Emerging research suggests a longer period of estrogen replacement therapy provides a prolonged cognitive benefit. However, investigators acknowledge that the risk-to-benefit balance of hormone therapy use is complicated and must be individualized.
Research has determined that estrogen has a significant role in overall brain health and cognitive function. This knowledge has fostered various studies on the prevention of cognitive decline as related to reduced estrogen levels during the menopause transition.
The new study suggests a cognitive benefit from a longer reproductive window complemented with hormone therapy. The study, “Lifetime estrogen exposure and cognition in late life: The Cache County Study,” appears online in Menopause, the journal of The North American Menopause Society (NAMS).
Because women comprise two-thirds of the 5.5 million cases of Alzheimer disease in the United States, researchers have long suspected that sex-specific factors such as estrogen may contribute to women’s increased risk for the disease. Moreover, multiple studies have suggested a role for estrogen in promoting memory and learning.
In this newest study involving more than 2,000 postmenopausal women, researchers followed participants over a 12-year period to examine the association between estrogen and cognitive decline.
More specifically, they focused on the duration of a woman’s exposure to estrogen, taking into account such factors as time of menarche to menopause, number of pregnancies, duration of breastfeeding, and use of hormone therapy.
Investigators concluded that a longer duration of estrogen exposure is associated with better cognitive status in older adult women. Furthermore, they documented that these beneficial effects are extended with the use of hormone therapy, especially in the oldest women in the sample.
Women who initiated hormone therapy earlier showed higher cognitive test scores than those who started taking hormones later, providing some support for the critical window hypothesis of hormone therapy.
“Although the assessment of the risk-to-benefit balance of hormone therapy use is complicated and must be individualized, this study provides additional evidence for beneficial cognitive effects of hormone therapy, particularly when initiated early after menopause.
This study also underscores the potential adverse effects of early estrogen deprivation on cognitive health in the setting of premature or early menopause without adequate estrogen replacement,” says Dr. Stephanie Faubion, NAMS medical director.
Source: The North American Menopause Society (NAMS)
People struggling with opioid addiction and chronic pain may experience fewer cravings and less pain if they use mindfulness techniques along with medication for opioid dependence, according to a new study published in the journal Drug and Alcohol Dependence.
Mindfulness is the meditative practice of focusing on the present moment and accepting one’s thoughts, feelings and bodily sensations, without judgment.
The study, led by researchers from Rutgers University in New Jersey, looked at the effects of mindfulness techniques and methadone therapy on 30 patients with opioid addiction and chronic pain.
The research team found that participants who received methadone and a mindfulness training-based intervention were 1.3 times better at controlling their cravings and had significantly greater improvements in pain, stress, and positive emotions, compared to participants who only received standard methadone treatment and counseling.
The findings held true even though the mindfulness participants were more aware of their cravings.
“Methadone maintenance therapy (MMT) has been an effective form of medication treatment for opioid use disorder,” said Associate Professor Nina Cooperman, a clinical psychologist in the Division of Addiction Psychiatry at Rutgers Robert Wood Johnson Medical School.
“However, nearly half of individuals on MMT continue to use opioids during treatment or relapse within six months.”
Cooperman said that people with opioid addictions often experience chronic pain, anxiety and depression while on methadone maintenance, which is why mindfulness-based, non-drug interventions are promising treatments.
The researchers said mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain.
Individuals with an opioid addiction could also be taught to change their negative thought patterns and savor pleasant events, which may help them to regulate their emotions and experience more enjoyment.
In 2017, more than 70,000 people died from a drug overdose, making it a leading cause of injury-related death in the United States. Of those deaths, almost 68% (47,600 overdose deaths) involved a prescription or illicit opioid, according to the Centers for Disease Control and Prevention (CDC). Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.
Source: Rutgers University
Research has established a link between food insecurity and higher rates of disease, but there is little evidence showing exactly why this occurs. A new study of more than 10,000 Canadian households shows this association may be at least partially attributed to lack of access to prescription medication.
“We knew that negative health outcomes are associated with food insecurity. But we didn’t really understand the mechanism,” said study co-author Dr. Craig Gundersen, distinguished professor of agricultural and consumer economics in the College of Agricultural, Consumer and Environmental Sciences at the University of Illinois in Champaign-Urbana.
The findings, published in the journal CMAJ Open, suggest that people may become ill or get worse because they can’t afford their medications. “For example, we know that there is a close connection between food insecurity and diabetes; it could be the case that part of the reason is medication nonadherence,” he said.
The study draws on data from the Canadian Community Health Survey, conducted annually by the Canadian national statistics office.The researchers evaluated data from 11,172 respondents, combining information on food insecurity with prescription drug use.
Overall, they found that food insecurity affects 12.6% of Canadian households, and 8.5% of respondents reported some form of nonadherence to prescription drugs. Nonadherence includes skipping or reducing doses of medication, as well as delaying or not filling prescriptions because of cost.
The researchers found a strong link between food insecurity and prescription drug nonadherence. Almost half (47.9%) of those who did not adhere to their prescription drug usage also reported some level of food insecurity. Of those who did adhere to their medications, only 10.5% were food insecure.
The findings indicate that nonadherence increases as food insecurity status gets worse. While just 4.9% of food secure households reported nonadherence to prescription drugs, cost-related nonadherence was reported by 13.2% of marginally, 29.4% of moderately, and by 47.1% of severely food insecure households.
Gundersen says that even though the health care system in Canada differs from the United States, there are lessons to learn for Americans in the study. All Canadians have access to health care; however, prescription drugs are covered by a combination of private and public insurance. Over four million Canadians are not enrolled in any drug insurance program.
“The study helps separate the effects of access to medical care from access to prescription drugs,” Gundersen said.
“Even if health insurance is covered, people still face struggles if prescription drugs are not covered. This amplifies the conclusion that illness associated with food insecurity is related to lack of access to medication.”
Source: University of Illinois College of Agricultural, Consumer and Environmental Sciences
A Philadelphia jury awarded a young man, Nicholas Murray, $8 billion in punitive damages after he claimed he was not warned of a significant side effect — breast growth — of an atypical antipsychotic medication called Risperdal (risperidone).
Risperdal is made by Janssen Pharmaceuticals, a Johnson & Johnson (J&J) company.
Murray was originally prescribed Risperdal in 2003 when he was 13 years old for treatment of autism spectrum disorder. Risperdal was not yet approved by the U.S. Food and Drug Administration (FDA) for the treatment of autism in 2003. But doctors can prescribe an FDA-approved medication for any condition they choose.
Murray, now 26, was previously awarded $1.75 million in the lawsuit in 2015, but the amount was reduced to $680,000 in a state appeals court. Murray claimed the company failed to warn that teenagers and young men using Risperdal could grow breasts.
Risperdal is typically prescribed (and FDA-approved) to treat bipolar disorder, schizophrenia, and other mental health disorders. Murray’s lawyers claimed the drug can create a hormonal imbalance, causing the formation of female breast tissue in men (a condition called gynecomastia).
The FDA approved Risperdal for children and teens (5 to 16 years old) diagnosed with autism in 2007.
This is not the first legal action taken against J&J due to its marketing of Risperdal.
In 2013, the U.S. Justice Department settled a $2.2 billion claim against J&J for Risperdal allegations. In that settlement, the Justice Department alleged that despite repeated warnings from the FDA, J&J’s Janssen division continued misleading marketing messages to physicians.
From that 2013 article, it was also noted that Janssen apparently marketed Risperdal for use in children with behavior challenges, despite known health risks to children and adolescents. Until late in 2006, Risperdal was not approved for use in children for any purpose, and the FDA repeatedly advised the company that promoting its use in children was problematic and could violate the law.
According to additional legal filings, J&J apparently faces some 13,400 lawsuits tied to Risperdal and its potential side effect of breast growth in boys who take the drug. More than 7,000 of those lawsuits are pending in state court in Philadelphia.
According to ClassAction.com, J&J has settled more than 80 cases related to Risperdal for undisclosed amounts from 2012 to 2013. In 2016, a jury awarded $70 million to Andrew Yount, “ruling that the company not only failed to warn Yount about the issues surrounding Risperdal but had destroyed evidence related to the case,” according to Fox Business News.
They also noted that, “In August of 2012, J&J agreed to pay $181 million to 36 states and the District of Columbia to settle fraud charges related to its unlawful marketing of Risperdal.”
“This jury resoundingly told J&J that its actions were deliberate and malicious,” Tom Kline and Jason Itkin, two of Murray’s lawyers, said in an emailed statement to Bloomberg.
The $8 billion sum is likely to be reduced on grounds that it violates due process. J&J said that it will appeal the ruling, claiming the amount was “grossly disproportionate.”
J&J is also involved in lawsuits related to its marketing of opioid painkillers. It recently settled two Ohio opioid-related lawsuits for more than $20.4 million. J&J formerly marketed the painkillers Duragesic and Nucynta.
Opioids were involved in 400,000 overdose deaths in the United States from 1999 to 2017, according to the U.S. Centers for Disease Control and Prevention. The company claims the settlement includes no admission of liability.
Source: Wire reports
A new study finds that adolescent suicide attempts by self-poisoning often involve common household medications, such as ibuprofen or antidepressants.
The findings, published online in the journal Clinical Toxicology, also reveal that self-poisoning suicide attempts are more common in rural communities, particularly during the academic school year.
The study expands on previous research that looked at the incidence and outcomes from intentional suspected-suicide self-poisoning in children and young adults ages 10 to 24 years old from 2000-2018.
In that 19-year time frame, there were more than 1.6 million intentional suspected-suicide self-poisoning cases in youth and young adults reported to U.S. poison centers. The majority of cases were female (71%), and involved a pharmaceutical (92%).
“While most of these cases involved medications, with adolescents, any available medication can be a potential hazard,” said Henry Spiller, M.S., D.ABAT, director of the Central Ohio Poison Center at Nationwide Children’s Hospital, and co-author of the study.
“It’s not so much a matter of substance type, but rather a matter of access to the substance. Any type of medication can be misused and abused in ways that can unfortunately lead to very severe outcomes, including death.”
The two most common substance groups in all age groups were over-the-counter (OTC) painkillers such as acetaminophen, ibuprofen and aspirin, followed by antidepressants. In youth (ages 10-12) and adolescents (ages 13-15), ADHD medications were common, and had the highest risk of serious medical outcomes. Opiates only accounted for 7% of cases with serious medical outcomes.
“Because medications are so readily available in homes, many families do not take precautions to store them safely. Our findings suggest this is a big problem,” said John Ackerman, Ph.D., clinical psychologist and suicide prevention coordinator for the Center for Suicide Prevention and Research at Nationwide Children’s, and co-author of the study.
“Medications can be part of effective treatment, but they require an extra layer of care. The answer is not to stop prescribing medications to those who stand to benefit, but rather to emphasize the practice of safe storage and vigilance when administering any kind of medicine, especially when children and teens live in the home.”
The findings also show that states with a lower population per square mile (rural areas) had a greater number of reported cases with all outcomes and serious medical outcomes.
Results also revealed there was a significant decrease in the number of cases in school-aged individuals during non-school months of June through August (27.5% decrease in 10-12-year-olds; 27.3% decrease in 13-15-year-olds; and 18.3% decrease in 16-18-year-olds), compared with school months September through May.
Nationwide Children’s Big Lots Behavioral Health experts recommend that parents check in with their children regularly, and ask them directly how they are doing and if they have ever had thoughts about ending their life. These direct questions are even more critical if warning signs of suicide are observed.
Medications should be stored up, away and out of sight, preferably in a locked cabinet. Administration of medicine should always be supervised.
“It should concern us that youth in rural areas are about twice as likely as those living in urban areas to die by suicide. Although we are in dire need of more research to help us understand what places some people at more risk than others, available evidence indicates that include increased social isolation, stigma, access to lethal means and lack of appropriate mental health resources may play a role in this disparity,” said Ackerman.
His suicide prevention team provides comprehensive training to more than 140 central and southeast Ohio schools with the SOS Signs of Suicide program.
“It is vital that parents, teachers and other trusted adults start conversations about mental health early, and pay even closer attention during the school year, as rates of anxiety and depression are shown to increase during that time. Warning signs can often be detected and support is available for young people in crisis.”
Source: Nationwide Children’s Hospital
New research from the United Kingdom finds that antidepressant use among those over 65 more than doubled over two decades. But despite the rise in antidepressant use, there was little change in the number of older people actually diagnosed with depression.
The research effort, led by University of East Anglia investigators, evaluated data from the Cognitive Function and Aging Studies, conducted at two time points: between 1991 and 1993, and between 2008 and 2011. Researchers interviewed more than 15,000 over 65s in England and Wales to see whether the prevalence of depression and antidepressant use is changing.
“Between two comparable samples interviewed 20 years apart, we found little change in the prevalence of depression, but the proportion of participants taking antidepressants rose from 4 percent to almost 11 percent,” said lead author Prof. Antony Arthur, from UEA’s School of Health Sciences. “This could be due to improved recognition and treatment of depression, overprescribing, or use of antidepressants for other conditions.”
Arthur added, “Depression is a leading cause of poor quality of life worldwide, and we know that older people may be less likely than other age groups to go to their physician with symptoms of depression.
“Until now, little was known about how the relationship between the prevalence of depression and antidepressant use among older people has changed over time.”
Arthur noted that the Cognitive Function and Aging Studies led by the University of Cambridge can examine changes in the health needs of older people across generations. The studies are based on random sampling and diagnostic methods held constant over time.
“We asked participants about their health, daily activities, use of health and social care services, and the medications they were taking,” he said.
Arthur said a standardized interview process allowed the investigators to ascertain the presence or absence of symptoms of depression. They were then able to apply diagnostic criteria to see whether the participant was considered to have “case level” depression; a level of depression more severe than that characterized by minor mood symptoms, such as loss of energy, interest or enjoyment.
The study’s lead investigator, Prof. Carol Brayne, director of the Cambridge Institute of Public Health, said, “Our research has previously shown a dramatic age-for-age drop in dementia occurrence across generations. This new work reveals that depression has not shown the same reduction even in the presence of dramatically increased prescribing, itself not without concern given potential adverse effects we have also shown that are associated with polypharmacy.”
Among the key findings:
- the proportion of older people receiving antidepressant medication more than doubled over two decades, from 4.2 per cent in the early ’90s to 10.7 percent 20 years later;
- the estimated prevalence of depression among over 65s in the early 1990s was 7.9 per cent, compared to 6.8 percent 20 years later;
- depression and antidepressant use was more common in women than men at both time points;
- depression was associated with living in a more deprived area;
- the proportion of over 65s living in care homes declined, but prevalence of depression in care homes remained unchanged; affecting around one in ten residents;
- across both time periods, most people with case-level depression were not on antidepressants, while most of those on antidepressants did not have depression.
Arthur said the research shows that “depression affects one in 15 people aged over 65, and its impact is felt by the individual, their families and friends.”
“Substantial increases in prescribing have not reduced the prevalence of depression in the over-65 population. The causes of depression in older people, the factors that perpetuate it, and the best ways to manage it remain poorly understood and merit more attention.”
The research was led by the University of East Anglia in collaboration with the University of Cambridge, the University of Newcastle and the University of Nottingham.
The study appears in the British Journal of Psychiatry.
Source: University of East Anglia