As emphasized in several Newsletters, antidepressants are not much better than placebos in the vast majority of patients and can have serious side effects.1 This lack of efficacy was again confirmed in a recent Journal of The American Medical Association article, which also reported that the newer serotonin reuptake inhibitors (SSRIs) offered no advantages over older drugs.2 And they have alarmingly high rates of suicide, homicide and aggressive behavioral complications that have been hidden or minimized in advertising that hypes their benefits. For example, a previously court sealed 2007 report analyzing GlaxoSmithKline documents uncovered during recent litigation now leaves little doubt that the company had data from clinical trials demonstrating an increased risk of suicide as early as 1989, over 20 years ago. Internal reports and memos reveal that the risk of suicidal behavior in adults increased eightfold in patients on Paxil.3 Over 3,500 documented reports of suicide, self-mutilation, murder and other violent acts involving SSRIs are posted at http://www.ssristories.com/ Such problems are so prevalent in younger individuals that Paxil and similar SSRIs are banned in the UK and elsewhere for children and teenagers.

Their lack of efficacy is not surprising, since there is no solid evidence that depression is due to serotonin deficiency or disturbances in other neurotransmitters. Part of the problem is that depression is not a discrete diagnosis like diabetes, where the causes are clear and there is general agreement on objective diagnostic laboratory criteria. Depression is simply a description of certain symptoms that can have many causes, which explains why we have so many treatment options. These include: various classes of pharmaceuticals (monoamine oxidase inhibitors, tricyclic and tetracyclic antidepressants, selective serotonin reuptake inhibitors, lithium, estrogen and amphetamines); supplements (melatonin, St. Johns wort, Ginkgo biloba, Panax ginseng, SAM-E, fish oils, omega-3, glutathione, calcium, vitamin D, folic acid and other B vitamins); psychiatric interventions (psychoanalysis, cognitive restructuring, group therapy, stress reduction); sleep deprivation; exercise; ultraviolet light; acupuncture; surgery (stereotactic cingulotomy, deep brain or vagal stimulation with an implanted device); electroconvulsive therapy (ECT); and novel bioelectromagnetic approaches such as cranioelectrical stimulation and repetitive transcranial magnetic stimulation. There is no other disorder for which so many very different therapies are available, without any certainty of which will be effective for any given patient. Depression can also be seen in thyroid and other endocrine disturbances, particularly in post partum and menopausal females, in Parkinson’s disease and stroke victims, as well as a side effect of many medications.

One exception may be electroconvulsive (shock) therapy, which is beneficial in almost all severely depressed individuals. Although it has been utilized for more than eighty years and is currently administered to over one million patients annually, we still don’t know why it works. However, it has stimulated interest in other electrotherapeutic approaches, the latest being simulation of the habenula, a tiny nerve structure found deep in both sides of the brain. Studies have shown that the habenula is hyperactive in depression and that this can be suppressed by stereotactically placing electrodes on each habenula connected with wires under the skin to an electronic impulse generator implanted in the chest, which can be controlled with an external device.4 Researchers just reported complete remission in a 67-year old woman who had suffered from depression since the age of 18 despite numerous medications and several courses of ECT. The success of the procedure was confirmed when the patient had a bicycle accident which required surgery, and a preoperative ECG had to be obtained. The brain pacemaker was accidentally switched off for a few days, and the depression promptly returned. Following reactivation, the patient completely and quickly recovered. Repetitive transcranial magnetic stimulation (rTMS) has now been approved for used in depressed patients resistant to drug therapy, and more is known about its mechanisms of action. In many patients, the severity of depression has been shown to correlate with the degree of decreased electrical activity in the prefrontal lobe. rTMS is administered by means of an external device that corrects this deficiency by targeting short pulses of magnetic fields to the affected area. Treatment may result in marked improvement and even remission, but usually requires five 35-minute sessions a week for a month or more. Vagal nerve stimulation, originally developed for treating certain types of seizure, has also been recently approved for drug resistant depression that has persisted for at least two years. It requires the surgical implantation of a pulse generator with leads to the left vagus nerve that is controlled externally. Like rTMS it is expensive ($30,000 for the device and surgical implantation), is not covered by insurance and is not widely available.

Non-invasive cranioelectrical stimulation (CES) provides similar benefits, and although approved products require a prescription in the U.S., they can be purchased directly in Canada and other countries for personal use. Alpha-Stim CES has been shown to improve depression 63 percent when compared to placebos in double blind studies, in sharp contrast to only 21 percent for drug treated groups.5 In addition, there have been no associated suicidal or homicidal ideation or significant adverse side effects after three decades of use, during which this and other devices have been progressively improved. Treatment protocols vary, but many depressed patients go into remission or experience significant benefits after 15-20 minutes of treatment several times a week for 2 or 3 weeks. In addition to superior efficacy and safety, the one time price for the device is 25 to 50 percent of the cost for a year of SSRI therapy, and may be partially or completely reimbursable by insurance. Antidepressants often have to be taken perpetually, and can have serious withdrawal side effects, such as life threatening serotonin syndrome. It should be noted that Alpha-Stim CES has also been shown to be effective for treating anxiety, insomnia and other stress related complaints. However, it is crucial to avoid worthless copycat devices making similar claims supported only by lavish and self-serving testimonials, rather than studies published in peer reviewed scientific journals.

The numerous difficulties associated with drugs have raised increasing concerns, since although the number of Americans on antidepressants doubled between 1996 and 2005, it has continued to skyrocket. Antidepressants have now become the most commonly prescribed class of medications and are currently taken daily by one in ten people over the age of six.6 That figure is likely to escalate based on a paper in the current (January 2010) issue of Archives of General Psychiatry, which reported that only half of all Americans with depression receive treatment of any kind. And for those that do, only one in five is getting care in the form of medication and/or psychotherapy that conforms to American Psychiatric Association guidelines.7 Unfortunately, these recommendations date back to 2005, and it is not known whether a revision originally scheduled for publication last month will now include FDA approved non drug therapies. The Association receives over thirty percent of its annual income from pharmaceutical manufacturers, and Congressional investigators have recently uncovered huge and hidden kickbacks to leading psychiatrists. As has happened in prior years, it is likely that those responsible for updating treatment recommendations could also have potential serious conflicts of interest ⎯ so stay tuned to see what happens!

References:

1. Rosch, PJ. Health and Stress Newsletters #2 & 8 2009, #4 2004, #11 2003, #11 2003, #4 1999, #2 1998, #1 1997, #4 & 9 1994.

2. Fournier JC, DeRubeis RJ, Hollon SD et al. Antidepressant drug effects and depression severity. JAMA, 2010;303(1):47-53.

3. www.pharmalot.com/2008/02/glaxo-obscured-paxil-suicide-risks-report/

4. Sartorius A, Kiening KL, Kirsch P, von Gall CC, Haberkorn U, et al. Remission of major depression under deep brain stimulation of the lateral habenula in a therapy-refractory patient. Biol Psychiatry, 2010: Jan 15;67(2):e9-e11

5. Gilula, MF, Kirsch DL. Cranial electrotherapy stimulation review: A safer alternative to psychopharmaceuticals in the treatment of depression. Journal of Neurotherapy, 2005; 9(2):63-77.

6. Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry, 2009;66(8):848-856

7. González HM, Vega WA, Williams DR et al. Depression care in the United States: Too little for too few. Arch Gen Psychiatry, 2010;67(1):37-46.

Concerns that cell phones might cause brain tumors have made headlines in recent months, sparked by speculations about Senator Ted Kennedy’s malignant glioma.  Other health problems attributed to cell phone use include salivary tumors, eye cancer and infertility due to lower sperm counts. Cell phones are also suspected to be responsible for an increased incidence of autism, ADHD, and other behavioral problems in children born to mothers who used them as little as two or three times a day during pregnancy.  Children are at significantly increased risk because their brains are developing and their thinner skulls allow cell phone microwave emissions to penetrate deeper into the brain. They absorb twice as much energy as adults and a two-minute call can alter brain function in a child for an hour.  One study found that behavioral problems were 80 percent higher in those who used cell phones by age 7.
Older individuals also experience emotional stress from cell phone use that is often not appreciated because it is more insidious.  As previously noted, a study of over 1300 people who regularly used cell phones found that they “experienced an increase in psychological distress and a decrease in family satisfaction” due to the intrusion of frequent work related calls that disrupted life at home or while on vacation.  A new study in healthy Swedish teenagers reported that those who made more than 15 calls and/or sent 15 text messages a day suffered from increased restlessness, difficulty in falling asleep or waking up frequently, and were more fatigued compared to a control group making less than five calls or text messages.  They also consumed more stimulating beverages and only one-third ate breakfast in contrast to most of the controls.  In a recent Korean study that divided over 500 teens into four groups depending on cell phone use, those in the top tier scored 50% higher on a depression rating scale than those with the least use. Many teenagers become addicted to their cell phones and suffer withdrawal symptoms if they are not immediately available.  Some even keep them under their pillows at night to receive and send text messages, which interferes with sleep.

Companies that claim to block or neutralize cell phone radiation damage are promoting bogus products to profit from the public’s justifiable concerns.   They also take advantage of the general lack of ignorance about mechanisms of action by citing scientific studies that are irrelevant or by using confusing but impressive terms.  For example, a 7/28/08 newspaper article quoted the CEO of Biopro technology in South Africa as follows; “BIOPRO  cell chips combine the benefits of BIOPRO’s patented noise field nano-technology Molecular Resonance Effect Technology (MRET), and  BIOPRO’ s propriety subtle energy technology Energy Resonance Technology (ERT) . . . . I am worried about the future of peoples’ wellness and how a newly recognized, yet rapidly emerging toxin called electropollution may be silently accelerating the aging process. It is dangerously increasing stress levels, preventing essential nutrients from entering the body’s cell, as well as keeping damaging toxins from exiting them. BIOPRO Technology is breaking new grounds, with the introduction of BIOPRO Cell Chips, Universal Chips, home harmoniser and Water appliances that will reduce the dangers from electromagnetic radiation emitted by cell phones, PDAs, Bluetooth handsets and other home appliances.”

Electromagnetic radiation can only be blocked by dense materials like lead.  The BIOPRO Cell Chips are merely plastic stickers costing a few cents and more than one is required for different devices.  However, these are touted as being “the flexible resin mylar composite cell chip powered by BIOPRO’s Proprietary Energy Resonance Technology (ERT ™) ” that allegedly will “harmonize” all electromagnetic fields. Yet, they include the standard disclaimer that “These statements have not been evaluated by the FDA. The products and/or technologies listed are not intended to diagnose, treat, cure, or prevent any disease.” Biopro is a multilevel marketing scam with a history of promoting similar worthless products like their QX-3 Econo Fuel Saver chip to increase engine power and mileage while reducing emissions.  The FTC (Federal Trade Commission) has already fined 2 U.S. companies for claiming their “chips” could block 99% of cell and mobile phone radiation but it is not clear if their jurisdiction extends to Biopro’s Canadian and other foreign divisions that sell products over the Internet, so Caveat emptor!

References:

Cell Phones Injurious to Health,  Chinyere Okoy, This Day (African Views on Global Health) 7/28/08,

Paper presented at U.S. Associated Professional Sleep Societies annual meeting June, 2008 by Gaby Badre, Gothenburg, Sweden

Kim Dong-hyun Cell Phones and Mental Health Korean Journal of Epidemiology, March. 2005

Chesley, N. Journal of Marriage and Family 2005; 67:1237-1248.

One might think that cell phones would reduce stress by facilitating contacting someone in an emergency or transmitting time urgent information but a recent study suggests otherwise. A sociology professor who followed more than 1300 people found that those who regularly used cell phones or pagers “experienced an increase in psychological distress and a decrease in family satisfaction” compared to those who used these devices less often. No such effects were seen in others who regularly used e-mails.

The study also looked at “spillover” — the seepage of work concerns into home life, and vice versa. For both men and women, “cell phone and pager use allows negative job concerns to infiltrate another part of life,” and women got a “double-whammy,” reporting home concerns that spilled over into work. It’s dangerous to draw conclusions for everyone based on one study, but it does seem that cell phones and pagers are somehow increasing psychological stress and decreasing family satisfaction for many.

One reason may be that although cell phones may make people more accessible wherever they are, this may not be desirable for unwanted calls when you are on vacation or busy at work. In addition, as use of cell phones and pagers becomes increasingly prevalent, the line between family and work life can continue to blur. The professor suggests that consumers might want to consider whether technology use is “making your family better, even if it’s stressing you out . . . . Then, maybe it’s OK. Or maybe you should take stock: How much of this information that I’m getting from this technology is making my life easier? If the answer is, ‘Not a lot,’ maybe it’s time to shut things down.”

Reference: Chesley, N. Journal of Marriage and Family 2005; 67:1237-1248.

Hundreds of millions of dollars have been spent on worthless supplements that claim to promote weight loss by reducing stress and/or cortisol. Consumers can be easily confused since advertisements cite reliable references that confirm and explain how increased stress or cortisol can increase abdominal fat deposits. For example, Cushing’s syndrome is characterized by a persistent increase in cortisol levels and abdominal obesity. But when the cause of the elevated cortisol is removed, the excess abdominal fat deposits also disappear. Chronically stressed primates that have increased cortisol also develop abdominal obesity and laboratory studies confirm a clear correlation between cortisol levels and the deposition of deep abdominal fat. A study of stressed out middle-aged Swedish men similarly showed that those with the highest cortisol levels also had the biggest beer bellies.

Stress can also contribute to “middle aged spread” because many such individuals find that chocolates, cookies candies, chips and other high fat, high carbohydrate foods relieve their anxiety. Male and female hormones normally protect against the deposition of abdominal fat but their levels start to decline after age 40. Most incoming college freshman put on extra pounds their first year, and as noted in prior Newsletters, this so-called “Freshman 15″ is also due to stress. One study showed that a sample of university women gained weight 36 times faster than aged matched controls that did not attend college. In addition to being unsightly, stress induced abdominal fat secretes large amounts of inflammatory molecules that contribute to diabetes, insulin resistance and heart attacks. How many extra pounds you are carrying around may not be as important as where that excess weight is located. People with apple shaped figures are more susceptible to these disorders as well as certain cancers compared to those with pear shapes who are just as overweight due to fatty hips and buttocks. In fact, there is good evidence that increased fat in these locations may be associated with a decreased risk for coronary disease and atherosclerosis.

Since abdominal fat also tends to increase cortisol levels, this can lead to a vicious and unhealthy cycle, especially in women. There is little doubt that increased stress and/or cortisol can cause increased abdominal fat and weight gain. However, there is absolutely no proof that any nutritional supplement reduces stress, cortisol or the deposition of abdominal fat. The problem is that consumers are confused because studies in respected medical journals such as those noted below are often cited to provide scientific support, even though they have nothing to do with these products.

References: Health And Stress Newsletter #6 2000, # 5 2003, #5 2004, Eppel ES. McEwen B, Seeman T, et al. Stress and Body Shape: Stress-Induced Cortisol Secretion Is Consistently Greater Among Women With Central Fat. Psychosom Med, 2000;62:623-632. Yong Q. Takahashi N. Hileman SM, et al. Adiponectin Acts in the Brain to Decrease Body Weight. Nat Med 2004; 10(5):524-529.

People who suffer from hay fever, asthma and eczema often note that their symptoms worsen when they are under stress. For example, domestic disputes and violence frequently trigger an asthma attack, and asthmatic children subjected to emotional stress tend to have more hospital admissions for asthma and require higher doses of steroids for airway control. In an experiment done decades ago, when a volunteers with hay fever were placed in a room filled with ragweed for an hour or so, they had no symptoms, but promptly came down with a full blown attack of itchy eyes and sneezing after being deliberately provoked. More recently, medical students with hay fever and/or asthma and a healthy control group were extensively evaluated during a calm period of study and then prior to an important final examination. During the stressful exam period, both groups showed a sharp increase in regulatory T cells, which control the activity of other immune system cells that tend to reduce inflammation. However, although IL-6 and other immune system components associated with inflammation were significantly elevated in the allergy sufferers, there was no change in the control group.

A new study now provides additional information on how stress can magnify allergic responses. Hay fever sufferers received a series of skin prick tests to measure their responses to allergens based on the size of the wheals that developed. On one day the subjects were given five minutes to prepare and deliver a speech to an important audience about why they were the best person for a particular job, and then had to solve difficult math questions in their heads under time pressure. On another day, they had less stressful assignments, such as reading a magazine. When researchers compared the size of hive-like reactions to skin tests before, during and after the challenging task, there was no change in size in volunteers who experienced little stress, compared to a 75% increase in those with moderate anxiety, and wheal were almost 200% larger in the severely stressed. The wheals also lasted longer in the high stress groups. Even skin tests performed the day after the speech stress test showed much larger wheals in the most anxious individuals, who still had increased IL-6 levels. This helps to explain why allergic reactions in the nose, chest and skin that seem to resolve within hours can suddenly resurface the following day.

Stress does not cause allergies, but appears to trigger allergic reactions by immediately releasing histamine and immune system activities that sustain annoying symptoms. Antihistamines can help to prevent and minimize allergic reactions but are not effective for spontaneous recurrences the following day, which often require steroids and symptomatic treatment like decongestants. In addition to adverse health effects, allergies also exact a significant financial toll. Researchers estimate that Americans pay $2.3 billion for allergy medications each year; $1.1 billion for doctor visits, and are responsible for the loss of approximately 3.5 million workdays.

Reference

Kiecolt-Glaser JK, Heffner KL, Glaser R, et al. How stress and anxiety can alter immediate and late phase skin test responses in allergic rhinitis. Psychoneuroendocrinology. 2009, Jun;34(5):670-80

Chewing gum can provide a variety of health benefits.  The American Dental Association now recommends chewing sugarless gum after eating because the increased saliva washes away plaque and bacteria that cause periodontal disease. As previously indicated in the last Stress Scoop, chewing gum after a meal can prevent heartburn symptoms in GERD patients by neutralizing acid fluids and helping to force them back into the stomach. Chewing gum speeds up peristalsis further down in the small intestine and has been used to treat postoperative ileus following colon surgery for diverticulitis or cancer.  In one report, patients who chewed gum after colon surgery resumed normal GI function and left the hospital more than two days sooner than controls.

Other studies suggest that chewing gum can cause weight loss and improve concentration and memory. In one article published in the New England Journal of Medicine, Mayo Clinic researchers calculated that chewing sugar-free gum could help someone lose up to 11 pounds a year.  Unfortunately, this would require chewing at a fairly rapid rate most of the time you are awake, which could cause dental and gastrointestinal problems.  The act of chewing increases blood flow to the brain, which is used to support claims that it improves brain function.  College students have long recognized that chewing gum improves memory and concentration during important exams.  Schools usually do not approve of chewing gum in classrooms but many teachers now encourage it during exams and some even pass gum out.  We also now have Think Gum, developed by Matt Davidson, which includes six herbal additives that have been shown to improve cognitive function and memory.  While a student at U.C. Berkeley, Matt reviewed a study measuring productivity in factory workers while they were exposed to scents from different herbal extracts. Since the results showed that significantly fewer mistakes were associated with peppermint and rosemary aromas, Matt began chewing his own concoction of peppermint gum and freshly picked rosemary during exams and class and believes this enabled him to graduate Phi Beta Kappa and with high honors. He subsequently devoted all his efforts to developing Think Gum, which increases alertness, improves information recall, and boosts both short and long-term memory.  As explained on www.thinkgum.com/howandwhy.html these benefits are believed to come from the synergistic effects of vinpocetine, bacopa, Ginkgo biloba, guarana, rosemary and peppermint.

Chewing gum has been known to provide health benefits since antiquity.  The ancient Greeks chewed the lemon-white resin gum from the mastic tree to reduce fatigue and relieve stomach complaints.  Central American Mayans chewed chicle resin from the sapota tree and native U.S. Indians introduced a resin gum from spruce trees to early colonial settlers to promote relaxation. The U.S. Army has long recognized that gum chewing reduces stress and chewing gum has been included in combat rations since World War I.  More recent studies have shown that chewing gum reduces muscular tension and anxiety, especially in people who are trying to stop smoking or lose weight. There is little doubt that chewing gum can be a powerful stress buster.  One has only to look at a tightly contested baseball game on TV to see how many players, coaches and managers are vigorously chewing bubble gum or something else to relieve their pent up tension.  A recent survey sponsored by the Wrigley Science Institute also revealed that chewing gum helped men and women aged 18-49 feel more relaxed when dealing with daily stresses. The Wrigley Science Institute is now investigating the neuroendocrine and other mechanisms of action responsible for these stress reduction effects.

 References

Schuster R, Gerwal N, Greaney GC, Waksman K.  Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg 2006;141:174-176

Levine J, Baukol P, Pavlidis I. The energy expended in chewing gum. N Engl J Med 1999;341:2100-2100. 

FRC Research Corporation. “The Impact of Chewing Gum on Consumers’ Stress Levels.” Survey conducted in June, 2006 in 280 male and female respondents aged 18-49 for the Wrigley Science Institute

The stress reduction and health rewards of laughter have long been recognized. Solomon tells us “A merry heart doeth good like a medicine” (Proverbs 17:22) and
laughter might also be the best medicine for your heart according to a recent study.   Researchers randomly assigned 20 non-smoking, healthy men and women to view a 15–30 minute segment of a movie designed to induce mental stress and
another that made most people laugh.  Numerous measurements of arterial blood flow using an ultrasound technique were made prior to and for an hour following the viewing of each film.  Blood flow was found to be restricted in 14 of 20
subjects after the stressful film but increased in 19 of 20 after the film that made them laugh. The average difference between these two responses was greater than 50 percent.  The reduction in blood flow after the sad film was equivalent to doing mental arithmetic under time pressure while the increase following the funny film was similar to that seen with aerobic exercise.

Arterial tone is regulated by the endothelial cells that line the inner walls of these vessels.  It has long been known that anger, hostility, anxiety, depression and other stressors cause vasoconstriction, which may partially explain why they increase risk for heart disease.  This study suggests that laughter could have the opposite effect.   The same research group had previously given 150 patients with coronary disease and 150 healthy age-matched controls a questionnaire designed to determine their sense of humor and whether they would react to absurd situations with either laughter or irritation.  The results revealed that the heart disease patients were 40 percent less likely to see such situations as funny.

As emphasized in a recent Newsletter, laughter is the shock absorber that softens the blows of and blunts the harmful effects of stress on health and life.  As also noted in prior Newsletters, “He who laughs, lasts”, and “You don’t stop laughing because you grow old, you grow old because you stop laughing.”  Laughing may promote longevity not only because it helps to prevent cardiovascular disease and diabetes, but also because it improves immune system function, lowers blood pressure and stress hormone levels.  Numerous other studies also show that optimistic, happy people with a good sense of humor live
longer than their grouchy counterparts.

References: Miller M, Mangano C, Park et al. Impact of cinematic viewing on endothelial function. Heart 2006;
92: 261-262. Rosch PJ. Why Do Happy People And Optimists Live Longer? Health And
Stress Newsletter. July, 2005. Rosch PJ. Can Laughter & Humor Help You Live
Longer? Health And Stress Newsletter. November, 2005