Heart Patients Prone to Depression (Part 2)

1. Trouble falling asleep, staying asleep, or sleeping too much
2. Feeling tired or having little energy
3. Poor appetite or overeating
4. Feeling bad about yourself, that you are a failure, or that you have let yourself or your family down
5. Trouble concentrating on things such as reading the newspaper or watching television
6. Moving or speaking so slowly that other people could have noticed or being so fidgety or restless that you have been moving around a lot more than usual
7. Thinking that you would be better off dead or that you want to hurt yourself in some way
Screening could take place in a variety of medical settings; at the hospital, doctors’ office, clinic or cardiac rehabilitation centers. If depression is indicated, the patient may be referred to a professional qualified in treating the condition. Treatment strategies for patients with coronary disease and depression include antidepressant drugs, behavioral therapy, and exercise or a combination. The antidepressants Zoloft, sold as the generic sertraline, and Celexa, sold as generic citalopram, are considered good first-line therapies, as research has shown they are generally safe for cardiac patients.

These guidelines could potentially affect millions of Americans, including 16 million who have heart disease and 8.1 million who have suffered a heart attack. Erika Froelicher, RN, MPH, PHD, professor of nursing and epidemiology and statistics at the University of California, San Francisco and co-chair of the group that created the recommendations, said the hope is that routine screening for depression will be done on every cardiac patient. “I believe a lot of depressed cardiac patients are overlooked,” she said. “Unless you screen formally, you can miss a lot of people.”

The American Psychiatric Association endorsed the new recommendations, which were published online in advance of the October 21 issue of Circulation: Journal of the American Heart Association.

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Heart Patients Prone to Depression (Part 1)

Amid a dismal economy, rising food and health-care costs, and an uncertain job market, even the most optimistic person can get "down and out." But factor in a serious medical condition, and the result could be—depression. Scientists recently confirmed the long-held notion that diabetes contributes to depression, and vice versa, and multiple studies have shown a strong link between heart disease and depression. As a matter of fact, depression is so common among cardiac patients that the American Heart Association (AHA) recently issued new guidelines recommending that all heart patients be routinely screened for signs of depression.

“Studies show that depression is about three times more common in patients following a heart attack than in the general community,” said Judith Lichtman of Yale University School of Medicine, who helped write the new guidelines. Moreover, depressed heart patients are more likely to neglect their prescribed medications and are less likely to stay on a healthy diet and exercise regime, making them more vulnerable to recurrent heart problems. “There is no direct evidence yet that treating depression improves coronary heart disease outcomes, but plenty of evidence shows that having depression worsens those outcomes,” she said. “By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it.”

The recommendations call for all heart patients to be screened by initially asking two standard questions: Over the past two weeks, have you had little interest or pleasure in doing things? Have you felt down, depressed, or hopeless? If the patient answers yes to one or both, they should be further evaluated with seven additional questions:

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Honey is Now Sweet on Burns (Part 2)

One trial narrowed down the honeys that seemed to work the best healing wounds, those types that are derived from a single type of flower: aloe, jambhul, manuka or jarrah were most common. Honey is alternative medicine’s approach to harsh chemical-laden creams and ointments that are generally used to treat burns.

In a partner study also published in the Cochrane Library, an Australian researcher and co-author Jason Wasiak of the Victoria Adult Burns Service at Alfred Hospital in Melbourne, Australia, and his team looked through 26 random trials to determine there is no evidence to the effectiveness of common cream SSD used with gauze to prevent infections, he writes, “The use of silver sulphadiazine (SSD) as a comparator on burn wounds for the full duration of treatment needs to be reconsidered, as a number of studies showed delays in time to wound healing and increased number of dressing applications in patients treated with SSD dressings." The Australian researchers urge for better awareness for topical applications for burn victims and urge consumers to reconsider using SSD because it may be extending the healing process instead of speeding it up.

As with many trials, even randomly controlled trials, there still need to be more tests and more investigations into the natural fighting substance called honey for the purpose of treating burn wounds. So when you’re taking your tea or slathering it on your toast and you accidentally burn your fingers on the tea pot or the toaster, you might want to hold off on soaking your fingers in honey, at least until more research is published.

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Honey is Now Sweet on Burns (Part 1)

Praised for its ancient god-quelling qualities, throat-soothing remedies, and smile-inducing taste, honey dates back to the days before records were kept. The history of honey is long and the possibilities of honey used for healing has long been documented, including most recently as a possible sinus-fighter. A new study from New Zealand proves honey’s lasting healing qualities by introducing a new topical application: honey as dressing for a burn.

The University of Auckland study used 19 small clinical trials—using less than 100 participants for each—to show that tea’s favorite sweetener can actually accelerate the healing and rejuvenation of skin affected by burns. The New Zealand researchers discovered that honey helps promote new skin tissue growth and the removal of dead tissues.

By focusing on the antibacterial qualities of honey, the University of Auckland team reviewed 2,554 patients with a variety of different wounds and found out that the healing time was reduced with the application of honey compared with commonly used wound dressings made out of gauze. Although burn wounds seem to heal faster, the researchers caution that surgical scars, ulcers or cuts didn’t seem beneficial to the use of honey.

The investigations involved applying honey to partially thick burns as well as mild to moderately superficial burns that caused damage to nerves and the blood vessels were healed up to four days faster than normal approaches to burn wounds, such as the often-prescribed cream silver sulphadiazine known as SSD.

Published in the most recent issue of the Cochrane Library one of the researchers, Andrew Jull, explains in a release, “The evidence currently does not support the use of honey on acute wounds such as abrasions and lacerations or on minor, uncomplicated wounds left to heal …following surgery." Jull goes on to say that although the trials were positive, honey is not yet released for general use yet, “health services should refrain from providing honey dressing for routine use,” and the results—as well as being re-studied by more schools—should be looked upon with caution. The number of participants in each study is significantly low to prove results as each trial used a different type of honey on a slightly different wound.

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Alternative Medicine Under the Microscope (Part 2)

One of the poor lights shined on alternative medicine recently was an investigation into a 2004 Harvard Medical School study that claimed yoga therapy was almost a cure-all for such problems such as heart and lung disease, depression, back pain, diabetes, arthritis, and even cancer. Using 181 papers in their research as accurate reports, the investigation found that only 40 percent of those used controlled trials—testing the method against a random placebo group that is not using the method over a strict period of time—which are the most effective way to discern whether a certain drug or supplement is working positively and safely on the user group so it has a better chance of being approved for commercial use. Most of these studies too, were based on groups with a very small number of volunteers, proving that a positive could mean any number of other factors could have influenced the result. It’s because of these small numbers that Dr. Briggs is taking care to provide a better controlled testing group for her clinical trials so as to not inspire any more criticism.

In fact, one of the NCCAM’s biggest trials set to end in 2009 involves multiple research centers in California working with over 3,000 patients over the age of 75 to test the effects of ginkgo biloba extract against the onset of Alzheimer’s disease. Briggs continues that another way to progress in their trials is to stay consistent with product uniformity due to past studies which have used samples of vitamins, powders and extracts that had the percentage of the active ingredient misidentified, which could also yield unexpected results.

Even though the finger is wagging strongly in her direction, Dr. Briggs still thinks that alternative medicine trials can prove beneficial, “I believe that as the sensitivities of our measures improve, we’ll do a better job at detecting these modest but important effects.” I am glad to see NCCAM doing their best to work with the government to provide more accurate numbers for research but I wonder if spending all this money on clinical trials for alternative medicine will yield the same economical results as Western medicine. Instead of a health-conscious consumer throwing away money on pills or diet drinks, if yoga makes you feel better, would the absence of hard evidence be harmful? Alternative medicine ultimately is about healing the mind and the body and focusing on healthy complements to western medicine’s ideals, not about knowing the statistical analysis a daily glass of wine or a back adjustment has on your wellness scale.

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