In the good old days when Freud was king, we had “psychosomatic” illnesses, saying the illness was “all in your head” i.e. imaginary. Naturally, patients resented the implication they were either making up the illness or causing it by their negative thoughts.

Usually what I told my patient was that their heads were attached to their body, and that just like an illness could affect the head, so could stress and worries affect their body.

Now a couple studies show that this 2000 year observation is true.

The first shows loneliness increases Alzheimer’s disease, but did not increase brain changes of Alzheimer’s.

I’m always leery of these studies, since people with low IQ’s or people from different cultures tend to test higher on the Alzheimer tests for “cognition”.  For example, one of the tests is to draw a clock: but if you are a traditional Chippewa or Navajo, where time is not clock oriented, you might not do as well as an obsessive perfectionistic New Yorker who is always on time.

And of course when you live alone, you don’t receive mental stimulation, and we know that stimulating the brain keeps you smart.
But now they found…”Neither AD pathology nor cerebral infarction could account for the association, suggesting that novel neurobiologic mechanisms may be involved.”
Translation: If you don’t use it you lose it.

Then we have: Depressed women more prone to metabolic syndrome. This can be translated three ways: Fat women get depressed because they are fat, depressed women eat too much and get fat, or Diabetics  have a high rate of clinical depression, so those prone to diabetes also have a high rate of clinical depression.

“Women who reported feeling frequently and intensely angry, tense, or stressed at baseline also had an increased risk of developing metabolic syndrome.” Well, duh. Eating when stressed helps calm people down.

When docs talk about depression, they mean the blahs: can’t sleep, feel tired all the time, things seem just too much to cope with,  and they get angry and snap at those around them. In more severe depression, you feel worthless, everything looks bleak, and all you want to do is crawl into bed hide, or even kill yourself so you can get away from the bad feeling.

Depression is biochemical, but like any other illness can be brought on by physical, psycholgical, genetic and social stresses.

However, when I read depression is associated with metabolic syndrome, the question is whether the genetic syndromes are related or if depressed people just eat more and get fat, which is metabolic syndrome.

Diabetics have a high rate of depression, and poor blood sugar control increases depression. Where is the link? Or does one cause the other?

And then there is this: Does exercize help depression by reversing metabolic syndrome, or merely by increasing wellness and seratonin levels in the brain?
Again a strong mind body link, but since the study is not statistically significant, it might not pan out.

Then there is this long study. It seems to say that when you are depressed, not only don’t some brain cells work well, but that they shrivel up. And Prozac might work partly by making them grow back, so maybe medicines that make the cells grow back but don’t overload you with seratonin will help depression without the jitteryness that gives Prozac a bad name.

I’m not sure what to make of it. The studies are early, and for those of us who learned that brain cells never regrow or replace themselves, it brings up all sorts of possibilities. Maybe in another five or ten years we’ll see more on the subject.

The last study is of hormone replacement therapy. For years we “knew” it prevented heart disease, and then a couple years ago, the news came we had to stop it for all women because it doubled the rate of heart disease.
Well, now this study says: wait a second. It depends on the age of the women.
If you give it to women at menopause, i.e. in their fifties, it probably decreases heart disease by keeping the blood vessel linings healthy, but as you get older the stickiness problem of estrogen is more important, so the risk gets higher.

Of course whether or not you should take estrogen depends on other risks, such as high blood pressure, diabetes, obesity, etc. and the long term risk of cancer.
On the other hand, taking hormones helps keep you bones young (decreases osteoporosis) and keeps your tushie healthy (prevents atrophic vaginitis).

So what do you do?
Depends. If menopause has made you the woman from hell who has to change clothes three times a day thanks to hot flashes, take the hormones. Your husband and children will thank you for it. Did I mention that giving estrogen to depressed women going through menopause works as good as giving them prozac?
Again, a mind body connection.
But when you hit 55-60, it might be time to stop.

The BBC has some nice links on coping and mental stress…essentially saying take time and smell the roses.

The final science news is that Peter Rabbit’s mommy was….a botanist.
Beatrice Potter, who now has a movie made about her struggles in life, was also a farmer and did studies on fungi. Her scientific paper was accepted but she never got around to rewriting it, so it was never pubished. But she did manage to finish her children’s books, to the delight of children everywhere.

And perhaps that is the lesson of all these “scientific” studies. Each study sees a little part of the reason why, but it is we family docs who see the person as a whole, each one with a rich complicated life story to be listened to and cared for.

That is why practicing medicine is both a science, and an art.


Nancy Reyes is a retired physician living in the rural Philippines. Her webpage is Finest Kind Clinic and Fishmarket, and she writes medical essays to HeyDoc Xanga Blog

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