Raising an Optimistic Child: A Proven Plan for Depresion-Proofing Young Children--for Life
(McGraw-Hill, 2006) by Bob Murray and Alicia Fortinberry

Creating Optimism:
A Proven Seven-Step Program for Overcoming Depression
(McGraw-Hill, 2004) by Bob Murray and Alicia Fortinberry

Written and researched by Bob Murray, PhD

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• Heart Attacks Linked to Jobs Loss
  Losing a job late in life can be stressful, researchers have found. Workplace ageism is a major factor.
• Low Status Leads to Heart Disease
  If you're on the bottom rung of the ladder at work you may be at risk for a heart attack!
• Friends Help Sufferers Survive Cancer
  Social support indicates a good prognosis for ovarian cancer.
• Could Heart-Warming Be Heart-Saving?
  Socializing can save your life!
• Humor Heightens Hope
  Laughter is the best medicine for coping with stress and boosting long-term resilience and self-esteem.
• Breaking Hearts
  Marital strain, and suppressing feelings, increases women's risk of death, heart disease.
• To Help Your Mind, Take Steps to Help Your Heart
  Keeping blood pressure and cholesterol low may help some dementia patients more than Alzheimer's drugs.
• Pain Linked to Permanent Brain Loss
  Chronic pain may permanently shrink the brain, researchers believe.
• More on the Depression and Heart Disease Link
  New research explains why anger, hostility and depressive symptoms can predict heart problems in otherwise healthy people.
• Ageing Positively
  Social and environmental factors play important role in how ageing affects our health, happiness and competence.
• Pain Common Side Effect of Depression
  Headache, back or muscle pain, stomach ache and dizziness are just as likely symptoms of depression as fatigue, lack of motivation and moodiness.
• A Little Help From Friends Makes Wounds Heal Faster
  New research in hamsters suggests that without companionship, wounds don't heal as fast.
• Constant Confrontation And Defeat May Break Your Heart
  New study shows that while the body may seem to adapt to social stress, long-term damage to the heart may occur.
• Anxiety Is Bad for Your Teeth
  Dentists are being urged to take psychological problems into account before undertaking procedures.
• Infections Could Prolong Life
  Scientists say a virus or a high temperature can actually be good for you because they trigger body chemicals which can prolong cell life.
• Gulf War Syndrome?
  New research suggests that Gulf War veterans are no sicker than others who have been through stressful situations.
• Stress Linked to Multiple Sclerosis
  Stressful life events seem to make MS worse, a new study finds.
• Obesity, Depression Team up to Increase Heart-endangering Inflammation
  Obesity and depression may work together to provoke the chronic low-level inflammation associated with atherosclerosis and increased risk of heart disease.
• Happy People May Have More Immunities to Common Cold
  People who are energetic, happy and relaxed are less likely to catch colds, while those who are depressed, nervous or angry are more likely to complain about cold symptoms, whether or not they get bitten by the cold bug, according to a recent study.

Heart Attacks Linked to Jobs Loss

Sep 17, 2006

Losing your job late in your career doubles the chance of suffering a heart attack or stroke, a study says. Yale University researchers studied 4,301 people aged 51 to 61 who were working in 1992, the research, printed in the Occupational and Environmental Medicine journal claimed. Of the sample group over 10 years, there were 23 heart attacks and 13 strokes among the group of 582 who were forced out of a job.

Lead researcher Dr William Gallo said: "For many individuals, late career job loss is an exceptionally stressful experience, with the potential for provoking numerous undesirable outcomes. I don't think it is necessarily because of the age, but rather related to the problems people over 50 have finding jobs of equivalent standard because of the ageism in the workplace.

"Based on our results, the true costs of unemployment exceed the obvious economic costs and include substantial health consequences as well."

In total, 202 had heart attacks and 140 had strokes from all the groups studied, which included those who had lost their jobs involuntarily, retired, taken a temporary break from work or were still employed. Once risk factors such as diabetes, smoking, obesity and high blood pressure were taken into account, the risk of the involuntary job loss group having a heart attack after losing their job was 2.5% and a stroke 2.4%.

Read more in Occupational and Environmental Medicine

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Low Status Leads to Heart Disease

Aug 5, 2005

According to research published in Circulation, men with "low-grade jobs," those with little control over daily tasks and those in low "social positions" had faster heart rates and little variation of heart rate. Both these traits are associated with increased coronary disease risk.

"This finding helps explain why men with low-paying jobs and less education have a higher risk for heart disease, a trend that has been evident for the last 30 years," said lead researcher Harry Hemingway, M.D., professor of clinical epidemiology, of the International Centre for Health and Society, department of epidemiology and public health, University College London Medical School.

The study suggests that the autonomic nervous system--which controls the function of all major body organs below the level of consciousness--is responding to environmental factors related to low-paying, low-control jobs in a way that's damaging to the heart. This was true even after controlling for factors such as smoking, poor diet and lack of exercise, which also could adversely affect heart rate, Hemingway said.

Researchers studied 2,197 men (ages 45 to 68) who worked for the British government. Civil servant grades in Britain rank employees by salary. This research analyzed three levels in the work hierarchy: senior civil servants, (executive officers) middle grades and low grades (clerical and support staff).

Researchers measured social networks on a scale of frequency and number of contact with friends, relatives and participation in a social group. Job control was rated on a 15-item scale. Workers completed questionnaires assessing job status, psychosocial factors (job control), education level, smoking status, exercise level, diet patterns and alcohol use. The men were also rated for depression and underwent electrocardiogram testing for heart rate and heart rate variability.

Healthy hearts have highly variable heart rates. "The heart doesn't, or shouldn't, beat like a metronome," Hemingway said. Instead, a healthy heart rate varies--often in response to outside stimulus such as in a "fight or flight" response. In the study, heart rates of men in low-level positions were an average 3.2 beats per minute faster than men in top-level positions. This difference was "statistically significant."

"Arteries behave as if they know how much a person makes and how much education they have had," Hemingway said. He noted that this difference was present "at every rung of the ladder," so a higher social position translated into a better heart rate profile. Lower heart rate variability and faster heart rates also were consistently found among the men with lower social positions, lower job control and higher depression.

"We hope this information provides insight into the mechanisms at work so that there is a possibility for interventions that will change this outcome," he said. Those interventions, he said, may not be medical. He speculated that organizational change, for example, may be important.

Read more in Circulation

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Friends Help Sufferers Survive Cancer

Aug 5, 2005

As we keep saying, we humans are social animals. The state of our mental and physical health depends very largely on the state of our relationships. As if further proof were needed a new study funded by the National Cancer Institute reports that social support and other behavioral factors are related to levels of a circulating protein, which at high levels is associated with a poor prognosis in advanced ovarian cancer.

The study, published in the July 15, 2005 issue of Cancer, reports that factors that improved quality life, such as social support, were associated with low levels of a protein released by both immune cells and tumor cells, called interleukin 6 (IL-6). In contrast, negative quality of life factors were associated with higher IL-6 levels. The study is the first to find this association both in the peripheral blood and in the vicinity of the tumor.

IL-6 is an inflammatory cytokine that in healthy young people is almost undetectable. Levels of IL-6 increase with age, chronic psychological stress, and disease. Previous studies in humans and laboratory animals have shown IL-6 levels are also influenced by behavioral factors.

IL-6 has previously been shown to promote tumor growth, and IL-6 levels are also prognostic in ovarian cancer, with elevated levels associated with higher mortality and metastatic disease. Because depression and chronic stress are commonly associated with ovarian cancer, and IL-6 levels are responsive to psychosocial factors, Erin S. Costanzo, M.A. from the University of Iowa and colleagues investigated whether IL-6 levels were linked to psychosocial factors in 61 women with advanced ovarian cancer.

While levels of IL-6 and the incidence of depression were elevated in these patients, those who reported strong social attachments had significantly lower levels of IL-6 in both the blood and in the ascites fluid surrounding the tumor. Women with weak social attachments had 1.7 times more IL-6 in the circulating bloodstream and 2.5 times more in the ascites fluid surrounding the tumor than women with strong social attachments. Higher levels in the bloodstream were also found among women who reported poor quality of life, such as fatigue and decreased physical function.

The investigators conclude, that "the finding that social attachment is strongly related to IL-6 not only in the periphery but also in the vicinity of the tumor suggests that psychosocial factors may indeed be important clinically" in the course of ovarian cancer.

Read more in Cancer

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Could Heart-Warming Be Heart-Saving?

June 6, 2005

We have always maintained that since humans are primarily social beings almost everything that effects our mental and physical health depends on the state of our relationships, past and present. Over the past few years a flood of research has been published supporting our assertion.

Research presented at the recent American Heart Association's 45th Annual Conference on Cardiovascular Disease Epidemiology and Prevention showed that men who are socially isolated have elevated levels of a blood marker for inflammation that's linked to cardiovascular disease.

"Our analyses suggest that it may be good for the heart to be connected," said Eric B Loucks, PhD, an instructor in the department of society, human development and health at Harvard School of Public Health in Boston. "In general, it seems to be good for health to have close friends and family, to be connected to community groups or religious organizations, and to have a close partner."

Loucks' team studied 3,267 Framingham Heart Study participants, with an average age of 62 years, who underwent physical exams between 1998 and 2001. The researchers measured blood concentrations of four inflammatory markers including interleukin-6 (IL-6). The researchers asked the participants five questions about their social network:

• Their marital status
• The number of relatives in whom they can confide private matters
• The number of close friends in whom they can confide private matters
• Their involvement in religious meetings or services
• Their participation in groups such as senior centers.

They then assigned a social network index of 1 to 4, based on participants' response, with the lowest number corresponding to social isolation and the highest to high social connection.

After considering major known risk factors for heart disease, men with the lowest level of social involvement had the highest levels of IL-6, the study showed.

"This was a statistically significant difference," Loucks said. Researchers noted that the study counted the number of relationships, but did not assess the quality of relationships. For example, were these relationships supportive for the study participants, or did they often cause stress and conflict? Future studies on the quality of relationships will provide knowledge on the effect of social relationships on inflammatory markers in women.

Researchers say IL-6--and by extension, inflammation--may be elevated for two reasons in men who are socially isolated. First, social isolation may influence health behaviors such as smoking and physical activity, which in turn affect IL-6 levels. Second, socially isolated people are often depressed and under more stress than their more outgoing counterparts (studies show that even acute stress can increase levels of IL-6).

Note: This research is not available on the web.

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Humor Heightens Hope

May 1, 2005

Laughter might be the best medicine for transforming the faintest of glimmers of hope into an eternal spring, reveals research at Texas A&M University that shows humor may significantly increase a person's level of hope.

The experience of humor can positively influence a person's state of hopefulness, says psychologist David H. Rosen who, along with colleagues studied nearly 200 subjects ranging in age from 18-42.

As part of the study, which appeared in the International Journal of Humor Research, select participants viewed a 15-minute comedy video. Those that viewed the video had statistically significant increases in their scores for hopefulness after watching it as compared with those that did not view the video, Rosen notes.

The finding, he says, is important because it underscores how humor can be a legitimate strategy for relieving stress and maintaining a general sense of well-being while increasing a person's hope. Previous studies have found that as high as 94 percent of people deem lightheartedness as a necessary factor in dealing with difficulties associated with stressful life events, he says.

Rosen says humor may competitively inhibit negative thoughts with positive ones, and in so doing, foster hope in people. Positive emotions, such as those arising from experiencing humor, can stimulate thought and prompt people to discard automatic behavioral responses and pursue more creative paths of thought and action, he explains.

Such a process, Rosen says, could lead to a person experiencing a greater sense of self-worth when dealing with specific problems or stressful events. He says these positive emotions could, in turn, lead to an increase in a person's ability to develop a "plan of attack" for a specific problem as well as increase a person's perceived ability to overcome obstacles in dealing with that problem--two aspects that psychologists believe comprise hope.

During the course of the study, Rosen found that there was little or no relationship between hope and the number of stressors experienced throughout the past month, but did find a relationship between severity of the stressors and a decrease in hope. This suggests that the accumulated severity of recent stressors seem to have more of am impact on hope than the actual number of stressors, he says.

In the study, sense of humor was not only represented as the tendency to display laughter, smiles and other similar responses, but was measured across four factors--humor production, humor as a coping strategy, attitudes toward humorous people and attitudes about humor.

We use humor extensively in the Uplift Program. BM

Read more in the International Journal of Humor Research

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Breaking Hearts

March 1, 2005

Married women who avoid conflict with their spouses are at greater risk of dying, researchers reported recently at the Second International Conference on Women, Heart Disease and Stroke.

Researchers also found that men whose wives come home upset with work outside the home have an increased risk of developing heart disease.

Researchers examined information on participants of the Framingham Offspring Study, a large, ongoing community study that tracks the incidence and prevalence of cardiovascular disease and other social and demographic characteristics such as marital strain in the Framingham, Mass., community.

Previous studies have shown a link between levels of marital strain and the health of people with heart disease. However, few studies have looked into the effects of marital strain on contributing to heart disease or death from any cause, said Elaine D Eaker, ScD, principal investigator of the ancillary study of the Framingham Offspring Study.

Together with researchers from Boston University, Eaker collected data that analyzed marital discord. They determined traditional measures (satisfaction and disagreements) and more contemporary ones (conflict resolution and other interpersonal communication issues). The study included 1,769 men and 1,913 women between ages 18 and 77. Researchers conducted the baseline examinations from 1984-87. Of these participants, 1,493 men and 1,501 women were married or "living in a marital situation." The researchers tracked the health of the participants for 10 years to determine if they developed heart disease or died.

"Married men were heavier, older, and had higher blood pressure and a less favorable lipid profile compared to unmarried men," Eaker said. "Unmarried men were more likely to be smokers."

After the researchers made statistical adjustments for age, systolic blood pressure, body mass index, cigarette smoking, diabetes, and the ratio of total and high-density (or "good") cholesterol, married men were about half as likely to die compared to unmarried men.

On the other hand, marital status and the more traditional measures of marital strain had no effect on women developing heart disease or dying over 10 years of follow up. However, when considering more contemporary measures, two types of marital strain were found to be significantly related to the health of married women as well as men.

Men who reported that their wives' work was disruptive to their home life because their wives came home upset with work were more than two times more likely to develop heart disease. Women who reported usually or always keeping their feelings to themselves when in conflict with their husbands, known as self-silencing, had more than four times the risk of dying from any cause compared to women who always show their feelings.

Eaker noted that this is the first time marital strain -- as measured by disruption to one's life due to a spouse's work situation and self-silencing during conflict with one's spouse -- has been included in a longitudinal study of the development of heart disease and death. "These findings are unique," Eaker said. "We believe we have found characteristics of marriages that have an impact on peoples' health and longevity. Based on the strength of the associations we observed and the strengths of the design of the Framingham Offspring Study, we also believe there are some practical implications for clinical practice. While medical care providers are not specifically trained to intervene on psychosocial issues such as marital characteristics, they may be the most likely contact to observe or uncover these characteristics or emotions."

Eaker suggested that screening questions be added to medical history questionnaires to uncover psychosocial stressors, allowing for counseling referrals if appropriate. The research substantiates previous studies that found married men have a survival advantage over unmarried men. Eaker recommended that healthcare providers should also consider the physical and emotional risk factors among unmarried men.

Read more in the Circulation: Journal of the American Heart Association

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To Help Your Mind, Take Steps to Help Your Heart

January 11, 2005

Just as a regular brisk 20-minute walk has been shown to be the one of the best treatments of depression, scientists are now asking whether the same actions that help prevent a heart attack or stroke also prevent or slow the memory loss, confusion and thinking problems of dementia?

A new study suggests that for many people, the answer could be yes.

And for some, the impact of steps like controlling blood pressure and cholesterol might be greater than the effect of high-priced memory-preserving drugs. In the December 15 issue of the Journal of the American Medical Association, researchers from the University of Michigan Health System, the VA Ann Arbor Healthcare System and the Group Health Cooperative Center for Health Studies in Seattle present a comprehensive review of what's known--and what's not--about a condition called mixed dementia.

Mixed dementia is a combination of Alzheimer's disease and vascular dementia, caused in part by problems with blood flow in the brain. It may affect as many as 20 percent of the 6.8 million Americans with dementia. It is particularly common in older patients, who often have memory problems due to several conditions at once.

Doctors now think that many people with symptoms attributed solely to Alzheimer's--memory loss, confusion, wandering, trouble following instructions--may in fact have mixed dementia.

"Having risk factors like high blood pressure and high cholesterol does damage to small blood vessels in the brain and can cause death of brain cells over time," says lead author Kenneth Langa, MD, PhD. "In addition, the Alzheimer's disease process itself can affect the walls of blood vessels in the brain, making strokes more likely. Strokes can cause dementia through the death of large areas of brain tissue, or through the build-up of damage from multiple small strokes cased by athero-sclerosis in small arteries in the brain or the larger carotid arteries in the neck."

In other words, processes that hurt the cardiovascular system also hurt the brain, and inflict a further toll on those with Alzheimer's disease. For the new paper, the researchers reviewed all recent medical studies on mixed dementia, vascular dementia and Alzheimer's. They analyzed hundreds of articles, noting any results from drug studies that were relevant to mixed dementia. The review shows that drugs designed to slow the progression of Alzheimer's disease have about the same effect in people with mixed dementia as in people with Alzheimer's alone.

In all, says Langa, evidence is building that mixed dementia can be prevented or slowed by addressing both factors that cause it: the Alzheimer's disease process and the acute or chronic reduction of blood flow to the brain. The two are intertwined, he says, noting animal research data showing that amyloid protein, the chief sign of Alzheimer's disease, can infiltrate the walls of brain blood vessels and increase the risk of small bleeding strokes. And other evidence suggests that an under-supply of blood to the brain can stress brain cells and perhaps jump-start the Alzheimer's disease process. Chronically high blood pressure also impacts the brain's auto-regulation system for its own blood supply.

Read more in the Journal of the American Medical Association

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Pain Linked to Permanent Brain Loss

December 6, 2004

Researchers at Northwestern University had previously shown patients with back pain had decreased activity in the same brain region called the thalamus. This area is known to be important in decision-making and social behavior.

The team's current study in the Journal of Neuroscience suggests some of the changes may be irreversible and render pain treatment ineffective. If this is born out by subsequent research, it makes it all the more important to treat pain early to prevent any permanent change, say Dr Vania Apkarian and colleagues.

They scanned the brains of 26 patients with chronic back pain and 26 healthy people. The patients with chronic pain caused by damage to the nervous system showed shrinks in the brain by as much as 11%--equivalent to the amount of gray matter that is lost in 10-20 years of normal aging.

The decrease in volume, in the prefrontal cortex and the thalamus of the brain, was related to the duration of pain. Every year of pain appeared to decrease gray matter by 1.3 cubic centimetres. What the researchers now need to find out is whether this loss is permanent or whether it can be reversed with treatment.

Dr Apkarian said: "It is possible that some of the observed decreased gray matter shown in this study reflects tissue shrinkage without substantial neuronal loss, suggesting that proper treatment would reverse this portion of the decreased brain matter." However he cautioned that the prospects are not that hopeful because other research in rats had shown that spinal cord neurons die, which suggests the brain changes could be irreversible.

Dr Nigel Lawes, senior lecturer in biomedical science at St Georges Medical School, London told BBC Online that people with chronic back pain tended to move in automatic ways that perpetuate the pain. Therapies to teach people how to pay attention to and control their movement to limit this pain might help, he said.

Feldenkrais and our Repatterning Movements teach people new and more functional options for movement, helping people break the cycle of habitual movement and chronic pain.

Read more in the Journal of Neuroscience

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More on the Depression and Heart Disease Link

October 1, 2004

Depression, we all know by now, is a powerful causal factor in heart disease. But what is the means by which a psychological complaint can lead to a heart attack? This was a puzzle that researchers at Duke University Medical Center set out to solve.

What they discovered was that otherwise healthy people who are prone to anger, hostility and mild to moderate depressive symptoms produce higher levels of a substance that promotes cardiovascular disease and stroke. The substance, C-reactive protein (CRP), has garnered considerable attention for its role in both promoting and predicting heart problems in initially healthy people.

CRP is produced by the liver in response to inflammation, and inflammation has recently been shown to underlie the plaque that forms inside arteries as they clog.

People with traditional risk factors for heart disease--obesity, smoking, diabetes, hypertension, high cholesterol and sedentary lifestyles--have elevated CRP levels, said Suarez. But a large number of individuals without these traditional risk factors have elevated levels of CRP as well, without an identifiable cause.

The study demonstrates that anger, hostile behavior and depressive symptoms may account for why apparently healthy individuals have higher CRP levels and are thus at increased risk for cardiovascular disease and stroke. Suarez said his findings could also explain why people with mild to moderate symptoms of depression are at increased risk for cardiac events and early death--a link that has been clearly established but without an underlying mechanism to explain why.

"Fifty percent of all heart attacks occur among people without any traditional risk factors, so it is critical to identify other factors that may underlie heart disease and the inflammation that contributes to it," said Suarez.

Suarez said the levels of depressive symptoms and angry/hostile moods necessary to raise CRP do not constitute psychiatric conditions. "That is, you don't have to be clinically depressed or have extreme and frequent bouts of anger to show higher levels of CRP," he said.

Suarez has previously shown that hostile people who exhibit symptoms of depression have higher levels of stress hormones and circulating levels of an inflammatory substance called interleukin 6, another marker of inflammation that has been shown to predict heart disease in initially healthy people. The current data build upon his earlier research and demonstrate yet another mechanism through which the brain and the body interact to contribute to poor health, he said.

"Most individuals tend to think of heart disease as a condition that is associated with factors such as high cholesterol, high blood pressure, smoking and sedentary lifestyle," said Suarez. "Our findings, however, suggest the development of heart disease may also be due to psychological attributes that activate the inflammatory process shown to predict and contribute to the development of heart disease."

Read more in Psychosomatic Medicine

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Ageing Positively

October 1, 2004

Why do some older people experience a rapid decline in their physical and functional health while some of their peers remain healthy and active? While your genes and overall physical health play a role, new research shows how psychosocial factors can also play an important role.

Two studies report on this in the September 2004 issue of Psychology and Aging. In the first study, researchers at the University of Texas Medical Branch at Galveston found a link between positive emotions and the onset of frailty in 1,558 initially non-frail older Mexican Americans living in five southwestern states--Texas, California, Arizona, Colorado and New Mexico. This was the first study to examine frailty and the protective role of positive emotions in the largest minority population in the United States.

Study authors Glenn Ostir, PhD, Kenneth Ottenbacher, PhD, and Kyriakos Markides, PhD, followed the participants for seven years and assessed frailty by measuring the participants' weight loss, exhaustion, walking speed and grip strength.

Positive affect (positive emotions) was measured during the study period by asking the participants how often in the last week "I felt that I was just as good as other people," "I felt hopeful about the future," "I was happy," and "I enjoyed life."

The overall incidence of frailty increased almost eight percent during the seven-year follow-up period, but those who scored high on positive affect were significantly less likely to become frail.

The precise reason for this happening was beyond the scope of the current study, but the researchers speculate that positive emotions may directly affect health via chemical and neural responses involved in maintaining homeostatic balance. Or a more indirect process may be at work, according to the authors, with positive emotions affecting health by increasing a person's intellectual, physical, psychological and social resources.

In the second study, researchers Thomas Hess, PhD, Joey Hinson, MA, and Jill Statham, BA, from North Carolina State University investigated how negative stereotypes about aging influences older adults' memory. Their study involved 193 participants and two experiments, each with a younger (17 - 35 years old) and older (57 - 82 years old) group of adults.

Participants were exposed to stereotype-related words in the context of another task (scrambled sentence, word judgment) in order to prime positive and negative stereotypes of aging. This involved either words reflecting negative stereotypes about aging (brittle, complaining, confused, cranky, feeble, forgot, senile, etc) or words reflecting positive views of aging (accomplished, active, alert, dignified, distinguished, knowledgeable, successful, etc).

Results show memory performance in older adults was lower when they were primed with negative stereotypes than when they were primed with positive stereotypes. In addition, age differences in memory between young and older adults were significantly reduced following a positive stereotype prime, with young and older adults performing at almost identical levels in some situations.

The study also provides evidence that older adults can control the effect of negative stereotype activation but only when the primes are relatively subtle. In contrast, when the stereotype primes are relatively blatant, memory performance tends to be negatively affected.

The results of this study add to a growing list of findings that implicate the importance of the social environment in how it affects older peoples' memory performance, according to the authors. If older people are treated like they are competent, productive members of society, then they perform that way too.

Read more in Psychology and Aging

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Pain Common Side Effect of Depression

September 1, 2004

In fact physical symptoms are nearly as common as emotional ones in patients suffering from depression, according to Indiana University School of Medicine research published in the August 2004 issue of the Journal of General Internal Medicine.

Patients with depression frequently talk to their physicians about symptoms such as headache, back or muscle pain, stomach ache and dizziness instead of symptoms more commonly associated with depression such as fatigue, lack of motivation and moodiness, says Kurt Kroenke, MD, professor of medicine in the Division of General Internal Medicine and Geriatrics at IU.

"Depression is a risk factor for symptoms of pain," he said. "The most reports of pain--such as muscle pain, headaches, leg pain--are two or three times more common in people with depression." What's more physical symptoms also may serve as a barometer for physicians to gauge the effectiveness of common antidepressant treatments, he said.

"Physical symptoms may not respond to common antidepressant treatment as much as the emotional symptoms," says Dr. Kroenke. "Even though the physical symptoms may be related to or aggravated by the depression, they can linger longer than the emotional symptoms."

The study examined the prevalence, impact on quality of life and outcome of physical symptoms in patients with depression during nine months of antidepressant therapy. A total of 573 depressed primary care patients at 37 clinic settings were assessed at one, three, six and nine months. In more than a third of the patients, the physical symptoms persisted longer than the depression symptoms.

This ties in neatly with the point we made in our book Creating Optimism that depression can manifest either as a "mood disorder" such as being sad or anxious or mask itself as a physical complaint and may, in a large number of sufferers, cycle between one and the other. We believe that all most antidepressants do is make depression change symptoms, not go away.

On this point Dr Kroenke comments: "While physical symptoms showed, on average, some improvement with antidepressant treatment, the improvement was typically less than was reported for emotional symptoms," he said. "Most of the improvement for the physical symptoms occurred within the first month of treatment, while the emotional symptoms continued to improve over a nine-month period."

A related study by Dr Kroenke also revealed a correlation between the severity of pain as reported by the patient and the success of treatment for depression. The more severe the pain at the beginning of treatment, the less responsive depression is to antidepressant medication.

Read more in Journal of General Internal Medicine

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A Little Help From Friends Makes Wounds Heal Faster

August 4, 2004

We have long said that humans are so much social animals that without supportive relationships we tend to get more stressed, more sick and more depressed and anxious and take longer to heal psychologically and physically.

Recently researchers, using hamsters, another very social animal, as a model have added further evidence for our model. The researchers looked at the effect social contact had on wound healing in stressed hamsters. Results showed that skin wounds healed nearly twice as fast in the hamsters paired with a sibling. These animals also produced less of the stress hormone cortisol than unpaired hamsters.

“Stress delays wound healing in humans and other animals, and social contact helps counteract this delay,” said Courtney DeVries, the study's lead author and an assistant professor of psychology and neuroscience at Ohio State University. “Our goal is to understand the physiological mechanisms by which social support improves health.”

She and her colleagues also treated a group of socially isolated hamsters with oxytocin, a hormone released during social contact and associated with social bonding in monogamous animals. Oxytocin treatment seemed to ameliorate the effects stress had on wound healing, as the treated animals healed about 25 percent faster than the untreated lone animals.

The study appears in the September 2004 issue of the journal Psychoneuroendocrinology.

The researchers conducted a series of experiments to learn how social interaction affects health, and to better understand the mechanisms by which it does so. Female Siberian hamsters were housed with a sibling or isolated during the three-week study. All animals received minor skin wounds about the size of a sunflower seed on the backs of their necks. The researchers photographed and measured the wounds each day. Some of the hamsters were confined to small Plexiglas tubes for two hours a day for up to 14 consecutive days. Other studies have shown that such confinement causes stress and also delays wound healing. While the animals couldn't turn around in the tubes, they could move back and forth and stand up or lie down.

Hamsters were separated into four groups for one of the experiments: socially isolated, non-stressed; socially isolated, stressed; paired, non-stressed; and paired, stressed. As soon as a single day after injury, the wounds on the socially isolated, stressed animals remained about 25 percent larger than the wounds of the other three groups, and stayed this way for about a week.

In a second experiment, the researchers compared levels of cortisol -- the stress hormone -- of paired animals to those in isolated animals. Blood samples were collected immediately after the hamsters were stressed, and again 45 minutes later. Right after stress, the cortisol levels of the isolated animals were one-and-a-half times greater than those of the paired animals.

“We expected cortisol concentration to increase substantially in stressed and lone animals,” DeVries said. But cortisol levels didn't increase in the paired, stressed hamsters.

In a third experiment, the researchers found that surgically removing the adrenal glands -- the main source of cortisol -- from some of the isolated hamsters was just as beneficial to wound healing as having a companion in the cage. Wounds on the stressed and non-stressed animals healed at the same rate, suggesting that cortisol is a key player in delaying wound healing during stressful conditions.

Finally, the researchers experimented with the effects of treating two groups of socially isolated hamsters with either oxytocin or a substance that blocks oxytocin production. Hamsters in the oxytocin treatment group were given oxytocin injections daily for five days prior to wounding and restraint stress, while control animals were given a saline placebo. The treated animals' wounds healed at a faster rate than did wounds on the control animals. Treatment with an oxytocin antagonist delayed healing even in paired animals.

“This suggests that oxytocin may be the main buffer against delays in wound healing, since the presence of a sibling also increased oxytocin secretion,” DeVries said.

I'm pleased to report that the wounds on all of the hamsters -- stressed and non-stressed alike -- healed in less than two weeks.

Read more in Psychoneuroendocrinology

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Constant Confrontation And Defeat May Break Your Heart

It has long been known that stress is bad for the heart and also that prolonges exposure to certain stressors can result in permanent changes to the body's sympathetic nervous system (including blood pressure levels and heart rate).

A new study has shown that the same is true of social stressors as well. Using mice as a substitute for humans (the response systems are very similar) researchers have now found that if a mammal such as us is exposed to on-going social stressors of particular kinds (defeat, confrontation etc) the damage can be long lasting.

What happens is that the body adapts to these stressors by having a permanently faster heart beat, higher blood pressure and so forth. These remain even when the original stress is removed. With other stressors (loss, bereavement, poverty etc), even when they are on-going the nervous system adapts to them and the sympathetic-adrenomedullary system returns to normal.

This is one of the reasons why people who grew up in violent neighborhoods, or families, tend to be on permanent alert for danger and expect others to be aggressive to them even long after they have left that environment.

Read more in the American Journal of Physiology: Heart and Circulatory Physiology

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Anxiety Is Bad for Your Teeth

December 16, 2003

Anxiety disorders, which include phobias, panic attacks, generalized anxiety and post-traumatic stress disorders (PTSD), are serious conditions with oral health implications that can be treated with a variety of methods, according to a report published in the November/December 2003 issue of General Dentistry.

"Oral health problems associated with anxiety disorders include canker sores, dry mouth, Lichen Planus (lacy white lines, red areas or mouth ulcers), burning mouth syndrome, and temporomandibular joint (TMJ) disorders," says James W Little, DMD, lead report author.

Patients with anxiety disorders may disregard their oral health altogether and are at an increased risk for dental caries, periodontal disease, and bruxism (grinding). Problems can be increased if the patient has a fear of needles or other commonplace instruments. This can greatly complicate procedures.

Some anti-anxiety medications can decrease the mouth's ability to produce saliva, which can increase the risk of developing tooth decay and periodontal disease. Other medication side effects include dry mouth, vomiting (which could cause tooth decay and erosion), anemia and bleeding.

Sometimes dentists mistake neuralgia (which can manifest as a generalized pain in the jaw) for a serious dental problem, leading to unnecessary procedures being undertaken, further worsening the original problem. This has happened to a number of my own clients. On other occasions TMJ can have an psychological cause. For example a patient that I interviewed at Tufts New England Medical Center's Orifacial Pain Clinic. The origin of her TMJ lay in a secret that she had been forced to keep by her father. When I finally persuaded her to tell the secret the TMJ vanished. BM

Read more in General Dentistry

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Infections Could Prolong Life

December 16, 2003

The present flu epidemic in the United States has led to widespread panic as people call to mind the devastating one early in the last century which killed millions of people world-wide. Some people are afraid to go out of their houses or into public places. How timely, then is new research which shows that a mild flu or a cold may actually be a good thing.

Researchers writing in the journal Molecular Biology of the Cell say that these bursts of stress "turn on" key genes which encode protective molecules. However, if the stress is too great, if the flu is too severe, then damage may be done.

Scientists from Northwestern University in Illinois, US, studied C elegans, a transparent roundworm whose biochemical environment is similar to that of human beings (and why not--we even share a large percentage of our genetic inheritance with seaweed or moss). They focused on heat shock factor, the master gene that controls the expression of molecular chaperones, special protective chemicals that respond to stress in a cell.

Molecular chaperones "tidy up" damaged proteins in cells. Stress triggers this reaction, prolonging life by preventing or delaying cell damage. Much the same thing happens with emotional stressors--we need a certain amount of stress but too much can be hurtful and lead to more serious physical and psychological complications.

The scientists found that when heat shock factor genes were over-expressed, the worms' lifespan increased. But if they were under-expressed, the opposite was true. Professor Richard Morimoto, who led the research, said: "Sustained stress definitely is not good for you, but it appears that an occasional burst of stress or low levels of stress can be very protective. Brief exposure to environmental and physiological stress has long-term benefits to the cell because it unleashes a great number of molecular chaperones that capture all kinds of damaged and misfolded proteins."

Read more in Molecular Biology of the Cell

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Gulf War Syndrome?

December 16, 2003

Two papers in the December issue of the British Medical Journal describe the long term health of British veterans of the 1990-91 Gulf war. Researchers at the King's School of Medicine Gulf illnesses research group present the results of a study which indicates that 11 years after the conflict the Gulf veterans continue to experience considerably poorer health than control groups who have not been through similar stressors. In another article Gary J Macfarlane, professor of epidemiology at Manchester University examines the rate of malignancy in Gulf war veterans and shows that their overall rate of cancer is almost identical to those not deployed, even among those reporting exposure to potentially carcinogenic factors such as depleted uranium or pesticides.

These results are congruent with other data collected in both UK and US Gulf war veterans. Twelve years after the war, and after roughly $300m (£174m) has been spent on research, what do we know about the health of Gulf war veterans, in relation to what has actually happened to them?

Firstly, there is no evidence of excess malignancy, birth defects, or increased mortality associated with Gulf war deployment. However, and secondly, when those sent to the Gulf war are compared with military veterans of the same era who were not deployed to the Gulf, Gulf war veterans are two to three times more likely to have symptom complexes that include multifocal pain, fatigue, cognitive or memory problems, and psychological distress. Most of these individuals do not meet criteria for established psychiatric diagnosis, and in fact the rate of post-traumatic stress disorder in Gulf war era veterans was low compared with other wars.

Thirdly, many population based studies have shown that the same symptoms and clusters of symptoms that are observed in a substantial portion of Gulf war veterans are also common in the general population. When individuals develop these symptom complexes in the general population they typically receive diagnoses of conditions such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and tension and migraine headaches.

Fourthly, in addition to the relatively large proportion of deployed veterans (20-25%) who developed symptoms and syndromes found commonly in the population, there may be a much smaller proportion who developed a real neurological illness. For example, the rate of amyotrophic lateral sclerosis in Gulf war veterans may be double than in non-deployed troops.

Why did this happen? Firstly, no specific environmental exposure, with the possible exception of vaccines given at the time of deployment, has been associated with the development of these symptom complexes. Secondly, since the Gulf war several authors have looked retrospectively at the health consequences of other UK or US wars. After nearly every such conflict, a substantial number of veterans develop chronic symptoms similar to those seen after the Gulf war.

These syndromes are typically given different names and attributions (such as "shell shock," "soldier's heart") after each conflict. This recurring occurrence implies that there is a low likelihood that an exposure unique to the Gulf war was largely responsible for the excess symptoms seen in these veterans.

Thirdly, similar chronic symptoms are seen after catastrophic events other than war, such as terrorist attacks and natural or industrial disasters. Chronic somatic symptoms seem to be common after-effect when these catastrophic events last for a prolonged period or are accompanied by long term worry or fear. For example the rate of PTSD in the US population rose to an estimated 19% just after the terrorist attacks of September 11, 2001.

Fourthly, in the general population exposure to different types of "stress" can also lead to the development of these same symptom complexes. Examples of acknowledged triggers of fibromyalgia, chronic fatigue syndrome, or irritable bowel syndrome include certain types of infections, physical trauma, drugs, and emotional stress.

Together the data indicate that the various illnesses seen in association with Gulf war deployment had little to do with any specific environmental exposure. War is incredibly stressful, and when most individuals are exposed to stressors such as physical or emotional trauma, infections, or other types of immune stimulation, drugs, or chemicals they get sick. Usually these symptoms improve after the stressor passes. But in some people these symptoms become chronic and, once established, they can be disabling and difficult to cure. "Make no mistake," the BMJ points out: "Ill Gulf war veterans have a very real illness. It is not likely to get better without specific interventions. But we don't serve these or other veterans well by focusing inordinate attention on the specific exposure(s) that may have been responsible for some rare cases of illness. As patients, they deserve far better: the medical and scientific communities need to stop belittling and trivializing them and their illnesses (by focussing on some supposed 'Gulf War Syndrome')."

Read more in the British Medical Journal

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Stress Linked to Multiple Sclerosis

September 21, 2003

Stressful life events seem to make the symptoms of multiple sclerosis worse, a British Medical Journal study suggests. Dutch researchers followed 73 patients with relapsing-remitting multiple sclerosis. They found during periods of stress patients were twice as likely to develop new symptoms, or a more severe form of their existing symptoms.

The reason for the apparent link is unclear, although it is possible that stress triggers the release of hormones that affect the immune system.

The finding suggests that giving people with MS coaching on how to deal with stress may help to delay the development of symptoms. Researcher Dr Rogier Hintzen, a neurologist at the Erasmus Medical Centre in Rotterdam, said: "The knowledge that stressful events are associated with disease activity adds important information to the limited insight that patients and their care givers have on this unpredictable disease."

MS is caused by a malfunctioning of the immune system, which attacks the coating of the nerves. Symptoms include tingling, fatigue, loss of balance and slurred speech. The majority of patients experience periods when their symptoms become worse, followed by periods of stability. However, there has been much debate about just what role, if any, psychological stress plays in determining the progression of the disease.

Read more in the British Medical Journal

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Obesity, Depression Team up to Increase Heart-endangering Inflammation

September 21, 2003

Among a large group of German men ages 45 to 74, obese men had significantly higher concentrations of a protein called CRP compared with non-obese men. CRP serves as a signal of artery inflammation and high levels of the protein may be a good predictor of future heart disease.

The news is that depression seems to add to obese men's heart woes: CRP levels were higher in the most depressed obese men than in the less depressed obese men, according to Karl-Heinz Ladwig, PhD, of the GSF National Research Center for Environment and Health and colleagues.

Depression did not affect CRP levels among non-obese men, however, suggesting that a combination of obesity and depression may be more risky for some men. "We cannot provide a convincing explanation why the association between CRP and depression was much stronger in obese than in non-obese participants. However, it may be that both conditions--obesity and depression--share a common ground which, in onsequence, makes depressed, obese subjects in particular susceptible for coronary heart disease," Ladwig says.

The association between obesity and depression remained strong even after accounting for other factors that can affect CRP levels, including smoking, alcohol consumption and physical activity, according to the researchers.

Twenty-three percent of the 3,205 men included in the study were identified as obese. On the whole, the group of obese men was not any more depressed than the non-obese group, Ladwig says.

Read more in Brain, Behavior and Immunity

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Happy People May Have More Immunities to Common Cold

August 13, 2003

Study participants who had a positive emotional style weren't infected as often and experienced fewer symptoms compared to people with a negative emotional style, say Sheldon Cohen, PhD, of Carnegie Mellon University and colleagues, writing in Psychosomatic Medicine.

Cohen's team interviewed 334 healthy volunteers three evenings a week for two weeks to assess their emotional states. The volunteers described how they felt that day in three positive-emotion areas: vigor, wellbeing and calm. They were also questioned about three categories of negative feelings: depression, anxiety and hostility.

Other scientists have speculated that people who typically report experiencing negative emotions are at greater risk for disease and those who report positive emotions have less risk, says Cohen.

After their assessment, each volunteer got a squirt in the nose of a rhinovirus--the germ that causes colds. The researchers kept the subjects under observation for five days to see whether or not they became infected and how they manifested symptoms.

"We found that experiencing positive emotions was associated with greater resistance to developing a common cold," Cohen reports. "Increases in positive emotional styles were linked with decreases in the rate of clinical colds, but a negative emotional style had no effect on whether or not people got sick."

A positive emotional style actually had no effect on how often volunteers were infected (as measured by replication of the virus) but produced fewer signs and symptoms of the illness, says Cohen. This suggests that inflammatory chemicals produced by the body may link the positive emotional style with colds. Further analysis revealed that good health practices and lower levels of certain hormones did not account for the link between positive emotional style and illness.

Since the average person catches two to five colds a year, developing psychological risk profiles and considering ways to enhance positive emotion might reduce the risk of colds--and by extension, other infectious diseases.

Read more in Psychosomatic Medicine

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About the Author

Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).