Howard LeWine, M.D.
Posts by Howard LeWine, M.D.
A few years ago, the U.S. Food and Drug Administration issued warnings that children and teens who took a common kind of antidepressant might experience suicidal thoughts. The point of the warning was to make sure that parents and doctors paid closer attention to kids taking these medications. But the plan may have backfired. A national team of researchers tracked antidepressant use among 2.5 million young people between 2000 and 2010. After the FDA’s warnings in 2003 and 2004, use of commonly prescribed antidepressants fell by 30% in teenagers while suicide attempts rose by 22%. The researchers concluded that the decrease in antidepressant use, sparked by worries over suicidal thoughts, may have left many depressed young people without appropriate treatment and that may have boosted the increase in suicide attempts.
Researchers at Boston University and Massachusetts General Hospital have developed a bionic pancreas. In an early test of the device, reported online this week in the New England Journal of Medicine, it helped control blood sugar levels in 20 adults and 32 teenagers with type 1 diabetes who went about their daily lives without the constant monitoring and injecting that’s required with type 1 diabetes. Right now, this artificial pancreas is essentially an app that runs on an iPhone wirelessly connected to a monitor worn on the abdomen that continually checks blood sugar and two pumps, one for insulin and one for glucagon. The team that developed the bionic pancreas have begun a second round of testing, and hope to have a more sophisticated version on the market in five years. While not a cure, the development of a bionic pancreas represents a bridge that would let people with type 1 diabetes control their blood sugar with less hassle, and more safely, than they do now.
Antidepressant medications have helped millions of people cut through the dark fog of depression. Many others try these medications but stop taking them, often because of side effects such as weight gain. A new Harvard-based study, one of the largest and longest studies of the connection between antidepressant use and weight so far, shows that the amount gained is usually small, and that it differs little from one antidepressant to another. Using citalopram as a reference, because earlier studies suggested that it is “average” when it comes to weight gain, bupropion was associated with the least amount of weight gain, close to none. Two others that also appeared to have relatively less weight gain were amitriptyline and nortriptyline. At the other end of the spectrum, citalopram caused the most weight gain. Even so, the differences between the drugs was small. The results of the study were published online this week in JAMA Psychiatry.
If you want to stay healthy and mobile well into old age, start walking today—even if you’ve already edged into “old age.” That’s the conclusion of a report from the Lifestyle Interventions and Independence for Elders (LIFE) trial, published online yesterday in the Journal of the American Medical Association. Frail, inactive older people between the ages of 70 and 89 who started exercising were less likely to have become disabled over the course of a 30-month trial than a similar group who took part in workshops on healthy aging. Some older people they have passed the age at which starting an exercise program will do them any good. These new findings reinforce what other studies have shown: You’re never too old to exercise.
Today is National Hepatitis Testing Day. The point of this day is to raise awareness of viral hepatitis, a condition that can lead to liver failure, liver cancer, and death. Early detection of hepatitis in the millions of people who have it but don’t know it can protect them from its harms and keep them from spreading the infection to others. There are five main types of viral hepatitis: A, B, C, D, and E. Some hepatitis viruses make people sick soon after infection but don’t cause long-term harm. Others are mostly silent, but stay active in the liver for years, possibly causing long-term damage. Advances in testing and treatment make early diagnosis more important today than it has ever been.
When it comes to memory, sleep is a Goldilocks issue: both too much and too little aren’t good. Aim for “just right,” says a new report from the Harvard-based Nurses’ Health Study. Study participants who slept five hours or fewer per night or nine hours or more did worse on tests of memory and thinking skills that those getting seven to eight hours of sleep a night. The researchers estimated that undersleepers and oversleepers were mentally two years older than the women who got seven to eight hours of shut-eye a night. Although this study couldn’t prove that getting too little or too much sleep causes memory and thinking problems, it’s in line with other work showing the potentially harmful effects of poor sleep. Previous research has linked poor sleep with higher risks of heart disease and stroke, type 2 diabetes, and depression.
For the past few years, vitamin D has been gaining a reputation—not entirely earned—as a wonder vitamin that offers protection against some cancers, bone-weakening osteoporosis, heart attack, Alzheimer’s disease, and other chronic conditions. Not so fast, caution two reports in the journal BMJ. One concluded that “highly convincing evidence of a clear role of vitamin D does not exist for any outcome.” The other showed a link between low blood levels of vitamin D and increased risks of dying prematurely from cardiovascular disease, cancer, and other causes. But it isn’t clear if low vitamin D causes chronic conditions, or whether chronic conditions cause low vitamin D levels. To play it safe, get the amount of vitamin D recommended by the Institute of Medicine: 600 IU of vitamin D a day for everyone ages 1 to 70 and 800 IU for those 71 and older. Eating foods rich in vitamin D or getting a few minutes of sunshine a day can do the trick.
For anyone who has had a stroke, working to prevent a second one should be Job No. 1. Keeping blood pressure under control is an important part of that job. A study published yesterday in the journal Stroke shows that good blood pressure control after a stroke cuts the chances of having a repeat stroke by more than half. But the study also brought some bad news: less than one-third of stroke survivors in the study managed to get their blood pressure under control. Measuring blood pressure at home is one way to help control blood pressure—seeing that it is high can help you take steps to bring it down. These include lifestyle changes and medications.
Some good news on the cancer front: between 2000 and 2010, rates of colorectal cancer in American adults fell by about one-third. That decline mirrored a sharp rise in colorectal cancer testing during the same period. American Cancer Society researchers found that the drop in colorectal cancer rates was highest among Americans aged 65 years and older. Cases fell 3.6% a year from 2001 to 2008, then dropped even more by 7.2% a year from 2008 to 2010. But the researchers saw a troubling trend in younger adults: an increase in colorectal cancer of 1.1% a year among people under age 50. Rising obesity rates may be to blame. The researchers attribute the decline in colorectal cancer to early testing for the disease. Despite the optimistic findings, colorectal cancer is still a scourge. In the U.S. this year, an estimated 72,000 men and 65,000 women will be diagnosed with colorectal cancer; 26,000 men and 24,000 women will die of it.
How bad can a little high blood pressure be? It turns out that it might be worse than we thought. Researchers from Southern Medical University in Guangzhou, China, examined the results of 19 high-quality studies looking at links between prehypertension and stroke. The studies included more than three-quarters of a million people, whose health and wellbeing was followed for 36 years. Those with “high-range prehypertension” (blood pressure between 130/85 and 139/89) had a 95% higher stroke risk compared to people with healthy blood pressures. Those with “low-range prehypertension” (blood pressure between 120/80 and 129/84) had a 44% higher stroke risk. The size of the study and the length of the followup make the results believable. They don’t mean that we should elevate prehypertension to a disease. But they do signal that we need to take it seriously. The best way to treat prehypertension is with lifestyle changes.