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States-of-Mind

Farewell

Today’s offering will be the last installment of this column.

It has been my privilege to discuss issues in mental health and wellness here for several years and a true pleasure to hear from readers who have found the information helpful in some way.

In recent years, we have seen some advancements in the understanding of mental illness and its treatment. We have learned more about the way the brain works as well as the contribution of genetics and environment in mental health.

Importantly, we have also seen a gradual breaking down of stigma surrounding mental health. It seems now to be less of a taboo –— people are generally more willing to talk openly about mental health struggles and seek help.

We still have a distance to travel in this regard and though I am encouraged to see awareness and acceptance growing, I hope to see it continue in the coming years.

I hope people will view mental health in the same way we do our physical health — as something to be fostered and attended to — not a shameful topic to be pushed into a dark corner.

One in five of us will experience a mental illness at some point, and depression is the leading cause of disability worldwide. This is a topic that affects us all in some way.

If you or a loved one struggle with mental health symptoms, seek help. You are not alone.

Effective treatment options exist and can likely help you resume daily functioning and regain quality of life.

You do not need to suffer in silence. Speaking with your doctor is a good place to start.

From there, you can ask for a referral to a mental health specialist with a goal of achieving complete remission of symptoms.

There are good sources of information online and I encourage you to become an advocate for your own mental health. Seek out information from a reputable source with scientific evidence to back it up.

If you’re interested in re-reading any of these columns, they can all be found on my website (www.okanaganclinicaltrials.com).

Thank you for joining me here for all this time. I wish you well.





SSRIs during pregnancy

Risks, benefits of SSRIs during pregnancy

Pregnancy and childbirth can be a special time for women and families. Excitement and anticipation mount as parents-to-be await the arrival of their new baby.

For many, this is a wonderful time thinking ahead and imagining the personality and cuteness about to join the family.

Of course, along with all the excitement also comes a dose of worry – and this can be heightened for women experiencing depression, anxiety or other health issues during pregnancy.

Whether or not to continue taking prescribed medication is an important thing to consider when preparing for baby.

Finnish, American and Swedish researchers conducted a large study comparing pregnancy outcomes for women who had depression or anxiety and continued taking SSRI (Selective serotonin reuptake inhibitors) medication with those who had the condition but did not take medication.

A third group in the study had no psychiatric conditions and no medication use.

Researchers examined maternal outcomes including blood pressure/preeclampsia, whether delivery was vaginal or cesarean section and presence of bleeding during or after delivery.

In babies, they noted whether infants were late preterm (32-36 weeks), very preterm (fewer than 32 weeks), small for gestational age, or had neonatal problems including low Apgar score (a measure of the physical condition of a newborn infant), breathing problems, monitoring in neonatal intensive care unit and hospital stay at seven days of age.

Women in the SSRI group experienced 16 per cent lower risk of late pre-term birth and 48 per cent lower risk of very preterm birth than those in the non-SSRI group.

Babies in the SSRI group did have a higher risk of some neonatal complications including low Apgar score and increased chance of needing monitoring in a neonatal intensive care unit.

It is worth noting that these outcomes were elevated in babies from both groups with a psychiatric condition compared to those with no psychiatric condition and no medication.

Study authors noted that some risks seem to be associated with the illnesses themselves.

Lower Apgar scores can be associated with withdrawal from SSRIs in newborns. These symptoms may require monitoring for up to a week.

Women planning to become pregnant should speak with their physician about possible risks and benefits to any medical treatment during pregnancy.

When it comes to the question of whether to continue psychiatric medication, risks of treatment should be understood and weighed against the possible risks involved in leaving a mental health condition untreated.

In all cases, the health of mother and baby should be closely monitored by a health care professional.



Obesity and ADHD

North America is in the midst of an obesity epidemic. In Canada, one in four adults and one in 10 children have clinical obesity, which is a major public health concern.

Obesity is a leading cause of type II diabetes, hypertension, heart disease, stroke, arthritis, some forms of cancer and Alzheimer’s. For each unit increase of body mass index in a 50-year-old, one study predicts onset of dementia symptoms 6.7 months earlier.

We also known, obesity can be a problem in some psychiatric conditions. One meta-analysis found a significant link between ADHD and obesity in both children and adults.

Roughly four per cent of school-aged children experience ADHD and the majority of them will continue to have symptoms as adults. Examining this link between ADHD and obesity represents an important finding and public health challenge.

An international group of researchers examined data from 42 studies, which included more than 700,000 people, and found a significant association between ADHD and obesity.

Adults with ADHD saw an increase in the prevalence of obesity by about 70 per cent. In children with the condition, obesity prevalence was increased about 40 percent.

Individuals receiving treatment for their ADHD did not have any additional likelihood of obesity than their untreated peers. These findings are counter-intuitive in some ways because the stimulant medications used to treat ADHD have reduced appetite as a so-called adverse effect.

In children, weight loss can be a dose limiting side-effect and in some cases a reason to discontinue medication altogether. Most adults are delighted to hear that reduced appetite is an expected adverse effect.

Although reasons for this link between ADHD and obesity are unknown, it is likely to have at least some behavioural aspect.

ADHD is associated with symptoms of impulsivity, which could make it more likely for people with this condition to have difficulty regulating eating behaviour.

If this is the case, behviour therapy in combination with medication may be helpful for both conditions.

Study authors noted it is also possible ADHD and obesity share underlying causes such as genes or environmental risk factors.

Regardless of the cause, education and awareness of the issue could help parents of children with ADHD to intervene early and prevent obesity from developing.

Similarly, adults visiting their doctor for help in managing obesity may be helped by being screened for ADHD.  They may find better treatment success if both conditions are well-managed.



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Bi-polar disorder in youth

Lithium use in youth with bipolar disorder

In the past few years there has been a growing recognition that bipolar disorder does not always present for the first time in adulthood. 

More than half of all cases of bipolar disorder begin before age 25 and for many with this condition, symptoms begin much earlier in childhood or adolescence.

Bipolar disorder is a serious psychiatric condition characterized by extreme shifts in mood between mania and depression.

When it begins in childhood, the condition is called early-onset bipolar disorder and it seems to be more severe than forms that first appear in older teens and adults.

Often, youth with bipolar disorder have more frequent mood shifts and have more mixed episodes (when they exhibit simultaneous symptoms of mania and depression). People with early onset bipolar disorder also seem to be at greater risk of suicide than those whose symptoms begin in adulthood.

Treatment for bipolar disorder differs from treating unipolar depression. Using antidepressant medications for a bipolar patient is risky and can cause the person to shift from depression to mania.

Mood stabilizing medication such as lithium is typically used to help bring a bipolar individual to a normal mood state.

Lithium is considered a gold standard in treating bipolar disorder in adults, but research is lacking when it comes to its use in youth with the condition. 

One study examined the use of lithium on children aged 7-17 with bipolar disorder. It found those taking lithium experienced a greater reduction in manic symptoms than those on placebo.

The medication was also generally well tolerated and not associated with negative side effects such as weight gain.

Sometimes, people balk at the idea of using any medication at all in children exhibiting mental health conditions. However, growing evidence suggests it is best to begin treatment as soon as possible for best results.

As with many psychiatric conditions, bipolar disorder is chronic and progressive in nature. The earlier effective treatment can begin, the less lasting damage is done and the sooner the individual can get back to enjoying life.

More research is needed to monitor the long-term effects of lithium use beginning in youth as well as to compare it with other medications used in treatment of this condition, but these early results are promising.



More States of Mind articles

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About the Author

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

Like us on Facebook: facebook.com/oktrials

Follow us on Twitter: @OCT_ca



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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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