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More than 46 million adults in the United States smoke
cigarettes, cigars, or pipes, and a few million use snuff or
chewing tobacco. Although 70% of smokers say they'd like to stop,
nicotine is so addictive that only 3% successfully quit each
Smoking sends nicotine straight to the lungs, where it is
absorbed by oxygenated blood, delivered to the heart, and pumped
into the arteries and to the brain. The nicotine in snuff and
chewing tobacco, which is absorbed mainly through the mucous
membranes of the mouth, reaches the brain more slowly, but
constant use maintains a steady level in the blood and
Once in the brain, nicotine triggers the release of the
neurotransmitter dopamine in the nucleus accumbens, which is the
brain's reward and motivation center. Each hit of nicotine
produces pleasurable feelings. But as it gets washed out of the
body, the feelings of pleasure are replaced by uncomfortable
symptoms of withdrawal — trouble concentrating, nervousness,
headaches, increased appetite, dizziness, irritability, anxiety,
depression, and sleeping problems. This prompts most users to
reach for more tobacco.
For people who want to stop using tobacco, two hurdles must be
jumped: overcoming the physical addiction to nicotine and
breaking the psychological habit.
Thanks to longer life expectancy, the senior population is steadily
growing in the United States. A 2010 report from the Alzheimer's
Association estimates that, by 2030, the 65+ population will be 71
million — double what it is today. By then, the number of people
with Alzheimer's disease will be 7.7 million, more than a 50%
increase from the 5.1 million people ages 65 and over currently
suffering from the disease.
Because age is the most significant risk factor for Alzheimer's,
efforts to develop effective therapies are more important than
ever. However, while there are a variety of therapies on the
horizon, some in the form of new drugs that may quell the disease
by blocking the chain of events that underlies its destructive
process, truly effective therapies remain years away. Available
medications can only alleviate symptoms temporarily; no current
treatments prevent or stop cognitive deterioration due to
Alzheimer's. A number of medications can help with behavior
problems in this illness, such as outbursts of anger. But these are
best used in conjunction with environmental approaches, such as
simplifying the home environment.
Intermittent explosive disorder (IED) is characterized by
disproportionate rage responses, leading to serious harm through
violent words or deeds.
Several studies suggest that the disorder is associated with
abnormal activity of the neurotransmitter serotonin in parts of
the brain that play a role in regulating, even inhibiting,
aggressive behavior. Impulsive aggression in general is
associated with low serotonin activity as well as damage to the
prefrontal cortex, a center of judgment and self-control. One
study found that on some neuropsychological tests, people with
IED performed similarly to patients who had suffered damage to
the prefrontal cortex.
Research on drug treatment has been limited. A number of
medications are known to reduce aggression and prevent rage
outbursts, including antidepressants (namely selective serotonin
reuptake inhibitors, or SSRIs), mood stabilizers (lithium and
anticonvulsants), and antipsychotic drugs. In one study,
impulsively aggressive patients who took the SSRI fluoxetine
(Prozac) showed increased activity in the prefrontal cortex.
Cognitive behavioral therapy (CBT) that combines cognitive
restructuring, coping skills training, and relaxation training
A study of nurses found that those who had both diabetes and
depression had a much higher risk of premature death from
cardiovascular disease, compared to those who had only one, or
Researchers are exploring the possibility that certain
antidepressant medications may alleviate hot flashes in some
Dr. Michael Miller, editor in chief of the Harvard Mental Health
Letter, discusses post-traumatic stress disorder and research
into a biomarker that may identify those at increased risk of