Five Self-Care Strategies For Depression

There's no quick fix for depression. Even if you are under medical care and taking antidepressant medication, improvement takes time.

The December issue of Mayo Clinic Women's HealthSource offers five self-care strategies that can help you feel better and reduce the risk of recurrence.

1. Keep active.

--As little as 15 to 30 minutes of physical activity most days has been shown to improve mood.

--Long-term regular exercise can help prevent recurrence.

2. Eat well. A well-balanced eating strategy will help you feel better now and later.

-- Eat more whole grains, beans and vegetables. They provide a longer-lasting energy source than processed baked goods and sugar.

-- Eat regular meals, especially breakfast. Regular meals avoid the irritability and overeating that can come from skipping meals.

-- Increase your intake of cold-water fish such as salmon, halibut, tuna and bluefish. Research indicates that the omega-3 fatty acids in these cold-water fish may help reduce symptoms of depression.

-- Avoid alcohol and caffeine, which can contribute to depression and anxiety.

3. Get adequate sleep.

-- Aim for eight hours a night, and be consistent with bedtime.

4. Control stress. Coping with depression is stressful enough, so try to limit other sources of stress.

-- Simplify your schedule and prioritize.

-- Get organized so you know where to find things you need.

-- If you need a break, take it, even if it's just a day trip or weekend getaway.

-- Recognize stress signals and slow down. Is your stomach upset? Are you forgetting things or feeling extra irritable? Take notice of your signals and do something about it.

5. Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life.

-- Recognize the importance of give and take. It's true you should give of yourself in a relationship, but it's also important to receive from others, especially when you are depressed.

-- Cultivate your spirituality. Studies have shown that believing in something larger than yourself strengthens your ability to cope with life's ups and downs.

-- Avoid negative and unhealthy connections that might bring you down.

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FDA Approves Omnaris (ciclesonide) Nasal Spray For Allergic Rhinitis

The Food and Drug Administration (FDA) announced today the approval of Omnaris (ciclesonide) nasal spray, a new drug for the treatment of nasal symptoms associated with seasonal and perennial allergic rhinitis, commonly known as hay fever, in adults and children 12 years of age and older.

Although the precise way Omnaris works is unknown, the drug is a corticosteroid. Corticosteroids are hormone-like drugs that suppress the immune response.

Allergic rhinitis is the medical term for the inflamed, runny nose that's the main symptom of allergies. Seasonal allergic rhinitis is the most common allergic disease. About 35 million Americans suffer from this condition. The ailment's classic symptoms are watery nasal discharge, and fits of sneezing, and itching that can affect not just the nose but the roof of the mouth, throat and the Eustachian tubes which connect the middle ear to the back of the throat.

The safety and efficacy of Omnaris nasal spray were studied in four randomized placebo controlled clinical trials ranging in duration from two weeks to a year. The studies assessed how well Omnaris treated symptoms (runny nose, nasal itching, sneezing, and nasal congestion) in patients with hay fever. The results of these trials showed that patients treated with Omnaris nasal spray had an 8-10 percent greater reduction in nasal symptoms compared to placebo. The difference between Omnaris nasal spray and placebo was significant.

The most common side effects in clinical studies were headache, nosebleeds, and inflammation of the nose and throat linings.

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Treating Dog And Cat Bites To The Hand: Gnawing At Solutions To This Prevalent Problem

An estimated two million Americans are bitten by a domestic animal each year and 50 percent of Americans will be bitten in their lifetimes, posing a potential major public health issue. According to a study published in The Journal of Hand Surgery, dog and cat bites to the hand can result in serious injury, sometimes requiring hospital admission and surgery. Many of these injuries, however, can be lessened or prevented through early treatment and more careful animal handling.

The old adage, "Don't bite the hand that feeds you," apparently does not apply to man's four-legged friends: In more than 80 percent of domestic bite incidents, the victim knows the animal. Of the nearly 4.7 million dog bites that occur each year -- accounting for approximately 80 percent to 90 percent of domestic animal bites -- about 2 percent of these bites require hospitalization, constituting 1 percent of all U.S. emergency room visits.

The study, which was an extensive review of 111 cases of dog or cat bites to the hand, wrist or forearm, found that injuries ranged from relatively minor wounds to major injuries that included open fractures and persistent deep infections. Approximately two-thirds of patients in the study group required hospital admission at least for intravenous antibiotics, and approximately one-third of animal bite victims in the study required at least one surgical procedure. More than 10 percent of patients required long-term intravenous antibiotics and/or multiple surgeries, incurring medical expenses in excess of $77,000.

However the study also found that many of those cases would have been far less severe if the patient had sought treatment earlier. The average time from injury to evaluation by an orthopaedic hand surgeon was nearly eight days.

"If you have an animal bite to your hand, even from a pet you know, you should seek treatment immediately," stressed lead author of the study, Leon S. Benson, MD, orthopaedic surgeon at the Illinois Bone and Joint Institute in Glenview, Ill., and Fellow of the American Academy of Orthopaedic Surgeons. "Most people don't -- they think it's not that serious or worry there will be consequences for the pet -- so they wait to see a physician and then the injury is more difficult to treat."

Dr. Benson noted that a bite might just need antibiotics on the day it happened, but once an infection has had a few days to set in, the bite could end up requiring far more extensive and costly treatment. Many of the injuries seen in the study could have been prevented if the patient had known to exercise more caution with the animal.

"Most of the animals biting people are not strays or dangerous pets," Dr. Benson said. "They're biting because they're in a position where an animal would naturally bite: They're hurt or frightened, or they're fighting with another animal and the victim tried to separate them."

Because the study's patient population was selected from a small geographic area over a relatively short collection period, the results also suggest that domestic animal bite injuries may represent a major public health issue.

"Early treatment is going to make or break an injury," Dr. Benson emphasized. "If you get bitten, go to the emergency room right away so the bite can be assessed and treated early."

No external funding was provided for Dr. Benson's study. An orthopaedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, and nerves.

With more than 29,000 members, the American Academy of Orthopaedic Surgeons (http://www.aaos.org ) or (http://www.orthoinfo.org ) is the premier not-for-profit organization that provides education programs for orthopaedic surgeons and allied health professionals, champions the interests of patients and advances the highest quality musculoskeletal health. Orthopaedic surgeons and the Academy are the authoritative sources of information for patients and the general public on musculoskeletal conditions, treatments and related issues. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade ( http://www.usbjd.org ) -- the global initiative in the years 2002-2011 -- to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life.

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How Beneficial Are Multivitamins? We Don't Know

You see multivitamins for sale in supermarkets, health shops, pharmacies, general grocery stores and health clubs. Hundreds of millions of people worldwide take them regularly, without fail. But, what good do they do us? We simply don't know.

According to a US panel of experts from the NIH Office of Medical Applications of Research and the Office of Dietary Supplements, there is scant information on the benefits and safety of multivitamins.

Multivitamins, in the USA alone, bring in revenues of over $20 billion a year for those who sell them. Half of all American adults take multivitamins.

The panel looked at two days of expert presentations and public discussions. It concluded that more rigorous scientific research is needed on multivitamins use to prevent chronic diseases.

NIH Panel Chairman, Dr. M McGinnis, said the science base is especially thin with respect to the health impact of multivitamins. He said that insufficient available data makes it impossible for the panel to make a firm recommendation for or against the use of multivitamins. He said what little data there is, is not in-depth enough.

The theory goes that if you eat badly, multivitamins can compensate. But we just don't know whether this really happens. Some studies have indicated that the people who take multivitamins the most are also the most health-conscious ones. People who eat well and do exercise consume much larger quantities of multivitamins than those who eat badly and exercise the least.

Several studies have shown, though, that if you eat your fruit and vegetables regularly, you will be consuming the right amounts of vitamins needed for good health.

The panel did manage to make the following recommendations:

-- The combined use of calcium and vitamin D supplementation helps protect postmenopausal women's bone health.

-- Anti-oxidants and zinc should be considered for use by non-smoking adults with early-stage, age-related macular degeneration.

-- Women of childbearing age should take daily foliate to prevent neural tube defects in infants.

-- There is evidence that smokers should avoid taking beta carotene supplements regularly as there is a raised risk of lung cancer.

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UCSD Laser Technique Sheds Light On Strokes

A technique developed at the University of California, San Diego that precisely creates and images blood clots in the brain in real time could make it possible to understand the small strokes implicated in many forms of dementia, including Alzheimer's disease.

The study, published this week in the early on-line edition of the journal Public Library of Science Biology, represents a collaboration between the research groups of David Kleinfeld, professor of physics at UCSD, and Patrick Lyden, professor of neurosciences at UCSD's School of Medicine. The paper will appear in the print edition of the journal in February.

Using a laser to trigger the formation of individual blood clots in tiny arteries of the brains of anesthetized rats, the researchers were able to monitor the resulting changes in blood flow. They say that their study provides a way to understand small strokes common in elderly humans. These strokes often cause no immediate symptoms, but they are thought to contribute to dementia and may ultimately cause larger strokes.

"Our technique makes it possible, for the first time, to precisely target individual blood vessels to create a blood clot while causing very little collateral damage," explained Kleinfeld. "We can then follow, in real time, the changes in blood flow in surrounding vessels that occur as a result of the formation of a clot in one small artery of the brain."

"We know from MRI scans that small strokes are very common in the brains of elderly patients," added Lyden. "Such small strokes have been linked with dementia, and may also put patients at risk for a major stroke. The power of the technique we describe in the paper is that it allows us to study the response of the brain to stroke in a controlled way. By understanding what happens, we hope to learn how to prevent the major damage associated with stroke."

In the study, the team members used tightly focused laser light to excite a dye that they had injected into the bloodstream. The excited dye reacted with oxygen to form a free radical, which "nicked" the cells lining the blood vessel at the target location, and triggered the natural blood clotting cascade.

Using two-photon fluorescence microscopy--a powerful imaging tool that uses brief (less than one-trillionth of a second) laser pulses to peer below the surface of the brain, the researchers snapped frames every second before and after the formation of the blood clot. They also measured blood flow in the arteries upstream and downstream of the clot. Remarkably, immediately following the formation of the clot, blood flow downstream of the clot reversed itself.

"People tend to think of blood flow like a river," said Chris Schaffer, the lead author on the paper, who was an assistant project scientist working with Kleinfeld in physics at the time of the discovery. "If you dam one tributary, then everything downstream from there would be cut off. However, we've found that the more complicated topology of the blood vessels leads to the counterintuitive result that blood flow in some downstream vessels reverses direction to compensate for the blockage."

In the paper, the researchers discuss how this result can explain the observation, by clinicians, that certain regions of the brain seem to be protected from stroke. These protected regions of the brain have networks of vessels with extensive redundant connections. In the case of a blockage, these redundant connections permit blood to flow through alternate loops and be pushed in the opposite direction below the clot, as observed in this study. The reversal prevents downstream regions of the brain from being starved of oxygen.

In addition to what the researchers could observe in real time, the technique facilitates follow-up because the fluorescent molecules used to visualize blood flow bind to injured places in the artery.

"Rather than having to tediously search for the targeted vessels using brain sections, the fluorescence provides a kind of footprint that can be followed," said Beth Friedman, an associate project scientist working with Lyden in neurosciences and a contributing author on the paper. "Then you can look to see if there have been biochemical changes in the region of the clot, or changes in what genes are expressed, which is especially important to determine if an intervention protects against damage from stroke."

Kleinfeld and Lyden attributed the advance to collaboration across traditional disciplinary boundaries.

"Pat and I are coming from different worlds, but we had the same question at the back of our minds," said Kleinfeld.

"Joining forces allowed us to crack a puzzle that either one of us couldn't crack alone," added Lyden

Other contributors to the study were Nozomi Nishimura, Lee Schroeder and Philbert Tsai at UCSD and Ford Ebner at Vanderbilt University, Nashville. The research was supported by the David and Lucille Packard Foundation, the Veteran's Affairs Medical Research Department, the National Institutes of Health, the Burroughs Wellcome Fund and the National Science Foundation.

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