Archive for December, 2007

from Mayoclinic.com

Stress and depression can ruin your holidays and hurt your health. Being realistic, planning ahead and seeking support can help ward off stress and depression.
For some people, the holidays bring unwelcome guests — stress and depression. And it’s no wonder. In an effort to pull off a perfect Hallmark holiday, you might find yourself facing a dizzying array of demands — work, parties, shopping, baking, cleaning, caring for elderly parents or kids on school break, and scores of other chores. So much for peace and joy, right?

Actually, with some practical tips, you can minimize the stress and depression that often accompany the holidays. You may even end up enjoying the holidays more than you thought you would.

The trigger points of holiday stress and depression
Holiday stress and depression are often the result of three main trigger points. Understanding these trigger points can help you plan ahead on how to accommodate them.

The three main trigger points of holiday stress or depression:

Relationships. Relationships can cause turmoil, conflict or stress at any time. But tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you’re all thrust together for several days. Conflicts are bound to arise with so many different personalities, needs and interests. On the other hand, if you’re facing the holidays without a loved one, you may find yourself especially lonely or sad.

Finances. Like your relationships, your financial situation can cause stress at any time of the year. But overspending during the holidays on gifts, travel, food and entertainment can increase stress as you try to make ends meet while ensuring that everyone on your gift list is happy. You may find yourself in a financial spiral that leaves you with depression symptoms such as hopelessness, sadness and helplessness.

Physical demands. The strain of shopping, attending social gatherings and preparing holiday meals can wipe you out. Feeling exhausted increases your stress, creating a vicious cycle. Exercise and sleep — good antidotes for stress and fatigue — may take a back seat to chores and errands. High demands, stress, lack of exercise, and overindulgence in food and drink — all are ingredients for holiday illness.

12 tips to prevent holiday stress and depression
When stress is at its peak, it’s hard to stop and regroup. Try to prevent stress and depression in the first place, especially if you know the holidays have taken an emotional toll in previous years.

Tips you can try to head off holiday stress and depression:

1.Acknowledge your feelings. If a loved one has recently died or you aren’t able to be with your loved ones, realize that it’s normal to feel sadness or grief. It’s OK now and then to take time just to cry or express your feelings. You can’t force yourself to be happy just because it’s the holiday season.
2.Seek support. If you feel isolated or down, seek out family members and friends, or community, religious or social services. They can offer support and companionship. Consider volunteering at a community or religious function. Getting involved and helping others can lift your spirits and broaden your friendships. Also, enlist support for organizing holiday gatherings, as well as meal preparation and cleanup. You don’t have to go it alone. Don’t be a martyr.
3.Be realistic. As families change and grow, traditions and rituals often change as well. Hold on to those you can and want to. But accept that you may have to let go of others. For example, if your adult children and grandchildren can’t all gather at your house as usual, find new ways to celebrate together from afar, such as sharing pictures, e-mails or videotapes.
4. Set differences aside. Try to accept family members and friends as they are, even if they don’t live up to all your expectations. Practice forgiveness. Set aside grievances until a more appropriate time for discussion. With stress and activity levels high, the holidays might not be conducive to making quality time for relationships. And be understanding if others get upset or distressed when something goes awry. Chances are they’re feeling the effects of holiday stress and depression, too.
5. Stick to a budget. Before you go shopping, decide how much money you can afford to spend on gifts and other items. Then be sure to stick to your budget. If you don’t, you could feel anxious and tense for months afterward as you struggle to pay the bills. Don’t try to buy happiness with an avalanche of gifts. Donate to a charity in someone’s name, give homemade gifts or start a family gift exchange.
6.Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make one big food-shopping trip. That’ll help prevent a last-minute scramble to buy forgotten ingredients — and you’ll have time to make another pie, if the first one’s a flop. Expect travel delays, especially if you’re flying.
7. Learn to say no. Believe it or not, people will understand if you can’t do certain projects or activities. If you say yes only to what you really want to do, you’ll avoid feeling resentful, bitter and overwhelmed. If it’s really not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.
8. Don’t abandon healthy habits. Don’t let the holidays become a dietary free-for-all. Some indulgence is OK, but overindulgence only adds to your stress and guilt. Have a healthy snack before holiday parties so that you don’t go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and schedule time for physical activity.
9. Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Steal away to a quiet place, even if it’s to the bathroom for a few moments of solitude. Take a walk at night and stargaze. Listen to soothing music. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
10. Rethink resolutions. Resolutions can set you up for failure if they’re unrealistic. Don’t resolve to change your whole life to make up for past excess. Instead, try to return to basic, healthy lifestyle routines. Set smaller, more specific goals with a reasonable time frame. Choose only those resolutions that help you feel valuable and that provide more than only fleeting moments of happiness.
11. Forget about perfection. Holiday TV specials are filled with happy endings. But in real life, people don’t usually resolve problems within an hour or two. Something always comes up. You may get stuck late at the office and miss your daughter’s school play, your sister may dredge up an old argument, your partner may burn the cookies, and your mother may criticize how you’re raising the kids. All in the same day. Accept imperfections in yourself and in others.
12. Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for several weeks, talk to your doctor or a mental health professional. You may have depression.

Take back control of holiday stress and depression
Remember, one key to minimizing holiday stress and depression is knowing that the holidays can trigger stress and depression. Accept that things aren’t always going to go as planned. Then take active steps to manage stress and depression during the holidays. You may actually enjoy the holidays this year more than you thought you could.

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MERRY CHRISTMAS EVERYONE!
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Dr. Drug Rep

Posted: December 16, 2007 by Doc in Medical, Medical career
Tags: ,

I have been doing some speaking on behalf of several pharmaceutical companies in the course of the launch of their new products. I found this article compelling, it made me assess my own behavior during these talks. It can’t be denied that there is some pressure to put the best light on the sponsor’s drug, but the pressure varies. Fortunately for me, I feel I’ve been honest in my interaction with my audience, and have never gotten any sort of flak from the sponsor, except for one company, which is well known for its aggressive marketing. I subsequently quit speaking for that company and refuse to do any more talks for them.
Dr. Drug Rep
By DANIEL CARLAT
Daniel Carlat is an assistant clinical professor of psychiatry at Tufts University School of Medicine and the publisher of The Carlat Psychiatry Report.
Published: November 25, 2007, The New York Times
I. Faculty Development

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. He told me that I would go around to doctors’ offices during lunchtime and talk about some of the features of Effexor. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session, and he quickly floated some numbers. I would be paid $500 for one-hour “Lunch and Learn” talks at local doctors’ offices, or $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.”

I thought about his proposition. I had a busy private practice in psychiatry, specializing in psychopharmacology. I was quite familiar with Effexor, since I had read recent studies showing that it might be slightly more effective than S.S.R.I.’s, the most commonly prescribed antidepressants: the Prozacs, Paxils and Zolofts of the world. S.S.R.I. stands for selective serotonin reuptake inhibitor, referring to the fact that these drugs increase levels of the neurotransmitter serotonin, a chemical in the brain involved in regulating moods. Effexor, on the other hand, was being marketed as a dual reuptake inhibitor, meaning that it increases both serotonin and norepinephrine, another neurotransmitter. The theory promoted by Wyeth was that two neurotransmitters are better than one, and that Effexor was more powerful and effective than S.S.R.I.’s.

I had already prescribed Effexor to several patients, and it seemed to work as well as the S.S.R.I.’s. If I gave talks to primary-care doctors about Effexor, I reasoned, I would be doing nothing unethical. It was a perfectly effective treatment option, with some data to suggest advantages over its competitors. The Wyeth rep was simply suggesting that I discuss some of the data with other doctors. Sure, Wyeth would benefit, but so would other doctors, who would become more educated about a good medication.

A few weeks later, my wife and I walked through the luxurious lobby of the Millennium Hotel in Midtown Manhattan. At the reception desk, when I gave my name, the attendant keyed it into the computer and said, with a dazzling smile: “Hello, Dr. Carlat, I see that you are with the Wyeth conference. Here are your materials.”

She handed me a folder containing the schedule of talks, an invitation to various dinners and receptions and two tickets to a Broadway musical. “Enjoy your stay, doctor.” I had no doubt that I would, though I felt a gnawing at the edge of my conscience. This seemed like a lot of money to lavish on me just so that I could provide some education to primary-care doctors in a small town north of Boston.

The next morning, the conference began. There were a hundred or so other psychiatrists from different parts of the U.S. I recognized a couple of the attendees, including an acquaintance I hadn’t seen in a while. I’d heard that he moved to another state and was making a bundle of money, but nobody seemed to know exactly how.

I joined him at his table and asked him what he had been up to. He said he had a busy private practice and had given a lot of talks for Warner-Lambert, a company that had since been acquired by Pfizer. His talks were on Neurontin, a drug that was approved for epilepsy but that my friend had found helpful for bipolar disorder in his practice. (In 2004, Warner-Lambert pleaded guilty to illegally marketing Neurontin for unapproved uses. It is illegal for companies to pay doctors to promote so-called off-label uses.)

I knew about Neurontin and had prescribed it occasionally for bipolar disorder in my practice, though I had never found it very helpful. A recent study found that it worked no better than a placebo for this condition. I asked him if he really thought Neurontin worked for bipolar, and he said that he felt it was “great for some patients” and that he used it “all the time.” Given my clinical experiences with the drug, I wondered whether his positive opinion had been influenced by the money he was paid to give talks.

But I put those questions aside as we gulped down our coffees and took seats in a large lecture room. On the agenda were talks from some of the most esteemed academics in the field, authors of hundreds of articles in the major psychiatric journals. They included Michael Thase, of the University of Pittsburgh and the researcher who single-handedly put Effexor on the map with a meta-analysis, and Norman Sussman, a professor of psychiatry at New York University, who was master of ceremonies.

Thase strode to the lectern first in order to describe his groundbreaking work synthesizing data from more than 2,000 patients who had been enrolled in studies comparing Effexor with S.S.R.I.’s. At this time, with his Effexor study a topic of conversation in the mental-health world, Thase was one of the most well known and well respected psychiatrists in the United States. He cut a captivating figure onstage: tall and slim, dynamic, incredibly articulate and a master of the research craft.

He began by reviewing the results of the meta-analysis that had the psychiatric world abuzz. After carefully pooling and processing data from eight separate clinical trials, Thase published a truly significant finding: Effexor caused a 45 percent remission rate in patients in contrast to the S.S.R.I. rate of 35 percent and the placebo rate of 25 percent. It was the first time one antidepressant was shown to be more effective than any other. Previously, psychiatrists chose antidepressants based on a combination of guesswork, gut feeling and tailoring a drug’s side effects to a patient’s symptom profile. If Effexor was truly more effective than S.S.R.I.’s, it would amount to a revolution in psychiatric practice and a potential windfall for Wyeth.

One impressive aspect of Thase’s presentation was that he was not content to rest on his laurels; rather he raised a series of potential criticisms of his results and then rebutted them convincingly. For example, skeptics had pointed out that Thase was a paid consultant to Wyeth and that both of his co-authors were employees of the company. Thase responded that he had requested and had received all of the company’s data and had not cherry-picked from those studies most favorable for Effexor. This was a significant point, because companies sometimes withhold negative data from publication in medical journals. For example, in 2004, GlaxoSmithKline was sued by Eliot Spitzer, who was then the New York attorney general, for suppressing data hinting that Paxil causes suicidal thoughts in children. The company settled the case and agreed to make clinical-trial results public.

Story continued at NY Times.com

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