Depressive Episode May Not Always Follow Mania in Bipolar Disorder

MONDAY, May 9, 2016 (HealthDay News) — While many may associate bipolar disorder with episodes of mania followed by periods of depression, a new study suggests that’s often not the case.

Researchers say states of anxiety are equally as likely as to follow manic episodes as depression.

The finding might have implications for better treatment, the research team said.

“For years, we may have missed opportunities to evaluate the effects of treatments for bipolar disorder on anxiety,” said study lead author Dr. Mark Olfson, a professor of psychiatry at Columbia University Medical Center in New York City.

“The results of our study suggest that researchers should begin to ask whether, and to what extent, treatments for bipolar disorder relieve anxiety as well as mania and depression,” he added in a university new release.

According to the study authors, about 5.7 million Americans have bipolar disorder, which causes cycles of mania (elevated or irritable mood) and depression.

The new findings stem from an analysis of data from more than 34,000 American adults with bipolar disorder.

“Although it has long been widely assumed that bipolar disorder represents repeated episodes of mania and depression as poles along a single continuum of mood, the clinical reality is often far more complex,” Olfson said.

He said that, based on the new findings, “patients whose main symptom is anxiety should be carefully assessed for a history of mania before starting treatment.”

The study was published May 3 in the journal Molecular Psychiatry.

More information

The U.S. National Institute of Mental Health has more on bipolar disorder.

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Cutting Brand-Name Drug Use Could Save U.S. $73 Billion: Study

MONDAY, May 9, 2016 (HealthDay News) — Overuse of brand-name drugs may be part of the reason why the United States spends more on medication than any other country, a new study contends.

Too many brand-name drugs also contribute to greater out-of-pocket expenses for American consumers, researchers said.

“We wanted to see how much patients and society as a whole could save through the use of therapeutic substitution, in terms of both overall and out-of-pocket expenses on brand drugs, when a generic drug in the same class with the same indication was available,” said lead investigator Dr. Michael Johansen. He is a family medicine physician with the Ohio State University Wexner Medical Center, in Columbus.

What the researchers found was that Americans could save tens of billions of dollars with more efficient drug use. That means replacing brand-name drugs with their generic equivalents whenever possible.

For the study, the researchers reviewed self-reported prescription drug use by more than 107,000 Americans who were part of the 2010-2012 Medical Expenditure Panel Survey.

The study authors found that $760 billion was spent on prescription drugs during the study. Nearly 10 percent of all prescription drug expenses involved brand-name drug overuse, the study found.

Out-of-pocket expenses totaled $175 billion during the study. Brand-name drug overuse accounted for 14 percent of these costs, the study authors said.

The researchers said this represents an opportunity to save billions of dollars.

“We observed an estimated potential savings of $73 billion overall and nearly $25 billion in out-of-pocket expenses throughout the three years of the study,” Johansen said in a university news release.

The researchers said replacing brand names with generics remains a controversial topic. They recommended having systems in place to ensure patients’ safety and increase collaboration among doctors.

The study was published May 9 in JAMA Internal Medicine.

More information

The U.S. Food and Drug Administration provides more information on generic drugs.

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Blood Pressure Patterns May Predict Stroke Risk

By Steven Reinberg
HealthDay Reporter

MONDAY, May 9, 2016 (HealthDay News) — Instead of relying on individual blood pressure readings, doctors should review the overall pattern to predict a patient’s risk of stroke or early death, new research suggests.

“Our study suggests that looking at someone’s blood pressure over time and whether it increases slowly or steeply may provide additional information above only the level of blood pressure at a certain time,” said researcher Dr. Marileen Portegies. She is with the department of epidemiology at Erasmus University Medical Center in Rotterdam, the Netherlands.

High blood pressure is the number one risk factor for stroke. But, most studies assessing risk have looked only at measurements taken at a single point in time, the researchers said in background notes.

For this new study, Portegies and her colleagues collected 20 years of data on the systolic blood pressure (the top number in a blood pressure reading) of more than 6,700 Dutch adults. Participants were ages 55 to 106 and living in a suburb of Rotterdam.

The trial started in 1990, and five follow-up medical exams were conducted over two decades.

Those whose systolic blood pressure rose steeply from mid-life on and those whose high blood pressure dropped after age 65 had the highest risk of stroke or death from other blood pressure-related diseases up to age 80, the study found.

Moderately high blood pressure was linked to the highest risk of stroke overall, but the lowest risk of death from heart attack, heart failure and kidney disease, the researchers said.

This finding “further underlines the importance of treating people with a high blood pressure, even if it is only moderately elevated,” Portegies said.

People with normal blood pressure that gradually increased had the lowest risk of stroke and a low risk of death from other causes, the researchers found.

Systolic blood pressure is the force exerted on the arteries when the heart contracts and pushes blood to the rest of the body.

Overall, Portegies’ team identified four blood pressure patterns:

• Most common was a gradual increase in blood pressure from normal systolic blood pressure (120 mm Hg) in middle age to high (160 mm Hg).
• Normal blood pressure in middle age but a steep rise to very high (200 mm Hg).
• Moderately high blood pressure (140 mm Hg) in middle age that did not change much.
• High blood pressure (160 mm Hg) in middle age, which decreased after 65. This pattern was more frequent in men, and these patients were more likely than some others to take blood pressure medication.

Over two decades, more than 1,000 study participants suffered a stroke. The paths that blood pressure took over time appeared to have a bearing on stroke and death from heart attack, heart failure, kidney disease and other diseases, Portegies said.

Compared with people whose blood pressure increased gradually, people whose high blood pressure dropped after 65 had the highest risk of stroke (13.6 percent). Next in line were those whose blood pressure rose steeply (8 percent greater risk) and adults whose moderately high blood pressure stayed stable (a nearly 5 percent higher risk of stroke), the researchers found.

“The highest risk of stroke and death was found in the class with a high mid-life blood pressure and the class that increased steeply in blood pressure,” Portegies said.

The report was published online May 9 in the journal Hypertension.

Other doctors agreed the findings support the need for regular blood pressure checks.

“This study shows the importance of routine blood pressure checks and treatment of high blood pressure at early ages to maintain normal, or only modestly elevated, blood pressure,” said Dr. Andrew Rogove, medical director of stroke at Northwell Health Southside Hospital in Bay Shore, N.Y.

However, because the study was done among a mostly white population, it should be replicated in other groups to be certain the findings hold true for all populations, Rogove said.

Regardless, “control of high blood pressure starting at an early age and continued throughout one’s lifetime is important,” he said.

Also, with age, your blood pressure can change dramatically, and should be checked regularly, the researchers noted.

More information

For more about blood pressure, visit the American Heart Association.

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Could ‘Breast Cancer Genes’ Play Role in Prostate Cancer, Too?

By Dennis Thompson
HealthDay Reporter

MONDAY, May 9, 2016 (HealthDay News) — A man’s risk of aggressive and lethal prostate cancer may be heavily influenced by gene mutations previously linked to breast and ovarian cancer in women, a trio of new studies suggests.

And, at least one expert says these findings may indicate that men with a history of breast cancer in their family probably should receive more intense screening for prostate cancer in the future, particularly if those cancers are linked to mutations in the so-called breast cancer genes — BRCA1 or BRCA2.

One of the studies found that men newly diagnosed with prostate cancer seemed four times more likely to already have advanced cancer if they carry a BRCA2 gene mutation, compared with the general population.

“They are very much at high risk of cancer and we should be tailoring their screening, to be more aggressive in screening versus less aggressive,” said Dr. Srinivas Vourganti, a co-researcher on that study and an assistant professor of urology at SUNY Upstate Medical University.

Findings from the studies were scheduled to be presented Monday at the annual meeting of the American Urological Association, in San Diego. Results from meetings are generally considered preliminary until published in a peer-reviewed journal.

“I think BRCA is a tool we can start using to distinguish who is going to benefit from earlier treatment and more aggressive type treatments” for prostate cancer, added Dr. Brian Helfand, a urologic oncologist with NorthShore University HealthSystem in Chicago. Helfand was scheduled to moderate a panel presentation of the three studies.

Breast cancer has been definitively linked with BRCA1 and BRCA2 mutations. Up to two-thirds of women with a BRCA1 mutation and as many as 45 percent of women with BRCA2 will develop breast cancer by age 70, according to estimates from the U.S. National Cancer Institute.

BRCA mutations have been assumed to influence other forms of cancer as well, because these genes normally produce proteins that repair damaged DNA that could otherwise cause cancer, Vourganti said.

But previous research has estimated that BRCA mutations would be involved in as few as 5 percent of prostate cancers, Helfand said.

“We all just took it for what it was worth,” Helfand said. “Yeah, they’re there, but it’s not applicable to 95 percent of men.”

Now, these three new studies indicate that the prostate cancer risk from BRCA mutations may have been severely underestimated, Helfand and Vourganti said.

In the first study, Vourganti and his colleagues conducted an evidence review. The review combined the results of 12 prostate cancer studies. Those studies included 261 men who tested positive for a BRCA2 mutation.

The researchers found that the cancer already had spread to other parts of the body in 17 percent of newly diagnosed prostate cancer patients who had a BRCA2 mutation, compared with 4 percent of new diagnoses across the general population.

Men with BRCA2 mutations also were much more likely to be diagnosed with late-stage prostate cancer — about 40 percent compared with 11 percent of the general population, the findings showed.

“This is very telling,” Vourganti said. “When [these] men are diagnosed, they have very aggressive cancers.”

The second study reviewed blood DNA samples from 857 prostate cancer patients treated at the Walter Reed National Military Medical Center in Bethesda, Md.

Researchers found that black prostate cancer patients were more than three times as likely to have a BRCA1 or BRCA2 mutation as white patients — 7 percent versus 2 percent.

In addition, black prostate cancer patients were more likely to have their cancer spread to another part of their body than whites (9 percent versus 2 percent). And it tended to take less time for their cancer to spread, the findings showed.

BRCA mutations could help explain why black men are two or more times more likely to die from prostate cancer than white men, Helfand said.

“The frequency of BRCA mutations in African American men has been largely unknown,” he said. “This study shows it’s much higher than we thought, and may be a good reason why African American men are more likely to die or have aggressive disease.”

The third study focused exclusively on men who’d been treated for breast cancer.

Breast cancer is extremely rare in men, Helfand said. A man’s lifetime risk of breast cancer is about one in 1,000, compared with a one in seven lifetime risk for prostate cancer, according to the American Cancer Society.

A review of nearly 5,800 men diagnosed with breast cancer revealed that they had a more than 30 percent increased risk of developing prostate cancer later on.

Doctors should consider screening men with a personal or family history of breast cancer for BRCA mutations that could influence their risk of prostate cancer, Helfand concluded from these three studies.

“We need to recognize this as a risk factor and start screening those men more aggressively,” he said.

In addition, prostate cancer patients who test positive for a BRCA mutation might respond better to cancer treatments that are more effective in treating BRCA-positive breast cancer, Vourganti said.

“In this era of personalized medicine, there’s promise for men who present with BRCA2,” he said. “We’re learning that prostate cancer is not one disease. Rather, it is many different diseases that need to be treated on a personalized and individual basis. Men need to talk with their doctors and know that their genes do matter.”

More information

For more on BRCA mutations, visit the U.S. National Cancer Institute.

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Artificial Sweeteners During Pregnancy May Make for Heavier Infants

By Steven Reinberg
HealthDay Reporter

MONDAY, May 9, 2016 (HealthDay News) — Pregnant women who drink artificially sweetened drinks every day may be more likely to give birth to heavier babies who are then more likely to become overweight children, researchers report.

“Infants born to women who regularly consumed one or more artificially sweetened beverages during pregnancy were twice as likely to be overweight by 1 year of age,” said study author Meghan Azad, a research scientist at the University of Manitoba in Winnipeg, Canada.

By her definition, an overweight baby weighs more than 97 percent of other babies of the same height and weight.

This is the first study to investigate the potential effect of consuming artificial sweeteners during pregnancy and infant weight gain, Azad said. Interestingly, the researchers did not find any connection between drinking sugar-sweetened drinks and infant weight.

And the effects were not explained by maternal weight, diet, total calories consumed or other obesity risk factors, she added.

Although the study didn’t prove that artificially sweetened drinks cause infant weight gain, “caution is warranted,” Azad said.

“Given the current epidemic of childhood obesity and widespread use of artificial sweeteners, further research is warranted to confirm our findings and investigate the underlying biological mechanisms. Ultimately, this research could help improve dietary recommendations for pregnant women,” Azad said.

For the study, Azad and her colleagues collected data on more than 3,000 mothers and their babies. The women were asked what drinks they consumed during pregnancy. Nearly 30 percent said they drank artificially sweetened beverages, including 5 percent who reported drinking them on a daily basis.

The consumption of artificially sweetened drinks was determined by how often women drank soda or iced tea containing artificial sweeteners or added sweeteners to coffee or tea, Azad explained. The researchers could not determine which artificial sweeteners were consumed in each case.

The study findings were published online May 9 in the journal JAMA Pediatrics.

One health expert had a theory on the potential link.

“Limited research has suggested that artificial sweeteners may degrade the body’s innate mechanisms for sensing caloric intake and responding with feelings of fullness,” said Mark Pereira, an associate professor of epidemiology and community health at the University of Minnesota in Minneapolis.

However, it may not be that artificially sweetened beverages cause these effects on the fetus and young child. It could instead be the physical and biological characteristics of the women who choose to consume these beverages frequently, he said.

“A couple of other studies have also raised concern about the possible negative impacts of maternal consumption of artificially sweetened beverages on the fetus and offspring,” said Pereira, who co-authored a journal editorial accompanying the study.

“Since we do not yet really understand if these are real causal effects, women should refrain from consuming artificial sweeteners during pregnancy,” he added.

The Calorie Control Council, which represents the low-calorie food and beverage industry, stood by the safety of artificial sweeteners.

“Before a low-calorie sweetener may be used in foods or beverages, it must be determined by relevant regulatory bodies to be safe for all populations, including special groups such as the elderly, children, and pregnant and nursing women,” Robert Rankin, president of the council, said in a statement.

“These safety assessments include an evaluation of possible effects of low-calorie sweeteners during pregnancy and [they] continue to show that these sweeteners are safe for pregnant women and their children,” Rankin said.

Not only that, he added, but “low-calorie sweeteners can help pregnant women avoid excess calories… Excess weight gain during pregnancy can be harmful to both the mother and developing baby.”

More information

Visit the U.S. Department of Health and Human Services for more on healthy eating while pregnant.

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Targeted Drug-Delivery System May Treat Pregnancy Complications

MONDAY, May 9, 2016 (HealthDay News) — A treatment approach that typically targets tumors may also safely deliver medications directly to a pregnant woman’s placenta, a new mouse study suggests.

This type of treatment might one day help reduce pregnancy complications, such as preeclampsia, the researchers said. And it could also help prevent premature deliveries without harming fetuses, they added.

“Placentas behave like well-controlled tumors,” study author Lynda Harris, of the University of Manchester in England, explained in a news release from Sanford Burnham Prebys Medical Discovery Institute in California. “They grow quickly, produce growth hormones and evade the immune system.”

“A lot of cancer research focuses on finding ways of delivering drugs to kill the tumor without affecting the rest of the body,” Harris added. “We had the idea that if we could selectively target the placenta in the same way, we could deliver other drugs to help improve placental function and therefore treat pregnancy complications.”

Roughly 10 percent of babies are born prematurely, the March of Dimes reports, and a poorly functioning placenta is an underlying cause of many problems during pregnancy.

Without drugs to treat these issues, doctors are often forced to deliver babies early, the researchers explained.

Working with mice, the international team of scientists found that two chains of amino acids that are used to target tumors can also safely target placentas, delivering medication to support a growing mouse fetus. Amino acids are the building blocks of proteins.

In the study, the researchers delivered a growth hormone to mice placenta through tiny amino acid-coated nanoparticles. The drug did not affect normal-sized fetuses, but it prompted those that were too small to grow.

At the same time, the drug did not accumulate inside either pregnant mice or developing mouse fetuses.

Directing medication to the placenta might also help treat complications during pregnancy and avoid some premature deliveries, according to authors of the study published May 6 in the journal Science Advances.

The researchers said their findings suggest this treatment approach could one day be used on humans, although animal research often does not pan out in people.

They noted the treatment might not be appropriate for women with undiagnosed cancers because these drugs could also target tumors. But cancer screening could get around this potential issue, they added.

“Only one drug for use during pregnancy has been licensed in the last 20 years,” Harris said. “By developing this [drug delivery] platform, we have opened up the possibility that any number of new drugs can be adapted and then used safely to treat common and serious pregnancy complications.”

More information

The American Pregnancy Association provides more information on the placenta.

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Pesticides Linked to Raised Risk of ALS

By Kathleen Doheny
HealthDay Reporter

MONDAY, May 9, 2016 (HealthDay News) — Exposure to pesticides and other chemicals may increase the risk for ALS (amyotrophic lateral sclerosis), a fatal neurological disease, researchers say.

Three toxins in particular were associated with greater risk for the progressive condition, often called Lou Gehrig’s disease because it killed the legendary baseball player with that name.

“We are identifying these toxic, persistent, environmental pollutants in higher amounts in ALS patients compared to those who do not have ALS,” said study co-author Dr. Stephen Goutman. He is assistant professor of neurology at the University of Michigan and director of its ALS Clinic.

This new study doesn’t prove pesticides cause ALS, but it does build on an association suggested in previous research, Goutman said. Scientists already suspect pesticides may contribute to Parkinson’s disease, another neurodegenerative disorder.

For this study, Goutman and his colleagues evaluated 156 patients with ALS and 128 without the disease. Participants were asked about occupational and residential exposure to environmental toxins. Blood samples were taken to measure pesticide levels.

The researchers looked at 122 environmental chemicals and pesticides. Three in particular were linked to heightened ALS risk, Goutman said.

Persistent exposure to the pesticide cis-chlordane increased ALS risk nearly sixfold. Exposure to pentachlorobenzene — which was used in the manufacture of fungicides — doubled the odds for ALS. Polybrominated diphenyl ethers, used as a flame retardant in furnishings and textiles, raised the risk by about 2.7 times, the researchers said.

Military service was also linked to greater risk for developing ALS, but the investigators can’t explain why.

ALS, a progressive disease, affects nerve cells in the brain and the spinal cord. As the nerve cells that control muscles die, patients lose the ability to speak, move, breathe and eat, according to the ALS Association.

Experts contend that a combination of genetics and environmental factors triggers the condition, Goutman said.

The study was published online May 9 in JAMA Neurology.

The study, conducted between 2011 and 2014, was funded in part by the U.S. Centers for Disease Control and Prevention.

Dr. Merit Cudkowicz is director of the ALS Clinic at Massachusetts General Hospital. She said the new study “raises possibilities of the association of certain pesticides and ALS, but is far from certain.”

Those possible risk factors need to be studied further, added Cudkowicz, co-author of a journal editorial accompanying the study.

Goutman and Cudkowicz recommended avoiding pesticides. This is especially wise, Goutman said, for anyone with a family history of ALS.

However, it “really is hard to avoid” these chemicals, he noted, adding they’re in the air and soil, and often linger for years.

More information

To learn more about amyotrophic lateral sclerosis, visit the ALS Association.

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4 Times Changing Your Look Can Be a Healthy Choice (and 1 Time It Isn’t)

Kaley Cuoco has gone long again. Mid-hair extensions, she posted an Instagram pic and an explanation for her makeover—to celebrate the end of filming The Big Bang Theory.

“It’s very important for me to change my look after wrapping each season,” Cuoco wrote. “I love playing Penny, but it’s good for me to bring it back to Kaley.”

That familiar urge to mark a life transition with a physical transformation makes sense, because how you feel and how you look are so closely linked.

“A positive self-image can stimulate the reward center of our brain, so if we like the way we look, it can impact us emotionally, and help us feel better about more than just our appearance,” explains Vivian Diller, Ph.D., a psychologist in private practice in New York City who specializes in self-esteem, body image, and beauty.

Aside from milestones, here are three more instances when changing your appearance can be a healthy choice—and one time you may want to put away the box of hair dye.

RELATED: This Is the Grown-Up Way to Rock a Braid

When you feel uninspired

Maybe you’ve been in the same division at your company for a while now, and crave something fresh. Or you’ve in a long-term relationship and things seem … stuck. “When we feel unmotivated at work, or our relationship seems dull, change can help bring some vitality to our lives,” says Diller, who wrote Face It: What Women Really Feel as Their Looks Change and What to Do About It ($16; amazon.com). Of course, chopping your hair isn’t going to solve your problems. But it can affect how you view your life, and provide some much-needed clarity, Diller says.

When you land a new gig

It can feel energizing to start anew with a different style, says Diller. But if you’re moving to a new role within your company, don’t do anything too drastic, because a total makeover might give the wrong impression: “You don’t want to be viewed as trying to change things up too much,” she says.

RELATED: This Is the New “It” Haircut You’ll Want to Ask Your Stylist For

When you’re getting over a bad breakup

No one’s suggesting that you run to the salon and go platinum. But a well-thought out, well-planned change may do you good. (See: “Revenge looks” by any celebrity post breakup. Ever.) “It’s important to deal with a breakup emotionally, but it doesn’t hurt to move things along with changing up your look,” saysDiller. “It can help you leave behind bad memories or the associations with a past relationship,” she adds.

When everything’s changing

Maybe you’re pregnant. Or your company is relocating you across the country. These are times to proceed with caution. Big changes that create a good deal of upheaval in your life are not when you want to go wild at the salon, says Diller. Rather, “it can help to keep other things constant, including your look,” she explains.  “Maintaining stability can give us the wherewithal to deal with dramatic life changes.” Besides, we don’t have to tell you that you look beautiful just the way you are.

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Olympic Gymnast Gabby Douglas on Going After Your Dreams and Beauty Product Faves

Photo: Getty Images

The Rio Olympic Games are just a few short months away, so we were thrilled when we got the chance to sit down with Gabby Douglas. Yes, the would be the Olympic gymnast and Gillette Venus athlete who won gold in London back in 2012 in both the individual and team competitions.

Obvi, it was hard not to fangirl.

Gabby (who was rocking some amazing glittery eyeshadow, we might add) joined us with her mom, where we talked all about P&G’s new Thank You Mom video, “Strong,” beauty lessons, and fave products.

Btw, when I watched the video, I had a hard time holding back the tears. For Gabby, it got her thinking about the role that confidence plays in her sport and how her mom gave her strength to go after her dreams.

“When I watched the video, it brought me back to London, and I remember I had hard times and those hard days where I had to call my mom and be like, ‘Mom, I can’t do this anymore’ and she was like, ‘You got it! You can do it!’ She’s literally taught me everything that I know today and to go out there and be confident,” Gabby tells us. “I think that’s what the video is all about — being strong and confident and the mom is there to uplift you.”

So, in true Mother’s Day fashion, I had to ask Gabby what her mother taught her about confidence and beauty. The lessons are grand.

“Just to go out there and get what you want. Nothing in life is ever handed to you. You got to go out and you got to grab it. You can’t let these opportunities waste away and slip by,” she says. “You have to take every single one of them.”

As for her mom’s best beauty advice?

“I just think [she taught me] to be comfortable in your own skin and embrace your features and love who you are.”

RELATED: Olympic Swimmer Dana Vollmer Lives for Bubble Baths — and We Can Relate

#Agreed.

And for all of you who want to know Gabby’s favorite beauty products (because this girl always looks amazing), you’ll be psyched to know she swears by a product you’ve probably seen in your local drugstore and couldn’t be more appropriate for summer.

It’s the Gillette Venus Swirl ($13; target.com), a razor that curves and moves around so you can get those tricky areas. Idk about you, but I hate when I notice I’ve missed a random patch of hair around my ankles halfway through the day. Most. Annoying. Thing. Ever.

Gabby explained to me that it’s a game-changing essential, and it will make me look forward to shaving my legs. “Literally, this moves like no other,” she says of the razor that gives her what she says is a “sleek-finish” look.

“Especially for me, and I’m out there in a leotard and there’s HD cameras. I got to look good!”

RELATED: How to Curb PMS Symptoms with Your Diet

She said that on top of her grips and makeup, it’s always in her gym bag.

Into it. Thanks for the summer beauty tip, Gabby!

This article originally appeared on InStyle.com/MIMI.

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The 2-Minute Warning May Be Making Life Tougher for Parents