A weekly podcast on the latest medical, science and telehealth news.
Depression is one of the most common and most debilitating mental health disorders, affecting some 17 million adults in the US. It also continues to be a misunderstood, often hard-to-treat illness. Researchers have worked for decades to better understand the neurobiology underpinning depression.
For patients with severe, treatment-resistant depression, spending months or even years searching for good treatments can be totally disabling. The prevailing hypothesis for years was that depression was regulated by the neurotransmitter’s serotonin and norepinephrine.
Eventually, data began to suggest that maybe something much larger and more global was involved in the brain to account for depression, which led researchers to begin working with glutamate and GABA, the most abundant neurotransmitters in the brain. These chemicals are involved in neuroplasticity – the brain’s ability to adapt to change and protect itself against stressful events.
Neuroplasticity is a physical thing, too: it manifests itself “in terms of synapses, how these neurons are actually touching each other and communicating with each other,” explains Gerard Sanacora, PhD, MD, Director of the Yale Depression Research Program. “And we know that in depression, the number and strength of these interconnections decreases,” says Rachel Katz, MD, a professor of Clinical Psychiatry at Yale.
Ketamine – originally developed and still used as an anesthetic – works on those two neurotransmitters and was discovered to have rapid antidepressant effects. Some experience an improvement in symptoms in 24 hours or less. “We think that one of the things that Ketamine does, that helps to explain its antidepressant effects, is help the brain to regrow the synapses, the connections between nerve cells,” says John Krystal, MD, Chair of the Department of Psychiatry at Yale.
The risk of COVID-19 has been largely communicated only in terms of deaths and hospital capacity, with recovery and survival conflated with each other. Around one in three people with symptomatic COVID-19 still experience symptoms 12 weeks after onset (1). Long Covid can be experienced by all age groups and not only those with acute severe disease. The debilitating symptoms are wide-ranging, multisystemic, and predominantly fluctuating or relapsing. There is still much to understand about Long Covid, but what is not well understood should not be ignored.
Long Covid is likely the first illness in history that has been defined by patients through social media platforms such as Twitter and Facebook. People with Long Covid formed a movement that demanded recognition of what was happening to them. During the first wave of the pandemic in 2020, online testimonials of prolonged symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were the only source of reassurance to others with a similar experience, including this author (2). In the absence of any guidance or recognition about the possibility of a persistent illness, peer support is all that people with Long Covid had. Many previously healthy and active people described persistent symptoms of the acute illness that fluctuated, with new symptoms appearing weeks later. In many countries, most nonhospitalized people did not have lab confirmation of SARS-CoV-2 infection owing to lack of access to community testing, so their symptoms remained without a diagnosis.
By summer 2020, thousands were joining social media support groups. A common theme started to emerge: lack of recognition by the medical profession. Patients, including doctors, with Long Covid were consulting their health care providers, and their symptoms were commonly minimized, dismissed, or labeled as anxiety (3). A narrative emerged of people struggling to make sense of their symptoms and forming their own groups to understand and research what was happening to them in an international citizen science movement (4). The testimonials of people living with Long Covid demonstrated themes of stigma and discrimination.
Mayo Clinic researchers recently published a study that shows the proper use of masks reduces the spread of respiratory droplets. The findings strongly support the protective value and effectiveness of widespread mask use and maintaining physical distance in reducing the spread of COVID-19. Reporter Jason Howland has more in this Mayo Clinic Minute.
Pneumocystis is found in the respiratory tract of most mammals and Man. Pneumonia from this organism was extremely rare or unknown before the advent of AIDS.
When the lymphocyte count of a person with AIDS drops below 500, or especially 200, pneumocystis pneumonia is a frequent complication. Symptoms include cough, fever, rapid breathing, and shortness of breath.. The chest x-ray typically shows a “ground glass” appearance, caused by fluid inside the air sacs and throughout the lung. Treatment is usually with trimethoprim sulfa.
Immunosuppressive therapy is often given for organ transplants and auto immune diseases these days. Patients and doctors should be on the lookout for pneumocystis symptoms in this situation. Even long-term corticosteroids can produce enough immunosuppression to allow pneumocystis to invade the body.
Pneumocystis Jeroveci is the causative organism, and used to be called pneumocystis Carini. Doctors suspect this disease when an immuno-suppressed patient, especially AIDS , has a dry cough, with pneumonia and a very low oxygen concentration, more severe than expected. Fluid taken from the lung shows several organisms in little sacks or cysts.
Treatment is with sulfonamids, if they are tolerated. Cortisone must be given not the same time to prevent a severe reaction from absorption of the dead organisms. Pneumocystis is a yeast-like fungus and is also discussed under opportunistic fungal infections.
The following article will give you more information.
COVID-19 is admittedly a pandemic and has caused much economic and social disruption in the world. Now we learn that it may not be over after a few of weeks of illness. LONG COVID is now an accepted syndrome.
You can tell because of the many clinics for handling it being set up by the NHS in England, and millions in research money being directed towards a solution.
The most disturbing thing to me is that infected but asymptomatic or mildly ill people may get this condition, and have one or more symptoms for a long time .Certainly, those more seriously ill develop long Covid symptoms more commonly.
Long Covid is taking its place with chronic fatigue syndrome, posttraumatic stress disorder and post ICU syndrome as poorly understood conditions. They may in fact be taking place simultaneously, even if they are not identical.
The cause can be due to continuing viral infection in older or immune compromised individuals. Vascular damage is another reason that could account for the widespread involvement of practically any organ system that doesn’t go away after a few weeks.
Structural damage to the alveoli of the lungs and other organs can also play a role, which would account for shortness of breath as a prominent persistent symptom. Although it has not been highlighted in the articles that I have read, auto immunity can also be playing a role in long Covid.
This would go along with The myocarditis rarely caused by the mRNA vaccines; perhaps some of the protein sequences of the spike proteins have similar shapes to some human tissues. Name a symptom, and you’ll probably find it listed among the 50 odd symptoms mentioned in the Wikipedia article on long Covid, which is appended to the end of this article.
The most prominent symptoms include extreme fatigue, mental fog, and shortness of breath. Treatment is mainly supportive and general. After ruminating on this condition, it’s going to be quite a while before Yours truly wants to breathe in other peoples air spaces; I plan to continue masking in public, distancing and avoiding large groups.
That being said, I am planning to go out to eat dinner tonight, and can hopefully be placed at the edge of the room. I will inquire as to the vaccination status of our waiter. The people at my table will all be doubly vaccinated, which is not complete assurance of safety, but will help make me feel relatively comfortable.
I also plan on getting a booster shot as soon as it is available. Hopefully, the vaccine incorporating the special mutations of the delta virus will be soon available. You don’t want to be infected by this nasty, promethian shape-shifter. Take care.
A weekly podcast on the latest medical, science and telehealth news.
Syphilis is a venereal disease, or STD, that is unusual, unique in many ways. First of all, it is one of the few major diseases to have originated in the Americas, the New World, and carried back to Europe most likely by Columbus; Popularized by “guns germs and steel”, the infectious disease traffic was almost all the other way, most famously smallpox which decimated the Native Americans.
A second unusual characteristic is that it’s treatment(penicillin) is known, cheap, easy, and yet Syphillis infects millions of people yearly, most commonly to be sure in the developing world, but also large numbers in America where is helped by AIDS, and spread by men having sex with men.
A third unusual characteristic is that syphilis can mimic practically any disease. There are three stages. The first stage is a painless ulcer, usually on the genitals. After a few weeks, the second stage develops, showing a widespread rash and other symptoms. After a few more months, problems develop in the heart, brain, or growths ( gummas) in many other areas .
When I was in medical school we used to go to an old peoples home to listen for aortic regurgitation, and observe the neurologic symptoms of syphilis patients. Syphilis is still a cause of aortic insufficiency, if untreated.
Treponema pallidum, The causative agent, is also unusual. It has a very small geome, and has many missing cellular mechanisms, making it dependent upon Homo sapiens, it’s only known Reservoir. The fragile but very active organism will die in a few hours outside of its human host. Like it’s confederate,AIDS, The infection can easily spread from mother to child with devastating consequences. It is one of the major diseases for which pregnant mothers are tested.
Syphilis is one of the best arguments for being monogamous. If this can’t be, remember that syphilis is easily treatable, and that you should report any unusual illnesses to your doctor.
Although growing older comes with a number of major life changes, science can help inform the things we do in the here in and now to forestall the most serious features of the aging self, promoting healthspan and not just lifespan.
- Build Muscle – Muscle mass is one the best predictors of health and longevity. Muscle tissue is known to release its own chemicals called myokines, which can have benefits that span cognition, immunity and anti-cancer activity. By performing regular, resistance-based exercise that prioritizes strength, we can delay the loss of bone density and risk of physical injuries.
- Vitamin D – Commonly known as the sunshine vitamin, vitamin D is in fact a critical hormone that helps maintain healthy bones, boost our immune system and improve our cardiovascular function. With age, the production of vitamin D in the skin can become less efficient, so if we don’t spend enough time outdoors, our risk of vitamin D deficiency may increase.
- Neurodegenerative Diseases – One of the most unsettling aspects of aging is the potential for neurodegenerative disease. These conditions are increasingly prevalent in those with diabetes, suggesting that the brain’s blood flow and energy supply may be compromised. Research indicates that regular physical exercise, a healthy whole foods diet and staying intellectually active could at least slow the rate of decline.
- Mindfulness – As we get older, major arteries can become thicker and less flexible, leading to increased blood pressure and undue strain on the heart. A regular mindfulness practice such as yoga or meditation has been shown to stem the release of stress hormones like cortisol and adrenaline. By freeing us from this “fight-or-flight” state, this habit can improve blood flow and reduce the risk of heart attack and stroke.
- Stay Social – As social animals, maintaining a strong sense of community and close personal relationships into old age are underestimated contributors to longevity. While social isolation in seniors can result in significant physical and mental decline, research suggests that close loved ones offer important emotional support and behavioral modifications that can overcome periods of high stress.
- Metabolism – “My metabolism is slowing down!” That’s what we often hear, as the aging body becomes less effective at using energy, placing us at risk of obesity and type 2 diabetes. By maintaining our muscle mass and reducing sugar consumption, we can support hormonal health, preserve our metabolism and keep our vitality into those advanced years. As scientists continue to find ways to extend our lives, paying attention to these keys to healthy aging can help increase the quality of those extra years.