Start running and watch your brain grow, say scientists

The health benefits of a regular run have long been known, but scientists have never understood the curious ability of exercise to boost brain power.
Now researchers think they have the answer. Neuroscientists at Cambridge University have shown that running stimulates the brain to grow fresh grey matter and it has a big impact on mental ability.
A few days of running led to the growth of hundreds of thousands of new brain cells that improved the ability to recall memories without confusing them, a skill that is crucial for learning and other cognitive tasks, researchers said.
The new brain cells appeared in a region that is linked to the formation and recollection of memories. The work reveals why jogging and other aerobic exercise can improve memory and learning, and potentially slow down the deterioration of mental ability that happens with old age.
"We know exercise can be good for healthy brain function, but this work provides us with a mechanism for the effect," said Timothy Bussey, a behavioural neuroscientist at Cambridge and a senior author on the study. The research builds on a growing body of work that suggests exercise plays a vital role in keeping the brain healthy by encouraging the growth of fresh brain cells.
Previous studies have shown that "neurogenesis" is limited in people with depression, but that their symptoms can improve if they exercise regularly. Some antidepressant drugs work by encouraging the growth of new brain cells.
Scientists are unsure why exercise triggers the growth of grey matter, but it may be linked to increased blood flow or higher levels of hormones that are released while exercising. Exercise might also reduce stress, which inhibits new brain cells through a hormone called cortisol.
The Cambridge researchers joined forces with colleagues at the US National Institute on Ageing in Maryland to investigate the effect of running.
They studied two groups of mice, one of which had unlimited access to a running wheel throughout. The other mice formed a control group. In a brief training session, the mice were put in front of a computer screen that displayed two identical squares side by side. If they nudged the one on the left with their nose they received a sugar pellet reward. If they nudged the one on the right, they got nothing.
After training the mice went on to do the memory test. The more they nudged the correct square, the better they scored. At the start of the test, the squares were 30cm apart, but got closer and closer together until they were almost touching. This part of the experiment was designed to test how good the mice were at separating two very similar memories. The human equivalent could be remembering what a person had for dinner yesterday and the day before, or where they parked on different trips to the supermarket.
The running mice clocked up an average of 15 miles (24km) a day. Their scores in the memory test were nearly twice as high as those of the control group. The greatest improvement was seen in the later stages of the experiment, when the two squares were so close they nearly touched, according to a report in the Proceedings of the National Academy of Sciences.
"At this stage of the experiment, the two memories the mice are forming of the squares are very similar. It is when they have to distinguish between the two that these new brain cells really make a difference," Bussey said.
The sedentary mice got steadily worse at the test because their memories became too similar to separate.
The scientists also tried to wrongfoot the mice by switching the square that produced a food reward. The running mice were quicker to catch on when scientists changed them around.
Brain tissue taken from the rodents showed that the running mice had grown fresh grey matter during the experiment. Tissue samples from the dentate gyrus part of the brain revealed on average 6,000 new brain cells in every cubic millimetre. The dentate gyrus is part of the hippocampus, one of the few regions of the adult brain that can grow fresh brain cells.
The Guardian

ICSI (Intra Cytoplasmic Sperm Injection)

What is ICSI?

ICSI is an acronym for intracytoplasmic sperm injection - which is a fancy way of saying "inject sperm in the middle of the egg". ICSI is a very effective method to fertilize eggs in the IVF lab after they have been retrieved from the female.
* IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and pick up individual sperm in a specially designed ICSI needle.


* Then the needle is carefully advanced through the outer shell of the egg and the egg membrane - and the sperm is injected into the inner part (cytoplasm) of the egg.

* This will usually result in normal fertilization in about 75-85% of eggs injected with sperm.

* However, first the woman must be stimulated with medications and have an egg retrieval procedure so we can obtain several eggs for in vitro fertilization and ICSI.
Who should be treated with intracytoplasmic sperm injection?

There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not.

Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes.

Our thinking about ICSI has changed over time, and we are now doing more ICSI (as a percentage of total cases) than we were 10-12 years ago. As we learn more about methods to help couples conceive, our thinking will continue to evolve.
Common reasons used for performing ICSI

ICSI fertilization procedure in progressNeedle with a sperm inside is advanced to the leftShell of embryo has already been penetrated by needleMembrane of egg (oolemma) is stretching and about to breakSperm head visible at tip of needle

1. Severe male factor infertility that do not want donor sperm insemination.

2. Couples with infertility with:
* Sperm concentrations of less than 15-20 million per milliliter
* Sperm motility less than 35%
* Very poor sperm morphology (subjective - specific cutoff value is debatable)

3. Having previous IVF with no fertilization - or a low rate of fertilization (low percentage of mature eggs that were normally fertilized).

4. Sometimes it is used for couples that have a low yield of eggs at egg retrieval. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (mixing eggs and sperm together).

How is ICSI performed?

1. The mature egg is held with a specialized holding pipette.

2. A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.

3. This needle is then carefully inserted through the zona (shell of the egg) and in to the center (cytoplasm) of the egg.

4. The sperm is injected in the cytoplasm and the needle is removed.

5. The eggs are checked the next morning for evidence of normal fertilization.

Fertilization and pregnancy success rates with ICSI

Fertilization rates for ICSI: Most IVF programs see that about 70-85% of eggs injected using ICSI become fertilized. We call this the fertilization rate, which is different from the pregnancy success rate.

Pregnancy success rates for in vitro fertilization procedures with ICSI have been shown in some studies to be higher than for IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quantity and quality) as compared to some of the women having IVF for other reasons.

In other words, the average egg quantity and quality tends to be better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs - as compared to cases with unexplained infertility. Some unexplained cases have reduced egg quantity and/or quality - which lowers the chances for a successful IVF outcome.

IVF with ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician.

Sometimes IVF with ICSI is done for "egg factor" cases - low ovarian reserve situations. This is when there is either a low number, or low "quality"of eggs (or both). In such cases, ICSI fertilization and pregnancy success rates tend to be lower.

* This is because the main determinant of IVF success is the quality of the embryos.

* The quality of the eggs is a crucial factor determining quality and viability of embryos.

THE UNDESCENDED TESTICLE

What is an undescended testicle?

The testicle (testis) is responsible for the production of male hormone and also sperm. Before the child is born the testicle migrates down from high in the abdomen and passes through abdominal wall and groin to take its normal position in the scrotum. Undescended testicles are quite common. They may be present in 4% of boys at birth, and there is an even higher incidence in premature infants. Three-fourths of undescended testicles will descend within the first three months of life.

When a testicle is not in the normal scrotal location several possibilities exist:
There may never have been a testicle (congenital absence).
The testicle may have atrophied (withered away) before birth due to torsion (twist) or blockage of the testicular blood vessels.
The testicle may have descended incompletely and may lie within the inguinal canal (just above the scrotum).
The testicle may have not descended properly, but remains within the abdominal cavity.
In some children the testes may be found in the groin, but can be brought down into the scrotum during examination. These 'retractile' testicles also will be seen to descend when the child is in the bathtub. Retractile testicles are due to hyperactive muscles that temporarily pull the testicle into the groin. However, retractile testicles are not believed to injure the testicles and require no treatment.

Why should an undescended testicle be treated?

In humans, the scrotal location of the testicles keeps them cooler than the core body temperature. This lower temperature is important for the development of the testicle as well as for production of normal sperm. Studies have shown that there is an increased risk of infertility in men with a history of undescended testicles. Relocating the testicle into the scrotum may decrease the risk of fertility problems, particularly if done at an early age.

Renal Calculi

Author: Sandy Craig, MD, Adjunct Associate Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Carolinas Medical Center

Introduction

Background

Acute passage of a kidney stone from the renal pelvis through the ureter gives rise to pain at times so excruciating that it has been likened to the discomfort of childbirth. The often sudden, extremely painful episode of renal colic prompts more than 450,000 visits to EDs annually and places emergency physicians on the front line of management of acute nephrolithiasis. ED management is focused on excluding other serious diagnoses and providing adequate pain relief.

Pathophysiology

Most calculi arise in the kidney when urine becomes supersaturated with a salt that is capable of forming solid crystals. Symptoms arise as these calculi become impacted within the ureter as they pass toward the urinary bladder.

Frequency

United States

The lifetime prevalence of nephrolithiasis is approximately 12% for men and 7% for women in the United States, and it is rising. Recurrence rates after the first stone episode are 14%, 35%, and 52% at 1, 5, and 10 years, respectively. An increased incidence has been noted in the southeastern United States, prompting the term "stone belt" for this region of the country.¹

International

Nephrolithiasis occurs in all parts of the world, with a lower lifetime risk of 2-5% in Asia, 8-15% in the West, and 20% in Saudi Arabia.

Mortality/Morbidity

• Approximately 80-85% of stones pass spontaneously.
• Approximately 20% of patients require hospital admission because of unrelenting pain, inability to retain enteral fluids, proximal urinary tract infection (UTI), or inability to pass the stone.
• A ureteral stone associated with obstruction and upper UTI is a true urologic emergency. Complications include perinephric abscess, urosepsis, and death. Immediate involvement of the urologist is essential.

Race

• White males are affected 3-4 times more often than African American males.
• African Americans have a higher incidence of infected ureteral calculi than whites.

Sex

• The male-to-female ratio is approximately 3:1.
• Female patients have a higher incidence of infected hydronephrosis.

Age

Peak onset of symptomatic nephrolithiasis is in the third and fourth decades of life.

• Beware of the patient older than 60 years with an apparent first kidney stone. Consider the possibility of symptomatic abdominal aortic aneurysm (AAA) in the older patient, and rule out this possibility before pursuing the diagnosis of nephrolithiasis. Use bedside ultrasonography if the patient's condition is potentially unstable. CT scan is a reasonable alternative in the stable patient.
• Nephrolithiasis in children is rare; approximately 5-10 children aged 10 months to 16 years are seen annually for the condition at a typical US pediatric referral center.

Clinical

History

Most calculi originate within the kidney and proceed distally, creating various degrees of urinary obstruction as they become lodged in narrow areas, including the ureteropelvic junction, pelvic brim, and ureterovesical junction. Location and quality of pain are related to position of the stone within the urinary tract. Severity of pain is related to the degree of obstruction, presence of ureteral spasm, and presence of any associated infection.

• Stones obstructing the ureteropelvic junction may present with mild-to-severe deep flank pain without radiation to the groin, due to distension of the renal capsule.
• Stones impacted within the ureter cause abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen with radiation to the testicles or the vulvar area. Intense nausea, with or without vomiting, usually is present.
• Stones lodged at the ureterovesical junction also may cause irritative voiding symptoms, such as urinary frequency and dysuria.
• Calculi that have entered the bladder are usually asymptomatic and are passed relatively easily during urination.
• Rarely, a patient reports positional urinary retention (obstruction precipitated by standing, relieved by recumbency), which is due to the ball-valve effect of a large stone located at the bladder outlet.

Physical

The classic patient with renal colic is writhing in pain, pacing about, and unable to lie still, in contrast to a patient with peritoneal irritation, who remains motionless to minimize discomfort.

• Fever is not part of the presentation of uncomplicated nephrolithiasis. If present, suspect infected hydronephrosis, pyonephrosis, or perinephric abscess.
• The most common finding in ureterolithiasis is flank tenderness due to the dilation and spasm of the ureter from transient obstruction as the stone passes from the kidney to the bladder.
• Abdominal examination usually is unremarkable. Bowel sounds may be hypoactive, a reflection of mild ileus, which is not uncommon in patients with severe, acute pain.
• In patients older than 60 years with no prior history of renal stones, the emergency physician should look carefully for physical signs of AAA (see Aneurysm, Abdominal).
• Testicles may be painful but should not be very tender and should appear normal.

Causes

The formation of the 4 basic chemical types of renal calculi is associated with more than 20 underlying etiologies. Stone analysis, together with serum and 24-hour urine metabolic evaluation, can identify an etiology in more than 95% of patients. Specific therapy can result in a remission rate of more than 80% and can decrease the individual recurrence rate by 90%. Therefore, emergency physicians should stress the importance of urologic follow-up, especially in patients with recurrent stones, solitary kidneys, or previous kidney or stone surgery and in all children.²

• Calcium stones (75%): Recent data suggest that a low-protein, low-salt diet may be preferable to a low-calcium diet in hypercalciuric stone formers for preventing stone recurrences.³ Epidemiological studies have shown that the incidence of stone disease is inversely related to the magnitude of dietary calcium intake in first-time stone formers. There is a trend in the urology community not to restrict dietary intake of calcium in recurrent stone formers. This is especially important for postmenopausal women in whom there is an increased concern for the development of osteoporosis. Calcium oxalate, calcium phosphate, and calcium urate are associated with the following disorders:
  • Hyperparathyroidism - Treated surgically or with orthophosphates if the patient is not a surgical candidate
  • Increased gut absorption of calcium - The most common identifiable cause of hypercalciuria, treated with calcium binders or thiazides plus potassium citrate
  • Renal calcium leak - Treated with thiazide diuretics
  • Renal phosphate leak - Treated with oral phosphate supplements
  • Hyperuricosuria - Treated with allopurinol, low purine diet, or alkalinizing agents such as potassium citrate
  • Hyperoxaluria - Treated with dietary oxalate restriction, oxalate binders, vitamin B-6, or orthophosphates
  • Hypocitraturia - Treated with potassium citrate
  • Hypomagnesuria - Treated with magnesium supplements
• Struvite (magnesium ammonium phosphate) stones (15%)
  • Struvite stones are associated with chronic UTI with gram-negative rods capable of splitting urea into ammonium, which combines with phosphate and magnesium. Underlying anatomical abnormalities that predispose patients to recurrent kidney infections should be sought and corrected.
  • Usual organisms include Proteus, Pseudomonas, and Klebsiella species. Escherichia coli is not capable of splitting urea and, therefore, is not associated with struvite stones.
  • UTI does not resolve until stone is removed entirely.
  • Urine pH is typically greater than 7.
• Uric acid stones (6%): These are associated with urine pH less than 5.5, high purine intake (eg, organ meats, legumes, fish, meat extracts, gravies), or malignancy (ie, rapid cell turnover). Approximately 25% of patients with uric acid stone have gout. Serum and 24-hour urine sample should be sent for creatinine and uric acid determination. If serum or urinary uric acid is elevated, the patient may be treated with allopurinol 300 mg daily. Patients with normal serum or urinary uric acid are best managed by alkali therapy alone.
• Cystine stones (2%)
  • Cystine stones arise because of an intrinsic metabolic defect resulting in failure of renal tubular reabsorption of cystine, ornithine, lysine, and arginine.
  • Urine becomes supersaturated with cystine with resultant crystal deposition.
  • These are treated with low-methionine diet (unpleasant), binders such as penicillamine or a-mercaptopropionylglycine, large urinary volumes, or alkalinizing agents. A 24-hour quantitative urinary cystine determination helps to titrate the dose of drug therapy to achieve a urinary cystine concentration of less than 300 mg/L.
• Drug-induced stone disease: A number of medications or their metabolites can precipitate in urine causing stone formation. These include indinavir; atazanavir; guaifenesin; triamterene; silicate (overuse of antacids containing magnesium silicate); and sulfa drugs including sulfasalazine, sulfadiazine, acetylsulfamethoxazole, acetylsulfasoxazole, and acetylsulfaguanidine. emedicine.com

Boost your fertility

Having difficulty getting pregnant? There are some simple ways to help nature along.

If you've been trying to start a family without success, making some simple lifestyle changes may increase your chance of conception and help to ensure a healthy pregnancy. However, there are some factors, such as age, ovulation problems, sperm disorders and damaged fallopian tubes, that you can't change.

Changes you can make

Eat well: if you're a woman, a nutritious, balanced diet will help improve your general health and wellbeing, and ensure your body is able to nourish a baby. If you're a man, healthy eating is also important for sperm production.

Choose a varied diet containing fresh fruit and vegetables, bread, potatoes, rice and other cereals (wholegrain, where possible), milk and dairy products, lean meat, fish and other sources of protein.

Being overweight or very underweight can disrupt your periods and hinder conception

Watch your weight: being overweight or very underweight can disrupt your periods and hinder conception. A woman with a body mass index (BMI) of more than 29 or less than 19 may find it more difficult to conceive.

To work out your BMI, divide your weight in kilograms by your height in metres squared (your height in metres multiplied by itself) or use our BMI calculator. Fertility treatment may not be possible for very overweight or obese women.

Drink wisely: the government advises women trying to conceive to avoid alcohol completely. Men shouldn't drink more than three or four units a day, and should avoid binge drinking to prevent damage to sperm.

Stop smoking: smoking has been linked to infertility and early menopause in women, and sperm problems in men. It also reduces the success of fertility treatments.

Be active: regular moderate exercise (such as brisk walking) for at least 30 minutes a day will help to keep you fit for conception and help to control your weight.

Exercise also reduces stress and boosts levels of endorphins, the body's own feel-good hormones.

Keep cool: for optimum sperm production, the testicles need to be a couple of degrees cooler than the rest of the body. Avoid tight underwear and jeans, and excessively hot baths and saunas.

Think about your job: occupations that involve sitting for long periods, such as long-distance lorry driving, or exposure to environmental chemicals such as paints or pesticides, may affect sperm quality. If this is an issue, discuss it with your work supervisor. Watch an exclusive video interview with Professor William Ledger.

Manage stress: stress doesn't cause infertility, but excessive anxiety can sometimes upset the menstrual cycle. Try to reduce stress levels and give yourself time to relax.

Take folic acid: all women trying for a baby should take a supplement of 400mcg of folic acid a day to help prevent birth defects such as spina bifida.

Check drugs: certain prescription drugs can reduce the chance of conception. If you're taking regular medication, talk to your doctor.

Marijuana and cocaine can affect sperm counts.
Things you can't change

Not all factors affecting fertility are within your control.
Women

For women, the following may affect conception:

Ovulation problems: sometimes, women don't ovulate (release an egg each month) or do so only occasionally.

Reasons include:

* Polycystic ovary syndrome (PCOS), in which numerous small cysts develop on the ovaries and ovulation is erratic.
* The side effects of some medications, such as anti-inflammatory painkillers, chemotherapy and radiation treatment (for example, for cancer).
* Premature ovarian failure (early menopause).
* Hormonal imbalances.


Blocked fallopian tubes: below are the most common causes of inflamed and blocked tubes.

* Sexually transmitted infections (STIs) such as chlamydia and (more rarely) gonorrhoea.
* Endometriosis, in which cells from the lining of the womb implant elsewhere, such as the ovaries.
* Pelvic inflammatory disease, which can be caused by chlamydia and other STIs.
* Previous pelvic surgery - for example, for appendicitis or peritonitis.


Women in their early 20s are about twice as likely to get pregnant as women in their late 30s

Your age: the quantity and quality of your eggs decline with age. Women in their early 20s are about twice as likely to get pregnant as women in their late 30s.

Problems in the womb: problems with the lining of the womb, such as fibroids or physical abnormalities of the womb, can prevent the successful implantation of a fertilised egg.

Other medical conditions: conditions that can affect female fertility include diabetes, epilepsy, thyroid and bowel diseases, as well as gynaecological problems such as a previous ectopic pregnancy or more than one miscarriage.
Men

Male infertility is usually caused by sperm problems. These include:

* Low sperm count (not producing enough sperm), poor sperm quality or poor motility (slow-moving sperm).
* Previous inflammation of, or injury to, the testicles. This includes inflammation caused by mumps, drug treatment, radiotherapy or sporting injuries.
* A previous bacterial infection.
* Previous surgery - for example, to correct a hernia - or undescended or twisted testicles, which can damage the tubes or impair blood flow to the testicles.
* Diabetes, medication or urinary tract surgery can cause retrograde ejaculation, when sperm travels backwards into the bladder.
* Sexual problems, such as the inability to have an erection.

Sexually Transmitted Diseases In Men (STDs)

What are STIs and how can their spread be prevented?

Sexually transmitted diseases (STDs) are infections that are transmitted during any type of sexual exposure, including intercourse (vaginal or anal), oral sex, and the sharing of sexual devices, such as vibrators. In the professional medical arena, STDs are referred to as STIs (sexually transmitted infections). This terminology is used because many infections are frequently temporary. Some STDs are infections that are transmitted by persistent and close skin-to-skin contact, including during sexual intimacy. Although treatment exists for many STDs, others currently are usually incurable, such as HIV, HPV, hepatitis B and C, and HHV-8. What is more, many infections can be present in, and be spread by, patients who do not have symptoms.

The most effective way to prevent the spread of STDs is abstinence. Alternatively, the diligent use of latex barriers, such as condoms, during vaginal or anal intercourse and oral-genital contact helps decrease the spread of many of these infections. Still, there is no guarantee that transmission will not occur. In fact, preventing the spread of STDs also depends upon appropriate counseling of at-risk individuals and the early diagnosis and treatment of those infected.

In this article, the STDs in men have been organized into three major categories: (1) STDs that are associated with genital lesions; (2) STDs that are associated with urethritis (inflammation of the urethra, the canal through which urine flows out); and (3) systemic STDs (involving various organ systems of the body). Note, however, that some of the diseases that are listed as being associated with genital lesions (for example, syphilis) or with urethritis (for example, gonorrhea) can also have systemic involvement.

Depressive disorder

Depression is a complex matter. In recent years, with burgeoning research progress, we are finding out that depression is much more common than many of us thought. At least 15% (and likely more) of women take an antidepressant during their lifetime. Depression is much more common in women than in men, but the reason for this female predominance is unclear.

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.

In the 1950s and '60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job. In the 1970s and '80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree on the following:
A depressive disorder is a syndrome (group of symptoms) that reflects a sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.


Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished participation and a decreased or increased activity level.


Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.


Depressive disorders are a huge public-health problem, due to its affecting millions of people. About 10% of adults, up to 8% of teens and 2% of preteen children experience some kind of depressive disorder.
The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism from work or school.


Adolescents who suffer from depression are at risk for developing and maintaining obesity.


In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in some ways as often as coronary artery disease.


Depression can increase the risks for developing coronary artery disease, HIV, asthma, and many other medical illnesses. Furthermore, it can increase the morbidity (illness/negative health effects) and mortality (death) from these and many other medical conditions.


Depression can coexist with virtually every other mental health illness, aggravating the status of those who suffer the combination of both depression and the other mental illness.


Depression in the elderly tends to be chronic, has a low rate of recovery, and is often undertreated. This is of particular concern given that elderly men, particularly elderly white men have the highest suicide rate.
Depression is usually first identified in a primary-care setting, not in a mental health practitioner's office. Moreover, it often assumes various disguises, which causes depression to be frequently underdiagnosed.


In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.


For full recovery from a mood disorder, regardless of whether there is a precipitating factor or it seems to come out of the blue, treatment with medication and/or electroconvulsive therapy (ECT) (see discussion below) and psychotherapy are necessary. Medicinenet.com