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psiquiatria

#Las #redes sociales deprimen por su hipocresía

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Reflejan un mundo idílico con el que los usuarios más vulnerables comparan su normalidad vital

La autoestima sufre por los contrastes entre la vida real y la vida digital.

Al igual que ese mundo esbelto, sonriente, de playas limpias y ofertas tentadoras que presenta la publicidad, las redes sociales también escamotean alegremente los lados oscuros de la vida. Aunque acogen todo el espectro vital, abundan las vacaciones fantásticas, las fiestas maravillosas, los niños adorables y las comidas sabrosísimas. La mayoría de usuarios muestran sus éxitos y sus diversiones, y maquillan sus lunares, derrotas y defectos. Lejos de animarles, estos reflejos positivos pueden generar síntomas depresivos en adolescentes que comparan sus vidas con lo que ven compulsivamente en Instagram, en Facebook o en la televisión.

Es una de las conclusiones de un estudio realizado por un equipo del CHU Sainte-Justine y de la Universidad de Montréal, dirigido por la psiquiatra Patricia Conrod y que se acaba de publicar en JAMA Pediatrics. Analizaron a casi 4.000 adolescentes canadienses de 12 a 16 años que formaban parte del ensayo Co-Venture. Tenían que informar del tiempo que pasaban frente a las diversas pantallas -redes sociales, televisión, videojuegos y ordenador- y responder a cuestionarios sobre posibles síntomas depresivos. Durante cuatro años se evaluaron estos datos con otras observaciones conductuales. “Nuestra investigación revela que el aumento del tiempo empleado en algunas formas de medios digitales predice los síntomas depresivos”, afirma Conrod. “La identificación temprana de la vulnerabilidad a la depresión da a los médicos y padres margen para intervenir, regular los abusos digitales y establecer medidas correctoras“. La relación era más evidente con las redes sociales y la televisión, y menos acusada con los videojuegos y los ordenadores. Según los autores, al reducir su participación en relaciones directas o actividades físicas, las comparaciones sociales indirectas a través de las redes se asocian con menor autoestima y más síntomas depresivos, originando una espiral de refuerzo en personas más vulnerables y que más tiempo dedican a estas redes.

Los resultados son consistentes con hipótesis previas sobre cómo se desarrolla la depresión. “Las redes sociales y la televisión exponen con frecuencia a los adolescentes a imágenes de otros que operan en situaciones más prósperas, tienen cuerpos más perfectos y un estilo de vida más emocionante o rico. A partir de la teoría de las espirales reforzadas, las personas buscan y seleccionan información congruente con su estado de ánimo. Y las redes crean y mantienen bucles de retroalimentación al sugerir contenidos similares a los usuarios en función de sus comportamientos de búsqueda”.

La falacia digital

Este análisis coincide con otro publicado en julio en Behavior & Information Technology por el equipo de Phillip Ozimek, de la Universidad Ruhr de Bochum, en Alemania: los que visitan las redes con frecuencia pueden ver afectada su autoestima y desarrollar síntomas depresivos al pensar que todos son mejores que ellos. Mediante un estudio experimental y dos cuestionarios, dos grupos de voluntarios escribieron sus impresiones sobre las primeras cinco personas que vieron en su muro de Facebook o en el sitio web del personal de la Facultad de Teología de la universidad. Un tercer grupo quedó al margen. Luego, los tres grupos –alrededor de 800 personas- completaron un cuestionario con información sobre su autoestima. “Enfrentarse a la información social en internet, selectiva y favorable, ya sea en Facebook o en los sitios web de los empleados, conduce a una menor autoestima“, informa Ozimek. Y como la baja autoestima está estrechamente relacionada con los síntomas depresivos, incluso este efecto a corto plazo puede ser una fuente potencial de peligro.

Es decir, existe una correlación positiva entre el uso pasivo de Facebook, en particular, y los síntomas depresivos cuando se comparan las habilidades, las vacaciones, los negocios o las compras, “mientras que todo lo que veo fuera de la ventana de mi oficina es gris y está nublado”, resume Ozimek. “Y si experimento esto día tras día, una y otra vez, se promueven las tendencias depresivas a largo plazo”. De todos modos, matiza que “no es el uso de las redes sociales lo que lleva o está relacionado con la depresión, sino que ciertas condiciones previas y un tipo particular de uso aumentan el riesgo de tendencias depresivas. Es importante por eso aclarar que la impresión de que todos los demás están mejor que uno mismo es una falacia absoluta. De hecho, muy pocas personas publican en las redes sociales experiencias negativas. Sin embargo, el hecho de que estemos inundados de estas experiencias positivas en internet nos crea una impresión distorsionada”.

#Moins de #symptômes dépressifs chez les consommateurs de #chocolat noir

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Londres, Royaume-Uni / Calgary, Canada— On dit que le chocolat est bénéfique pour l’humeur, on lui attribue même des vertus anti-dépressives. Pour autant, les études divergent et certaines ne retrouvent pas cet effet. Pour explorer l’impact réel du chocolat, une équipe de chercheurs anglais et canadiens a conduit une grande étude longitudinale, en comparant les différents types de chocolat consommés, noir et non-noir, en essayant de s’affranchir au maximum des facteurs confondants.

Publiée dans Depression and Anxiety, cette étude est la première à se pencher sur l’association entre dépression et chocolat en fonction du type de chocolat consommé [1]. Elle confirme bien l’effet anti-dépresseur du chocolat et montre qu’il est réservé au seul chocolat noir.

Consommation quotidienne du chocolat

Les chercheurs de l’University College London (UCL) ont travaillé en collaboration avec des scientifiques de l’Université de Calgary et les services de santé de l’Alberta (Alberta Health Services Canada) et évalué les données émanant de 13 626 adultes ayant participé à la US National Health and Nutrition Examination Survey (NHANES) entre 2007/8 et 2013/4.

La consommation journalière en chocolat au cours des 24 dernières heures précédentes a été demandé aux participants lors d’un appel téléphonique et rapportée au questionnaire de santé des patients (Patient Health Questionnaire, PHQ‐9) qui évalue les symptômes dépressifs. Des scores ≥10 indiquaient la présence de symptômes cliniquement pertinents.  Les investigateurs ont utilisé une régression logistique à variables multiples pour évaluer l’association entre la consommation de chocolat (aucune, chocolat noir, chocolat autre que noir), quantité de chocolat consommée (en grammes par jour) et symptômes de dépression cliniquement significatifs.

Les adultes souffrant de diabète ont été exclus et de nombreux facteurs incluant la taille, le poids, le statut marital, l’origine ethnique, le niveau socio-culturel, l’activité physique, le tabagisme, la consommation d’alcool, et les pathologies chroniques ont été pris en compte pour se prémunir contre d’éventuels facteurs confondants et focaliser sur les symptômes dépressifs.

70% de risque en moins avec le chocolat noir

Au final, il s’est avéré que 11,1% de la population étudiée consommait du chocolat (de n’importe quel type), et 1,4% disaient manger spécifiquement du chocolat noir.

Après ajustement de tous les facteurs cités ci-dessus, il a été établi que les individus qui rapportaient manger du chocolat noir avaient 70% de risque en moins de rapporter des symptômes dépressifs cliniques notables par rapport à ceux qui ne consommaient pas du tout de chocolat. Par ailleurs, l’analyse en termes de quantité consommée a montré que les 25% de consommateurs de chocolat qui en mangeaient le plus (104–454 g/jour et de toute sorte, pas juste le noir) étaient aussi moins enclins à rapporter des symptômes dépressifs comparés à ceux qui ne mangeaient (OR = 0,43, 95%CI 0.19–0.96) pas du tout de chocolat, et ce, après ajustement sur la consommation de chocolat noir.

En revanche, aucun lien n’a pu être établi entre la consommation de chocolat autre que noir et symptômes dépressifs cliniquement pertinents.

Mais une faible quantité de chocolat consommée

Les auteurs reconnaissent des limites à leur étude, comme le fait que le groupe de consommateurs de chocolat noir était petit, avec une consommation relativement faible (moins de 1,1% de la population totale avec une moyenne de 11,7 grammes chocolat noir consommé quotidiennement) et différait du reste de la population sur un certain nombre de critères. « Néanmoins, le fait que nous ayons observé une association avec le chocolat noir malgré les deux remarques ci-dessus atteste de la force du résultat » remarquent les auteurs tout en reconnaissant qu’« il n’est pas impossible que, malgré de nombreux ajustements sur nombre de facteurs confondants, il puisse en rester certains qui n’aient pas été pris en compte, ou qui ne soient pas mesurables ».

Substances psychoactives et notion de plaisir

Le chocolat a très largement été rapporté comme ayant des propriétés bénéfiques sur l’humeur et plusieurs mécanismes ont été avancés. On sait par exemple que « le chocolat contient un certain nombre de substances psychoactives qui produisent un effet d’euphorie similaire à celui des cannabinoïdes, trouvés dans le cannabis. Il contient aussi de la phényléthylamine, un neuromodulateur dont on pense qu’il est important pour réguler l’humeur » écrivent les auteurs.

Des preuves expérimentales suggèrent aussi que les améliorations de l’humeur ne surviennent que si le chocolat est appétissant et agréable à consommer, « ce qui suggère que l’expérience qui consiste à apprécier la dégustation est un facteur important, qu’il ne s’agit pas seulement d’une question d’ingrédients » ajoutent-ils. La consommation de chocolat, en tant qu’expérience plaisante, peut interagir avec un certain nombre de neurotransmetteurs impliqués dans le système de récompense et la régulation de l’humeur (comme la dopamine, la sérotonine, et les endorphines).

Si ce qui est indiqué ci-dessus est vrai pour tout type de chocolat, « le chocolat noir possède une concentration en flavonoïdes plus élevés, des composants antioxydants qui améliorent les profils inflammatoires, dont on sait qu’ils jouent un rôle dans la survenue de la dépression » précisent les chercheurs.

Clarifier le sens du lien causal

Pour le premier auteur, le Dr Sarah Jackson (UCL Institute of Epidemiology & Health Care, Londres) : « Cette étude apporte des preuves que la consommation de chocolat, particulièrement le chocolat noir, peut être associée à un risque moindre de symptômes dépressifs cliniquement pertinents » [2].

Bien évidemment, d’autres recherches, notamment longitudinales, voire randomisées, sont nécessaires « pour clarifier le sens du lien causal – on pourrait aussi penser que la dépression entraine une perte d’intérêt pour le chocolat, ou qu’il existe d’autres facteurs qui conduisent, à la fois, les gens à manger moins de chocolat et à être déprimé ».

« Si une relation causale montrant un effet protecteur de la consommation de chocolat sur la dépression était établie, resterait à comprendre le mécanisme biologique pour déterminer le type et la quantité de chocolat à consommer pour un effet préventif maximal de la dépression ».

#How Does #Sex Affect Your Emotions? 12 Things to Know About Attraction and Arousal

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First things first: Sex means different things to different people

Sex can be the ultimate expression of romantic love and intimacy. Or an emotional roller coaster. Or a tension reliever. Or it’s all about procreation. Or it’s simply a good time. It can be all of these things and more.

Sex means different things to different people. And whatever it means to you isn’t necessarily constant, either.

It can mean different things at different points in your life, or even from one day to the next.

And you know what? It’s all perfectly normal.

Despite the stereotypes, your gender has nothing to do with your emotional response to sex

Women are at the mercy of their roller-coaster emotions; men are firmly in control of the few emotions they have. At least that’s what popular wisdom would’ve once had us believe.

These ideas have deep roots, but humans are much more complex than that.

There have been some studiesTrusted Source to suggest that women are more expressive about emotions, at least in the United States and some Western European countries.

They also suggest men have the same or greater physiological response to emotional stressors.

This difference could be due to the influence of the culture in which we live. Maybe we’ve simply been acting on what we were told is acceptable.

These days, people are less inclined to conform to simple gender categorizations.

Whatever your gender and whether you openly express it or not, your emotional response to sex is uniquely yours.

Some people require emotional attraction to experience physical attraction

Do you need to feel some level of emotional attraction before any thought of sex enters your mind? If that sounds like you, you’re surely not alone.

Maybe you need to connect on a spiritual level. Maybe it’s their mind or the fact that you share some basic philosophies of life.

Perhaps you felt that first twinge of excitement when they made you laugh ’til you cried.

Or it’s a case of je ne sais quoi — that certain something you just can’t put into words, but you know it when it happens.

You’re seeking intimacy. Once your feelings are in the zone and you’ve made an emotional connection, you may begin to feel physical arousal.

Outside of that zone, you’re just not into sex. You’re into making love.

Others find that acting on physical attraction can lead to emotional attraction

Some people are physically drawn together like magnets.

There’s a chemical reaction, a hunger, a purely physical craving for getting physical with another person. It’s lust.

When the chemistry between people is just right, getting physical can grow into so much more.

2012 retrospective review found two areas of the brain that track the progression from sexual desire to love. One is the insula. It’s located in the cerebral cortex.

The other is the striatum. It’s located inside the forebrain. Interestingly, the striatum is also associated with drug addiction.

Love and sexual desire activate different parts of the striatum.

Sex and food are among the pleasurable things that activate the lust part. The process of conditioning — of reward and value — activates the love part.

As sexual desire is rewarded, it becomes a bit of a habit, which can lead you right down the path to love.

As feelings of lust start to turn into love, another area of the striatum takes over.

Others may find that emotional and physical attraction operate in two entirely different vacuums

People are intricate creatures with many layers.

For some of us, there are clear dividing lines between emotional attraction and physical attraction. They don’t necessarily come together.

You might be emotionally attracted to someone without having the slightest sexual urge. Or you have a mind-blowing physical attraction for someone who doesn’t really do it for you emotionally.

Even in long-term relationships, people can alternate between making love and having sex — or forgoing sexual activity entirely — and that’s OK.

Regardless of your individual outlook, sex and emotion affect the same pathways in the brain

2018 study suggests integral links between sexual, emotional, and reproductive brain processes having to do with the endocrine system and, in particular, a hormone called kisspeptin.

According to a Tufts University neuroscience blog, sexual arousal doesn’t happen in a vacuum, but in a context.

It involves cognitive, physiological, and neurological processes, all of which include and are influenced by emotion. Makes sense.

What’s more, most people experience similar emotions during sexual activity and release

The rush of hormones involved in sex means that certain feelings are fairly common during or immediately following sex.

Nobody feels every emotion every time, of course.

Among the more positive ones are:

  • euphoria
  • total release
  • relaxation and calm
  • satisfaction

Depending on the circumstances, you might have some less than positive emotions, such as:

  • vulnerability
  • embarrassment
  • guilt
  • feeling physically or emotionally overwhelmed

If you have postcoital dysphoria, you might even feel sad, anxious, or tearful after sex.

It’s also worth noting that sexual arousal can turn off parts of the prefrontal cortex

We don’t always recognize it when it’s happening to us, but it’s obvious in hindsight. It’s not the stuff of science fiction or fantasy. It’s very real.

Sexual arousal can deactivate parts of the brain that help you think critically and behave like a rational human being.

Yes, you actually take leave of your senses.

Good judgement and reasoning are lost to sexual desire, swept away in the excitement of it all.

When you snap back to reality, you might wonder, with a tinge of regret or embarrassment, what you were thinking.

Hint: You weren’t.

Oxytocin dependency is also a thing

Oxytocin is a hormone produced in the hypothalamus, which opens the floodgates when you have sex.

That rush of oxytocin is involved in the physical part of sex. It can also boost emotions like love, affection, and euphoria.

It well deserves its reputation as the love hormone. Alias, you can become hooked on the feeling or outright enthusiastic about love.

Oxytocin keeps you coming back for more.

Researchers are still unpacking the different variables in the lust, attraction, and attachment equation

The biology of lust, attraction, and attachment is far from simple. Hormones certainly play a role.

Generally speaking, lust is driven by testosterone and estrogen, regardless of gender. And lust is driven by the craving for sex.

Attraction is driven by dopamine, norepinephrine, and serotonin.

Attraction may or may not involve lust, but the brain’s reward center is a factor. That’s why you get all giddy or feel like you’re walking on air in a relationship’s early phase.

Attachment is driven by oxytocin and vasopressin. That’s what sets the stage for bonding and long-term relationships.

There’s some overlap of hormones, hormone levels differ, and there’s a whole lot more to it than that.

Let’s face it: Sex and love are complicated. We’re only skimming the surface of what makes humans tick.

The scientists among us continue to delve into the mysteries of our sexual desires and emotions and how they play on each other.

Yet it’s entirely possible that we’ll never solve the equation, leaving a little something to the imagination.

If you want to separate sex and emotion

There’s any number of reasons why you might want to compartmentalize sex and emotion.

It’s a good idea to explore your motivation so, if needed, you can deal with any unresolved issues.

In any case, there’s no right or wrong here. You’re not locked into one way of being for the rest of your life.

If you’re looking for a casual relationship or a “friends with benefits” situation, here are some suggestions:

  • First and foremost, be honest with the other person. It’s only fair.
  • Talk about what you’re willing — and unwilling — to give physically and emotionally, along with what you expect in return.
  • Discuss birth control and safe sex practices.
  • Work together in establishing rules to avoid getting overly attached or dependent on each other.
  • Talk about what you’ll do if one of you starts to want something more.

Keep in mind that whatever your plan or however careful you may be, feelings can crop up anyway. Emotions are funny that way.

If you want to deepen the relationship between sex and emotion

So, despite the hormones and biology of it all, maybe you need something to help deepen the bond.

Here are some ways to get started:

  • Don’t let physical intimacy become an afterthought, a thing you do as time permits. Schedule it. Make a date. Give it top priority.
  • Incorporate affectionate touch throughout the day. Hold hands. Stroke an arm. Hug. Cuddle up. Give each other a massage. Touch doesn’t necessarily have to lead to sex right away. A little anticipation goes a long way.
  • Make eye contact and hold it. Do this often — when you agree, when you disagree, when you share that inside joke, and when life gets overwhelming.
  • Let your guard down. Be emotionally vulnerable and available for each other. Be their person.
  • Kiss. Really kiss. And take your time about it.
  • Communicate your emotions. Say “I love you” if that’s how you feel.
  • What turns you on? Candlelight, sensual music, a long soak in a hot tub? Whatever it is, take the time to set the stage and get in the mood.
  • Communicate your physical desires. Take turns leading each other through what you like.
  • When things get physical, tune in to your senses. Touch, see, hear, smell, and taste with every fiber of your being.
  • Really be there in the moment with this person who wants to be in the moment with you. Let there be nothing else. And by all means, turn off the TV and cell phone during your time together.
The bottom line

Let’s face it. The world would be pretty boring if we all felt the same way. When it comes to sex and emotions, there’s no right way to feel. Just be yourself.

 

HealthLine

 

#How Parents Can Get Kids with #ADHD Prepared to Start School

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A new study found that children with ADHD may have more difficulty starting school. Getty Images

  • A new study found that children with ADHD are less likely to be ready to start kindergarten.
  • Parents can take steps to prepare their children for school and ease them through the transition.
  • For some children, waiting an extra year before starting kindergarten can help.

Many preschoolers with attention deficit hyperactivity disorder (ADHD) — or symptoms of it — are much less likely than their peers to be ready for school, a study in Pediatrics found.

Experts say, though, that’s no reason to stop the child from entering kindergarten.

A team led by Dr. Irene Loe, an assistant professor of pediatrics at Stanford University, found 79 percent of children with ADHD weren’t at full readiness compared to 13 percent of children without the disorder.

“A lot of these kids are not identified until they’re really having a lot of trouble in the school setting,” Loe said in a statement.

She studied 93 children ages 4 and 5 — most who attended or had attended preschool, some who were enrolled in kindergarten. Of them, 45 were diagnosed with ADHD or identified by parents as having symptoms, 48 of the children didn’t have ADHD.

The researchers confirmed they were properly classified. They looked at five areas of functioning: physical well-being and motor development; social and emotional development; approaches to learning; language development; and cognition and general knowledge.

Children were deemed to be impaired if scores in one area were more than one standard deviation worse than the mean score for their age. They were considered unready for school if they were impaired in two or more of the five areas.

Where some children fall short

Kids who had ADHD were no more likely than their peers to struggle with cognition and general knowledge. They were more likely than children without the disorder to have difficulty in the other four areas.

They were:

  • 73 times more likely to struggle in approaches to learning
  • more than 7 times as likely to have impaired social and emotional development
  • 6 times as likely to have trouble with language development
  • 3 times as likely to have impaired physical well-being and motor development

Families need access to behavioral therapy for preschoolers with ADHD — something recommended for the age group but not always covered by insurance.

“If a child has solid preacademic skills (they don’t need to be reading and writing yet) and plays with same-age friends, they are going to be more engaged in kindergarten than preschool. That’s true even if they have ADHD,” said Dr. Mark Bertin, a developmental pediatrician from New York.

 

Getting help

Parents whose children aren’t yet in school can seek help from a psychologist, pediatrician, or developmental pediatrician, Bertin said.

Preparing children for school usually starts prior to entering kindergarten, as some children have speech delays or autistic spectrum disorders, added Dr. Marc Lerner, a clinical professor of pediatrics at the University of California, Irvine School of Medicine.

Part B special services, which provides services for toddlers, can start at age 3.

What parents can do

Many children with ADHD may also experience high levels of worry, so being able to get comfortable on campus or with peers before school starts can be helpful.

Another way to prepare children is to ensure regular schedules and good sleep habits. Parents can also mimic a child’s upcoming school schedule the month before school begins in order to help prepare the child.

Growing their social-emotional competence is critical to learning for all children headed to school. It can be quite valuable for children with ADHD symptoms, Lerner said.

Parents should encourage developmental skills that can aid in school success such as physical health, sensory development, behavioral management, being able to focus, sharing, communicating emotions, coping with emotions, and early academic skills.

Holding children back

Some parents consider waiting a year to let a child with ADHD enter kindergarten, but there’s not much evidence that it’s useful for most students, Bertin said.

The American Academy of Pediatrics (AAP) suggests only doing so around kindergarten or first grade, or at a time of a natural transition such as family relocation.

Bertin said holding a child back doesn’t help in the short run. When their disorder is manageable, the child may then be less academically engaged.

“Holding someone back also can disrupt educational services, and can affect self-esteem,” he said.

Lerner concurred.

“Parents… may believe they are giving them a better chance to succeed in academics, athletics, or social settings… this isn’t necessarily the case,” Lerner said. “Labeling children as ‘not ready’ for kindergarten and delaying the start of school can prevent them from being in a more appropriate learning environment.”

Some evidence suggests that being among the youngest in a class can cause academic problems, but most issues seem to disappear by the third or fourth grade, Lerner explained.

Other research indicates that children who are old for their grade are at a greater risk for behavioral problems during adolescence, possibly because they aren’t challenged and become bored.

School readiness a problem

The AAP released a report this month calling for kindergarten screening, rather than a gatekeeping test, for age-eligible children to enter school.

School readiness skills in most young children have improved, but achievement gaps based on poverty, race, and early trauma still exist.

The AAP found that 48 percent of low-income children are ready for school at 5 years old, compared to 75 percent of children of the same age who came from moderate- or high-income households.

Kids who’ve experienced two or more key traumatic events (abuse, neglect, seeing violence, or being separated from a parent due to death, incarceration, or divorce) are 2.67 times more likely to repeat a grade than peers who didn’t have adverse experiences.

“It’s not just about preacademic skills,” said Dr. P. Gail Williams, lead author. “It’s a combination of physical well-being, social emotional abilities, being able to self-regulate, as well as language skills and cognitive skills. And that starts right from birth.”

 

HealthLine

#Treating #Insomnia Outside the (Black) Box

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Elaine K. Howley

The modern scourge of insomnia takes a heavy toll, with 40 million Americanshaving trouble falling asleep, staying asleep, or waking up feeling unrefreshed.

No matter which type of insomnia a patient is dealing with, there are ways to manage and improve the situation. Most sleep medicine practitioners prefer behavioral interventions over pharmacologic solutions, but prescription medications have been part of the treatment picture for more than a century. And, since the 1990s, clinicians have had a powerful group of drugs called sedative-hypnotic medications at their disposal to treat sleep disorders. Unfortunately, many of these drugs come with their own set of problems.

Three of these medications in particular—eszopiclone(Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, and Zolpimist)—have gained widespread adoption by clinicians and patients for their effectiveness over the past quarter century. The US Food and Drug Administration (FDA) reports that in 2018, an estimated 5.1 million total patients received a zolpidem prescription, 600,000 total patients received an eszopiclone prescription, and 200,000 total patients received a zaleplon prescription.

But side effects are a concern. Although these medications have long carried warning labels that have been strengthened in the past, in April 2019, the FDA took the additional step of adding black-box warnings, the strongest notice the FDA offers.

Although nonmedical interventions have long been at the top of the American Academy of Sleep Medicine (AASM) recommendations, at least one expert hopes the warnings will encourage practitioners to consider alternatives to the commonly prescribed sedative-hypnotic drugs. “Oftentimes, the hypnotic ‘Z’ drugs, such as zolpidem, are a Band-Aid or cosmetic fix for something more involved,” says Alex Dimitriu, MD, a sleep medicine specialist in Menlo Park, California.

A History of Adverse Effects

In the case of these three insomnia medications, the new warnings come after the FDA had identified 66 cases over the past 26 years of complex sleep behaviors resulting in serious injuries and death among people taking the medications, according to the agency’s announcement. Of those 66 events, 46 were nonfatal and 20 were fatal, with the causes of death including carbon monoxide poisoning, drowning, falls, hypothermia, motor vehicle collisions with the patient driving, and apparent suicide.

Dimitriu says that in his own clinical practice, he’s seen patients have adverse reactions to the medications. “I have witnessed falls; sleepwalking; nighttime eating; and, in very rare instances, even driving, which people will not recall the next day.” The intensely sedative nature of these drugs can trigger these behaviors in certain individuals, resulting “in, what we call in sleep medicine, ‘disorders of confusional arousal.’ This is almost the same as sleepwalking; however, in these cases, other complex behaviors can occur,” he explains.

Disorders of confusional arousal can occur in anyone, but “they normally occur when something disturbs sleep, which can be breathing issues due to sleep apnea, loud noises or bed partners, or even when alcohol wears off after an evening of drinks,” Dimitriu notes. The incidence of such events spikes in people taking prescription sleep aids “because now there are two opposed forces—one is the natural insomnia for which the medicine is prescribed, competing with the sedating effects of the sleep medication. When it is not a clear victory for either side, disorders of confusional arousal, or these complex behaviors, can arise.”

#Las #mujeres toman de dos a tres veces más #antidepresivos que los hombres

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Aumenta el consumo de antidepresivos en todas las edades; por género, las mujeres reciben más este tratamiento que los hombres, y eso contrasta con la menor presencia de ellas en ensayos clínicos, lo que sugiere una mayor necesiad de estudios observacionales.

mujer con depresión

Un equipo de profesionales del Instituto Universitario de Investigación en Atención Primaria (IDIAPJGol) y del Servicio de Farmacología Clínica del Hospital Universitario Valle de Hebrón ha llevado a cabo un estudio para conocer si determinados factores económicos, sociodemográficos y culturales están relacionados con el consumo de antidepresivos en cinco regiones europeas (Suecia, Noruega, Dinamarca, Veneto y Cataluña).

Para llevar a cabo el estudio, los investigadores analizaron el uso de antidepresivos en estas cinco regiones, con una población de tamaño similar, y, después, lo relacionaron con diferentes factores económicos (PIB y gasto farmacéutico), sociodemográficos (tasas de inmigración, paro, suicidios y número de médicos y psiquiatras por habitante) y culturales (se utilizó el modelo de las dimensiones de Hofstede, que proporciona puntuaciones para las siguientes dimensiones en cada país obtenidas mediante cuestionarios: distancia al poder, individualismo, masculinidad, evasión de la incertidumbre, orientación a largo plazo e indulgencia).

Durante los cinco años en que se llevó a cabo el análisis (2007-2011), el consumo de antidepresivos aumentó en todas las regiones, pero el principal aumento se detectó en Dinamarca y Cataluña (22,2%). El país con un mayor uso de estos medicamentos el 2011 fue Dinamarca (83,8 DHD –dosis diaria definida por habitante y día–), seguido por Suecia (77 DHD) y, después, por Cataluña (75,5 DHD).

El aumento en el consumo se comprobó para todas las edades, pero a nivel de género se confirmó que las mujeres tomaban de dos a tres veces más antidepresivos que los hombres en todas las regiones. Esto contrasta con la menor presencia de mujeres y personas mayores en ensayos clínicos, por lo que los investigadores concluyen que son necesarios más estudios observacionales para evaluar el uso de los medicamentos por parte de estos grupos de población.

Precipitantes y factores protectores

El estudio no ha podido confirmar la relación entre un mayor desempleo y el incremento del consumo de antidepresivos. Respecto a la inmigración, el país de origen, las dificultades en el lenguaje y las diferencias en la manera de expresar externamente los síntomas psicológicos pueden determinar un menor uso de los recursos sanitarios en relación con la patología depresiva.

La investigación concluye que en las regiones con una mayor tasa de médicos de atención primaria por habitante también se comprobó un menor consumo de antidepresivos. El motivo podría ser que el médico de familia conoce a su paciente y, cuantos más médicos, más tiempo para las consultas de atención primaria, lo que lleva a una terapia diferente que reduce la necesidad de medicación.

Por otro lado, el consumo de antidepresivos se puede entender mejor teniendo en cuenta diversos factores culturales, ya que estos hacen entender la enfermedad mental de una manera diferente. En este marco, vivir en una sociedad más competitiva e individualista (alta puntuación en las dimensiones de Masculinidad e Individualismo de Hofstede) tiene relación con un menor consumo de antidepresivos.

#Estimulación magnética transcraneal, otro escalón terapéutico en #depresión

Postado em

La estimulación magnética transcraneal ya se administra de forma protocolizada a los pacientes dependientes del Hospital 12 de Octubre.

La interpretación del electroencefalograma podría variar.

La estimulación magnética transcraneal repetitiva (EMTr) es un procedimiento no invasivo que se emplea desde hace años en diferentes trastornos neuropsiquiátricos. De hecho, la agencia reguladora estadounidense FDA considera que es una estrategia de elección en la depresión resistente y el trastorno obsesivo compulsivo (TOC) también resistente a la farmacoterapia y a la psicoterapia.

Recientemente, el Servicio de Psiquiatría del Hospital Universitario 12 de Octubre ha incorporado este abordaje de forma protocolizada, de tal manera que los pacientes con depresión resistente al tratamiento convencional son derivados desde los centros de Salud Mental, dependientes del este hospital madrileño, cuando los médicos responsables de su seguimiento consideran que este tipo de estimulación puede ser una alternativa viable.

El psiquiatra Gabriel Rubio.

“Cualquier psiquiatra de nuestra área de influencia que trata a un paciente con depresión que no mejora con terapia farmacológica lo puede remitir al hospital para que le administremos la EMTr. En caso de que esta fracase, se intentaría la terapia electroconvulsiva”, destaca a DM Gabriel Rubio, jefe del Servicio de Psiquiatría del Hospital 12 de Octubre.

Esta modalidad terapéutica ofrece importantes beneficios pues se aplica de forma ambulatoria, no requiere anestesia y no se han descrito hasta el momento efectos secundarios relevantes. Por todo ello, apunta Rubio, es un tratamiento que puede indicarse en determinados pacientes que se benefician de una estrategia biológica sin fármacos, tales como embarazadas, personas mayores y adolescentes.

La EMTr se administra en el Hospital de Día, donde se centraliza el tratamiento de la mano de un equipo multidisciplinar. El procedimiento se basa en la aplicación de campos magnéticos a través de una bobina electromagnética que emite estímulos con una determinada intensidad y cadencia, lo que permite activar las áreas cerebrales implicadas en la depresión. Para tener garantías de éxito, cada paciente debe recibir aproximadamente 30 sesiones de una hora de duración.

Más aplicaciones de la EMTr
-Ictus
-Memoria
-Epilepsia
-Acúfenos

Hasta el momento, el Servicio de Psiquiatría del 12 de Octubre ha atendido a 21 enfermos, en su mayoría mujeres con edades comprendidas entre los 45 y 70 años. Los resultados obtenidos evidencian una mejoría significativa en la evolución de la enfermedad.

Más allá de la mejoría en los síntomas y en la calidad de vida de los pacientes tratados, Rubio alude a las implicaciones económicas de este abordaje. “El 40% del coste que genera el tratamiento de la depresión se puede imputar a la forma resistente de la enfermedad, por lo que recurrir a esta estrategia también redunda en un beneficio para el sistema sanitario”.

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