How to choose online pharmacy

ONLINE PHARMACIES: ARE THEY SAFE?

It seems that you can buy just about anything over the Internet That may be a good thing when it comes to purchasing CDs and watches, but it may not be so good when it comes to prescription medications.

Convenience and lower cost are the two main reasons people say they like to get their prescriptions from online pharmacies. If you don’t want to drive to a drugstore to get your prescription and you can wait a few days or a week to get your prescription in the mail, then you may find online pharmacy services convenient. However, if your child develops an earache and you want antibiotics immediately, an online pharmacy won’t be able to help you.

If you are homebound or live far from a pharmacy, online drug availability can be very convenient Online pharmacies also allow you to comparison shop for price and availability. When it comes to cost, you must consider the cost of shipping. Once you tack on postage and handling fees, the cost of your prescription may meet or exceed your neighborhood pharmacy.
The Food and Drug Administration (FDA) warns consumers that they should beware of shady websites, undocumented claims, and illegal deals when it comes to online prescription drugs. Here are some of the factors you should consider before you make an online purchase.

Suspect any online pharmacy that does not require you to mail in your prescription, or one that does not verify your prescription with your prescribes These practices suggest that these pharmacies have little or no regard for their customers’ health or welfare, because they do not bother to make sure individuals are getting the proper prescription and that the drugs are indeed going to the person for whom they were intended.

Suspect any online pharmacy that dispenses drugs based solely on a questionnaire you are asked to complete online.

There is no way the recipients of your questionnaire will know whether you are telling the truth, and basically anyone can fill out a questionnaire and say they need a particular drug. Some state medical boards are taking action against health-care practitioners who prescribe medications over the Internet. Why? Because these health-care practitioners do not know you or the condition of your health. They can only rely on what you tell them.

• Make sure the website offers a street address for the pharmacy service and a toll-free number you can call. If these are not available, do not use the site.

• The pharmacy should have a pharmacist available to answer your questions, either via phone or E-mail correspondence. Preferably this service should be free. If no pharmacist is available, do not purchase from that site.

• Be wary of websites that offer only a few drugs, especially “lifestyle” drugs—those that help you lose weight, improve your sexual performance, or grow hair. Such sites may not be legitimate.

• Review the pharmacy’s guidelines regarding confidentiality of patient health-care information.
  Do not patronize any website that makes unrealistic claims about “magic cures” or quick-fix medications for serious medical conditions.

• Question any site that claims to be backed by well-known medical institutions or government agencies without first checking to see if their claims are true. This means you’ll need to contact the institutions or agencies named (which can be done easily online via their public information offices), but it’s better to be safe than sorry.

• Buy from nationally recognized chains (e.g., CVS, Walgreen’s, Drug Emporium) or established prescription businesses (e.g., American Association of Retired Persons Pharmacy Service).

• Beware of foreign websites. They may be dispensing sub-potent, outdated, contaminated, or counterfeit products. Even though the Food and Drug Administration contacts foreign pharmacy sites and questions their activities, many continue to operate.

• Look for a site that offers a money-back guarantee and promises reasonable delivery times.

• Look for the Verified Internet Pharmacy Practices Site seal on the websites you visit This seal is an endorsement from the National Association of Boards of Pharmacy (NABP), an organization that can tell you whether a particular online pharmacy is in good standing.

• You can also contact each state board of pharmacy (the state in which the online pharmacy is physically located) to verify the pharmacy’s legitimacy.

BRAND-NAME VS. GENERIC DRUGS

generic VS brand drugs

Generic drugs are medications that are identified by their chemical composition rather than their brand, or trade, name. Most people, for example, recognize the brand name Valium, yet the generic name of this anti-anxiety drug is diazepam. You can ask for the brand name or the generic if your health-care practitioner prescribes this drug for you, although if you have a prescription drug plan, your insurance company may only pay for the cost of the generic drug.

Why Brand-Name Drugs Cost More Than Generics.

In the majority of cases, generic drugs are equally as effective as brand-name medications. They also are typically less expensive than brand names, often as much as 50 percent or more. Why is this so?
Pharmaceutical companies spend a great deal of time (usually a decade or more) and money—typically more than $300 million—researching, developing, producing, and marketing a new drug. The result of all that time and effort is, if all goes well, a brand-name drug that is patented and sold exclusively under a single trade name for 17 years, which allows the company to make back the money it invested. Once a patent expires, or if there is no patent, other companies can manufacture and sell that drug under the drug’s generic name or under different brand names. These other companies don’t have to invest all that time and money to bring the original drug to market. Therefore, they can sell the drug at a lower cost

Are Generic Drugs Really Any Good?

if you’ve been reluctant to ask your health-care practitioner or pharmacist for the generic equivalents of drugs you are taking, or if someone has told you that brand-name medications are superior to generics, consider this: did you know that major drug companies produce an estimated 70 to 80 percent of the generic drugs on the market? And did you know that the Food and Drug Administration (FDA) approves generic drugs only if they act in the body the same way as the original brand-name drug? So what are you waiting for?

True, there isn’t a generic form available for every brand name. Your health-care practitioner or pharmacist can tell you if generics are available, or you can check in the drug entries in the second part of this book. There are also a few rare exceptions in which the same active ingredient, produced by different manufacturers, is absorbed by the body at a different rate. This difference can mean one drug may be slightly more or less effective than another one.

For example, generic conjugated estrogens are slightly different from Premarin, a brand-name estrogen hormone, and the difference may make the generic less effective at preventing osteoporosis. If you have any questions about the bio-equivalence of any generic, ask your health-care practitioner or pharmacist about it.

WHEN PRESCRIPTION DRUGS ARE SOLD OVER-THE-COUNTER

OVER-THE-COUNTER PHARMACIES

More than 600 ingredients or dosages that once were available by prescription only are now available over-the-counter (OTC) During the past twenty-five years, the FDA has authorized the over-the-counter sale of more than fifty drugs that previously were sold by prescription. Most of those drugs fall into the categories of decongestants, antihistamines, analgesics (painkillers), anti-ulcer, and anti-itch medications.
Drug companies like to market a prescription drug as OTC because it means more profits for them. But there is also an advantage for consumers: convenience. You don’t need to go to your health-care practitioner and get a prescription for your medications. That’s where you may also save money, depending on the type of insurance coverage you have. Some OTC versions of prescription drugs are less expensive, but in many cases they are not And while some insurance plans pay most or all of a prescription’s cost, you must foot the bill for OTC drugs.
Making the Transition to OTC. Not just any drug can make the transition from prescription to OTC. The FDA has criteria a prescription drug must meet before it can make the transition.

• The prescription drug must have at least a three-year history of safe use

• The OTC drug cannot cause serious side effects if it is misused

• The medical condition the OTC drug will treat must be self-diagnosable. That’s why you can buy OTC drugs for the common cold or a headache but not for high cholesterol or Alzheimer’s disease

• The OTC drug should relieve symptoms

In 2000, Merck & Co., maker of lovastatin (Mevacor), and Bristol-Myers Squibb, maker of pravastatin (Pravachol), petitioned the FDA to sell these two cholesterol-lowering prescription drugs over-the-counter. However, in 1997, the FDA had clearly stated in its “Guidance for Industry” statement that cholesterol-lowering drugs should be available by prescription only. One reason is that these drugs are used to treat a condition that is not self-recognizable. You must be tested for your cholesterol level, and your levels need to be monitored by a health-care practitioner. Thus cholesterol-lowering drugs do not meet one of the criteria set forth by the FDA, and Merck and Bristol-Myers Squibb were turned down.

The Safety Factor. Just because a drug is OTC does not mean it can’t cause serious side effects if it isn’t taken properly. For example: aspirin, the “wonder drug,” can cause bleeding of the stomach if taken in too high doses and, among a small percentage of people, even when taken at recommended doses. Thus any drug, prescription or OTC, should be taken according to directions or your health-care practitioner’s instructions, and regarded with caution.

COMPOUNDING PHARMACIES

COMPOUNDING PHARMACIES

When it comes to getting your prescription filled, you have more than one option: you can go to a standard pharmacy or drugstore, or you can go to a compounding pharmacy. A compounding pharmacy prepares a specialized drug product to fulfill an individual’s specific needs that cannot be met by a standard prescription.
For example: if you have difficulty swallowing a tablet or capsule, you can get your prescription prepared into a solution. Many drugs contain dyes and fillers such as lactose (e.g., decongestants, antibiotics) that can cause allergic reactions in a small percentage of people. If you are one of those people, you can get a compounding pharmacist to prepare your prescription without the offending ingredient. And if your child refuses to take a bad-tasting medication, flavoring it with cherry or grape can make the medicine go down.
The Food and Drug Administration (FDA) defined the limits of legitimate compounding under the FDA Modernization Act of 1997. However, although compounding pharmacists begin with an FDA-approved drug, changes they make to any given drug may convert an approved drug into an unapproved one. That means there is the potential for reactions to occur between ingredients because of the change that was made.

Compounding pharmacies are an option. Pharmacist and former FDA pharmacy compounding steering committee member Robert Tonelli said, “Whenever possible, FDA would recommend that patients use an approved drug. We have more data and reporting requirements on those to assure us of their safety and effectiveness.”

GUIDELINES FOR SAFE DRUG USE

safe drug use

Until the day the perfect drug exists—one that relieves all your symptoms and causes no side effects—we must recognize that every drug has potential benefits as well as potential risks. To maximize the first and minimize the latter, you need to follow some guidelines concerning everything from storing drugs properly to understanding the dosage instructions.

Storing Your Medications

This seems obvious: in the bathroom medicine cabinet, right? Wrong. The heat and humidity generated in the bathroom can change the chemical composition of some drugs. The same goes for the kitchen. Because not all drugs are alike, here are some storage guidelines.

• Ask your pharmacist how to store your prescription. The instructions should be on the prescription, but ask anyway.

• Some medications need to be refrigerated. Make sure, however, that you only refrigerate those that should be.

• If a drug should be refrigerated, don’t keep it at the back of the refrigerator, as some units tend to be much colder in the back and may freeze your prescription.

• Keep medications away from excess heat and light. For example, don’t leave your prescriptions on a bureau that gets direct sunlight.

• Keep your medications in their original containers to help prevent deterioration or losing their labels.

• Many medications, such as narcotics and sedatives, are subject to theft. Make sure you keep all medications in a safe and perhaps unlikely place (e.g., a linen closet, pantry, or utensil drawer), especially if you have repair people or other “stranger traffic” in your home. Drugs left in bathroom medicine cabinets, for example, can easily be lifted by individuals who ask to use your bathroom. Continue Reading

Adjustment Disorder with Depression

Adjustment disorder with depression is the term for the condition commonly referred to as situational depression or reactive depression. Individuals with this malady feel sadness about a loss or a major life change. The sadness, depressed mood, or sense of hopelessness begins within three months of a major stress and is excessive. People with this form of depression may find it difficult to carry on routine activities at home, at work, or at school. The depression gradually disappears once the stress is over and is not usually considered a serious depression, although it may be very uncomfortable. Often the support and advice of concerned friends, loved ones, or a doctor are enough to help sufferers manage until their mood improves following removal of stress or a decrease in its intensity.

Bereavement

Bereavement, or grief, is a normal feeling of sadness that occurs following the loss of a loved one. Uncomplicated grief is believed to advance through a series of stages that, in many aspects, mimic the illness depression, raising questions as to where normal bereavement ends and major depressive illness begins. The initial stage of grief occurs during the first few weeks after the loss and is experienced as feelings of disbelief and shock. It is commonly associated with bouts of crying, loss of appetite, loss of sexual drive, restless sleep or insomnia, lack of energy, and difficulty concentrating. In women, disturbances in the menstrual cycle are common.

The intermediate stage of grief takes place during the first year after the death of the loved one. During that phase, feelings of intense loneliness and sadness are accompanied by persistent thoughts about the death, the events leading up to the death, why it happened, and how it could have been prevented. Limited capacity for pleasure, lack of energy, sleep and appetite problems, and bouts of tearfulness persist to varying degrees.

The recovery phase of grief is the time when people begin to return to their social lives and “get on with life.” That usually begins about the second year following the loss.

Little is known about the actual duration of normal grief. Studies of spouses and parents dealing with unexpected loss point to normal grief processes lasting up to seven years. Sudden death often causes bouts of grief that are more severe and longer lasting than the bereavement following an anticipated death.

Death of a spouse can have significant impact on the health of the surviving partner. Women tend to be at increased risk for health problems within the first three months after the loss. Men whose spouses die are particularly likely to develop emotional or physical problems during the first year after the loss and have an increased mortality rate. Bereaved men who remarry tend to have lower mortality rates than those who do not.

Death of a child is particularly likely to produce severe grief reactions regardless of the age of the parent and child. Bereaved parents experience high levels of psychological distress that are accompanied by changes in physical health, functional activities, and family cohesion, including an increased risk of divorce.

The distinction between “normal” grief and depression can be a difficult one to make. The two states share many similar

physical and emotional symptoms, and the duration of both can be prolonged. Grief can produce a preoccupation with guilt about actions taken or not taken surrounding the death of a loved one and thoughts that the survivor would be better off dead. Experiences of transiently hearing or seeing the deceased loved one can also be a part of the normal grief process, especially in some cultures. Morbid rumination regarding other feelings of guilt, a sense of worthlessness, anticipated death of other loved ones, prolonged decrease in level of function, marked slowness of behavior or speech, reports of unusual beliefs, or persistent or recurring hallucinations should be considered outside the normal grief process and more indicative of a major depressive episode. When symptoms of severe grief extend more than two months beyond the death of a loved one, treatment with antidepressant medication may be needed in addition to supportive psychotherapy.

Grief in young children is most profound when it involves the death of a parent or a primary caretaker. It can produce such behaviors as crying, calling and searching for the deceased loved one, and refusing to be comforted. Emotional withdrawal often occurs and is associated with sad facial expressions, lethargy, and lack of interest in former activities. Eating and sleeping may be disrupted. Children may regress by losing some of their developmental milestones; i.e., toilet-trained toddlers may begin to soil themselves again. Bereaved young children may become detached and lack much facial expression. They often are very sensitive to any reminder of the lost loved one. Grief in young children is generally treated with supportive measures; use of antidepressant medication is usually not required.

Types of Depression

Many different and sometimes complicated systems attempt to classify depressions according to their symptoms, severity, causes, and other characteristics. One reason for these rigorous attempts is the need to conduct research on relatively pure forms of the illness. Such research should result in improved treatment for the various forms of depression.

The two most common systems use similar terms in naming various types of depression. The international version is the ninth edition of the International Classification of Diseases, commonly referred to as ICD-9, which classifies all medical and mental disorders. The system used by most clinicians in the United States is the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, or DSM-IV, produced by the American Psychiatric Association. Further attempts are made to standardize these common classification systems with each new edition.

Depression can take many forms, and these may be of varying degrees of severity with different natural courses. The types of depression commonly diagnosed in the United States include adjustment disorder with depressed mood; dysthymic disorder; major depressive disorder, single episode or recurrent; major depressive episode associated with bipolar disorder; and mood disorder associated with a general medical condition.

Mild mood alterations do not require help and therefore are not matters for diagnosis. For instance, a bad mood is just that— temporary frustration associated with current circumstances. A person exhibiting a somewhat more persistent alteration of mood is often described as being “blue, ” “bummed out, ” or mildly depressed. People with such negative feelings still enjoy their hobbies, family, and friends. Such mild depressions are usually time-limited and unlikely to require treatment.

Moderate-to-severe forms of depression frequently come to the attention of caregivers, although the initial complaint may not be depression. Those are the forms of depression that fall into formal diagnostic categories.

Depression and Suicide

Every 17.3 minutes someone commits suicide in the United States. According to National Institute of Mental Health statistics, suicide is the ninth leading cause of death in Americans and accounts for more than 30,000 deaths every year. More Americans die of suicide than are victims of homicide. Although most people who become depressed do not commit suicide, depression can be a lethal illness. Contrary to popular belief, not everyone who commits suicide is depressed, but the majority of people who commit suicide do so during a severe depressive episode. The suicide risk in people with severe depression ranges between 15 and 30 percent, with approximately seven suicide attempts for every successful suicide. Women are two to three times more likely to attempt suicide, but men are four to five times more likely to be successful in their attempt.

Over 70 percent of all suicides in the United States are committed by white men, and the majority of those deaths involve firearms. The second highest rate in the country is reported in white women, followed by rates for black women. Black men in the United States currently have the lowest suicide rate; unfortunately, it is rising.

Bob T. was a seventy-two-year-old retired government employee who lived alone in a retirement community. He had been the sole caretaker for his wife, who had been bedridden for two years before her death the previous year. Bob was hypertensive and diabetic. Both conditions had been well controlled with diet and medication until the past few months. Despite repeated visits to his physician, Bob did not feel well. He experienced vague stomach discomfort, joint aches, increasing insomnia, and fatigue, which he reported to his doctor on repeated visits. Bob did not discuss with his physician his fear that his memory was failing rapidly and that he might have “old-timer’s disease.” He often thought of his wife in a “happier place” and longed to join her. One Sunday afternoon after attending church services, Bob went home, wrote his name and the current date in the family Bible below the entry noting his wife’s death, and shot himself in the head.

Thoughts of suicide may be intermittent and relatively brief, but they may also be persistent and intrusive, developing into plans for carrying it out. Circumstances that increase the risk for suicide in depressed patients include advancing age, male sex, Caucasian race, living alone, chronic medical illness, a recent major loss, substance abuse, panic attacks, psychotic symptoms, previous episodes of depression, previous suicide attempts, and family history of depression. In addition, people who are depressed and simultaneously have other brain disorders such as schizophrenia, dementia, or brain damage from illness or trauma may be at increased risk for suicide because of impaired judgment and a tendency toward impulsiveness.

Common methods of suicide include gunshot wound to the head or chest, overdose of over-the-counter or prescription medications, overdose of street drugs, laceration of neck or wrists with a sharp object such as a razor blade or a knife or broken glass, asphyxiation by hanging or from the breathing of a toxic gas such as natural gas or carbon monoxide from an automobile exhaust, and purposeful “accidents, ” such as car crashes against trees or off bridges. In the past, women were reported to choose less violent means of suicide, such as overdose or asphyxiation by gas, while men chose more violent means, such as guns. Now, however, suicide by firearms is the most common method for both men and women, accounting for over half of all suicides. Unfortunately, depressed people intent on suicide can be very creative in choosing their method of death, despite the efforts of their doctors and their loved ones to prevent the tragedy.

The risk for suicide, ironically, may be greatest when the sufferers have passed the lowest point in the course of their illness and have begun to recover. The reasons are not clear but may relate to the observation that recovery from depression often begins with an increase in energy level without immediate improvement in mood. When such is the case, depressed people in the early stages of recovery have regained enough energy to plan and carry out a long-desired suicide. It may also be that once seriously depressed individuals finally make the decision to escape the anguish of illness through death, they feel a temporary reprieve from their symptoms.

Suicide may occur without warning, but 80 percent of people who attempt or commit suicide do give some indication of their intent by means such as voicing despair and world-weariness, expressing suicidal thoughts, threatening to harm themselves, increasing the use of alcohol or drugs, or writing suicide notes. Rehearsing suicide or seriously discussing specific methods may also indicate a determination to go forward with it. More often the hints are subtle behavioral changes that may serve as red flags. Such warnings perhaps indicating that the despondent individual is putting his or her house in order may include making out a will, reviewing life insurance coverage, purchasing cemetery plots, giving away valued possessions, or getting in touch with close relatives. Contrary to popular understanding, most people do not leave notes.

Once someone has decided to commit suicide, it may be impossible to prevent the tragedy. Although many suicide attempters are ambivalent about their course of action until the last moment, others are determined to die and give few clues ahead of time.

Symptoms of Depression

There is no blood test for depression. The diagnosis is based on the reports of sufferers about how they feel and on observations of how they look and behave made by doctors and by people who know them well.

John D. was a forty-five-year-old, self-employed, successful businessman when he suddenly initiated negotiations to sell his company. For months preceding the decision to sell, John had experienced increasing fatigue and decreasing ability to concentrate, which he attributed to the pressures of work. He quit meeting his friends for golf on Sunday afternoons, preferring to sleep in front of the television, but then had problems going to sleep at night. John’s appetite, energy level, and sex drive gradually diminished, while he experienced a growing sense of restlessness, irritability, and futility. John’s wife became concerned when she learned of her husband’s recent purchase of additional life insurance and of his revision of his will. She convinced John to see his family physician for a “good physical.”

The symptoms of depression fall into four categories: mood, cognitive, behavioral, and physical. In other words, depression affects how individuals feel, think, and behave as well as how their bodies work. People with depression may experience symptoms in any or all of the categories, depending on personal characteristics and the severity and type of depression.

Depressed people generally describe their mood as sad, depressed, anxious, or flat. Victims of depression often report additional feelings of emptiness, hopelessness, pessimism, uselessness, worthlessness, helplessness, unreasonable guilt, and profound apathy. Their self-esteem is usually low, and they may feel overwhelmed, restless, or irritable. Loss of interest in activities previously enjoyed is common and is usually accompanied by a diminished ability to feel pleasure, even in sexual activity.
As the illness worsens, the cognitive ability of the brain is affected. Slowed thinking, difficulty with concentration, memory lapses, and problems with decision-making become obvious. Those losses lead to frustration and further aggravate the person’s mounting sense of being overwhelmed. The sufferer longs for escape, and thoughts of death intrude, sometimes taking the form of wishful thinking, as in “I wish God would just take me” or “I wish I could vanish, ” and often involving ideas of suicide.

In its most severe forms, depression causes major abnormalities in the way sufferers see the world around them. They may become psychotic, believing things that are not true or seeing and hearing imaginary people or objects.

Ann H. was forty years old when her husband took her to the family physician after she began crying daily and begging her husband to take good care of their teenage daughters after her death. Despite a normal medical assessment, Ann remained convinced that she was dying of metastatic cancer as had her mother years before. She “felt” the cancer cells destroying her liver and kidneys and pointed to her twenty-pound weight loss in six months as proof of terminal illness. Ann’s appetite was poor, yet she remained constantly, unproductively active throughout the day. At night she lay awake crying about leaving her daughters without a mother, while during the day she worried constantly about becoming an emotional and financial burden on her family in the late stages of her “terminal” illness. Ann decided she must kill herself to protect her family and took a lethal overdose of an antidepressant medication that had been prescribed by her family physician.

Psychosis in depression is not rare. Between 10 and 25 percent of patients hospitalized for serious depression, especially elderly patients, develop psychotic symptoms. Symptoms of psychosis may include delusions (irrational beliefs that cannot be resolved with rational explanations) and hallucinations (seeing, hearing, feeling, tasting, or smelling things or people that are not present).
People with psychoses may develop paranoia, believing that they are being manipulated by known or unknown people or forces, that there is a conspiracy against them, or that they are in danger. No amount of rational explanation changes the delusional belief. Others may be convinced that they have committed an unpardonable sin against loved ones or against their God and deserve severe punishment, even death. Some sufferers become so firmly convinced of their own worthlessness that they begin to view themselves as a burden to their families and choose to kill themselves. Occasionally, severe depression may result in hallucinations in which the depressed person hears or sees things or people that are not present; other types of hallucinations, such as smelling or feeling things that are not present, are less common in severe depression than in some other brain disorders.

The changes occurring with depression understandably result in alterations in behavior. Most individuals with moderate-to-severe depression will experience decreased activity levels and appear withdrawn and less talkative, although some severely depressed individuals show agitation and restless behavior, such as pacing the floor, wringing their hands, and gripping and massaging their foreheads. Given a choice, most begin to avoid people and activities, yet others will be most uncomfortable when alone or not distracted. In general, the severely depressed become less productive, although they may successfully mask the decline in performance if they have been highly productive in the past. In the workplace, depression may result in morale problems, absenteeism, decreased productivity, increased accidents, frequent complaints of fatigue, references to unexplained aches and pains, and alcohol and drug abuse. Severely depressed individuals have been known to work their regular schedule during the day, interact with their coworkers in a routine way, and then go home and kill themselves.

Depression is more than a mental illness. It is a total body illness. People suffering from moderate-to-severe depression experience changes in their body functions. Their energy levels fall, and they fatigue more easily. Insomnia is common and takes many forms; depressed individuals may have difficulty going to sleep or experience early morning awakenings. A subgroup of depressed patients feel an excessive need for sleep. Depressives consistently complain that their sleep is not restful and that they feel just as tired in the morning when they awake as they did when they went to bed the evening before. Some may be troubled by dreams that carry the depressive tone into sleeping hours, causing abrupt awakenings due to distress.

Appetite changes are common. Most depressives experience decreased or total loss of appetite, with associated weight loss resulting in lower energy levels. The same individuals who oversleep when depressed also tend to overeat. They gain weight from a combination of increased caloric intake and decreased activity level, which compounds their problems through increased frustration and lowered self-esteem. Whether the appetite increases or decreases, the end result is a vicious cycle of physical symptoms aggravating the depression.

Physical complaints are common and may or may not have a physical basis. Many seriously depressed people, in fact, first go to their physicians with physical complaints. The depressed mood may not be recognized initially by these patients, especially if they are men. Men, in general, are less apt to look inward when they “feel bad, ” attempting instead to locate the problem in their environment.

Physical symptoms associated with depression can occur in any part of the body and can include pain (headache, backache), gastrointestinal problems (nausea, stomach pain, diarrhea, constipation), neurologic complaints (dizziness, numbness, memory problems), sexual disorders (lack of desire, failure of orgasm), and general complaints of feeling unwell and heavy, as if one’s feet are stuck in mud. The physical complaints of depressed patients cannot be overlooked, because many studies indicate an increased risk of real physical illness in people who have severe forms of depression.

Costs of Depression

Approximately one in five adults in the United States will suffer from depression at some time. Depression affects more than 17 million Americans each year. Mood disorders, including mania and various forms of depression, account for as many as 70 percent of psychiatric hospitalizations.

Sufferers of depression include some of the most creative and productive members of society, which means that the direct and indirect costs of this common illness are very high. The latest National Institutes of Health (U.S.) study on the cost of depression, reported for 1990, estimated the cost of depressive illness in the United States at between $33 billion and $44 billion annually (fig. 1.1), including direct treatment costs ($12.4 billion), absenteeism ($11.7 billion), lost productivity ($12.1 billion), and mortality costs ($7.5 billion). The number of lost work days due to depression may be as high as 200 million days per year.

On a more personal level, patients treated in psychiatric hospitals for serious depression may find themselves billed $1,000 to $1,500 a day or more for a hospitalization that may exceed five to seven days and occasionally last several weeks. Those charges may not even include the costs of physician visits, consultants, or special studies such as antidepressant medication blood levels or brain scans.

Most people, even solid middle-class individuals with good health insurance, will find themselves psychiatrically indigent if they require hospitalization for the treatment of depression. Health insurance policies, even good ones, commonly discriminate against psychiatric illness. Many policies have a poorer reimbursement rate for mental disorders, impose a lifetime maximum reimbursement limit (sometimes as little as $50,000), and require larger copayments for psychiatric treatment. The length-of-stay allowances for inpatient care of seriously depressed patients may also place the patient at significant risk. For example, a psychiatrist recently hospitalized a severely depressed woman on an emergency basis following her suicide attempt by overdose of prescribed medications. The insurance company ruled that the patient had to be discharged the day she no longer reported suicidal intent. The fragility of severely depressed patients in early recovery, including their increased risk for suicide, was apparently not a cost-efficient consideration.

Another problem is the stigma associated with mental illness, which can make treatment for depression and other brain disorders that are labeled as mental illnesses costly in personal ways. Traditionally, people with mental illnesses such as depression have been required to report their disorders on applications for a driver’s license, for employment, for security clearance, and for other routine purposes, while people with other medical conditions generally have not. Although the recent federal Americans with Disabilities Act attempted to correct that form of discrimination, the problem remains. When a physician recently changed her medical liability insurance policy, the application asked whether the applicant had ever been treated for mental illness. Nowhere on the policy was there another question about any other medical illness or treatment. Fearing discrimination in hiring, promotion, and other occupational and educational opportunities, many people who recognize their own depression will not seek treatment because of concerns that they may have to report it later.

What Is Depression?

what is depression

The innocuous-sounding word “depression” refers to a potentially disabling illness that affects many but is understood by few. Sufferers often do not realize the nature of their terrible malaise until they are so devastated that they can no longer help themselves, or they may recognize what they have been through only after they are on their way out of the shadows. The reason is simple. Depression is a sneak thief, slipping into a life gradually and robbing it of meaning, one loss at a time. The losses are imperceptible at first, but eventually weigh so heavily that the person’s life becomes empty. Once begun, the course of depression varies with the individual and with the form of the illness. Untreated, it can last weeks, months, or even years.

In the general population, as many as one in five individuals may eventually suffer a significant depressive illness, although most will not seek treatment. During any year, one in ten people experience the sluggishness of mind, body, and spirit we know as depression. The risk is about the same in prepubertal boys and girls, but the ratio alters in adulthood, with females twice as likely as males to become depressed. This two-to-one ratio exists regardless of racial, ethnic, or economic background and has been reported in several countries.

Although depression can occur in very young children, even in those under five years of age, it is more likely to occur for the first time during teenage years or in early adulthood. Depression can also occur for the first time in midlife or later.

Depression tends to run in families. Children of depressed parents have a twofold-to-threefold greater risk of developing depression than children of non depressive parents. Studies of families with histories of depression in many of their members support the theory that predisposition to depression can be inherited. Since the family tendency could be explained by similar environments rather than by genes, twins who have been adopted outside their biological families and reared apart have been studied with regard to risk for depression. Most of those studies show that if one identical twin (identical twins share the same genes) suffers from depression, the second twin will have a 70 percent chance of also becoming depressed, while the risk for siblings who are not identical twins is only about 25 percent. If heredity were the only factor, the shared rate of depression in identical twins would be 100 percent. Since this is not the case, genetics cannot be the only factor involved. At this point, no single gene has been identified as the culprit in causing depression, and it is more likely that several genes are involved.

According to the fertile ground theory, heredity and environment collude to cause depression. Environmental factors that may be important in causing depression include loss of a parent early in life, separation or divorce of parents, rearing patterns, abuse, low socioeconomic class, and recent life stresses.

How a Touch of Prozac Could End the Hell of PMT

TINY amounts of Prozac could end the monthly misery of PMT for millions of women – and their partners, scientists believe.

In studies, the ‘happy pills’ banished the mood swings, bloating, lethargy and pain that blights the lives of up to three quarters of women in the run-up to their period.

The doses given were around a tenth of that used to treat depression and so should be free of the side-effects that have dogged the drug’s use in psychiatry.

Preliminary experiments on rats have had ‘dramatic’ results and researchers believe low-dose Prozac could be routinely used to prevent PMT – pre-menstrual tension – within two years.

Neuroscientist Thelma Lovick, from the University of Birmingham, said: ‘A lot of women experience PMT and a lot of men are on the receiving end. I can’t say we are going to cure everyone but when taken in conjunction with sensible lifestyle changes we are in with a chance.’ Dr Lovick pinned the symptoms on the sharp fall of progesterone that occurs the week before a women menstruates. Normally, a waste product of progesterone called allopregnanolone, or allo, helps keep a lid on brain circuits involved in controlling emotions.

When progesterone levels fall, amounts of allo also fall, and emotions run riot. Prozac is known to raise allo levels, so Dr Lovick decided to see if it would ease the condition in rats.

Very small doses completely prevented the anxiety and increased sensitivity to pain the creatures normally experience.

Dr Lovick told the British Science Festival: ‘It completely blocked the symptoms – we are amazed.

‘The time is right for a controlled clinical trial in women. The solution for PMT could be as simple as taking a pill for a few days towards the end of your menstrual cycle.’ It is likely women would take a pill at the first signs of PMT and one a day for the following week.

Used alongside lifestyle changes such as controlling stress and cutting out sugary foods, it could have a major impact on millions.

Regular strength Prozac lifts depression by raising levels of ‘feel good’ brain chemical serotonin but can cause problems from loss of libido to suicidal thoughts and selfharm.

Dr Lovick said that using around a tenth of those used to treat depression should not trigger any side-effects.

This is because although very small doses raise levels of allo, they do not have any effect on serotonin.

A daily dose of regular-strength Prozac is already sometimes prescribed to ease PMT, but Dr Lovick believes the way forward is a very small dose taken for a week a month.

Professor Tim Kendall, consultant psychiatrist, said that the idea warranted more research. But he warned that self-medicating with Prozac could be disastrous.

He said: ‘It can make you anxious and wound-up and affect appetite. I don’t know if these side-effects would occur at low doses but it would strike me as unwise to start tipping drugs out of capsules.’

THE TROUBLED ‘QUICK FIX’

ONCE hailed as a miracle cure for depression, Prozac and similar drugs are prescribed to millions around the globe.

Known as selective serotonin reuptake inhibitors, the ‘happy pills’, which include Seroxat and Efexor, keep mood-boosting serotonin in the brain for longer. When introduced in the late 80s, they were seen as safer than previous anti-depressants. But their use has since been linked to suicidal thoughts and self-harm.

This led to advice that patients with mild depression should instead be offered counseling.

It is claimed that many GPs give out tablets rather than condemn patients to a long wait for counseling.

Some GPs say they are pressurised by patients anxious for a ‘quick fix’ to their problems.

20% of Americans have some mental problems

20% of Americans suffer in one way or another from mental disorder. The highest percentage of mentally unstable people – 30% – in the category 18-25 years. Among Americans older than 50 years of mental disorders in varying degrees, affected 13.7%. Scientists explain such high rates of economic instability.

Ireland Is Facing Obesity Epidemic in Just 25 Years

IRELAND faces an obesity epidemic with half of the population likely tobe overweight in just 25 years’ time, a leading Irish health charity haswarned.

The Irish Heart Foundation (IHF) made its bleak prediction after UK figuresshowed the extent of the obesity problem there.

A landmark British study warned that as well as half of all Britons becomingobese by 2032, 86 per cent of men stand to become overweight in the next 15years, while 70 per cent of women will suffer a similar a fate within 20 years.

The IHF issued a stark warning yesterday, saying the worrying obesity trends inthe UK are mirrored in Ireland. It called on Irish politicians to makeprevention of heart disease a number one priority.

Chief executive Michael O’Shea said: ‘Ireland and indeed, Europe, is in thethroes of an obesity epidemicanditisthreateningto reverse the downward trend in mortality from heart disease which hasoccurred over the last 20 years.’ The British health secretary Alan Johnsonsaid that ‘obesity is a potential crisis on the scale of climate change’. Thesenew statistics show that Ireland is heading in the same direction.

The latest figures show that more than 300,000 children in Ireland areoverweight or obese and this is a figure that is growing every year by astaggering 10,000.

One in five adults is now obese andtwo out of five adults are overweight.

International Obesity Taskforce’s 2002 figures show that Ireland’s men are thefourth heaviest in the EU, while women come in at No. 7 in the league table.

MrO’Sheaadded:’Therisk factors for obesity such as heart disease, high blood pressure and highblood cholesterol, are largely preventable and at the foundation we workcontinuously with schools, workplaces and communities to encourage healthierliving.

‘But our efforts can only go so far inanenvironmentwhereitis increasingly difficult to make the healthy choice in what has been describedasthe”obesogenic” environment.’ MrO’Sheaalsocriticisedthe mass-marketing of ‘energy-dense foods to our children’, and said that alack of ‘adequate exercise facilities in our schools and the provision of safewalking and cycling paths’ made obesity even more difficult to control.

The British study, compiled by 250 leading scientists, said the obesity crisisthere is so bad it will take 30 years to reverse.

Modern lifestyles – with the easy availability of cheap unhealthy food andpeople relying too much on their cars – means it is almost impossibleformanypeopleto avoid putting on weight. And the effect on health – both in the UK andIreland – will be stark.

The report expects rates of type 2 diabetes to rise by 70 per cent, strokes togo up by 30 per cent and a 20 per cent rise in coronary heart disease. Therates of certain types of cancer will also go up.

Recently,thedirectorofthe WeightManagementClinicat Dublin’s Loughlinstown Hospital reported that eight out of ten type 2diabetes cases, and four out of ten cancer cases, were because of obesity. Twomore weight clinics, in Cork and Galway, will open within six months.

The British government’s chief scientific advisor, Professor David King,said:’Wemustfightthe notion that the current obesity epidemic arises from individualoverindulgence or laziness alone.

‘We live in a consumer society which encourages us to eat. We have a sedentarylifestyle. It’s an environment which means that if we just behave normally wewill become obese.

‘Wemayonlyputonabitof weight a day but there are 365 days in the year.’ Dr Susan Jebb of the HumanNutrition Research Unit said action against obesity needed to be asstrongas the action taken against infectious diseases in the nineteenth century.

She said people were eating more unhealthily and taking less exercise becausethat was becoming normal behaviour and ‘we act as a herd’.