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Around since the 1950s, antidepressants are primarily used to treat depression.

Nowadays these drugs are used to treat several disorders such as post-traumatic stress disorder (PTSD), generalised anxiety disorder, obsessive compulsive disorder (OCD) and even chronic pain.

But as much as antidepressants are hailed as a “miracle drug” for mental illness, many have a serious downside – sexual dysfunction. 

How do they work?

According to a previous Health24 article, current drugs for depression target the regulatory process for neurotransmitters like serotonin, noradrenaline and dopamine. 

Antidepressants treat the symptoms of depression and not the cause, and are therefore mostly used combined with therapy in the case of severe depression.

There are three main kinds of antidepressants available:         

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
• Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Success rate

Antidepressants appear to work, and studies of adults with moderate or severe depression have shown that with an antidepressant about 40 to 60 out of 100 people noticed an improvement in their symptoms within six to eight weeks.  

Side effects

Like most other medications, antidepressants are not without side effects and, according to a Health24 article, in SSRIs these include:

• Nausea
• Headache
• Agitation/anxiety
• Sleep disturbances
• Decreased appetite
• Sexual disturbances

Reduced sexual function

About 30–60% of men and women who take SSRIs experience some degree of sexual dysfunction.

An American Family Physician article points out there is consistent evidence that antidepressant medications may cause a decline in libido or sexual functioning despite improvement of depression.

Problems with sexual function may include:

• In men: erection and ejaculation impairment
• In women: loss of lubrication
• In both sexes: decreased or lost libido, and delayed or blocked orgasm

According to a 2010 PMC article, the problem of antidepressant-induced sexual dysfunction is complex, and while there is some evidence for pharmacological management of antidepressant-associated sexual dysfunction, this is too limited and insufficient to formulate a clinical guideline.

In many cases, the sexual side effects of mainly SSRIs lead to patients stopping the drugs without telling their doctors, which can lead to a serious relapse.  

What are your alternatives?

If you find you cannot cope with the sexual side effects of your SSRI, speak to your doctor.

Other options include:

• Switching to a different antidepressant: i.e. antidepressants with fewer or no sexual side effects from the SNRI en NDRI categories. 
• Switching to one of the older antidepressant tricyclate drugs, or one of the MAO Inhibitors. Bear in mind that these may have additional unwanted side effects.
• Reducing your dosage. This may, however, mean losing some of the therapeutic benefit.
• Taking “drug holidays”. This involves taking e.g. weekends off from antidepressants, which can significantly improve sexual function during the drug-free days. These brief “holidays” do not seem to lead to a worsening of depressive symptoms. But don’t do this without your doctor’s supervision.
• Adding another performance enhancer  to counter orgasmic failure induced by the antidepressant, or sexual stimulants such as Viagra. Some women benefit from small doses of testosterone, while others have reported a reduction of sexual side effects with the help of herbal remedies.  

These tips should boost you sexual desire and function — without feeling blue. 

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Eugene Lotter

If you are short, you may have to leap over puddles that normal people step over, but at least you will have the last laugh.

There may be at least one advantage to being short: a lower risk for dangerous blood clots in the veins, a new study shows.

A previous Health24 article also stated that added height and weight contributed to the risk of blood clots.

Smaller risk for deep vein thrombosis

These clots, called venous thromboembolisms, include blockages known as deep vein thrombosis (DVT), which typically start in the legs and can travel to the lungs, raising a person’s odds for stroke.

Sometimes DVTs occur after long-haul flights, so they’ve been dubbed “economy class syndrome”. But new research suggests a slight advantage for shorter people in avoiding the clots.

Why the effect? “It could just be that because taller individuals have longer leg veins there is more surface area where problems can occur,” theorised study lead author Dr Bengt Zoller.

“There is also more gravitational pressure in leg veins of taller persons that can increase the risk of blood flow slowing or temporarily stopping,” noted Zoller, an associate professor at Lund University and Malmö University Hospital, in Sweden.

Connection between height and blood clots

According to the American Heart Association, up to 600 000 people in the United States develop a blood clot that starts in a vein each year. Risk factors for these clots include having surgery, cancer and being immobilised or hospitalised. Pregnancy or taking hormonal oral birth control pills or oestrogen therapy for menopause can also cause blood clots.

According to the Southern African Journal of HIV Medicine, over 200 000 South Africans suffer from DVT each year, and because most DVT is not obvious, the true incidence is unknown.

Although the new study can’t prove a cause-and-effect link, one US heart expert said other recent research has also suggested a connection between height and clots in veins.

“As we can’t do much about our height, it is worthwhile considering some preventative action” in shielding taller folks against these clots, said Dr Maja Zaric. She’s a cardiologist at Lenox Hill Hospital in New York City.

“Wearing gradual support stockings along with avoidance of dehydration and increasing walking during ‘periods of risk’ [such as prolonged sitting] may help prevent the problem before it occurs,” Zaric said.

Lower risk for shorter people

The new study involved more than 2.6 million people from Sweden: male soldiers whose health was tracked from the 1950s to the 1990s, and newly pregnant women tracked from 1969 to 2010.

The entire study group consisted of sibling pairs, to tease out any genetic or environmental factors, the researchers explained.

Zoller’s team found that men shorter than 1.6m were 65% less likely than men 1.8m or taller to develop one of these clots.

The risk dropped 69% for women shorter than 1.5m who were pregnant for the first time, compared to women 1.8m or taller, Zoller’s team reported on 5 September in Circulation: Cardiovascular Genetics.

Of course, “height is not something we can do anything about,” Zoller said in a journal news release. And he noted that “the height in the population has increased, and continues increasing, which could be contributing to the fact that the incidence of thrombosis has increased.”

Study limitations

The study does have some limitations. The researchers said they weren’t able to consider lifestyle factors from the participants’ childhood, such as diet, physical activity and whether or not their parents smoked. But they believe their findings could possibly apply to the US population, because the current Swedish population is now similarly ethnically diverse.

It is unclear how ethnic diversity in South Africa affects the prevalence of blood clots.

And Zaric agreed that a link between height and clotting seems plausible.

“This can be explained by the simple mechanics of a large and long blood vessel being exposed to the higher gravitational force which is exerted on the ‘longer’ blood column,” she said. This could cause blood to flow less well, “which in turn may trigger development of a clot in the leg veins,” Zaric said.

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An early birth can be a traumatic event for the mother as well as the baby. According to statistics published in the South African Medical Journal, premature birth accounts for 40% of all newborn deaths worldwide. Parent24 previously reported that approximately 14% of all babies born in private care in South Africa are premature, with as much as 23% of babies born premature in the public sector. 

But it seems that there could be a way to establish whether a mother is prone to a premature birth. 

By learning more about the immune system changes that occur during pregnancy, scientists hope they can someday predict if babies will be born prematurely.

Immune system changes

“Pregnancy is a unique immunological state. We found that the timing of immune system changes follows a precise and predictable pattern in normal pregnancy,” said study senior author Dr Brice Gaudilliere. He’s an assistant professor of anaesthesiology, perioperative and pain medicine at Stanford University School of Medicine in California.

If scientists can identify immune-system changes predicting premature birth, they say they might eventually develop a blood test to detect it.

“Ultimately, we want to be able to ask, ‘Does your immune clock of pregnancy run too slow or too fast?'” Gaudilliere said in a university news release.

According to a report on South African births, 35% of newborn deaths are because of complications of premature births. Currently, doctors have no reliable way to predict which babies will be born prematurely.

Immunity ‘algorithm’ could predict birth

For the study, which was published in Science Immunology, the researchers collected blood samples from 18 women who had full-term pregnancies. The women gave one sample during each trimester and another six weeks after childbirth. The researchers used samples from another group of 10 women who also had full-term pregnancies to verify the findings.

Using a technique called mass cytometry, the researchers simultaneously measured up to 50 properties of each immune cell in the blood samples. The investigators counted the types of immune cells, determined which signalling pathways were most active in each cell, and assessed how the cells reacted when exposed to compounds that mimic bacterial or viral infection.

The research team then used advanced statistical modelling to document the immune system changes occurring throughout pregnancy. (These adjustments keep the mother’s body from rejecting the unborn baby.)

“This algorithm is telling us how specific immune cell types are experiencing pregnancy,” Gaudilliere said.

The study confirmed that natural killer cells and certain white blood cells have enhanced action during pregnancy. The researchers also found that a signaling pathway among helper T-cells increases on a precise schedule.

Exciting outcome

“It’s really exciting that an immunological clock of pregnancy exists,” said study lead author Nima Aghaeepour, an instructor in anaesthesiology, perioperative and pain medicine.

“Now that we have a reference for normal development of the immune system throughout pregnancy, we can use that as a baseline for future studies to understand when someone’s immune system is not adapting to pregnancy the way we would expect,” Aghaeepour added.

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Research finds aspirin stimulates the regeneration of damaged tooth structure.

Auditors are concerned the rising cost of clinical negligence is too high a burden for hospitals.