the median daily MME dropped to 150 mg (P=0.002). Pain intensity (P=0.29) and pain interference (P=0.44) did not increase.

This research shows dose and duration may not be as important as we think, Darnall observed.

"Common lore is that patients taking high dose opioids are unlikely to have successful outpatient opioid taper results -- or if they have been taking opioids for years or even decades they will likely have a poor taper response," she said. "To the contrary, we found that starting dose and duration of use did not predict taper response."

Let's say you're a scientist, and you've invented what you think is a useful treatment for pain. But you have a problem. You don't have the money to go through the regulatory approval process. Should you try to sell it to consumers anyway, and run the risk of being accused of selling snake-oil?

That's the dilemma Ted Price and his colleagues faced. Price is a researcher at the University of Texas, Dallas. His work focuses on solving a vexing question about pain: why does pain persist even after injuries heal?

Price experienced this himself, from basketball injuries that hurt long after the initial swelling and inflammation went away.

To find the answer, Price and his colleagues focused on chemical signals sent inside nerve cells. They found that a lot of chemical pathways used by these signals were activated inside nerves immediately after an injury, but just two pathways remained activated when pain persisted.

"We had this really great idea a long time ago, that was 2009," says Price. "We would inhibit one of these pathways, and that would solve pain."

There was one small problem with this really great idea. "We were completely wrong," he says. Shutting down just one pathway had no effect on pain.

But they eventually found a compound that seemed to shut down both pathways, acting like a kind of fire extinguisher to the persistent pain signals. It was a natural compound called resveratrol.

You may have heard of resveratrol. It's a compound in red wine that was supposed to have all sorts of healthful properties. Wine, however, doesn't have enough resveratrolto provide any real benefits. But Price and his colleagues were able to show that using concentrated resveratrol in a cream applied to the skin relieved pain in animals.

Under U.S. Food and Drug Administration rules, Price didn't need to do a clinical trial in order to sell the cream, as long as he didn't make any specific claims that resveratrol would ease pain.

"We just eventually decided that it was better to get this out there than to continue to try to raise the money, and run the risk of never getting it into the hands of people that it can help," he says.

The FDA is looking at whether gabapentinoids are an addiction threat, FDA Commissioner Scott Gottlieb, MD, said Thursday.

Gabapentinoids such as pregabalin (Lyrica) as well as the original agent gabapentin (Neurontin) are approved to treat a variety of conditions, including post-herpetic neuralgia, fibromyalgia, and neuropathic pain associated with diabetes, and "some literature suggests that clinicians may be prescribing these drugs off-label ... as alternatives to opioids, outside approved indications," Gottlieb said at a meeting here on safe opioid prescribing, sponsored by the Duke Margolis Center for Health Policy.

"Our preliminary findings show that abuse of gabapentinoids doesn't yet appear to be widespread, but use continues to increase, especially for gabapentin," he said. "FDA is investigating whether abuse or misuse is also increasing and if so, what should be done to address this problem."

Although the data are limited, they do suggest that gabapentinoid abuse and misuse "may be growing, both [when] taken alone and in combination with opioid, benzodiazepines, or other central nervous system depressants," Gottlieb continued. "We're concerned that abuse and misuse of these drugs may result in serious adverse events such as respiratory depression and death. We want to understand changes in how patients are using these medications."

Last week, Congress passed the Family First Prevention Services Act, a sweeping reform of the child welfare system as part of a larger spending package. The measure allows states to use federal foster care matching funds for prevention services addressing mental health, substance use and parenting skills to keep at-risk children from entering the foster care system. The Act also limits federal reimbursements for foster youth who are placed in congregate care settings. After coming close to passage in 2016, the Family First Act was tucked into last week’s massive budget deal, fast-tracking its enactment.

PREVENTION SERVICES

The main provision of the Act will allow states to use funds derived from Title IV-E of the Social Security Act – the entitlement that pays for child welfare – for “time-limited” services aimed at preventing the use of foster care. Currently, Title IV-E funds are only used as foster care maintenance payments or as assistance to adoptive families. For parents of children who are candidates for foster care, states can elect to provide up to 12-months of mental health services, addiction treatment or in-home parent skill training with the goal of keeping the child with their parent(s) or a biological relative. Notably, these time-limited prevention services would not be subject to the Title IV-E income eligibility requirements for the child or parent.

Additionally, the Act would support residential addiction treatment facilities that allow for children to live with their parents as the parents receive treatment. For instance, if a child meets the IV-E foster care income tests, then a state can seek IV-E reimbursement for a child placed in a residential addiction treatment facility alongside their parent. There must be a formal recommendation made for the placement, and the facility must provide parenting and counseling sessions, in addition to rehabilitation services.

CONGREGATE CARE

Ms. L. always showed up 10 minutes early for her appointments, even though I always ran late. Her granddaughter would rest her cheek against Ms. L.’s chest, squishing one eye shut, and scroll through Ms. L.’s phone while they waited. After reviewing her blood sugars, which Ms. L. recorded assiduously in a dog-eared blue diary, we’d talk about smoking cessation. That was a work in progress. “There’s just nothing like a cigarette,” she’d sigh. “Don’t you ever start,” she’d admonish her granddaughter, kissing the top of her head.

One day, I knew something was wrong the moment I opened the door. Ms. L. was alone. Sweat dotted her lip and forehead. She closed her eyes and looked away, and tears fell onto her lap. “I need help,” she whispered, and it all came out: she had taken a few of the oxycodone pills prescribed for her husband after a leg injury, then a few more from a friend. And like a swimmer pulled into the undertow, she was dragged back into the cold, dark brine of addiction. I tried to hide my shock. I’d known she was in recovery from opioid use disorder (OUD), but it had simply never come up. She hadn’t used in decades.

I evaded her question: “I don’t have the right kind of license to prescribe it,” I said. “Let me refer you to a colleague.”

But my incomplete answer gnawed at me. In truth, the reason I didn’t have a waiver to prescribe buprenorphine was that I didn’t want one. As a new primary care physician, I spent every evening finishing notes and preparing for the next day. Every Friday I left the office utterly depleted, devoid of the energy or motivation it would take to spend a weekend clicking through the required online training.

The Food and Drug Administration on Wednesday approved a long-awaited blood test to detect concussions in people and more quickly identify those with possible brain injuries.

The test, called the Banyan Brain Trauma Indicator, is also expected to reduce the number of people exposed to radiation through CT scans, or computed tomography scans, that detect brain tissue damage or intracranial lesions. If the blood test is adopted widely, it could eliminate the need for CT scans in at least a third of those with suspected brain injuries, the agency predicted.

Concussion-related brain damage has become a particularly worrisome public health issue in many sports, especially football, affecting the ranks of professional athletes on down to the young children in Pop Warner leagues. Those concerns have escalated so far that it has led to a decline in children participating in tackle sports.

 In the early 2000s, the Jeanne Geiger Crisis Center, a domestic violence organization that serves a series of small towns in northeastern Massachusetts, developed an innovative program to prevent domestic homicide by targeting situations where abusive men showed signs that they might turn to lethal violence.

The program worked well and now the center is fundraising in hopes of teaching other communities how to use some or all of its program to prevent homicide in their own communities. With this approach, leaders of the Geiger Center also hope to help reshape the public understanding of domestic violence. They advocate for more focus on helping survivors not just escape violent situations but also get their lives back on track, and clearly putting the responsibility on abusers, not victims, to stop the abuse.

"We all read those stories that happen almost every day in our country about domestic violence homicides," Suzanne Dubus, CEO of the Jeanne Geiger Crisis Center, told Salon, meaning cases "where there’s a ton of history and the police know this guy’s dangerous and he goes and kills his wife and kids" -- and often, as in the Texas church shootings last year, kills innocent bystanders as well. "We’re always jumping up and down on the sidelines going, wait a minute, there is a solution,” she said.