Using hearing aids significantly increased the likelihood of a longer life for adults with hearing loss—but only if the hearing aids were used regularly, according to a study. For 10 years, researchers tracked the status of nearly 1,900 adults who had been shown to have hearing loss and who had completed questionnaires about their hearing aid use. The patients who used hearing aids regularly (at least once a week or at least five hours a week) were 25 percent less likely to die during the study period compared with those who never used hearing aids. Previous research has shown that untreated hearing loss can result in social isolation, increased risk of falling, and a reduced life span. The researchers noted that people who regularly use hearing aids may be more socially active and less isolated, and that they fall less, and these factors might explain the increased longevity.

Some Women with Early-Stage Breast Cancer May Safely Skip Radiation

Postmenopausal women in their 50s and 60s who have been diagnosed with early stage HR+ breast cancer and skip radiation treatment after breast-conserving surgery have a very low risk of disease recurrence within five years, according to an Emory University study.

Earlier studies have suggested that women who are 65 and older might do just as well if they skip radiation treatments. Now, this study found the same might hold true for even younger postmenopausal women. The research team first gave sensitive genetic tests to each patient, to gauge their tumor’s likelihood of recurrence after lumpectomy. If tests revealed a low risk of recurrence, the patient was given the option to skip radiation therapy and instead continue taking five years of hormonal treatments. Of the 186 patients who could be fully evaluated, all were still alive five years after their lumpectomy, and 99 percent were found to be free of breast cancer at that time.

Regular Sleep Schedules Are Critical to Good Mental Health

Older women who stick to a set sleep and wake schedule are more likely to avoid feelings of depression and anxiety, according to a University of Michigan study. For the study, researchers analyzed sleep patterns and assessed the psychological health of close to 1,200 postmenopausal women. The study showed that women with a sleep midpoint (the halfway point in time between falling asleep and waking up) that fell outside 2 a.m. and 4 a.m. were 72 percent more likely to report significant depression symptoms. Each hour of sleep schedule irregularity increased a woman’s chances of experiencing significant depressive symptoms by 68 percent and significant anxiety symptoms by 62 percent. Previous studies regarding sleep irregularity have found that not sticking to a regular bedtime and wake-up schedule and getting different amounts of sleep each night can put a person at higher risk for obesity, high cholesterol, hypertension, and diabetes.

The post Frontline: Hearing aids and longer life span; breast cancer; sleep and good mental health appeared first on University Health News.

It’s a simple question, but the answer can play a pivotal role in the complexities of memory, thinking skills, stress management, and mood disorders. Two recent studies out of the United Kingdom underscore years of previous research findings implicating sleep quality and quantity as essential, if often underappreciated, elements of your cognitive and mental health.

In one study, published in The Lancet Healthy Longevity, researchers found that the cognitive benefits of regular exercise, for example, can be diminished if you don’t get enough sleep. They found that adults who exercised regularly but experience “short sleep” (less than six hours a night on average) experience significantly faster cognitive decline compared with their similarly active peers who average between six and eight hours of sleep per night.

The impact of insufficient sleep was especially noticeable among individuals in their 50s and 60s, while short sleep seemed to have a lesser effect on active older adults.

The takeaway message from the study suggests that in order to get the full benefit of regular physical activity, consistently getting enough quality, uninterrupted, and restorative sleep is necessary.

“Sleep deprivation directly impairs the activity of the parts of the brain that are associated with cognitive tasks such as executive functioning, thereby causing cognitive dysfunction,” explains Massachusetts General Hospital psychiatrist Amit Chopra, MBBS. “Sleep deprivation can also affect learning and memory processes such as the formation of a new memory or the recall of stored memories, thus leading to memory problems.”

Sleep Can Mitigate Stress

In the second study, published in the journal Cortex, researchers found that a person’s ability to handle prolonged stress can be strengthened by getting quality sleep on a consistent basis. The benefits of good sleep were further bolstered by healthy coping strategies, such as reframing how you think about stressful situations by identifying positive elements or opportunities within those circumstances. The researchers further noted that because stress is a major risk factor for depression and anxiety, behaviors that help manage or lower stress may also help reduce the risk of certain mood disorders.

“Insomnia has been recognized as not only a symptom of depression and anxiety, but also a risk factor for the development of depression and anxiety disorders,” Dr. Chopra says. “Cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment of insomnia disorder, has been shown to not only improve depression/anxiety symptoms, but also significantly reduce the likelihood of developing depression.”

Are You Getting Enough Sleep?

The standard advice for sleep requirements is usually seven to nine hours a night, with the understanding that many adults may function well with six hours of sleep. Some studies have suggested that sleeping more than nine hours a night may be a sign of an underlying health problem, though it’s important to understand that optimal sleep requirements vary from person to person.

     “There is no absolute cut-off for total sleep time, and it may vary on an individual basis,” Dr. Chopra says. To know if your sleep habits are likely to be ideal, he suggests looking at certain parameters of sleep continuity, such as sleep onset latency, the time taken for transition to sleep from wakefulness during bedtime. That process should take less than 30 minutes.

Another helpful indicator is known as wakefulness after sleep onset. That’s the time spent awake during the night after an individual has fallen asleep. Ideally, you shouldn’t spend more than 30 minutes of wakefulness after falling asleep at bedtime. Similarly, a measure called sleep efficiency (percent of time asleep while in bed) should be more than 85 percent. “Other parameters, such as optimal deep sleep and dream sleep, are considered in determining the sleep quality and quantity on an individual basis,” Dr. Chopra says.

      He adds that behaviors such as lying in bed for more than 20 minutes if not able to sleep, sleeping beyond the desired wake-up time, and taking daytime naps can adversely affect the sleep quality and quantity in those with insomnia. “These behaviors can be changed to improve sleep,” Dr. Chopra says. “Additionally, increased physical activity and avoidance of caffeine and alcohol use can help improve sleep quality and quantity.”

If you feel that you are not getting enough good, restorative sleep on a regular basis, talk with your doctor. You may be advised to adjust your sleep hygiene habits, such as your sleep schedule. Going to bed and waking up at the same times help reinforce your circadian rhythms and promote better sleep. Your doctor or a sleep specialist may review your medication regimen and suggest changes if the time you take certain medications is interfering with your sleep. And alcohol, which promotes sleepiness, can actually interfere with restful sleep as the effects of alcohol wear off over night. Limiting or avoiding screen time (computer, television, phone, etc.) before bed may help, too.

You may also be advised to have a formal sleep study, which measures not only the time it takes to fall asleep and the time spent awake during the night, but also the time spent in various stages of sleep and whether conditions such as obstructive sleep apnea may be present.

Can You “Catch Up” on Sleep? When you’ve had a couple of poor sleep nights in a row, you may instinctively try to make up the difference by sleeping in or otherwise getting a few more hours of sleep as soon as possible. You may also be surprised about how much it takes to actually catch up on lost sleep. “Sleep debt due to sleep deprivation is cumulative, and it can add up quickly,” Dr. Chopra says. “Research shows that it can take up to four days to recover from one hour of lost sleep and up to nine days to completely eliminate sleep debt.” Even if you do make a deposit in your sleep bank, can you reverse the injury to your cognitive and mental health? Perhaps, but only if you are able to commit to getting enough sleep night in and night out. “Better quality and quantity of sleep may not fully restore optimal brain functioning,” Dr. Chopra says. “Maintaining consistent sleep patterns and timings while avoiding sleep deprivation on an ongoing basis is recommended to undo harm caused by insufficient sleep.”

The post Research Suggests Sleeping On It for Better Mood and Memory appeared first on University Health News.

According to the U.S. Department of Health and Human Services, about half of all American adults—117 million people—have one or more preventable chronic diseases. Seven of the 10 most common chronic diseases are favorably influenced by regular physical activity. Yet nearly 80% of adults are not meeting the key guidelines for both aerobic and muscle-strengthening activity, while only about half meet the key guidelines for aerobic physical activity. This lack of physical activity is linked to approximately $117 billion in annual health-care costs and about 10% of premature mortality.

The encouraging news is that nearly everyone, even people who have been sedentary for weeks or years, can improve their health with regular physical conditioning.

Test for Success

If you have recently recovered from a serious illness or injury, have been sedentary for a long time, or have concerns about exercise, it’s wise to talk with your doctor. Once you’ve been cleared for exercise, it’s important to establish your current level of fitness.

“You need to get a good baseline measure to understand your starting point because you can’t improve what you don’t measure,” says occupational therapist Genevieve Kras, OTR/L UCLA Medical Center. “By setting goals, you are setting measures for yourself in a realistic, tangible way. It makes your progress more obvious, prevents complacency, and brings more self-awareness.”

A personal trainer or a physical or occupational therapist can help you benchmark your current state of fitness and create a custom exercise plan. You also can establish some benchmarks with the following two simple tests detailed below. Record the results of the tests before you start your exercise plan, and then do so again four to six weeks later to see your progress. To gain full health benefits from exercise, include aerobic, flexibility, balance/stability, and strength-training exercises in your weekly routine.

30-Second-Sit-to-Stand Chair Test. This assesses lower body strength and endurance and provides a range of scores according to age and sex (see the box on page 5).

Elbow Plank/Core Strength Test. This measures muscular endurance and core strength and stability. Using a mat, position your elbows on the floor, with your shoulders directly over your elbows. Hold your body in a straight line from your ankles to your shoulders, with your neck neutral. Your hips should not hike or sag.

Understanding Aerobic Intensity

How do you know if you’re working hard enough? A simple method is the talk-sing test. As a rule of thumb, a person doing moderate-intensity aerobic activity can talk, but not sing, during the activity. A person doing vigorous-intensity activity cannot say more than a few words without pausing for a breath.

Fitness trackers and heart rate monitors are quite practical because they automatically record how hard and how long you’ve exercised. You also can monitor exercise intensity in real time. “Because these devices measure how hard you are working during a workout, it can teach you how to pace yourself,” says Kras. “If you’re not working hard enough, you can add a little bit more intensity. If you’re overdoing it, you need to scale back. Many heart rate monitors can also display the calories burned during a workout.”

After just a few weeks of regular activity, most people will be able to exercise a bit longer and harder, and that data will be stored on the device’s history. It’s rewarding and inspiring to see the difference just a few weeks can make.

How Much and How Long?

According to the Physical Activity Guidelines for Americans, adults (including people with chronic conditions or disabilities who are able) should do at least 150 to 300 minutes  a week of moderate-intensity exercise, or 75 to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.

Don’t Overthink It

While those recommendations are valuable, don’t overthink it when starting out. Instead, just set a goal of walking every day for 30 minutes. After a week or two, increase your distance and/or duration. If you’re getting back to strength training, start with light weights and then gradually add more. The rule of thumb is you want to be able to lift the weight eight to 10 times, and the last rep should be quite difficult. Once it becomes easy, it’s time to increase the weight. All of this should be done with correct form. If you don’t know what that is, educate yourself by hiring a personal trainer or checking out training videos online. A good place to start is with the National Institute on Aging Fit for Life video training series available on YouTube (https://tinyurl.com/NIAFitForLife). A fun starter video is with instructor William Yates (https://tinyurl.com/NIAYates), who offers a complete strength-training class.

Commit to Fitness

Scheduling exercise in your daily planner can help you keep your commitment to fitness. However, your plan should be attainable and reasonable. If it’s too far-fetched, it can be discouraging, frustrating, and possibly injurious. “Someone can be chasing a far-fetched goal for weeks, months only to be let down, left feeling unmotivated, having self-doubt, and contemplating quitting altogether,” cautions Kras. “An extreme goal can also make someone feel impatient with their progress and approaching their goals in an unsafe way, thinking heavier and faster means it’s better and can lead to injury, which would only hold them back from reaching their goals. Instead, set small goals and add along the way.”

Group classes can be quite motivating and a great place to meet other people who value the benefits of regular exercise. The added bonus is the friendships that develop. There is some truth to the adage: Tell me who your friends are, and I’ll tell you who you are. Studies show that people who have exercise buddies are more likely to exercise more often and more intensely. If you don’t have such a friend right now, you will likely find one at group exercise classes.

Preventing Injuries

Choosing the right workout for your needs or physical limitations and learning the proper technique for performing each exercise can keep you from hurting yourself. Vary your workouts so you aren’t stressing the same muscle groups. The main risk is that your muscles may be sore in the first few weeks of starting an exercise program. Although you likely won’t be able to avoid this, and it’s important to challenge yourself, one of the best ways to reduce muscle soreness is to gradually progress in your exercise program rather than trying to do too much at the start. Muscle soreness generally resolves within a few days.

Warming up and cooling down  help prevent injury. Warming up before exercise helps provide a safe transition to moving your body and cooling down at the end of a session supports your body’s recovery after you finish your workout.

Get Moving

While a mix of aerobic and strength-training exercise is ideal—and mind-body and power training are valuable—any activity is better than none. Remember that the benefits of exercise begin to accrue after just one session. According to the Physical Activity Guidelines for Americans Advisory Committee, just one bout of moderate-to-vigorous physical activity will reduce blood pressure, boost insulin sensitivity, enhance sleep, reduce anxiety symptoms, and perk up cognition on the day that it is performed.

Regular activity makes these improvements more profound. The reduction in disease risk and improved physical function can be seen within days to weeks after adopting a new physical activity routine.

The post Rebuilding Your Exercise Routine appeared first on University Health News.

The post Acts of Kindness Help Relieve Depression appeared first on University Health News.

Understanding those aspects as part of the statistical reality starts to explain why reported rates of anxiety are higher in women. Then there are physiological differences in how men and women might experience stress—a triggering element in anxiety disorders. Genetics and neuroanatomical features also differ between men and women, and these sex differences influence emotional responses, says UCLA psychiatrist Misty Richards, MD, MS.

“Specifically, there are significant sex differences in the brain regions relevant to emotions. For example, where and how fear is regulated in the amygdala, hippocampus, and the prefrontal cortex differs between the sexes,” Dr. Richards explains. “Simply put, various stimuli and exposures impact these brain regions differently in men and women.

Women are exposed to far more hormonal changes than men, with major fluctuations in estrogen and progesterone during menstrual, perinatal, and menopausal cycles. Physiologically, women are inherently more vulnerable to these fluctuations, and the rapid change in hormone level is thought to be the catalyst to anxiety diagnoses.”

The Role of Serotonin

Serotonin is a neurotransmitter that also acts as a hormone. As a neurotransmitter, it performs as a messenger to transmit signals within the brain. Women are much more likely than men to suffer from serotonin deficiency. Low serotonin levels can trigger panic attacks, depression, and other signs of anxiety in women. There is also some evidence that female hormones interact with serotonin to cause anxiety symptoms to occur or worsen during the premenstrual time, the postpartum period, and around the time of menopause. In contrast, men tend to have a steady level of sex hormones until middle age, when the decline is gradual.

Unreasonable Societal Pressures

Dr. Richards points out that the societal pressures on women to navigate the hormonal perturbations and transitions of life flawlessly are unreasonable. From the onset of menses to motherhood to menopause, each one of these transitions offers a shift in identity that carries profound meaning. “It is important to normalize anxiety as a healthy response to change. I would be more concerned if a woman did not feel some level of anxiety with ‘changes of life,’” she says. “Having said that, an anxious response can quickly become unhealthy when it no longer guides decision-making, but instead interferes with it. If you find yourself in this position, realize that you are not alone and that there are multiple highly effective treatments for pathological anxiety.”

What Is Pathological Anxiety?

Anxiety can be a normal emotional reaction to a stressful situation. You may feel anxious, for example, when you’re about to speak in front of a crowd or wait in an exam room for a medical diagnosis. Many people may be uncomfortable in these situations, but they can tolerate, manage, and overcome their anxious feelings. Other people, however, can experience anxiety in an abnormal (or pathological) way. For example, some people can become hypervigilant, meaning they are constantly on guard, expecting dangerous and negative outcomes. Their worries can become irrational, even crippling, preventing them from seeking medical care, attending social events, or leaving the house. At this point, anxiety has crossed into the realm of an anxiety disorder.

The Diagnostic and Statistical Manual of Mental Disorders classifies several distinct types of anxiety disorders. Among the most common are generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. In older adults, GAD is frequently associated with traumatic events such as a fall or an acute illness. The trauma of experiencing these events may create inhibitions, such as becoming fearful of physical activity after a fall. GAD also can cross into many life domains. While most people occasionally worry about health, money, or marital problems, people with GAD persistently have a heavy sense of dread that interferes with daily life. Symptoms of GAD include feeling restless, wound up, or on edge, having difficulty concentrating, being irritable, taking frequent trips to the bathroom, experiencing sleep problems, and having headaches, muscle aches, stomachaches, or unexplained pains.

People with panic disorder have frequent, sudden, and intense feelings of fear, doom, and losing control even when there is no present danger or threat. These attacks can appear out of the blue, and the individual can experience physical symptoms that mimic a heart attack (e.g., chest pain or rapid heart rate). Making matters worse, people with panic disorder worry about the possibility of having another attack and therefore may significantly change their life situations to avoid having another attack. For example, they may forgo travel and public gatherings. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.

Social anxiety disorder is hallmarked by feeling extremely self-conscious and fearful of being judged by others. Some experts suggest that what is referred to as shyness in childhood may actually be social anxiety disorder. People with this disorder can become overwhelmed with anxiety when meeting and talking with people, especially in unfamiliar situations. While they may be able to accomplish some of these activities, they experience a great degree of discomfort and they fear that people will judge them negatively. Blushing, sweating, difficulty making eye contact, having a rigid body posture, or speaking with an overly soft voice are characteristic symptoms of social anxiety disorder.

Anxiety Disorders and Health

Those who suffer from anxiety disorders experience a greater risk of developing numerous health conditions with severe symptoms, including heart disease and gastrointestinal disorders such as irritable bowel syndrome. Numerous studies have found a link between anxiety and increased risk of cardiovascular diseases. One such study reported in the Journal of the American College of Cardiology examined Vietnam-era veterans and found that those who suffered from PTSD (a type of anxiety disorder) were more than twice as likely to suffer from coronary heart disease than those who didn’t have the disorder. Anxiety also can escalate or lead to substance use disorders, social isolation, and risk of suicide.

Fortunately, there are treatments available. While medication is sometimes necessary to treat anxiety disorders, research shows that psychological therapy can be quite effective. Therapists help people understand their condition and teach positive and effective ways to cope with and manage anxiety. Through various methods such as cognitive behavior therapy, people can learn to understand and change thoughts that worsen their symptoms, and develop the fortitude to face an anxiety-inducing place or situation.

Though some anxiety is normal, if it is persistent, overwhelming, and depletes your quality of life, seek care. With help from a mental health professional, many people learn positive coping strategies and therefore can experience a more joyful, higher quality of life.

The post Why More Women Are Diagnosed with Anxiety appeared first on University Health News.

The findings may be especially timely given the recommendation issued last fall by the U.S. Preventive Services Task Force that adults should be screened for anxiety disorders. Amanda Baker, PhD, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and one of the JAMA study’s co-authors, suggests that while MBSR may not be the right choice for everyone, it’s a welcome addition to the tools available to therapists and people struggling with anxiety. “There are many reasons why some treatments will be better suited for some people than others, including treatment availability, cost, and personal preference,” she explains. “Our study provides the important evidence supporting MBSR as another helpful treatment option for anxiety.”

How Does MBSR Work?

Mindfulness is essentially the opposite of multitasking and of doing one thing while thinking about another. There is no rushing with mindfulness. Instead, mindfulness is about deliberately and intentionally paying attention to the present moment and doing so without judgment. “Mindfulness approaches teach us to learn to be aware of current thoughts, feelings, and sensations as passing events of the mind and body, rather than absolute truths of reality,” Dr. Baker says.

MBSR is typically taught in an eight-week program that instructs participants on how to use mindfulness in daily life. The program features weekly 2.5-hour classes and daily 45-minute “homework” assignments, as well as a daylong retreat.

The primary focus of MBSR is mindfulness meditation, while other parts of the program include practices such as simple yoga poses, body awareness, and an exploration of an individual’s patterns of behavior, thoughts, and feelings. One of MBSR’s main goals is to teach people to be aware of their negative and anxious thoughts, and equip them with strategies and tools to deal with anxious thoughts and stressful situations in healthy, constructive ways.

“MBSR promotes greater acceptance of what we cannot control, which helps us to avoid getting absorbed in the content of a negative, anxious thought as well as helps us to engage in the behaviors we would want to engage in if we otherwise weren’t feeling anxious,” Dr. Baker says. “This is opposed to anxiety-driven behaviors, such as avoidance, for example. This process improves emotion regulation, and individuals become less reactive to thoughts and sensations. In addition, mindfulness is practiced with a nonjudgmental, accepting attitude, which over time correlates with increased self-acceptance and self-compassion.”

Dr. Baker also notes that there have yet to be studies exploring whether more or less training can be as effective as the standard eight-week MBSR training program. However, “we do see a correlation between practice and progress,” she adds.

Moving Forward

You can learn mindfulness in a variety of settings. Many colleges and meditation centers offer mindfulness training programs. You can also find training programs online and with smartphone and computer apps. There hasn’t been much research comparing the effectiveness of online training with in-person classes, but getting an introduction at least through an app is one way to learn more about mindfulness and how it might help you.

Dr. Baker suggests that having more mindfulness trainers and training opportunities for interested parties would be ideal, as would having increased health insurance coverage for MBSR and further comparative research on the subject. “We also need studies of which treatment will work best for whom, so we can better personalize our empirically supported treatment recommendations,” she says.

While this study suggests that MBSR can be as effective as escitalopram, it’s important to understand that for some people, medications and talk therapy may still be the best ways to get a handle on their anxiety. If your anxiety is significantly interfering with your everyday life, then you may not have the time to complete an eight-week course. But if anxiety is still something that is manageable, but is becoming an increasingly difficult challenge, then consider looking out for an MBSR program near you or online and learn how to turn negative thoughts and feelings into ones that will serve you better moving forward.

The post Mindfulness-Based Stress Reduction May Be
an Answer for Pill-Free Anxiety Treatment appeared first on University Health News.

The USPSTF acknowledged that the expanded focus on mental health in recent years, as well as the uptick in people seeking treatment for anxiety and depression associated with the COVID-19 pandemic, were the catalysts for the recommendation.

But what about adults ages 65 and older? While it’s difficult to get reliable estimates for the prevalence of anxiety in this population, many experts suggest that about one in 10 older adults may have anxiety.

“There is a wide variability in prevalence estimates for anxiety disorders, based on a number of factors including the specific disorder, age cohort, and community versus clinical sample,” explains Rachel Ishikawa, PhD, a psychologist with Massachusetts General Hospital’s Center for Anxiety and Traumatic Stress Disorders. “In community samples, prevalence of individual disorders ranges within the 1 to 5 percent range. Taken together, that translates into a 15 to 20 percent prevalence for all anxiety disorders.”

She adds that the prevalence of anxiety among people ages 60 to 75 is greater than that among individuals older than 75.

Dr. Ishikawa also notes that the prevalence of subclinical anxiety—a condition that doesn’t meet the diagnostic criteria for anxiety, even with the presence of mild or brief but recurrent symptoms—is also likely to be underestimated.

Screening Older Adults

The goals of screening are to both identify people with anxiety and encourage them to seek treatment if appropriate. “Anxiety left untreated can have serious consequences for older adults’ physical as well as mental health, including isolation, physical inactivity and deconditioning, avoidance of health-care visits, among other concerns,” Dr. Ishikawa says. “Screening for late-onset anxiety is especially important because it is a risk factor for dementia.”

However, she adds that screening everyone presents a logistical challenge given the shortage of mental health providers. “It will be a considerable challenge to connect all positively screened individuals to treatment, and to make sure this is done in a way that does not perpetuate mental health utilization inequities,” Dr. Ishikawa says.

Anxiety as We Age

The nature of anxiety is, in some ways, age specific. Dr. Ishikawa says that some anxiety symptoms, such as arousal of the autonomic nervous system (increased heart and respiration rates, for example), muscle tension, and irritability tend to decrease with age. Other symptoms, such as worry and fatigue, often increase with age, while concentration and sleep impairment remain stable across age groups.

“In terms of disorders, the most common anxiety disorder among older adults is specific phobia, with fear of falling being the most common phobia,” Dr. Ishikawa says. “As people age, the source of anxiety changes as well. As concerns about career, parenting, or life direction typically resolve by later life, other concerns such as health problems, financial security, safe housing, mobility impairment, and mortality may provoke more anxiety.”

Getting Help

Reducing your anxiety levels can sometimes be accomplished with self-generated solutions, such as increasing your supportive social interactions. Regular exercise, even if it’s limited to moving more around your home, can help. Stress management, through better sleep and strategies such as meditation and tai chi, also may provide benefits.

Dr. Ishikawa adds that maintaining your functional abilities as much as possible is also important, as the prospect of reduced functioning and loss of independence can increase anxiety significantly in older adults.

“If you notice you’re avoiding things that make you anxious, focus on confronting the avoidance by doing ‘opposite action,’ such as engaging in the feared activity rather than avoiding it,” Dr. Ishikawa recommends. “This can interrupt the cycle of anxiety. If you are still struggling, speak with your primary care doctor about treatment options.”

She notes that certain medications, including many of the short-acting anxiolytics, such as benzodiazepines, carry risks for older adults. “Psychotherapy, particularly cognitive behavioral therapy, is recommended as the first-line treatment for anxiety for older adults,” Dr. Ishikawa says.

Your doctor may be able to recommend a therapist or mental health practice in your community. Finding someone who specializes in treating older adults may be especially beneficial.

The post Should You Be Screened for Anxiety? appeared first on University Health News.

This type of acute anxiety typically resolves quickly once the stressful situation has passed. This differs from chronic anxiety, which is persistent and can last for weeks, months, and even years. Chronic anxiety, which is experienced by one out of every three women in her lifetime, can be a truly debilitating disease. It can cause problems with work, sleep, relationships, daily activities—in short, it can affect every aspect of your life.

The tipoffs to anxiety that I see in my patients (and you may see in yourself or family members) are difficulty sleeping or relaxing, a general agitation or unease, gradual isolation from friends and family or activities that used to bring pleasure, or an inability to be satisfied or happy, even if no major crises have occurred in the person’s life.

I usually advise my patients to begin targeting their anxiety symptoms by doing a few simple things. Eliminate caffeine and alcohol; these interfere with good sleep and can contribute to feelings of nervousness. Exercise regularly. It’s especially important to do cardio exercise that increases your heart rate and keeps it elevated (at least 30 minutes, three days a week). Create and preserve a good sleep regimen. Keep your bedroom dark and quiet, and go to bed and get up at the same time every day. Spend several hours a day off electronic devices like your smartphone and computer; these tend to overstimulate our brains and contribute to anxiety.

If anxiety is interfering with work, family, and concentration, it is important to get professional help. Chronic anxiety is a medical condition; you can’t just “snap out of it,” and it’s not “all in your head.” Your doctor can refer you to a mental health professional—usually, a psychologist or psychiatrist—who has been trained in treating anxiety. Cognitive behavioral therapy and medication can be very effective at getting you back to living a normal, productive life.

The post Identifying and Managing Anxiety appeared first on University Health News.

Anxiety disorders are commonly treated with cognitive behavioral therapy and sometimes medications as well. But there are studies that suggest that anxiety symptoms can be reduced with exercise. A study published last year in the Journal of Affective Disorders reported that people who exercised were three times more likely to report fewer, less severe anxiety symptoms compared with those who did not exercise. This outcome was based on analyzing three groups of participants. One group did moderate exercise, one did strenuous exercise, and the control group received advice on physical activity based on public health guidelines. Both exercise groups had 60-minute training sessions three times a week which included aerobic activity and strength training. After 12 weeks, most participants in the exercise groups went from a baseline level of moderate to high anxiety to a low anxiety level after the exercise program. More strenuous exercisers reported greater relief than the moderate group. If you’re unclear on the difference between strenuous and moderate exercise, consult with a personal trainer or physical therapist who can design a program for you and help track your progress. Because stress can make a person feel anxious, activities that invite calm can also help. Listening to calming music, taking a casual stroll in nature, and practicing deep breathing exercises can help quell anxious feelings. It’s also important to distinguish between occasional anxiety and an anxiety disorder. Many people feel a little anxious before giving a speech, for example, or even talking with other people through Zoom calls. Anxiety disorders are more than temporary worry or occasional nervousness. The pandemic certainly has had a lot of people on the edge but not everyone has a disorder per se. For people with an anxiety disorder, the anxiety doesn’t go away and can get worse through time. The symptoms include feeling restless, being easily fatigued, being irritable, having difficulty concentrating, having muscle tension and sleep problems. These symptoms can disrupt relationships, jobs, and quality of life. These symptoms also can be triggered by other health issues as well. If you frequently experience anxiety, discuss your symptoms with your physician or a mental health professional. It’s also wise to discuss your current medications with your physician.

I’ve heard that type 2 diabetes can increase the risk for cardiovascular disease. Why is that?

People with type 2 diabetes are twice as likely to have heart disease or a stroke compared with people without diabetes. That is because diabetes can lead to a cascade of events that increase cardiovascular disease risk. Type 2 diabetes occurs when the body can no longer make good use of the insulin the body provides, causing blood sugar (glucose) levels to rise. Most cells in the body use glucose as fuel, which comes from the foods we eat. Insulin, a hormone produced in the pancreas, enables cells to absorb glucose. When the cells stop responding to glucose, a condition called insulin resistance, blood glucose levels start to rise. High glucose levels can damage blood vessels and the nerves that control the heart. People with diabetes also are often at higher risk for other conditions that raise the risk for heart disease, such as high blood pressure, high LDL “bad” cholesterol, not enough HDL “good” cholesterol, and high triglycerides, a type of fat found in the blood. Studies show that lifestyle habits that help reduce risk for diabetes, or keep it from getting worse, are the same ones that are beneficial for your heart. These lifestyle recommendations include following a heart-healthy diet rich in colorful fruits and vegetables, lean protein, and whole grains, avoiding highly processed, sugary, and salty foods, losing weight if you’re overweight, and being physically active. Exercise makes the body more sensitive to insulin, which helps manage diabetes, and physical activity also lowers the risk of heart disease. 

The post Ask The Doctor: May 2022 appeared first on University Health News.

“It is very common for people with depression to also have an anxiety disorder, and vice versa,” explains David Mischoulon, MD, PhD, director of the Depression Clinical and Research Program at Massachusetts General Hospital. “Research suggests that 50 to 60 percent of individuals with major depression may also meet criteria for a comorbid anxiety disorder. Likewise, most individuals with diagnosed anxiety disorders also meet criteria for major depression, although comorbidity rates may vary widely across the different anxiety disorders.”

Anxiety disorders that more often coexist with depression may include generalized anxiety disorder (GAD), specific phobias, social phobia, agoraphobia, and panic disorder. Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are no longer classified as anxiety-related disorders per se, and are in their own categories. But Dr. Mischoulon adds that OCD symptoms are commonly seen in individuals with depression. And people with PTSD often present as depressed and/or generally anxious.

Intersection of Symptoms

Though depression and anxiety can be present at the same time, the same treatment plan can often help with both conditions. Working with an experienced mental health professional and having the support of family members can make all the difference.
© shapecharge | Getty Images

It’s not hard to see how anxiety and worry can feed into depression and how someone with depression may develop anxiety symptoms, too. “Psychologically speaking, a person with depression tends to view the world through very gloomy eyes, often envisioning worst-case scenarios for everything, and this can, in turn, produce anxiety,” Dr. Mischoulon says. “Conversely, individuals with anxiety who spend significant amounts of time worrying about bad things that may happen may eventually become depressed as a result of the stress of worrying so much.”

Anxiety-Depression Connection

Anxiety and depression probably have similar genetic and biological underpinnings, Dr. Mischoulon says. For example, selective serotonin reuptake inhibitor (SSRI) antidepressants have been shown in many studies to be effective not only for depression but also for various anxiety disorders as well as OCD and PTSD. SSRIs work by boosting levels of the neurotransmitter serotonin—a chemical messenger in the brain involved with mood, reward, and other functions.

“This suggests that mechanisms of these illnesses involve predominantly serotonergic pathways in the brain,” Dr. Mischoulon explains. “From a clinical standpoint, symptoms may also overlap. For example, patients with depression will often express feelings of hopelessness and thoughts that things will never get better for them or will turn out poorly. This is also seen in individuals with anxiety. Other symptoms, such as depressed mood, poor motivation, insomnia, appetite disturbances, irritability, fatigue, difficulty with concentration, fidgetiness or agitation, as well as suicidal thoughts or attempts, are seen in both depression and in the anxiety disorders.”

When trying to make a diagnosis, clinicians will often focus on a person’s “chief complaint,” while also reviewing symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard classification of conditions used by mental health professionals in the United States.

“Given this overlap of symptoms between the two disorders, proper diagnosis can be complicated,” Dr. Mischoulon says. “The patient may meet criteria for both conditions, based on diagnostic criteria. Or they may meet criteria for one of those conditions and have symptoms of the other. The DSM has a provision that allows for a determination of anxiety secondary to depression, meaning that the patient meets criteria for major depressive disorder and has significant anxiety symptoms that are thought to be driven by the depression as opposed to being an independent entity. Making the right diagnosis is important, because it will help determine the ­optimal treatment approach.”

Coping and Treatment

Someone dealing with depressive and anxious symptoms at the same time can be more difficult to treat, because both conditions can exacerbate each other. “Consequently, the clinician needs to be mindful of targeting both sets of symptoms simultaneously in order to optimize treatment,” Dr. ­Mischoulon says.

As challenging as it is to live with both conditions, it’s important to keep in mind that effective treatments for one disorder can often help ease symptoms of the other. “SSRIs are considered a first-line treatment for both depression and anxiety,” Dr. Mischoulon says. “This is often where a psychiatrist may begin with the patient who is experiencing symptoms in both areas. When things turn out well, one medication could manage all the symptoms effectively.”

There is also strong evidence that cognitive behavioral therapy (CBT) is effective for both depression and anxiety. CBT is a form of psychotherapy aimed at helping individuals identify unrealistic or unhelpful thoughts and replace them with realistic thoughts that will eventually ease their symptoms.

“CBT may, in some cases, be used as an alternative to antidepressants, though the evidence suggests that the optimal treatment may be a combination of medication plus CBT targeting specific symptoms,” Dr. Mischoulon says. “There is growing evidence that other modalities such as mindfulness meditation can be helpful with these conditions, either by itself or in combination with antidepressants. In some more severe cases, antidepressants alone may not help with the anxiety portion of the illness, in which case anxiolytic drugs such as buspirone or benzodiazepine sedatives may be necessary to add to the regimen. Individuals who have difficulty tolerating benzodiazepines, or who have to avoid them due to past histories of substance use disorders, can also be treated with some of the newer antipsychotic medications, which can also be effective for anxiety. Antipsychotics should be used cautiously, however, because they can carry some significant side effects.”

Takeaway

If you are struggling with depression or anxiety, get treatment, starting with an evaluation by a qualified mental health clinician such as a psychiatrist or psychologist, Dr. Mischoulon says. “These professionals can recommend an effective course of treatment,” he adds. “I want to emphasize that these conditions are highly treatable, and there is no need for a person to suffer needlessly because of them. With adequate treatment, people can experience tremendous improvement in their symptoms and in their overall quality of life.”

The post When Anxiety and Depression Occur Together Your Treatment Options May Be Similar appeared first on University Health News.