Bad Case of the Blues
Heartbreaker
During the colder, darker winter months, a lot of patients come to me with a bad case of the blues. I try not to prescribe drugs if I don't have to, but some of them have it so bad that a dose of antidepressants is in order to help them through this rough patch. But during a look into the latest research, I found some news that reinforces my "play it safe" approach.
It turns out that two different types of common antidepressants -- tricyclics and SSRIs -- have been linked to higher risk of first-time heart attacks during the first 28 days of treatment. They appear to raise heart attack risk by up to 2.5 times, which is no small potatoes. And this study was a big one, including about 360,000 patients in the British Isles, so its findings hold some weight.
That's not to say that this information should keep people who really need the help of an antidepressant from talking to their doctors about taking one. But it does strengthen my resolve that the drug approach won't be my first line of attack against depression -- especially for patients with pre-existing heart problems. Luckily, it doesn't have to be. Keep reading...
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St. John's Wort as Effective as Paxil
Paxil is one of the standard antidepressant drug treatments these days. For lots of folks, it's very effective for lifting depression. But it does come with some pretty unpleasant side effects. Luckily, there's a safer, even more effective option out there many of you may have heard of, called St. John's wort.
A study over in Germany found that St. John's wort (a natural herb, by the way) did a better job than Paxil of treating even severe depression over a six-week test period. In fact, the patients who got St. John's wort improved by 57 percent, compared to just 45 percent for the ones on Paxil. The herb formula was better tolerated, too, with fewer adverse side effects. Paxil and similar "SSRI" anti-depressants such as Prozac, Zoloft, Celexa and Lexapro can cause nausea, headache, nervousness, somnolence, fatigue and impotence, not to mention increased risk of gastrointestinal bleeding, due to a blood thinning effect the drug companies have done a pretty good job of keeping under wraps till recently. There is also a reported risk of suicide in some patients, although this is still controversial.
Now this is only one study, and it was sponsored by the company that makes the St. John's wort product the participants took. But the results were pretty positive, and it looks like St. John's wort is at least as effective as Paxil -- maybe more so -- with less chance of those unpleasant side effects. That makes is a good first-line treatment for depression and Seasonal Affective Disorder (the winter blues) in my book.
But you should also be aware that St. John's wort can alter the effects of several commonly used drugs such as Coumadin, birth control pills, cholesterol lowering medications, blood pressure drugs, and certain medications used to treat HIV, so you definitely should work with someone experienced in prescribing herbs, especially if you are on other medications. And don't use it in addition to other antidepressants. Side effects from St. John's wort are rare, but on occasion there have been reports of an allergic rash or skin reddening from the sun, which has been grossly exaggerated by the popular and medical press.
Now, on to the other topic I wanted to tell you about today: The easy test I use with my female patients to see if they're at higher risk for heart disease. Read on...
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Simple Test Predicts Heart Troubles in Women
We keep getting more and more good information out of the Women's Health Initiative, the big study that went on for quite a while and included a lot of women (72,242 of them). One of the things we learned was a really simple way to tell if a postmenopausal woman has a higher chance than average of developing heart disease.
Turns out that a simple white blood cell count is a great predictor of risk. This test is quick, easy, cheap...and usually included in routine periodic blood work. But the information you can get from it is worth a whole gold mine. Postmenopausal women with white blood cell counts higher than 6,700 face a higher risk of heart attacks, strokes, even death -- and that's even when they had no history of heart disease to begin with.
I now pay extra attention to this common test so that I have even more to work with in patients. If we find out they've got some risk factors, we start working together right away to keep heart disease from ever kicking in. Talk to your doctor about this test and what it can mean. When you know what you're up against, you've got a much better chance of winning the fight.
Until next time,
Dr. Alan Inglis
House Calls
