Depression can worsen the symptoms of rheumatoid arthritis or have a less effective treatment?

About one in six suffering from rheumatoid arthritis (RA) suffer from depression. Common symptoms of depression, such as fatigue, muscle pain and difficulty to complete activities of daily living (eg, dressing, cooking, cleaning), can mimic the symptoms of an epidemic of arthritis. It is also possible that depression can contribute to a relapse.

So unravel the relationship between depression and RA flare is a challenge.

Recently, a team of researchers set out to do just that. They studied 379 people with RA who are already enrolled in a trial comparing different drugs for the treatment of arthritis. Participants were asked to describe their feelings using one of the following sentences: "I am not anxious or depressed", "I am moderately anxious or depressed" or "I am very anxious or depressed" This evaluation was administered using standard scales used. to measure whether RA symptoms are getting better or worse or remaining stable (doctors call the disease activity).

The researchers found that participants who reported more anxiety and depression scores had higher disease activity. They also reported more tender joints and, when asked about your symptoms, they rated their disease as superior activity. At the same time, depression and anxiety seem to have no effect on the number of swollen joints found during physical examinations or the level of inflammation in the body, as measured by a blood test called ESR (also known as the speed sedimentation).

This is not to the first study to observe an association between depression and anxiety and activity of RA. In another recent study of 275 people with RA, the researchers measured the activity of disease and the symptoms of depression in the same visit. Here, as in the previous study, depression was associated with increased disease activity and the inability to achieve clinical remission, even with treatment. In another study involving 31 RA patients, depression and mood, they were assessed several times a day for a period of one week. Patients who reported more depressive symptoms also reported more pain and articulate during the sensitivity of the study period.

These studies suggest that depression may aggravate RA disease activity and even reduce drug benefits with rheumatoid arthritis. But the results are not conclusive and more studies need to understand the complex relationship between RA and depression. For example, another explanation for these results is that patients with RA more tender joints and less able to carry out regular activities are more depressed because your illness is worse.  

Another problem is that we normally use scales to measure disease activity in RA may not be as accurate when used with depressed patients. Despite the uncertainties, these studies make the important point that people with RA need to be educated about and planned for signs of depression and the appropriate resources data and processing needed. In addition, physicians should consider the depressive symptoms in the assessment of disease activity.

More importantly, if you have rheumatoid arthritis and begins to experience symptoms of depression - fatigue, feeling blue, loss of interest in usual activities, tasks difficult to perform, sleep disorders - or you feel that RA drugs do not work as well as general, be sure to tell your doctor.
By: Bonnie Bermas,MD.

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First, do no harm

As an important step to becoming a doctor, medical students must take the oath of Hippocrates. And one of the promises in this oath is "first, do no harm" (or "First do no harm", the Latin translation of the original Greek).

Right?

Wrong.

While some medical schools require their graduates to meet the Hippocratic Oath, others use a different garment - or not at all. And in fact, although "First, do no harm" is attributed to the ancient Greek physician Hippocrates is not part of the Hippocratic oath at all. In reality, it is another of his works called epidemics.

So why the confusion? 
It is true that there are similar language found in two places. For example, here is a line of a translation of the Hippocratic Oath:

"I will follow this treatment system, according to my ability and my judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous."

Yes, the applicant must be avoided damage, but nothing that is a top priority. Meanwhile, epidemics says

"The doctor should be able to tell the story, meet present and predict the future - must reconcile these things, and they have two special view of illness, that is, to do good or evil purposes".

Again, there is no clear priority to the prevention of damage to the objective of providing assistance.

It is "First, do no harm" possible? 
The idea that doctors should, as a starting point, will not harm his patients is an attraction. But that does not mean that since the bar low? Of course, any doctor should be set to do something that comes only predictable and preventable damage. We do not need an old ancestor, so respected, or an oath to convince us that!

But if doctors took "First, do no harm" literally nobody would have the surgery, even if it was rescue. We could stop ordering mammograms because they could lead to a biopsy of a non-cancerous tumor. In fact, we could not even require blood tests - pain, bruising or bleeding required to draw blood are clearly avoidable damage.

But doctors do not recommend these things within ethical practice, as the modern interpretation of the "first, do no harm 'is closer to this: physicians should help patients as much as possible by recommending tests or treatments that the potential benefits outweigh the risks of damage yet, in reality, the principle of "first, do no harm" may be less useful -. and less convenient - than you think. 

How convenient is "First, do no harm"? 
Imagine the following situations:

   * Their diagnosis is clear - for example, strep throat - and there is no effective treatment available that carries less risk. Here, "First, do no harm" is not particularly relevant or useful.

   * Its diagnosis is difficult and the optimal conduct of the test or treatment is uncertain - for example, you have back pain or suffer from headaches. It may be impossible to accurately compare risks and benefits concessions from a particular course of action against another. So you can not know in advance whether a test or treatment is "do no harm".

   * His diagnosis is severe - for example, an inoperable cancer - and treatment can cause damage. In this case, the term "First, do no harm" is relevant again. The only reasonable solution is to provide comfort care, support and relief from suffering. This is already a guiding principle of palliative care and is widely accepted.

The bottom line 
The fact is that when you have to make tough decisions in real time, is difficult to apply the "first, do no harm" dictum because estimates of risks and benefits are so uncertain and subject to errors.

But it is a reminder that we need high quality research to help better understand the balance of risks and benefits for tests and treatments we recommend. Ultimately, it is also a reminder that doctors should not overestimate their ability to heal, or underestimate their capacity to cause damage.
By: Robert Shmerling, MD,

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Premenstrual dysphoric disorder (PMDD): When there is more than the PMS

Most women have at least a little familiar with the miseries of premenstrual syndrome (PMS). Nearly 75% of women suffer from PMS symptoms during the two weeks before menstruation. Premenstrual dysphoric disorder (PMDD) is PMS with a twist.

Although both the physical symptoms of PMDD and PMS are similar - tiredness, breast swelling, back pain, headaches, food cravings, bloating, constipation, diarrhea - TDP includes emotional symptoms much more severe than the mood swings associated with PMS. It is characterized by extreme mood swings, irritability, depression and anxiety appear the week before a woman has her period and disappears a few days after its launch. They can produce depression and feelings of severe despair. In particularly serious cases, women may even feel suicidal. For these reasons, the TDP is a formal psychiatric diagnosis.

How to know if you have PMS or premenstrual dysphoric disorder? A diary of symptoms can help. Keep track of the dates of his term, and note when symptoms occur and how severe they are. (Start with your next period. - Do not try to hide the symptoms of your last cycle) The next step is to meet with your doctor. He or she will examine the reason for their symptoms and try to rule out other causes for them. The good news is that you can treat PMDD. But there is no one size fits all. It may take time and trial and error to find an effective cure.

The use of the "pill" for PMS and PMDD 
My first recommendation for soft SPM techniques is to promote regular exercise and relaxation. Some women find that reducing sodium reduces swelling and inflammation. For women with premenstrual syndrome or premenstrual dysphoric also want contraception, birth control pills and shortening or eliminating the "bye" Typical (where you get your period) can be very effective.

Several studies suggest the best birth control pills to control the symptoms of PMS or PMDD are those containing drospirenone hormone. When I command one of these drugs for a woman who wants to control their PMS or PMDD, I usually start with a dosing schedule that includes only a four-day interval, the "free time". If symptoms persist, I recommend a different pill with a higher dose of estrogen. If symptoms do not improve, I have next to the woman taking pills with active hormones every day, by completely omitting any "free time". (It is also called the continuous method.)

Women who stop taking birth control pills still have periods, but may have occasional irregular bleeding. Many people find the compromise is worth it to relieve symptoms of premenstrual syndrome and premenstrual dysphoric disorder. Keep in mind that birth control pills containing drospirenone are slightly more likely to cause blood clots than pills with other types and quantities of hormones. However, the risk is still very low in healthy women.

Doctors used to prescribe progesterone alone for PMS and PMDD. The most recent studies suggest that it does not help you. Although there is still a lot of attention to the use of progesterone, I do not recommend it.

SSRIs: Another option for symptom relief 

A class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) is another excellent option for treating PMS and PMDD. In fact, most doctors now consider them first-line therapy for these conditions. There are many SSRIs to choose from, and studies suggest that they are equally effective. There are two ways to take an SSRI for PMS/PMDD.

The first is to simply take it every day throughout your cycle. Another way is to take it only after ovulation (which usually occurs about 14 days before your period) and to stop when menstruation starts. This is called luteal-phase-only treatment.

The results of a recent study suggest that some women may benefit from taking an SSRI only when they are experiencing PMS/PMDD symptoms. Of course, any woman who continues to have symptoms during her period would benefit more from taking the SSRI throughout her period instead.

It may take several cycles before you see improvement. If the initial dose does not work, your doctor may increase it and give the new dose a few cycles to see if it helps. If you don’t find relief from the first SSRI you try, ask your doctor about trying a different one. Some women who do not respond to one SSRI may do better with a different one. Side effects of SSRIs are common and may include nausea, jitteriness, and headache. These drugs can also decrease sexual interest and interfere with the ability to have an orgasm. Taking them only in the luteal phase may ease side effects.

Whether you have PMS or experience the extreme emotional symptoms of PMDD, don’t suffer in silence. Pay close attention to the pattern of your symptoms and ask your doctor for help.
By: Hope Ricciotti, MD,

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If you think you are depressed, do not wait - know

October 8, 2015 is the national screening depression. The first day was in October 1990, when my colleague Douglas Jacobs, MD followed by his belief that the detection of mental disorders should not be different from the detection of other physical illnesses.  

Since this inaugural event 25 years ago, the program has significantly expanded, and similar awareness workshops for a variety of mental disorders, such as disorders and problems with alcohol eat, now held throughout the year . These events are organized detection in the community, in schools, at work and in the army.

Sadness affects all our lives at different times, but depression can have a tremendous depth and power to stay. It is more than a passing sadness and melancholy fight, or feeling "down". It can make you feel overwhelmed and can harm the joy of previously enjoyable activities. It has physical and emotional symptoms,. You may find that you can not sleep or eat, you are tired, or headaches or other pains that appear to have arisen without cause.

If you have had depression or been near someone who has, you know that this disease can be raised or ignored at will. A man in the grip of depression can not solve their problems by showing a little spine. Can make a depressed woman who is simply getting rid of the blues.

There are too many people struggling silently with depression. Do not be among them. Talk to your doctor, attend a screening for depression event, or using an online tool. There are medications and treatments that can help. Effective treatment can lighten your mood, strengthen their relationships with their relatives, let you rediscover the satisfaction of their interests and hobbies, and you will feel more like yourself again.

Research continues to pave the way for better treatment of mood disorders. Genetic discoveries and brain imaging help physicians better understand the biology of depression, what you can do, the more accurate personalized treatment possible.

At that time, to find real and lasting relief, you may need patience and perseverance - it can be a difficult task when you feel depressed. Some people find a drug or therapy is working for them immediately. But for many others, so the treatment lasts several turns and an occasional visit. You may need to try several drugs, altering a dose, or try a new therapist. Side effects, health insurance coverage and stigma associated with having a mood problem can be obstacles, but you can overcome them. There are even self-management strategies (including exercise, diet and meditation) and alternative therapies that help heal.

You can learn more about the National Day by organizing Depression Screening Screening for Mental Health (SMH). SMH helps organize depression screening events around the country - you can find a list of participants in the state here. For more information on depression, take our survey. You can also find information myriad of mental health problems in www.helpguide.org. 
By: Michael Craig Miller, M,D.

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Children and vaccines against flu: two common myths

As a pediatrician, I'm really passionate about the vaccine against the flu. The flu can be a nasty disease; Each year, thousands of people are hospitalized from influenza and its complications, and some of these people die. The vaccine against influenza can protect my patients and their families, and I enthusiastically recommend to each of them.

Yet many of them refuse, despite my best efforts. What is particularly frustrating is that many of them refuse because of misconceptions about the vaccine against the flu. There are all kinds of misinformation out there, but here are the two most common myths:

1. The vaccine against influenza can make you sick.  
That's what I hear more than anything. Now, like any medical treatment, it is true that the vaccine against influenza can have side effects. Very often, people will have some pain for a few days in those receiving the vaccine, and some people may feel a little sick for a few days, and some may have mild fever. These side effects are not serious and disappear on their own; More serious side effects are extremely rare.

The vaccine against influenza, however, will not give you the flu. The vaccine itself is made of the influenza components; Here's how it works by helping the body to produce antibodies that can fight against the flu if you are exposed. But these components are dead (in the case of the vaccine) or very low (in the case of the nasal spray version) and can not give you the flu. 

To be safe, we recommend the shot instead of the nasal spray for people with very low defenses and their caregivers. But it is really only those with very weakened defenses, such as those undergoing chemotherapy for cancer, who are affected by this recommendation - and is more conservative than anything else.

It is important that we remember the vaccine against influenza during the flu season - and that can take a couple of weeks to take effect. Therefore, it is possible to get vaccinated against the flu, but to take the vaccine against the flu before you have a chance to work. The vaccine against influenza does not give a 100% protection, and there are many other viruses that cause illness similar to the flu, so it is always possible to get sick, even if you get the vaccine against flu. But it is not the vaccine against the flu makes you sick!

2. Healthy people do not need the vaccine against the flu.  
I heard many times, too. "My son got sick." "We are a healthy family, we do not need that." "I'm not worried about the flu, we will be well." Well, besides the fact that luck does not last very long time, people in good health can be very sick with the flu, too, there is one other important point: it is not only you.  

You and your family can fine Weather flu, but you could easily spend other people around you - as a newborn by his friend, his grandmother, the boy at school to chemotherapy - that the flu is extremely dangerous. Vaccination not only protects you; protects all around you. By getting vaccinated against the flu, you can literally save lives.

If you have questions about the vaccine against influenza or the flu, talk to your doctor or rendez-www.flu.gov. Make your decision based on the facts - not myths.
By: Claire McCarthy,MD

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Low levels of the impact of brain chemicals on your child's development

Low levels of the impact of brain chemicals on your child's development - Many parents think that baby products are tested and not be on the market if they were dangerous.

But the fact is that most of the chemicals in the products have not been evaluated for their safety - not even a most basic security review.

Although science shows that the chemical is toxic and exposure is causing health problems, it may take years before the manufacturers are banned from use in products, whether it is prohibited at all . Normally when a chemical is banned finally, manufacturers are allowed to substitute alternatives that are proven and probably just as toxic.We can not simply trust our government or manufacturers to keep safe products. Therefore it is up to us as parents to make informed decisions on products that will allow us in the environments of our children.

When it comes to fragile babies develop a common sense approach for parents, it is to adopt the precautionary principle, which recognizes that prevention is better than cure.

It may take 5-10 years or more between the time we suspect damage, and when there is sufficient scientific evidence of cause and effect to ban the substance. This term can encompass most important years of your child's development, and it is too late.

Where to start? that low levels of a brain chemical impact on your child's development

Start with what their kids to sleep in. Baby mattress may ship the most common toxic exposure due to close, broad and long term.

Babies sleeping in bed for 10-14 hours or more a day for years lower development. Meanwhile, they are lying directly on the mattress absorption, inhalation of chemicals and the release of gas. Including baby crib mattress, cradle, bassinet, crib and a porta Co-Sleeper mattress. All kinds of mattresses usually contain ingredients that can be very toxic.

Children still need protection and they grow and sleep in their "Big Boy" sleep. Typical, full, queen and king-size beds containing hazardous materials, including flame retardants.

The good news is there are many things you can do to reduce or eliminate some of the major risks and give your children a safer environment, more natural.
By: Jane sheppard

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Healthy meals and practices on the fly: Yes, you can

The change of season brings little change in difficult times in our house. Summer, for example, marked the beginning of the activities of non-stop school children. Now, with the fall, is a return to full schedules children return to school. It leaves little time for family meals, and even less time to cook. And when your child is late for practice, prepared and packaged foods suddenly seem not so unhealthy.

But is there such thing as a food nutritious convenience? "Yes, there are some healthy options out there, but you really have to look at the ingredient lists and nutrition labels," says dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and l 'women's Hospital.

Typical convenience food 
Packaged prepared foods come in many forms:

   * Boxed dry goods such as pasta and quick cooking rice mixes
   * Canned foods, such as soup or dumplings
   * Frozen food, as a single portion frozen lasagna dinner or a "family size"

These are usually loaded with calories, salt, saturated and trans fat, sugar, refined carbohydrates, additives and preservatives. "It is not the worst thing if you eat this kind of fast food from time to time, but if you start to eat a lot of it, which can cause weight gain and risk of health that go with it, such as high cholesterol, high blood pressure, diabetes and heart disease, "said McManus.

And I do not think shipping is the answer, either. "" Go "foods has the same problem. It is fast and it's hot, but is likely to be salty, fatty, and very high in calories, "says McManus.

The healthier versions 
Some convenience foods healthier versions come in. However, it takes a little detective work to find them. Start with the list of ingredients. "The fewer ingredients, the better, and to ensure that real food is on the list, meat or vegetables," says McManus. If there is no added sugar, should be one of last ingredients, since the ingredients are listed in order of quantity.

Next stop: the nutrition label. McManus advised to remain at or below these limits for a main course:

So the food does the trick? Dry foods such as whole grains (cracked wheat or oats); frozen or canned vegetables; tuna or canned salmon; some fish and frozen shrimp; and some frozen meals, usually companies that promote the fact that they use organic ingredients of high quality.

A better option 
An easy way to feed your family in a hurry is to plan in advance the possibility of food agitated. "You know, there will be times when you want to get something out of the freezer and have it ready in five or 10 minutes," said McManus.

It recommends much cooking - make a meal on land that can be frozen in small portions. "It works well with turkey or vegetarian chili and lentil or bean soup with lots of vegetables. The marinara sauce is a simple thing that can create a lot, and then add some turkey meatballs that you made to the advance and whole wheat pasta, "he adds. She also suggests using a slow cooker to create dishes that are cooked all day and are ready when you get home. But in fact, all the food that will work as well for this article.

McManus also suggests having healthy snacks on hand at all times. "Maintaining a grab-and-go foods list that replenish every week," said McManus Among low yogurt ideas fat, no sugar added;. Whole fruit, hummus, you can assemble. "Snack packs" each week filled nuts, whole wheat crackers or chopped vegetables. Just keep in the refrigerator or pantry.

"The presence of these foods on hand is most important," McManus said. "It just takes a little planning. But in the long run is healthier and cheaper, too. "

And it is a strategy that will stay the same no matter the season or the program!
By: Heidi Godman, 

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Too little sleep and overweight: a dangerous duo

You walk down the street early in the morning after spending all night to complete a project for your boss. The coffee shop is called as usual. But today siren song is more than a cup of coffee. In a way, there is an irresistible urge to buy a donut or two as well.

If ever you wondered why, read on.The number of Americans say they get sleep every night has fallen from an average of about 8.5 hours in 1960 to just under 19 hours today. 
There are probably many reasons why, but probably include 24/7 Professional extension of the "day" with artificial lighting, use of electronic devices before bedtime (blue light wavelength of these devices delays sleep onset) and widespread belief that sleep is a lower priority compared to other activities, whether work-related or pleasure.

And today, not only do most of us sleep less, but tend to weigh more, too. Over 30% of US adults are obese, compared with less than 15% of adults in the 1960s this "obesity epidemic" has been extended to children, with about 17% considered obese today. This is an alarming trend because obese children are likely to become obese adults.

Is there a relationship between sleep duration and increased the reduced obesity? Irrefutable evidence suggests there. A number of large studies involving thousands of adults have generally found that short sleepers (defined as five hours or less a night, but sometimes six hours or less) were up to 45% more likely to be obese. We do not have much data on children, but a study has shown that children who slept less than 7.5 hours per night were three times more risk of developing obesity in a period of 5 years.

Studies also show that short sleepers do not eat healthily. Above all, their diet have less variety of food, a higher percentage of calories from snacks, and a greater amount of sugar, caffeine and alcohol. They also tend to skip meals (breakfast, lunch and dinner) and also tend to snack more. These habits promote weight gain and the possible development of obesity.

Is there a scientific explanation of the feeding behavior of short sleepers? Experimental studies suggest that sleep restriction leads to abnormalities in the processing of blood sugar (glucose) and variations of hormones that control appetite. For example, ghrelin hormone stimulates the appetite, and reducing the hormone leptin. With sleep restriction, increased ghrelin levels and leptin decrease, resulting in increased hunger and appetite. In addition, these studies have shown that individuals with restricted sleep have a greater desire for high-calorie carbohydrate-rich foods.So what evidence linking lack of sleep to weight gain told us?

The bottom line is that getting enough sleep is one way to reduce the risk of weight gain and obesity. There is a tendency to put on pounds as you age. Lack of sleep will only worsen this trend. If a person is already overweight or obese, losing weight will be more difficult without adequate sleep.  

From a social perspective, the obesity epidemic, associated with increases in rates of several chronic diseases (eg, heart disease, diabetes), puts a greater burden on the health care system and contributes to rising health care costs. Adequate sleep should be included with exercise and good nutrition as one of the essential elements of good health.
By: Stuart Quan, MD,

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