Mental Health

Eating Disorders Awareness Week

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An analysis of hospital data by the Royal College of Psychiatrists showed that hospital admissions for eating disorders had increased by 84% in the past five years, reaching a total of 24 268 admissions. Some 11 049 more admissions were recorded in 2020-21 than in 2015-16. The number of young people with eating disorders rose by 90% in the five year period analyzed, from 3541 to 6713 episodes, with a 35% increase in the past year alone. Boys and young men showed a 128% rise in hospital admissions, from 280 in 2015-16 to 637 in 2020-21.

One in five deaths of people with anorexia nervosa is due to suicide, and all eating disorders see high rates of self-harm and depression. Eating disorders: Guidance is issued to doctors after 84% rise in past five years – BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1256 (Published 19 May 2022)

Need help? https://www.nationaleatingdisorders.org/get-help/

Antidepressant Use Associated With Cognitive decline in Patients with Dementia

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In this cohort study, use of antidepressants was associated with faster cognitive decline in patients with dementia, in particular SSRIs (i.e., citalopram, sertraline and escitalopram) and mirtazapine. These effects appeared to be more pronounced in patients with more severe dementia. Compared with sertraline, escitalopram presented faster cognitive decline, while citalopram was linked to a slower cognitive decline. Additionally, higher dispensed doses of SSRIs were associated with greater cognitive decline, as well as increased risks of severe dementia, all-cause mortality, and fracture. Our study cannot distinguish whether these findings are due to the antidepressants or the underlying psychiatric indication. Mo, M., Abzhandadze, T., Hoang, M.T. et al. Antidepressant use and cognitive decline in patients with dementia: a national cohort study. BMC Med 23, 82 (2025). https://doi.org/10.1186/s12916-025-03851-3

If I develop dementia no SSRI’s for me please.

There Are Health Related Benefits to Working Past Age 65

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“Our perceptions of working after age 65 have changed over time, and these data suggest that most older adults who are still able to work after the traditional retirement age derive health-related benefits from doing so,” said poll director Jeffrey Kullgren, M.D., M.P.H., M.S., a primary care physician at the VA Ann Arbor Healthcare System and associate professor of internal medicine at U-M. “As we learn more about how loneliness, lack of social connection and isolation intertwine with physical and mental health in older adults, the role of work is important to consider.”Michigan Medicine – University of Michigan. “As more Americans work later in life, poll shows positive health impacts, especially for those over 65.” ScienceDaily. http://www.sciencedaily.com/releases/2025/02/250211141049.htm (accessed February 12, 2025)

National Poll on Healthy Aging Team. The Intersection of Work, Health, and Well-Being. University of Michigan National Poll on Healthy Aging. January/February 2025. Available at https://dx.doi.org/10.7302/25186

Lisdexamfetamine Dimesylate (not just for ADHD anymore)

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Llisdexamfetamine dimesylate is currently the only drug to be approved in the USA for the treatment of moderate to severe binge eating disorder (BED) in adult patients. – https://pubmed.ncbi.nlm.nih.gov/29134566/

Just a few side effects BTW.

The prescribing information also includes warnings and precautions regarding serious cardiovascular reactions, blood pressure and heart rate increases, psychiatric adverse reactions, suppression of growth, peripheral vasculopathy (reduced circulation of blood flow to body parts), and serotonin syndrome (a potentially life-threatening overage of serotonin). Please see Vyvanse’s full prescribing information for additional details.

The most common side effects in children, adolescents and/or adults with ADHD taking lisdexamfetamine dimesylate capsules and chewable tablets were anorexia, anxiety, decreased appetite, decreased weight, diarrhea, dizziness, dry mouth, irritability, insomnia, nausea, upper abdominal pain, and vomiting. The most common side effects in adults with BED were dry mouth, insomnia, decreased appetite, increased heart rate, constipation, feeling jittery, and anxiety. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-multiple-generics-adhd-and-bed-treatment

Take Home Lesson for Life Underwriters

Know your drugs and read the prescription DB reports. You’re welcome.

Smartphones, Ultra-Processed Foods, Diminished Family Bonds and Mental Wellness

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As mental well-being has remained largely static across the world since 2021, so too have the rankings of countries. At the top of the rankings are many Latin American and African countries while much of the core Anglosphere ranks in the bottom quartile. With national wealth indicators such as per capita GDP negatively correlated with average mental well-being scores (see our 2021 report), this year we have made substantial progress in our understanding of why this is so. Two key findings published in Rapid Reports in 2023 show that younger age of first smartphone ownership and ultra-processed food consumption are two major contributors to our mental health challenges. In wealthier countries, the age of first smartphone ownership is much younger and ultra-processed food consumption much higher. Other contributing factors are the relatively diminished family relationships in wealthier countries that are highlighted in our 2022 annual report. The Mental State of the World in 2023 – https://mentalstateoftheworld.report/2023_read/

Another Sunday morning, just reading and connecting the dots.

I’ve downloaded several of these reports and plan to do a deep dive later.

Read these reports and think about it.

Now do something about it.

Humans are Difficult

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That day at the Costco checkout, I paid for my groceries at a human-powered cash register and received the tiny oxytocin boost that comes from a random interaction with strangers, the kind that Mehret Biruk is always raving about, those small insignificant moments of connection that add to the richness of life…

This interaction made me realize that much of what I explore in this newsletter is about embracing inefficiencies—making phone calls instead of texting, planning your route ahead of time instead of relying on a GPS, waiting to check your email from a desktop instead of on-the-go, letting people know that you can’t always be instantly available across various communication platforms.

We live in a world obsessed with optimization. An era of contactless everything. This holiday season, lean into the inefficiencies. Make eye contact with strangers. Take your AirPods out of your ears and make small talk with the cashier instead of scanning your own groceries. Chat with the kind humans handing out samples at Costco. Choose human connection, however uncomfortable that may be. You might be pleasantly surprised. Humans are difficult – https://substack.com/@carmellaguiol

Choose human connection.

Telehealth Company Cerebral Agrees to pay $3.7M fine (and found guilty of nothing)

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Telehealth company Cerebral has agreed to pay a fine of more than $3.6 million for allegedly attempting to boost prescriptions of Adderall and other controlled substances, the Department of Justice and Drug Enforcement Administration said Monday. 

Regulators allege Cerebral’s initial visit metric didn’t consider medical literature or whether prescriptions would be clinically appropriate for patients. The company also used financial incentives to spur providers to meet prescribing metrics — and even considered disciplinary measures for those who hadn’t prescribed enough stimulants for ADHD patients, according to a press release.

https://www.healthcaredive.com/news/cerebral-controlled-substance-prescribing-fine-doj-dea/732108/

This company agreed to a fine it was unable to pay so the regulators deferred payment.

Huh?

FDA Announces Recall for Duloxetine

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Nitrosamine impurities have prompted a number of drug recalls in recent years, including oral anticoagulants, metformin, and skeletal muscle relaxants.FDA Announces Recall of More than 7000 Bottles of Duloxetine – Medscape – October 28, 2024. – https://www.medscape.com/viewarticle/fda-announces-recall-more-than-7000-bottles-duloxetine

Depressing. But will be very depressing for people on this medication.

Cannabis and Impaired Brain Development

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The adolescent brain is particularly vulnerable to cannabis, especially today’s higher-potency products, which put teens at risk for impaired brain development; mental health issues, including psychosis; and cannabis use disorder (CUD).  That was the message delivered by Yasmin Hurd, PhD, director of the Addiction Institute at Mount Sinai in New York, during a May 6 press briefing at the American Psychiatric Association (APA) 2024 annual meeting. 

“We’re actually in historic times in that we now have highly concentrated, highly potent cannabis products that are administered in various routes,” Hurd told reporters. Tetrahydrocannabinol (THC) concentrations in cannabis products have increased over the years, from around 2%-4% to 15%-24% now, Hurd noted. High-Potency Cannabis Tied to Impaired Brain Development, Psychosis, CUD – Medscape – May 13, 2024. https://www.medscape.com/viewarticle/high-potency-cannabis-tied-impaired-brain-development-2024a1000935

Earlier posts on this topic:

Marijuana is Too Strong (THC turbocharged)

Cannabis Use and Psychosis Risk

Cannabis Use and Psychosis Risk (Aussie Version)

Reefer Madness