Know Suicide's Warning Signs

(HealthDay News) -- While many people view spring as a time of renewal and hope, the greatest number of suicides in the United States occur each year in April and May, notes the American College of Emergency Physicians.

It's not clear why suicide rates spike in the spring, said ACEP President Dr. Linda L. Lawrence. But "we do know that suicide is the 11th leading cause of death for all ages in the United States, with one suicide occurring every 16 minutes or about 11 suicides per 100,000 people," she said in a prepared statement.

"Moreover, suicide is the second leading cause of death among 25- to 34-year-olds and the third leading cause of death among 15- to 24-year-olds. Men take their own lives nearly four times more often than women, with men ages 75 and older having the highest rate of suicide, although over a lifetime, women attempt suicide two to three times as often as men," Lawrence said.

For every successful suicide attempt, there are 25 failed attempts that often leave people seriously injured and in need of medical care. More than 90 percent of all suicides are linked with a mood disorder or other psychiatric illnesses, which can be treated through behavioral therapy and medication, Lawrence said.

"So we want to build greater public awareness and understanding of suicide in order to prevent these needless deaths and injuries from occurring," she said.

As part of that effort, the ACEP wants to educate people about the warning signs of suicidal behavior, which include:

• Feeling depressed, down or excessively sad.


• Feelings of hopelessness, worthlessness or having no purpose in life, along with a loss of interest or pleasure in doing things.


• Preoccupation with death, dying or violence, or talking about wanting to die.


• Seeking access to medications, weapons or other means of committing suicide.


• Wide mood swings -- feeling extremely up one day and terribly down the next.


• Feelings of great agitation, rage or uncontrolled anger, or wanting to get revenge.


• Changes in eating and sleeping habits, appearance, behavior, or personality.


• Risky or self-destructive behavior, such as driving recklessly or taking illegal drugs.


• Sudden calmness (a sign that a person has made the decision to attempt suicide).


• Life crises, trauma or setbacks, including school, work or relationship problems, job loss, divorce, death of a loved one, financial difficulties, diagnosis of a terminal illness.


• Putting one's affairs in order, including giving away belongings, visiting family members and friends, drawing up a will or writing a suicide note.

If a person is threatening to commit suicide, take it seriously, remain calm and take the following steps, ACEP advises:

• Don't leave the person alone. Prevent access to firearms, knives, medications or any other item the person may use to commit suicide.


• Don't try to handle the situation alone. Call 911 or the local emergency response number. Phone the person's doctor, the police, a local crisis intervention team, or others who are trained to help.


• While waiting for help, listen closely to the person. Let the person know you're listening by maintaining eye contact, moving closer, or holding his or her hand, if appropriate.
  Ask questions to determine what method of suicide the person is considering and whether he or she has an organized plan.


• Remind the person that help is available.


• If the person does attempt suicide, immediately call for emergency medical assistance and administer first aid, if necessary.

More information

For more on preventing suicide, visit the U.S. Centers for Disease Control and Prevention.

Quit-Smoking Drug May Raise Suicide Risk

(HealthDay News) -- There's increasing evidence that the smoking-cessation drug Chantix is linked to serious "neuropsychiatric" side effects, including agitation, depressed mood and even suicide, U.S. health officials said Friday.

The U.S. Food and Drug Administration has asked Chantix's manufacturer, Pfizer Inc., to make the warning about these potential problems more prominent on prescribing information and on the drug's label. The agency is also working with Pfizer to produce a Medication Guide for patients, officials said.

"We have become increasingly concerned as we have seen a number of compelling cases that truly look as if they are the result of exposure to the drug and not to other causes," Dr. Bob Rappaport, director of the FDA's Division of Anesthesia, Analgesia and Rheumatology Products, said during an afternoon teleconference.

"These cases involve abnormal behaviors, changes in mood, and suicidal ideation and suicide," Rappaport said.

The FDA knows of 491 cases of suicidal behavior associated with Chantix, said Dr. Celia Winchell, a team leader in the FDA's Division of Anesthesia, Analgesia and Rheumatology Products.
"Of these, 420 are from the United States," Winchell said. "There are 39 that involve completed suicides, 34 in the United States."

According to Pfizer, 5 million patients have taken Chantix, whose generic name is varenicline.
Friday's warning follows a Nov. 20 FDA statement that the agency was "evaluating post-marketing adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior."

At that time, Pfizer said there had never been a cause-and-effect relationship shown between Chantix and these symptoms. The company also said that part of the problem may be due to nicotine withdrawal.

Last month, Pfizer agreed, after consulting with the FDA, to update packages of Chantix sold in the United States to more prominently display a warning that users should be monitored for suicidal behavior, depressed mood, and other mental health symptoms.

The FDA approved Chantix in May 2006 as a smoking-cessation drug. It acts in areas of the brain affected by nicotine and may ease withdrawal symptoms and block the effects of nicotine if users resume smoking.

On Friday, FDA officials advised patients to tell their doctor about any history of psychiatric illness before starting Chantix. The drug can cause current psychiatric illness to get worse even if it is under control. Chantix may also cause the recurrence of an old psychiatric illness, the officials warned.

Patients should also report changes in mood and behavior to their doctor. Symptoms to look out for include anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide, the FDA officials said.

In most cases, these symptoms developed while taking Chantix, but they can also appear after stopping the drug, the officials noted.
"We are continuing with the review process over the next several months as we try to pin down to what extent these problems are being seen with Chantix," Rappaport said.

Vivid, unusual, or strange dreams may occur while taking the drug. Patients may also experience impaired ability to drive or operate heavy machinery, the officials said.

More information
For more on quitting smoking, visit Smokefree.gov.

'Easy Does It' Eases Holiday Stress

(HealthDay News) -- It's supposed to be the happiest time of the year, but don't tell that to the patients who mob the offices of San Diego cardiologist Dr. Mimi Guarneri between Thanksgiving and New Year's.

Some complain of what doctors call "holiday heart" -- skipped beats, high blood pressure and angina due to stress or overindulgence. Others feel physically and emotionally overwhelmed, distracted by thoughts of difficult relatives or missing loved ones.

Guarneri, medical director of the Scripps Center for Integrative Medicine, has different advice for her patients, depending on their situations. But she's always sure to emphasize one theme: relaxation.

"The one thing is do is to take time out, take a deep breath, connect your mind with your body by simple breathing," she said. "And remember to not sweat the small stuff."

Easier said than done, of course. But when it comes to crippling holiday stress, specialists say the simplest pieces of advice are also the best.

Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C., advises people to be reasonable with their expectations from the season, and to anticipate trouble -- ranging from long lines at stores and airports, to bouts of sadness when images of absent loved ones come to mind.

By readying yourself for these moments, "they won't come as a shock when you realize, 'I'm getting ready to honk my horn or get steamed over this person who just pulled in front of me.' If you can do that, you can probably head off some of it," Williams explained.

He said it's not clear how many people get the blues around the holidays, but it's probably not uncommon. "It's perfectly normal to get a little bit depressed or a little sad during the holidays at one point or another," Williams said.

However, it may not be as bad as some might assume. In recent years, American researchers have looked at local statistics and debunked the long-held assumption that suicide rates shoot up around the holidays.

Not every episode of Christmastime depression is minor, however. If you find yourself early in the new year having trouble with sleeping or eating -- doing either one too much or too little -- it's possible that you've fallen into a clinical depression.

If that might be the case, "You should seek some professional evaluation and possibly treatment," Williams said.

In other cases, a little self-help can be key. "In the grand scheme of life, we say, 'Don't sweat the small stuff,'" Guarneri said. "We have to realize that a lot of stress is what we put on ourselves, not what other people are putting on us."

If you're alone and feeling isolated, she said, "get out and do service work, which brings joy to people." And, if you have the opposite problem -- too much to do and too many people to worry about pleasing -- learn to do less. "None of this is worth dying for," she said.

More information
Learn more about holiday stress from the American Psychological Association.

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Advantages and Disadvantages of Alcohol Intake on Cardiovascular Health Reviewed

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD

The latest American Heart Association guidelines caution people not to start drinking alcohol if they do not already drink alcohol, according to a review of the advantages and disadvantages of alcohol intake on cardiovascular health published in the August 23 Online First issue of the Journal of the American College of Cardiology.

"Accumulating scientific evidence indicates that light to moderate drinking done on a daily basis may significantly reduce the risks of coronary heart disease (CHD) and all-cause mortality," write James H. O'Keefe, MD, FACC, and colleagues from the Mid America Heart Institute in Kansas City, Missouri. "In contrast, excessive alcohol intake and binge drinking are toxic to both the heart and overall health and are the third leading cause of premature death among Americans.

The purpose of the present review is to:
1) outline the specific benefits and risks of alcohol, and the threshold of intake at which drinking becomes a health danger rather than an advantage;
2) detail the mechanisms whereby alcohol confers cardioprotection; and
3) discuss the ideal quantities, drinking patterns, and beverages, and which individuals are most likely to benefit."

Research to date has shown J-shaped relationships between alcohol consumption and several adverse health outcomes, including all-cause mortality, CHD, diabetes, hypertension, congestive heart failure, stroke, dementia, and Raynaud's phenomenon.

Some cardioprotective benefits have been demonstrated for light to moderate alcohol consumption (up to 1 drink daily for women and 1 or 2 drinks daily for men). Most studies have shown that light to moderate drinking is associated with risk reductions for CHD of approximately 30% to 35%.

Alcohol consumed in moderation seems to have an antiatherosclerotic effect, with decreased incidence of peripheral arterial disease and decreased atherosclerotic burden shown by coronary angiography, computerized tomography-detected coronary calcium, and carotid ultrasound.
Like exercise, alcohol consumption seems to be most cardioprotective when done daily and in moderation. However, increasingly excessive consumption is associated with proportional worsening of outcomes.

Because of the beneficial effects on high-density lipoprotein (HDL) cholesterol, insulin action, and inflammation, light to moderate alcohol intake may be particularly helpful for patients with abnormal glucose metabolism and/or insulin resistance. Light to moderate alcohol intake may be associated with reductions in the prevalence and incidence of diabetes, and a large meta-analysis with 12-year follow-up showed a 30% reduction in new diabetes in those who consumed 1 to 2 drinks daily.

The cardiovascular benefits associated with alcohol consumption protection are thought to be mediated by improvements in insulin sensitivity and HDL cholesterol. The major protective component seems to be the ethanol itself, and not the other ingredients found in different types of alcoholic beverages.

In a meta-analysis incorporating data from more than 1 million participants, consumption of 1 drink daily by women and 1 or 2 drinks daily by men was associated with an 18% reduction in total mortality, but daily intakes of more than 2 drinks in women and 3 drinks in men were associated with dose-dependent increased mortality.

Although low-dose, daily alcohol consumption has been linked to better health than less frequent use, binge drinking increases cardiovascular events and mortality, even in otherwise light drinkers.

"Alcohol should not be universally prescribed for health enhancement to nondrinking individuals owing to the lack of randomized outcome data and the potential for problem drinking," the study authors note. "Alcohol (ethanol) consumption is analogous to the proverbial double-edged sword, and perhaps no other factor in cardiovascular (CV) health is capable of cutting so deeply in either direction depending on how it is used."

Guidelines from the United Kingdom suggest that middle-aged or elderly men and postmenopausal women who drink seldom or never might consider the possibility that light drinking would benefit their health. On occasion, the reviewers have made a similar recommendation to patients who do not smoke and who have no personal or family history of substance abuse and no history of depression or bipolar disorder. However, they argue that light to moderate drinking should not be universally recommended to the general public or even to patients with cardiovascular disease.

As an analogy, they point out that observational data and findings from randomized trials using surrogate endpoints suggested that hormone replacement therapy for women and antioxidant vitamins improved cardiovascular outcomes, whereas later randomized trials with larger samples led to the opposite conclusions. They note that no randomized trials of alcohol for improving clinical outcomes have yet been performed. In observational studies, residual unmeasured confounding factors could be contributing to apparent benefits that seem to be associated with light to moderate drinking.

The investigators further note that heavy drinking has caused significant individual and societal problems and morbidity. In the past 15 years, the rates of alcohol abuse and binge drinking have been increasing, according to the findings of some studies. Alcohol abuse causes 100,000 deaths each year in the United States, and it has been deemed the third largest preventable cause of death.

Excessive alcohol consumption has been associated with increased risks for all-cause mortality, motor vehicle crashes, stroke, cardiomyopathy, cardiac dysrhythmia, sudden cardiac arrest, suicide, cancer (particularly of the breast and gastrointestinal tract), cirrhosis, fetal alcohol syndrome and sleep apnea.

"Sobering statistics warn that moderate daily drinking is a slippery slope that many individuals cannot safely navigate," the study authors conclude. "The latest American Heart Association guidelines caution people not to start drinking if they do not already drink alcohol, because it is not possible to predict in which people alcohol abuse will become a problem. Until we have more randomized outcome data, and tools for predicting susceptibility to problem drinking, it would seem prudent to encourage physicians and patients to focus on more innocuous interventions to prevent CHD."

J Am Coll Cardiol. Published online August 23, 2007.
2007;50:1009-1014.

Antidepressants Help More Kids Than They Harm

(HealthDay News) -- Whether depressed or troubled kids should take antidepressants has been the question at the center of an intense public debate in recent years, and the latest evidence suggests the answer is "yes."

A study in the April 18 issue of the Journal of the American Medical Association found that the benefits of antidepressants outweighed the risks for children and adolescents under the age of 19.

Anecdotal reports released over the past few years suggest that antidepressants raise suicide risk in children and teens. But the drugs may also prevent deaths by curbing depression, experts say.

"Our study shows that, at least in the short-term, treatment benefits appear to outweigh the risks," confirmed study author Jeffrey A. Bridge, an investigator with Columbus Children's Research Institute, in Ohio.

The findings seem to tip the scale more in favor of antidepressants, which include widely used selective serotonin reuptake inhibitors (SSRIs) such as Celexa, Paxil, Prozac and Zoloft.

"They're saying that, yes, there is a slightly increased risk but it's not as big as we thought and the risk-benefit ratio is favorable. But that's a decision that every family has to make. It's not a generalized decision," said Dr. Jane Ripperger-Suhler, an assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine and a psychiatrist with Scott & White Mental Health Center in Temple.

"This leans us more toward the middle -- that we don't have to say these are terrible medicines, that this looks like a fairly good option. and let's not take them off the table," she said.
Antidepressants, particularly SSRIs, have been the subject of intense controversy in recent years.

In October 2003, the U.S. Food and Drug Administration issued a public health advisory, warning of an increased risk of suicide attempts or suicide-related behavior among children and teens taking SSRIs.

One year later, the FDA directed manufacturers of those drugs to revise their labeling to include a black-box warning. The warning alerts health-care providers to an increased risk of suicide and suicidal thoughts in children and teens.

On the other side of the argument, a major new study found that SSRIs have actually saved thousands of lives by preventing suicides since they were introduced in 1988.

The negative press SSRIs received may have had a chilling effect on their use in the pediatric population, however. One recent study found that the number of U.S. children being prescribed the antidepressants has dropped since warnings about suicidal behavior associated with the drugs emerged. This trend could be worrisome if it means that young patients who might benefit from SSRIs aren't getting them, experts have said.

The only SSRI approved by the FDA for use in pediatric patients is Prozac, but others are prescribed on an off-label basis.

In 2004, an FDA review of 24 placebo-controlled trials involving antidepressant medication in more than 4,400 children and adolescents found that the medications spurred a twofold (4 percent vs. 2 percent) increased risk for suicidal behavior or ideation (thoughts of suicide), although no completed suicides were reported.

The current paper was a large review of all of the published and unpublished randomized clinical trials involving the use of antidepressants by children and adolescents younger than 19. The youngsters were being treated for major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and anxiety disorders other than OCD. In all, 27 trials were reviewed and 5,310 patients were followed.

For every 100 children and adolescents treated with antidepressants, about one child would have thoughts of suicide or would attempt suicide beyond the risk associated with the underlying condition, the researchers found.

This was a number that was lower than the FDA's review, which found two instances of suicidal ideation or attempted suicide per 100 patients.

The study also found that the only antidepressant effective in treating depression in children under 12 was Prozac. Several medications were effective in older children.
The effects of the drugs were most pronounced for non-OCD anxiety disorders, followed by OCD and then MDD.

But the new findings are unlikely to be the last word on the subject.
"There are a few studies that are ongoing right now and that will certainly inform our findings," Bridge said.

"It doesn't seem like they have resolved the issue completely," added Ripperger-Suhler. "I'm hoping that someone will do a prospective study."

More information about Depression

The Toxicity of Tylenol

As you know, acute liver failure is one of the more health-harming side effects of acetaminophen. Interestingly, incidents of acute liver failure caused by this over-the-counter (OTC) painkiller, according to a new study, are evenly split between attempted suicide and unintentional overdose.

These numbers will surprise you:

• Cases of acute liver failure blamed on acetaminophen use rose sharply from 28 percent in 1998 to 51 percent five years later.
• More patients overdosed unintentionally on acetaminophen (48 percent).
• Sixty-three percent who accidentally overdosed used a prescription acetaminophen compound while 38 percent had been taking two acetaminophen meds at the same time.
• Some patients had been taking less than 4 grams of acetaminophen daily before their livers failed.

The Toxicity of Tylenol