Depression

SAN DIEGO -- Although antidepressants may have an effect on fetuses in utero, so may the lack of the drug during pregnancy.

OTTAWA, Ontario -- American cancer patients are more than twice as likely to commit suicide as the general population, with the rate for men nearly five times that for women, a radiation oncologist reported.

FLINT, Mich. -- Moderate aerobic exercise three to five times a week may make adjuvant radiation for breast cancer more tolerable, found researchers here.

SEOUL, South Korea -- The key to selecting the right antidepressant for initial treatment of late-life depression may lie in the patient's genetic makeup, researchers here have found.

ABSTRACT: Signs that strongly suggest Parkinson disease (PD) include unilateral hand tremor, slowed or decreased movement, and gait changes. Postural alterations include leaning forward or asymmetric shoulder height; the arm may not swing when the patient walks, or it may be held flexed at the elbow. Patients may report increasing difficulties in occupational and social functioning. Mimics of PD include essential tremor, normal pressure hydrocephalus, other neurodegenerative diseases, and drug-induced parkinsonism. Most patients report such nonmotor symptoms as sleep disturbances, visual difficulties, bowel and bladder problems, fatigue, depression, and anxiety. Cognitive impairment in many patients takes the form of slowing of memory and difficulty with visual spatial tasks and executive function. A more realistic treatment goal than tremor eradication is improved overall mobility.

ABSTRACT: Although levodopa and the dopamine agonists remain the mainstays of treatment, the number of therapeutic options has increased, and trials of new medications are ongoing. Some trials are evaluating ways to alter disease progression. Medical management of the symptoms of Parkinson disease is generally successful but requires familiarity with the agents to avoid troublesome side effects. Deep brain stimulation surgery is an option for some patients whose symptoms are not adequately managed with medication.

Because the manifestations of Parkinson disease are protean and complex, the diagnosis can be difficult and treatment challenging. However, an awareness of the key clinical features and familiarity with 2 or 3 of the dopaminergic medications can facilitate management.

BOSTON -- When a diagnosis of irritable bowel syndrome comes to mind, consider migraine, fibromyalgia, and depression as well.

NEW ORLEANS -- Coronary artery disease patients younger than 55 reap a greater benefit from formal cardiac rehab and exercise training than those who are older, found a study here.

AUSTIN, Tex. -- The widely used acne drug Accutane (isotretinoin) appears to cause depression in mice -- another chapter in the checkered history of the agent.

OTTAWA, Ontario -- A large study of women with cosmetic breast implants found they had a suicide rate over two decades that was 73% higher than the general population -- but the rate was similar to that of women who had other cosmetic procedures.

PITTSBURGH -- Concerns about weight gain and body shape may sabotage pregnant women's motivation not to resume smoking after the baby is born, researchers reported.

PITTSBURGH -- Concerns about weight gain and body shape may sabotage pregnant women's motivation not to resume smoking after the baby is born, researchers reported.

EAST HANOVER, N.J. -- Investigators looking to see whether an Alzheimer's drug could help the memory of patients after a traumatic brain injury had to mine the data hard for a faint light at the end of the tunnel.

EAST HANOVER, N.J. -- Investigators looking to see whether an Alzheimer's drug could help the memory of patients after a traumatic brain injury had to mine the data hard for a faint light at the end of the tunnel.

BANGOR, Wales -- Selective serotonin reuptake inhibitors (SSRI) can have a rare paradoxical effect, sparking aggressive or violent behaviors in otherwise placid patients, said researchers here.

ROCHESTER, Minn. -- When medical residents make major errors, as many of them believe they do, their emotional suffering and guilt may require counseling to avoid burnout, according to Mayo investigators.

Bipolar disorders cause twice as much lost time in the workplace as does major depression, according to a national mental health survey.

ATLANTA -- Men with major depression have an exaggerated inflammatory response to stress, a finding that could partly explain some of the somatic diseases associated with the condition.

ABSTRACT: Subclinical hypothyroidism is associated with elevated low-density lipoprotein (LDL) cholesterol levels and several factors related to atherosclerosis, including increased C-reactive protein levels and impaired endothelium-dependent vasodilatation. However, considerable controversy exists about screening for and treating this thyroid disorder. Thyroxine therapy lowers elevated LDL cholesterol levels in patients whose serum thyroid-stimulating hormone (TSH) concentrations are higher than 10 mIU/L ; thus, most experts recommend treatment for such patients. However, there is no consensus regarding the management of patients with TSH levels of less than 10 mIU/L. Although the evidence supporting treatment of these patients is not compelling, it is reasonable to offer a therapeutic trial of thyroxine to those who have symptoms.

ABSTRACT: The number of medical therapies for patients with erectile dysfunction (ED) has increased in recent years because of our expanded understanding of the physiologic and neurologic causes of ED. Oral agents range from testosterone to antidepressants to phosphodiesterase inhibitors. Nitroglycerin and minoxidil have shown some effectiveness as topical agents. Alprostadil, which can be applied intraurethrally, is also effective as intracavernosal injection therapy. Prostaglandin E1 and papaverine are effective as intracavernosal injection agents. Some studies have shown that combined use of intracavernosal injection and oral therapy produces satisfactory erections.

ABSTRACT: Our knowledge of chronic diseases has advanced significantly in recent decades, but patient outcomes have not kept pace. This is largely because the traditional acute care model does not adequately address the needs of patients with chronic disease. Patients play an active role in the management of chronic disease, and successful outcomes are highly dependent on adherence to treatment. Thus, clinicians need to have skills in coaching and encouraging as well as an awareness of factors in patients' backgrounds that are likely to affect their ability or willingness to follow treatment plans. Provider- and system-related factors, such as lack of reimbursement for counseling and high copayments, can also act as barriers to compliance. Among the strategies that can improve adherence are the use of community resources, multidisciplinary approaches, and regular follow-up.

The optimal approach to subclinical hypothyroidism continues to be debated. Experts disagree over screening for thyroid dysfunction, the threshold TSH level for treatment, and the upper limit of normal of the TSH reference range.

An up-to-the-minute review of the array of oral and topical agents as well as those used intraurethrally or for intracavernosal injection.

Over the past few decades, the management of chronic disease has assumed a greater role in health care. Diseases such as diabetes, chronic obstructive pulmonary disease, and depression have replaced acute disorders as the leading cause of morbidity, mortality, and health care expenditures.