tag:blogger.com,1999:blog-3045634714760830992.post5832871204304776034..comments2023-06-05T11:51:38.383-04:00Comments on Evolutionary Psychiatry: Heart and SoulAnonymoushttp://www.blogger.com/profile/04429177284200775781noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-3045634714760830992.post-49382988070204355162010-07-19T19:28:00.221-04:002010-07-19T19:28:00.221-04:00This came through this morning on Medscape if you ...This came through this morning on Medscape if you have access... ties in with some of your post Emily. We have known that erectile dysfunction is perhaps a lead indicator for cardiovascular dysfunction for a while now. <br /><br />http://www.medscape.com/viewarticle/725333?sssdmh=dm1.627813&src=nldne&uac=129374HR<br /><br />"Our results show that when evaluating patients for sexual dysfunction, doctors should think about general health as well. Erectile dysfunction may be the first disease or depression may be first disease, but we should look beyond these initial conditions to look at secondary consequences such as increased cardiovascular risk. If we treat depression and sexual dysfunction, we may be able to improve cardiovascular outcomes, too.<br /><br />What is important . . . is the broader concept of the sexual-medicine problem no longer being just about a man's performance in the bedroom, but about his psychological mood and his cardiovascular health."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-46406410445121206762010-07-19T07:49:42.366-04:002010-07-19T07:49:42.366-04:00Jacflash - a recent German study looked at that. ...Jacflash - a recent German study looked at that. Here's my snippit - "Germans (primarily women) with Celiac Disease on a gluten-free diet were compared with a group of Germans with inflammatory bowel disease (Crohn's or Ulcerative Colitis) and a group of normal controls. Women with IBD and celiac disease were both more anxious than the controls. Men seemed to be serene no matter what. Adherence to the gluten-free diet didn't seem to matter much with regards to level of anxiety. In a related study, anxiety improved in patients with celiac disease in a year on a gluten-free diet, but not depression."<br /><br />Jamie - yes, I certainly agree that the ratio is more important than the absolute amount of omega-3.<br /><br />Steve - I think SADHEART was the biggest and baddest trial (there are a couple of cutesy-named depression/cardiology trials and I can never remember off the top of my head the exact details of each one) - but the summary of the big trials came down to this - SSRIs like zoloft improve mortality in depressed individuals after a heart attack. Tricyclic antidepressants are a wash (and maybe do worse), even if the depression is treated successfully with the medications. So the improvement in depression has little to do with the mortality benefit, it was all about the type of drug. SSRIs have known anti-platelet effects and are likely cardioprotective. TCAs are known to be somewhat cardiotoxic (they increase heart rate, etc.). There's always that question of self-care - people who aren't depressed or anxious ostensibly take care of themselves better, but that doesn't seem to matter overall in the trials I remember. <br /><br />I think the most intriguing interpretation is that an underlying derangement causes both heart disease and depression (and anxiety, though that is trickier still to sort out, perhaps, because you get the rushes of stress hormones and subsequent arrhythmia and sudden cardiac death/toxicity, takutsobu cardiomyopathy is an extreme case of this - saw a case recently! Tough to know exactly what to do. I can't order people to relax, after all :). SSRIs happen to destickify platelets so incidentally improve mortality in heart disease (rather like the incidental anti inflammatory effect of statins in the appropriate candidate for them).<br /><br />I agree talk therapy takes an undeserved second place in the big trials. But then that's not where the money is.Anonymoushttps://www.blogger.com/profile/04429177284200775781noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-19238027802618201732010-07-18T22:46:04.336-04:002010-07-18T22:46:04.336-04:00It's hard to tease apart the relationship betw...It's hard to tease apart the relationship between mental health and heart disease. I always look for studies that test whether TREATMENT of anxiety or depression actually reduces future cardiac event rates.<br /><br />Those studies are few and far between.<br /><br />First of all, you have to decide which single method you're going to use to treat all that anxiety and depression. You don't want too many variables. Talk therapy (e.g., cognitive therapy) always takes a back seat to drug therapy.<br /><br />Very difficult endeavor.Steve Parker, M.D.https://www.blogger.com/profile/13127995984175635389noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-77319934269223201192010-07-18T21:32:09.207-04:002010-07-18T21:32:09.207-04:00Nice post. If I were a betting man, I'd be pu...Nice post. If I were a betting man, I'd be putting money on gluten being at least one of the factors in a 'common background origin'. <br />Interesting re: the lower omega-3 fatty acid levels. It would have been good to see the full analysis of RBC's - n-3, n-6, & SFA. There is certainly a 'bias' toward n-3 being protective, thereby suggesting that increasing n-3 intake would be beneficial. It is possible that it is the lowering of n-6 intake that holds as much if not more benefit. There is a lot of focus on the ratio between the two, but the absolute amounts of each could be equally or more important.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-64009944830500543392010-07-18T20:35:31.395-04:002010-07-18T20:35:31.395-04:00What I'd love to see someone study is the conn...What I'd love to see someone study is the connection between anxiety (with or without depression) and gluten intolerance. Lotsa celiac folk seem to report anxiety-flavored depression that abates with a gluten-free diet.Anonymousnoreply@blogger.com