Mental Health

Generalized Anxiety Disorder

San Jose Care Resource Guide: Anxiety, few do not have it, but there are levels. Here is a link to a good article on the topic of generalized anxiety disorder published by JAMA, the Journal of the American Medical Association.

Symptoms mentionned in JAMA:

• Fast or irregular heartbeat (palpitations or “fluttering” in the chest)

• Sweating or flushing of the skin

• Muscle tension

• Headaches

• Difficulty sleeping

• Changes in appetite

• Nausea, vomiting, and diarrhea

• Edginess or irritability

Note: Article mentions there can be physical reasons for the anxiety:

•  heart problems,
•  thyroid conditions,
•  or other medical issues

The symptoms look  fairly general, and can probably be everything and anything. Which means, you have to talk to your Doctor…

• Treatments include
• Cognitive behavioral therapy(CBT)
• relaxation techniques
• medication

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Aging: Pain and worry about health in older men and the CHAMP study

San Jose Care Resource Guide: Pain and health worry seem to be a common issue for older people. Here is a link to a study on a group of  1217 community-dwelling men in australia, aged 70years or older the CHAMP study, published in the pain journal. 

Results are interesting,quoting :

•  12.5% had persistent and intrusive pain,
• 22.4% were worried about their health,
• and 6.3% had anxiety.

Let us us rephrase this:

       Of the men studied,

•  87.5% did not have persistent and intrusive pain,
• 77.6% were not worried about their health,
• and 93.7% did not have anxiety

Remarkable! The Australian sun?

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Depression: Bright Light Treatment in Elderly Patients With Nonseasonal Major Depressive Disorder

San Jose Care Resource Guide: Study shows that “..Three weeks of 1-hour early-morning Bright Light Treatment [ BLT]  (pale blue, approximately 7500 lux) can lift someone out of Major Depression. The study followed Eighty-nine outpatients 60 years or older who had MDD underwent 3 weeks of treatment (T1), and were evaluated  and 3 weeks after the end of treatment (T2).

The study concludes that :”..  In elderly patients with MDD, BLT improved mood, enhanced sleep efficiency, and increased the upslope melatonin level gradient. In addition, BLT produced continuing improvement in mood and an attenuation of cortisol hyperexcretion after discontinuation of treatment. 

That does sound like a substantial treatment achievement. Click here for article in the Archives of General Psychiatry

• Notes: The “elderly men” are 60+….
• That the  depression is not season related is counter intuitive, but also consider another study with similar results for Seasonal Depression: “Phototherapy for seasonal major depressive disorder: effectiveness of bright light of high or low intensity.”  With these differences:
  • The patients are not elderly
  •  The treatment is from 8 p.m. to 10 p.m. ( using light at 2000 lux, as opposed to 7500lux  for the nonseasonal case.)

Talk to your psychiatrist

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Fibromyalgia: Study shows music can help

SJCRG: This study from Spain entered in the ScienceDirect shows that “… The [fibromyalgia] treatment group reported a significant reduction in pain and depression at week 4 compared with the control group…”

Music Therapy

SJCRG: Note that the study doesn’t seem to care about which genre of music: From Bach to Beatles, whatever works for you….One of the key elements seems to be that there is some discipline and commitment  involved: “..Music interventions consisted of listening to music once a day for 4 consecutive weeks using two types of CDs…”  Abstract does not provide the duration of listening  per day , though.

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Telephone-Administered Therapy and Quality of Life among Patients with Multiple Sclerosis (Pubmed)

SJCRG: Not everybody who needs counselling can easily go to therapy appointment.  Multiple Sclerosis (MS) patients are a very good subset  of  chronically ill class to evaluate different methods of phone therapy support. So we are happy to have found this study from the Center for the Management of Complex Chronic Care,Il.    The study formed two groups:

1. Patients given  telephone-Administered Cognitive-Behavioral Therapy
2. Patients given   telephone-administered  Supportive emotion-focused Therapy

The study concluded:  Cognitive-Behavioral Therapy  provided greater Quality of Life benefits compared with supportive emotion-focused Therapy.

SJCRG Notes: So it seems that phone therapy works and highly skilled therapy works best: Not a surprise, but documented

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Comments on “FDA clears Cymbalta to treat chronic musculoskeletal pain”

SJCRG:  Good news, more treatment options for chronic musculoskeletal pain! Here is the link to the FDA press release.   “..Cymbalta was first used to treat major depressive disorder in 2004..” 

SJCRG:  Very interesting is the FDA’s philosophy for drug approval for serious illnesses:

Quoting:  “..While these serious side effects have been associated with the use of Cymbalta, they have occurred in less than 1% of treated patients. There are a finite number of drugs available for the treatment of chronic musculoskeletal pain, all of which are associated with rare, serious side effects. There are patients in whom none of the available treatments are effective. ….

So let us do the math: According to the US Govn’t “..An estimated 1.5 million adults had rheumatoid arthritis in 2007….”
…so 15,000 patients are expected to come down with serious side effects.

 But  “..Since its initial approval, about 30 million patients in the United States have used Cymbalta..[for other conditions]..”  Let us do the math now for that larger population: 1% of 30 million= 300,000 patients with serious side effects!  half of the Multiple sclerosis popultation in the US!

Please do a careful risk/reward analysis with your doctor if you need Cymbalta, or any of these potent drugs….

Cymbalta is no free ride…

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Efficacy of Internet Peer Support for Individuals with Psychiatric Disabilities (ScienceDirect)

Care Resource Guide: So many boards and support groups… This study from Temple U. Pennn. examines their efficacy of such internet groups for mental illness:  Three hundred individuals resident in the USA diagnosed with a Schizophrenia Spectrum or an Affective Disorder.

Care Resource Guide: Results are mixed for unguided groups, professional leadership seems to be needed for the group to be useful.

Care Resource Guide: This study does not evaluate internet groups for primarily non-mental illnesses, where results could be quite different.

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