The Rise of All-Purpose Antidepressants

 

Doctors are increasingly prescribing SSRIs to treat more than just depression Oct 16, 2014 By Julia Calderone Antidepressant use among the US people  is skyrocketing. Adults  consumed four times more antidepressants in the late 2000s than they did in the early 1990s. As the third most frequently taken medication in the U.S., researchers estimate that 8 to 10 percent of the population is taking an antidepressant. But this spike does not necessarily signify a depression epidemic. Through the early 2000s pharmaceutical companies were aggressively testing selective serotonin reuptake inhibitors (SSRIs), the dominant class of depression drug, for a variety of disorders—the timeline below shows the rapid expansion of FDA-approved uses. As the drugs' patents expired, companies stopped funding studies for official approval. Yet doctors have continued to prescribe them for more ailments. One motivating factor is that SSRIs are a fairly safe option for altering brain chemistry. Because we know so little about mental illness, many clinicians reason, we might as well try the pills already on the shelf. Common Off-Label Uses Doctors commonly use antidepressants to treat many maladies they are not approved for. In fact, studies show that between 25 and 60 percent of prescribed antidepressants are actually used to treat nonpsychological conditions. The most common and well-supported off-label uses of SSRIs include: Abuse and dependence ADHD (in children and adolescents) Anxiety disorders Autism (in children) Bipolar disorder Eating disorders Fibromyalgia Neuropathic pain Obsessive-compulsive disorder Premenstrual dysphoric disorder Investigational Uses SSRIs have shown promise in clinical trials for many more disorders, and some doctors report using them successfully to treat these ailments: Arthritis Deficits caused by stroke Diabetic neuropathy Hot flashes Irritable bowel syndrome Migraine Neurocardiogenic syncope (fainting) Panic disorder Post-traumatic stress disorder Premature ejaculation An Expanding Repertoire: Above are the SSRIs approved in the U.S. and the dates the FDA approved each to treat various disorders. This article was originally published with the title "All-Purpose Antidepressants."

 

 

 

 

Matched 'hybrid' systems may hold key to wider use of renewable energy

 

Wind farms such as this one in Idaho might be combined with other forms of alternative energy to better balance the output of sustainable energy. The use of renewable energy in the United States could take a significant leap forward with improved storage technologies or more efforts to "match" different forms of alternative energy systems that provide an overall more steady flow of electricity, researchers say in a new report. Historically, a major drawback to the use and cost-effectiveness of alternative energy systems has been that they are too variable -- if the wind doesn't blow or the sun doesn't shine, a completely different energy system has to be available to pick up the slack. This lack of dependability is costly and inefficient. But in an analysis just published in The Electricity Journal, scientists say that much of this problem could be addressed with enhanced energy storage technology or by developing "hybrid" systems in which, on a broader geographic scale, one form of renewable energy is ramping up even while the other is declining. "Wind energy is already pretty cost-competitive and solar energy is quickly getting there," said Anna Kelly, a graduate student in the School of Public Policy at Oregon State University, and an energy policy analyst. "The key to greater use of these and other technologies is to match them in smart-grid, connected systems. "This is already being done successfully in a number of countries and the approach could be expanded." For instance, the wind often blows more strongly at night in some regions, Kelly said, and solar technology can only produce energy during the day. By making more sophisticated use of that basic concept in a connected grid, and pairing it with more advanced forms of energy storage, the door could be opened for a much wider use of renewable energy systems, scientists say. "This is more than just an idea, it's a working reality in energy facilities around the world, in places like Spain, Morocco and China, as well as the U.S.," Kelly said. "Geothermal is being paired with solar; wind and solar with lithium-ion batteries; and wind and biodiesel with batteries. By helping to address the price issue, renewable energy is being produced in hybrid systems by real, private companies that are making real money." Advanced energy storage could be another huge key to making renewable energy more functional, and one example is just being developed in several cooperating states in the West. Electricity is being produced by efficient wind farms in Wyoming; transmitted to Utah where it's being stored via compressed air in certain rock formations; and ultimately used to help power Los Angeles. This $8 billion system could be an indicator of things to come, since compressed air can rapidly respond to energy needs and be readily scaled up to be cost-competitive at a significant commercial level. "There are still a number of obstacles to overcome," said Joshua Merritt, a co-author on the report and also a graduate student in mechanical engineering and public policy at OSU. "Our transmission grids need major improvements so we can more easily produce energy and then send it to where it's needed. There are some regulatory hurdles to overcome. And the public has to more readily accept energy systems like wind, wave or solar in practice, not just in theory." The "not in my back yard" opposition to renewable energy systems is still a reality, the researchers said, and there are still some environmental concerns about virtually any form of energy, whether it's birds killed by wind turbine rotors, fish losses in hydroelectric dams or chemical contaminants from use of solar energy. The near future may offer more options, the researchers said. Advanced battery storage technologies are becoming more feasible. Wave or tidal energy may become a real contributor, and some of those forces are more predictable and stable by definition. And the birth of small, modular nuclear reactors -- which can be built at lower cost and produce no greenhouse gas emissions -- could play a significant role in helping to balance energy outflows from renewable sources. The long-term goal, the report concluded, is to identify technologies that can work in a hybrid system that offers consistency, dependability and doesn't rely on fossil fuels. With careful matching of systems, improved transmission abilities and some new technological advances, that goal may be closer than realized, they said. "With development, the cost of these hybrid systems will decrease and become increasingly competitive, hopefully playing a larger role in power generation in the future," the researchers wrote in their conclusion.

 

 

Artificial pancreas shown to improve treatment of type 1 diabetes

 

 

The world’s first clinical trial comparing three alternative treatments for type 1 diabetes was conducted in Montréal by researchers at the IRCM and the University of Montreal, led by endocrinologist Dr. Rémi Rabasa-Lhoret. The study confirms that the external artificial pancreas improves glucose control and reduces the risk of hypoglycemia compared to conventional diabetes treatment. The world's first clinical trial comparing three alternative treatments for type 1 diabetes was conducted in Montréal by researchers at the IRCM and the University of Montreal, led by endocrinologist Dr. Rémi Rabasa-Lhoret. The study confirms that the external artificial pancreas improves glucose control and reduces the risk of hypoglycemia compared to conventional diabetes treatment. The results, published in the scientific journal The Lancet Diabetes & Endocrinology, could have a significant impact on the treatment of type 1 diabetes, a chronic disease that can cause vision loss and cardiovascular diseases. An emerging technology to treat type 1 diabetes, the external artificial pancreas is an automated system that simulates the normal pancreas by continuously adapting insulin delivery based on changes in glucose levels. Two configurations exist: the single-hormone artificial pancreas that delivers insulin alone and the dual-hormone artificial pancreas that delivers both insulin and glucagon. While insulin lowers blood glucose levels, glucagon has the opposite effect and raises glucose levels. "Our clinical trial was the first to compare these two configurations of the artificial pancreas with the conventional diabetes treatment using an insulin pump," says Dr. Rabasa-Lhoret, Director of the Obesity, Metabolism and Diabetes research clinic at the IRCM and professor at the University of Montreal's Department of Nutrition. "We wanted to determine the usefulness of glucagon in the artificial pancreas, especially to prevent hypoglycemia, which remains the major barrier to reaching glycemic targets." People living with type 1 diabetes must carefully manage their blood glucose levels to ensure they remain within a target range in order to prevent serious long-term complications related to high glucose levels (such as blindness or kidney failure) and reduce the risk of hypoglycemia (dangerously low blood glucose that can lead to confusion, disorientation and, if severe, loss of consciousness, coma and seizure). "Our study confirms that both artificial pancreas systems improve glucose control and reduce the risk of hypoglycemia compared to conventional pump therapy," explains engineer Ahmad Haidar, first author of the study and postdoctoral fellow in Dr. Rabasa-Lhoret's research unit at the IRCM. "In addition, we found that the dual-hormone artificial pancreas provides additional reduction in hypoglycemia compared to the single-hormone system." "Given that low blood glucose remains very frequent during the night, the fear of severe nocturnal hypoglycemia is a major source or stress and anxiety, especially for parents with young diabetic children," adds Dr. Laurent Legault, paediatric endocrinologist at the Montreal Children's Hospital, and co-author of the study. "The artificial pancreas has the potential to substantially improve the management of diabetes and the quality of life for patients and their families." IRCM researchers are pursuing clinical trials on the artificial pancreas to test the system for longer periods and with larger patient cohorts. The technology should be available commercially within the next five to seven years, with early generations focusing on overnight glucose control. According to the Canadian Diabetes Association, an estimated 285 million people worldwide are affected by diabetes, approximately 10 per cent of which have type 1 diabetes. With a further 7 million people developing diabetes each year, this number is expected to hit 438 million by 2030, making it a global epidemic. Today, more than nine million Canadians -- or one if four -- are living with diabetes or prediabetes. Story Source: The above story is based on materials provided by Universite de Montreal. Note: Materials may be edited for content and length. Journal Reference: Ahmad Haidar, Laurent Legault, Virginie Messier, Tina Maria Mitre, Catherine Leroux, Rémi Rabasa-Lhoret. Comparison of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional insulin pump therapy for glycaemic control in patients with type 1 diabetes: an open-label randomised controlled crossover trial. The Lancet Diabetes & Endocrinology, 2014; DOI: 10.1016/S2213-8587(14)70226-8

What happened to England's abandoned mansions?

 

By Katie Wray BBC News

Evocative of an aristocratic and glorious history, there are many mansions around England that now stand empty or abandoned.

These impressive buildings may look lonely and forlorn but behind every mansion is a story.

Winstanley Hall in Winstanley, Wigan

Shiela Gummerson, 72, spent much of her childhood living in the grounds of Winstanley Hall, where her parents worked for its owners, the Bankes family.

"It was my own personal Downton Abbey," she said. "We were downstairs and the Bankes family were upstairs."

The hall dates back to the reign of Queen Elizabeth I and had been the home of the Bankes family since 1595.

Mrs Gummerson lived in a cottage on the grounds from 1942 until 1969 when her father, Frederick Parker, was their chauffeur and her mother, Sarah, was their cook.

"We got on well with the Bankes family. Every year they used to have a daffodil day once a year in the spring, where they'd invite local people to come and buy daffodils that would grow outside the Hall. Mother used to cook yeast buns and sell them to the locals."

She lived there until she was 27 when she got married. Her mother, by now a widow, left the cottage two years later.

The last member of the Bankes family left the house in 1984 and the building has since fallen into disrepair. It was sold to developers in 2000 and Save Britain's Heritage is now working to rescue it from decay.

While Mrs Gummerson has nostalgic memories towards the Hall, she has not been back since 1978.

"I can't bring myself to do it," she said. "I can see on the internet what it looks like now and I get so upset."

Shiela Gummerson in 1963, the morning after her 21st birthday, and her father - Frederick Thomas Parker - who was a chauffeur for the Bankes family

Woodchester Mansion, near Nympsfield, Gloucestershire

Work began on Woodchester Mansion in the 1850s but it was abandoned unfinished in 1873

While most mansions fell into disrepair after decades of use, Woodchester Mansion was never actually finished. Work began in the 1850s but construction was abandoned in 1873.

According to rumour, a French plasterer was bludgeoned to death in the kitchen and his spirit scared the tradesmen off the site. However, the more likely explanation for its abandonment is that the owner, William Leigh, ran out of money after taking out a £10,000 mortgage, according to the estate manager Hannah McCanlis.

Andrew Fryer lived and worked in the mansion as a caretaker from 1994 until 2011. For the first 10 years he lived in one room on the ground floor with a Saniflo toilet.

"There were always weird things happening - noises coming from areas that no-one was allowed in," he said.

Despite now standing empty, Woodchester Mansion does have some unusual residents. It houses five different breeds of bat. Two of the bat colonies, the lesser horseshoe and greater horseshoe, live in the attics of the mansion.

The entire mansion is left in different states of incompletion, but the carved stonework is some of the best in the country, said Ms McCanlis.

Woodchester Mansion currently attracts about 6,000 visitors yearly and is open six days a week between April and October.

Andrew Fryer looked after Woodchester Mansion for 17 years, and lived in the caretaker's apartment behind him

Witley Court in Worcestershire

The South Portico of Witley Court, eight columns wide and two columns deep

Today, Witley Court is a large and impressive ruin, but 100 years ago it was in spectacular condition.

The rich industrialist Sir Herbert Smith bought the house in 1920 and lived there for 17 years until a devastating fire broke out in September 1937 while he was away.

The blaze began in the bakery in the basement of the south-east corner of the house. Fanned by strong winds, the fire spread rapidly to the main rooms, completely gutting the central and eastern sections.

According to English Heritage, insurance money would not pay for more than a quarter of the cost of rebuilding.

Therefore Sir Herbert decided to leave the property, and it has been empty since 1938.

English Heritage has restored the south garden. In addition to this, Wolfson Foundation funding has assisted with major restoration works in the East Parterre garden.

The service courtyard behind the curved wing of the Court, was known as the "kitchen court" or "back court". Servants and tradesmen would access the house this way

Poltimore House, near Exeter in Devon

Poltimore House has become increasingly derelict since a great fire in 1987

Poltimore House dates back to the 16th Century and was home to the Bampfylde family for five centuries before becoming Poltimore College, a girls' school, in 1921.

However, a fire destroyed the former ballroom wing in 1987 and it has since fallen prey to vandalism, theft and the effects of bad weather.

Jocelyn Hemming, now 90 years old, was 21 when her parents bought the 112-acre estate in 1945.

The family lived in two rooms on the ground floor while the house was converted into a hospital.

She is now a member of the Poltimore House Trust, which has looked after the site since 2000 and hopes to restore it.

"I don't want to let the house go," she said. "It needs a lot of tender loving care and money.

"But my parents really loved that place, and I know they would like to think we were looking after it."

Jocelyn Hemming outside Poltimore House in 1949, and in 2014 with Ashley Roberts, who was born in the house in 1951 when it was a hospital

Bank Hall in Bretherton, Lancashire

Bank Hall in Bretherton has stood empty since 1962

Bank Hall, which dates back to the 17th Century, was used as a military headquarters during World War Two.

The Royal Engineers used it as a base for co-ordinating the transatlantic crossing of convoys of merchant shipping and also billeted officers there between journeys.

The Grade II-listed country house was built in 1608 but since the early 1960s it has been empty and "at the mercy of vandals", according to the Bank Hall Action Group, which is hoping to save it.

Janet Edwards, the group's chairwoman, said she had been fascinated by the building since she was 10 years old and the group had run a 16-year campaign to save it.

"It is a project that no-one in their right minds would take on, but once under its spell, it is hard to walk away," she said.

In February it was announced that Bank Hall would receive £1.69m for a restoration project from the Heritage Lottery Fund.

Planning consent is currently in place to turn the hall into a series of apartments while the Prospect Tower will be open for public exhibitions and tours.

Janet Edwards, chairwoman of Bank Hall Action Group, is passionate about restoring the Hall to its former glory

Leading medical experts call for an end to UK postcode lottery for liver disease treatment, detection

 

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In a major new Lancet Commission, led by Professor Roger Williams, Director of the Institute of Hepatology, London, UK, doctors and medical scientists from across the UK call for a radical scale up of liver disease treatment and detection facilities in the country, which has one of the worst rates of death from liver disease in Europe.

The UK is the only country in western Europe (except Finland) where the prevalence of liver disease has increased in the past three decades, and the rate of death from the disease for those under the age of 65 years has increased by almost 500% since 1970.

"There is a human, social, and financial imperative to act now if the UK's burden of liver disease and all its consequences are to be tackled and the NHS is not to be overwhelmed by the cost of treating advanced stage liver disease," says Professor Williams.

Although 1 in 10 people in the UK will experience liver disease at some stage in their lifetime, the Commission shows that nationally, early detection of liver disease through primary care services (such as GPs and walk-in centres) is virtually non-existent, despite the fact that the disease is much more effectively treated when identified early.

As a recent Public Health England (PHE) report showed, the burden of liver disease in different regions of the UK is closely linked to socioeconomic deprivation, with areas such as the north west of England experiencing nearly four times as many deaths from liver disease as more affluent areas.

Despite the fact that these regions experience a far greater burden of death and illness from liver disease, the Commission shows that specialist treatment services for liver disease in its advanced stages are unevenly distributed throughout the UK, with some of the regions most badly affected having inadequate specialist provision, leading to a postcode lottery for patients which is resulting in unacceptable rates of death and illness in many regions of the UK.

As well as improving treatment and detection services, the Commission demonstrates that a powerful commitment is needed from UK policymakers to implement policies which address the lifestyle factors leading to most death and illness from liver disease, especially excessive alcohol use and obesity. This includes recommendations to implement minimum pricing policies for alcohol, prominent health warnings on alcohol packaging, and regulation of sugar content in food and soft drinks.

The Commission provides a cost-effective and achievable blueprint for improving hospital care for people with severe liver disease, by recommending that Liver Units providing acute services are established in every District General Hospital in the UK, linked with 30 Specialist Centres -- for more complicated cases -- distributed equitably around the country. Screening of high risk individuals using new diagnostic techniques are part of proposed improvements at GP and community level.The authors also recommend a review of the transplant services to ensure better access for patients in some areas of the country, and to ensure sufficient capacity for an anticipated 50% increase in availability of donor organs by 2020.

Although the report highlights shortcomings of the current national provision for liver disease in adults, it shows that UK services for childhood liver disease -including genetic disorders or viral infection -- could, in terms of their centralised funding and organisation, provide a positive example for improving adult services.

The report also suggests that another major cause of liver disease, hepatitis C, could be eliminated from the UK by 2030, now that safe and highly effective antiviral drugs are available. The spread of hepatitis B also needs to be controlled, with monitoring of immigrants from countries with high prevalence of the infection bringing new infections into the country a priority.

According to Professor Williams, "This Commission builds on recent work by the All Party Parliamentary Group on Hepatology and Public Health England, amongst others, to clearly identify the scale of the problem posed by liver disease in the UK, and current deficiencies in NHS care provision. The evidence outlined in the report, contributed by some of the UK's leading experts in the field, should leave nobody in any doubt about the present unacceptable levels of premature death and the overall poor standards of care being afforded to liver patients."

"The good news is that if our recommendations -- many of which will require additional government regulatory action -- are followed, deaths from liver disease will fall, with profound benefits in health and social wellbeing and economic productivity, as well as reduced costs for the NHS. However, the health and policy reforms we are recommending need to take place now -- the scale of the problem is too great for it to take second place to short-term political considerations."

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Story Source:

The above story is based on materials provided by The Lancet. Note: Materials may be edited for content and length.

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Journal Reference:

1. Roger Williams, Richard Aspinall, Mark Bellis, Ginette Camps-Walsh, Matthew Cramp, Anil Dhawan, James Ferguson, Dan Forton, Graham Foster, Sir Ian Gilmore, Matthew Hickman, Mark Hudson, Deirdre Kelly, Andrew Langford, Martin Lombard, Louise Longworth, Natasha Martin, Kieran Moriarty, Philip Newsome, John O'Grady, Rachel Pryke, Harry Rutter, Stephen Ryder, Nick Sheron, Tom Smith. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. The Lancet, 2014; DOI: 10.1016/S0140-6736(14)61838-9

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