TIME Mental Health/Psychology

These Antidepressants May Be Riskier For Pregnant Women, Study Says

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Alfredo Ausina—Getty Images/age fotostock RM

Treating depression properly is important, but a new analysis found a link between certain SSRIs and birth defects

In a study published in the BMJ, researchers conducted the most thorough study to date looking at how popular SSRI antidepressants taken by pregnant women affect their unborn children.

Previous studies, most of which investigated individual medications and their potential effects on the still-developing fetus, have resulted in conflicting results; some have found associations between the antidepressants and birth defects, while others have not.

In the BMJ study, Jennita Reefhuis, team lead in the birth defects branch at the U.S. Centers for Disease Control and Prevention, and her colleagues analyzed data from six existing studies of selective serotonin reuptake inhibitors, called SSRIs—a class of antidepressants—and their relationship with birth defects, as well as the National Birth Defects Prevention Study, which collected birth defect information from hospitals in 10 U.S. cities. The added data from nearly 18,000 mothers who had children with birth defects provided more power to the analysis that Reefhuis and her team performed.

MORE: Therapy and Antidepressants Work Better Together Than Just Pills Alone

Overall, they found that two SSRIs—fluoxetine (Prozac) and paroxetine (Paxil)—were linked to seven specific birth defects, including those involving heart structures, abnormal brain formation and the growth of the intestines outside of the body. The other SSRIs studied—citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft)—did not show strong associations with birth defects.

The researchers don’t yet know exactly why these SSRIs were linked to birth defects, and Reefhuis stresses that the risks she uncovered are small. For example, a heart structural defect occurs normally in about 10 per 10,000 births, and for women taking paroxetine, that risk doubled to 24 per 10,000. “But two times a small number is still a small number,” she says.

MORE: Why Some Antidepressants Make You Feel Worse Before Better

Still, the results should provide better information for doctors and women who want to start families about how to balance the benefits of antidepressants like SSRIs in treating depression and the potential risks the medications can pose to the baby. “I think our data points in the direction that maybe they could choose an SSRI that has not been shown to be associated with, or has been associated with fewer, birth defects,” she says. But more studies like this are needed to confirm and expand on what we know about how specific antidepressants are linked to specific birth defects. “This information is most helpful in trying to unravel this mystery,” says Reefhuis. “I really hope it provides options for treating women who need treatment for depression during pregnancy.”

TIME diabetes

How Diabetes Harms the Brain

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ALFRED PASIEKA/SCIENCE PHOTO LIB—Getty Images/Science Photo Libra

Diabetes can damage a number of organs, from the eyes to the kidneys and the heart. Now there’s fresh evidence that unchecked blood sugar can affect the brain as well, which may lead to drops in cognitive functions

When blood sugar levels start to climb in diabetes, a number of body systems are harmed—and that list includes the brain, since studies have linked diabetes with a higher risk of stroke and dementia. Now, a new study published in the journal Neurology reports that changes in blood vessel activity in the brains of diabetics may lead to drops in cognitive functions and their ability to perform daily activities.

Dr. Vera Novak, associate professor of neurology at Harvard Medical School and Beth Israel Deaconess Medical Center, and her colleagues followed a group of 65 older people. About half had type 2 diabetes, and half did not. After two years, the diabetic patients had lower scores on cognitive tests compared to when they began, while people without diabetes showed little change on the tests.

MORE: The Strange Way a Diabetes Drug May Help Skin Scars

What drove the decline, says Novak, were changes in the brains of the diabetic patients. Diabetes can cause blood vessels to be less responsive to the ebb and flow of demand in different parts of the brain. Normally, flexible vessels will swell slightly to increase blood flow and oxygen to areas that are more intensely active, such as regions involved in memory or higher reasoning during intellectual tasks. But unchecked blood sugar can make these vessels less malleable and therefore less responsive.

“When doing any task, from cognition to moving your fingers, you need to increase blood flow to that specific area of the brain,” says Novak. “With diabetes, however, that vasodilation ability is reduced, so you have fewer resources to perform any task.”

MORE: Statins May Seriously Increase Diabetes Risk

In the study, Novak measured the changes in the flexibility of the blood vessels and found that among the diabetic patients, their flexibility declined, while it remained essentially the same for those without the condition. When blood sugar levels fluctuate as they do among people with diabetes, it can damage cells and nerves and trigger inflammation. What’s concerning, says Novak, is that these changes occurred even among people who were taking medication and had their diabetes under relatively good control. “Blood sugar control alone cannot treat [cognitive declines] associated with diabetes,” Novak says. “We need a new medication to improve [blood vessel] reactivity, cognition and brain function in diabetics.”

Her group is continuing to study ways that brain function can be improved by addressing the health of blood vessels; one method they are investigating involves using insulin inhaled through the nose or blood pressure medications to get brain vessel activity back to normal.

Figuring out whether such therapies can improve the brain function among people with diabetes is critical, since more people are diagnosed with the disease earlier in life, including in childhood. In previous studies, Novak and her colleagues showed that people with diabetes have brains that look five years older than those of similar-aged controls; for children with the disease, that could take a drastic toll on their cognitive skills as they age. “We really don’t have any treatment for cognitive decline in diabetes,” she says, “because the brain is not listed as an organ of risk for this disease. So we need more research and evidence like this.”

TIME Aging

Here’s Why You May Be Aging Faster Than Your Friends

Researchers zero in on more than a dozen factors that can predict how fast you’re aging — and have some ideas about what makes people age more slowly

We all have friends who were born in the same year but look years younger (or older) than we do. Now researchers say that such perceptions aren’t just about outward appearances but about something deeper—the different pace at which each of us ages, and what that means for our health.

In a study published in the Proceedings of the National Academy of Sciences, scientists led by Daniel Belsky, an assistant professor of medicine at the Duke University School of Medicine’s division of geriatrics, describe a panel of 18 measures tested in 20- and 30-year olds that showed how quickly they are aging. The markers proved to be a good indicator of physiological age; they mirrored the biological effects of aging found in older people. But they were also good markers of physical age, meaning that those who aged faster also looked older, according to unbiased assessments by random people looking at their photos.

MORE: The Cure for Aging

Most studies on aging, and the factors that affect aging, come from investigations of older populations, says Belsky. And in most cases, the chronic diseases or physiological changes that come with aging are already well established in these groups. But it’s clear that aging doesn’t happen overnight; rather, it occurs gradually over a period of decades, much like water affects the shape of riverbanks or stones over time. It’s not obvious on a day-to-day basis, but can be dramatic if several years have passed.

In the study, 954 people born in 1972 or 1973 in Dunedin, New Zealand, agreed to participate in a study that followed them from age 26 to age 38. Each participant agreed to be tested on a range of 18 different factors that earlier studies have linked to aging, including blood pressure, lung function, cholesterol, body mass index, inflammation and the integrity of their DNA. Based on their scores on these measures, researchers calculated a biological age for each volunteer. They did this again when the people in the study were 32 and 38 years old, and combined them to calculate the pace at which each person was aging.

MORE: This Diet Has Been Linked to a Longer Life—Again

Some people were biologically older and aging faster than others, despite being the same chronological age. Not only that, but the researchers showed, by giving the 20- and 30-somethings the same tests of balance and thinking skills that gerontologists give for older adults, that these aging changes were the same as those occurring later in life.

Though some people really were biologically older than they are, the good news is that some were younger than their chronological age and aging more slowly than they should be. Comparing the slower and faster aging groups should reveal some hints about how to keep aging in check. And of the factors that influence aging, says Belsky, the vast majority, as much as 80%, aren’t genetic and therefore well within our control. (Even the 20% that’s DNA-based is modifiable to some extent.) “This is just the beginning,” he says. “The next step is to figure out what knowing this information helps us to do. One of the things it can help us do is identify the causes of accelerated aging so that we might slow it down. And the other thing it can help us do is evaluate therapies that slow down aging.”

MORE: Eat Better and Stress Less: It’ll Make Your Cells (and Maybe You) Live Longer

Having a way to measure, relatively accurately, the pace at which people age provides a good way of tracking whether any anti-aging treatment works or not. Some of those keys to youth likely won’t be surprising; given the 18 factors that the scientists studied, they will probably involve habits like having a healthy diet that’s low in fat and salt, maintaining a healthy weight, reducing stress, having a strong immune system and getting regular exercise. Not smoking, or quitting smoking may also play a role. To find out, Belsky says he will continue to follow the study group and re-evaluate them again when they are 45. The researchers are charting the participants’ diet, exercise and other behaviors. “We can start to evaluate which behaviors are working to slow down aging,” he says, by seeing which changes slow down the pace of aging. “It’s a tremendous opportunity to begin to sort things out.”

TIME Mental Health/Psychology

How Fireworks Can Trigger PTSD

Fireworks will be going off with a bang all weekend, but for some, they cause more anxiety than celebration

You may see the signs popping up around your neighborhood this July 4—red, white and blue notices that indicate the home of a vet with the request to “Please be courteous with fireworks.”

The signs are the work of a Facebook-launched nonprofit, Military With PTSD, begun by Shawn Gourley, whose husband, Justin, served in the Navy for four years and returned with post traumatic stress disorder (PTSD). Sudden and loud noises can trigger episodes of PTSD, bringing veterans back to traumatic experiences they have lived through during their service. According to the U.S. Department of Veteran Affairs, up to 20% of military personnel who served in Iraq or Afghanistan experience PTSD each year.

The signs are posted on the lawns of veterans’ homes to alert people to be more considerate when setting off fireworks in the area. According to Gourley, who spoke to CNN, the group has mailed 2,500 signs, some of which were paid for by donations and others by the vets themselves, while 3,000 people remain on a waiting list.

The signs are not meant to quash any Fourth of July celebrations, but to raise awareness that the explosive sounds, flashes of light and smell of powder may trigger unwelcome memories for some. “If you are a veteran, on the one hand July 4th should be one of the most patriotic holidays that you feel a part of,” says Dr. John Markowitz, professor of psychiatry at Columbia University. “On the other hand, the rockets’ red glare and the bombs bursting in air are likely to evoke traumatic memories, and you might want to hide. It’s a tricky one.”

Having advanced knowledge of a fireworks display can help some people with PTSD to better prepare and cope with any symptoms they may experience. “A big component of the startle response and PTSD is the unexpected,” says Rachel Tester, program director of the Law Enforcement, Active Duty, Emergency Responder (LEADER) Program at Harvard Medical School’s McLean Hospital. “When people are able to anticipate, they are able to put into place mechanisms they have to cope ahead of time.”

That might include things such as relaxation techniques or being able to see the fireworks show and therefore know that they’re coming, as well as having headphones, music or other distractions at the ready.

Such strategies may not work for every PTSD patient, but being more aware that the explosive celebrations of the holiday might affect those with PTSD is an important step toward ensuring that everyone can enjoy the holiday without fear, anxiety or pain.

TIME Diet/Nutrition

Here’s What Happens To Your Steak When You Grill It

Nothing says the Fourth of July like juicy seared food, so here’s a quick lesson on the science behind grilling

It’s time to throw nearly everything you can think of—meat, chicken, fish, vegetables and even fruit—on the grill and give it a good sear. But what makes food cooked over a fire taste so good? Here’s the simple (we promise, it’s not that complicated) science behind what makes red meat red, when to take your food off the flame, and whether gas or charcoal is really better for that getting that smoky flavor, thanks to the experts at the American Chemical Society.

TIME Obesity

Injecting This Drug Helps Patients Lose Weight

Daily shots of liraglutide (Saxenda), recently approved by the FDA, helps overweight or obese patients lose weight

In a study published in the New England Journal of Medicine, researchers say that the only injectable weight loss drug approved by the Food and Drug Administration (FDA) helps people to lose more than 12 pounds, more than twice as much as people taking a placebo.

The study is one of several that the FDA considered before approving the drug in 2014. It included data on 3,731 patients who were randomly assigned to take liraglutide or a placebo for just over a year. The trial continued to follow the patients for another year, and that data will be published soon.

MORE: This Pill Can Trick the Body Into Losing Weight, Study Finds

Liraglutide is similar to an already approved drug to treat type 2 diabetes, but is used in higher doses for weight loss. The drug mimics the effects of a hormone that works in the gut to signal the brain that you’ve eaten enough and feel full. As a diabetes drug, it helps the beta cells in the pancreas release insulin to keep blood sugar levels in check. In the NEJM study, none of the patients had diabetes, although some were pre-diabetic, and the FDA says liraglutide for weight loss should not be used together with the diabetes drug, also made by Novo Nordisk.

According to the study’s lead author, Dr. Xavier Pi-Sunyer, director of the obesity research center at Columbia University, liraglutide works as well as phentermine-topiramate (Qsymia), which doctors believe works by suppressing appetite. They key to making any weight loss medication effective, he says, is combining it with diet and exercise changes as well, which is what the participants in the study did. One advantage of liraglutide is that it can be used by women in their child-bearing years.

So far, the side effects of litaglutide, which include nausea, diarrhea, gall bladder abnormalities and pancreatitis, were minimal and did not outweigh the benefits of weight loss. But in approving the drug, the FDA asked the company to continue to study the drug to ensure that the adverse events remain within an acceptable range.

TIME medicine

How This Common Drug Can Have Lasting Effects on Kids

Antibiotics are prescribed for a range of childhood ailments, from ear to throat infections. But the drugs may be changing kids’ health in potentially unwelcome ways

In a study published in Nature Communications, scientists document the possible long-term effects of antibiotics when they’re used early in life. Their study involved mice, but the team used the drugs in doses and treatment regimens that mimic those frequently administered in young children.

Dr. Martin Blaser, professor of medicine and microbiology at New York University Langone Medical Center, and his colleagues tested three different antibiotic regimens: one involving amoxicillin, another involving macrolides and a final one that combined the two. They compared these animals to mice that received a placebo. The mice got antibiotics 10 to 15 days after birth, then again 27 days later and finally after day 39. They lived for 160 days, at which point they were sacrificed and their gut bacteria were studied.

MORE: Here’s What Eating Nothing But McDonalds for 10 Days Does to Your Gut Bacteria

Compared to the mice taking the placebo, the antibiotic-treated animals had less diverse communities of bacteria, and the proportions of the bugs living in their guts were also different. The macrolides seemed to have the biggest effect on reducing microbial richness, while amoxicillin led to abnormally large bones. The changes in the microbiome persisted even to the animals’ death, nearly four months after their last antibiotic dose.

“There are really long-term, probably permanent effects on the microbiome from antibiotics,” says Blaser. “We showed changes in the richness and the community structure, and also the genes present in the bacteria.”

MORE: Antibiotics Before Age 2 Increase Risk of Childhood Obesity

What this means for humans still isn’t clear from this study, but the findings do provide hints. Other studies that have analyzed the potential effects of antibiotics found that children receiving more rounds of the drugs because of early infections tend to be heavier and are more likely to be obese as adolescents and adults. And the earlier children are exposed to the drugs, the more likely their metabolism is to be affected.

Blaser notes that antibiotics are a necessary and potentially life-saving treatment for some, but for many infections, their risks might be greater than their benefits. “If what we found in mice is true for human children, then this is yet another reason to be cautious in using antibiotics,” he says. “We know there are kids who are severely ill who must have antibiotics. But there is a larger number of kids who are only mildly ill. The question is, what proportion of them really need antibiotics?” Based on the animal data, he says, the first two to three years of life are particularly important for development, and doctors and parents should be judicious about prescribing antibiotics during this sensitive time.

TIME Diet/Nutrition

New York City Restaurants Are Cleaner Than Ever

18% fewer eateries have been cited for evidence of mice

It’s been five years since New York City instituted a strict grading policy assessing restaurants for cleanliness, food safety and handling—an attempt to address its somewhat unsavory reputation as a mecca for unsanitary eating establishments.

Now, in the latest report, city health officials have some good news: 95% of restaurants now earn A grades, and violations that can contribute to foodborne illnesses have dropped by 11%, giving New York its cleanest report card since the program began.

The requirements and methods of the health inspections are not without critics; even high-end establishments with Michelin-star honored chefs like Per Se were notoriously cited for not maintaining hot foods at high enough temperatures or cold foods at cold enough temperatures, despite commonly used practices of “resting” dishes after they come out of the oven or refrigerator to balance flavor and temperature. But the system works, say health officials. The report says that 37% more new restaurants in the city earn A grades in their first year compared to five years ago, and 18% fewer eateries have been cited for evidence of mice.

The program allows eating establishments one do-over; if they don’t meet criteria for earning an A grade, they have up to 30 days to fix their violations and receive a second inspection before getting the final grade that gets posted on their window. That posting, says Dan Kass, deputy commissioner for environmental health at the New York City Department of Health and Mental Hygiene, is key to the program’s success. “You need transparency in governmental inspection programs,” he says. “It’s the best way to inform the public and encourage them to vote with their feet and the best way to motivate restaurants—especially those that lag behind others in hygiene and food safety practices—to feel motivated to comply [with health regulations.]”

When the letter grading and public posting of the grades began five years ago, says Kass, officials expected about a 5% improvement in grades every year. “We have seen much more rapid change than that,” he says, “and it truly influences the practice of food safety in restaurants.”

The department now plans to launch a food safety workshop for restaurant workers—not just owners—to help them better understand the value and importance of proper handling and storing of food. But the public and prominent posting of letter grades will remain, so diners will still have a quick and easy way of knowing where the restaurant stands with respect to food safety and sanitation. “Inspections and education alone are insufficient to drive restaurants to improve,” Kass says. “Threats of fines may help, but those too are insufficient to move some restaurants to really change practices and put the public’s health first. There is no question that public transparency and making the information available to public at the point of sale is probably the most important driver—at least for the improvements we see.”

In fact, the system is gaining in popularity; Yelp reviews now include the grades or number scores for restaurants in cities that provide them.

TIME Brain

Alzheimer’s May Begin 20 Years Before Symptoms Appear

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PASIEKA—Getty Images/Science Photo Library RM

The two decade mark is the earliest that scientists have placed the beginnings of the disease. The good news is that gives doctors a long window of time in which to slow down or reverse the condition

The latest breakthroughs in Alzheimer’s research focus on the time well before patients even know they might have the neurodegenerative condition. Studies so far have found evidence that the biological processes that cause the mental decline may begin 10 to 12 years before people first notice signs of cognitive decline. But in the most recent report published Wednesday in the journal Neurology, experts say that the disease may actually begin even earlier — 18 years earlier, in fact — than they expected.

MORE: Mental and Social Activity Delays the Symptoms of Alzheimer’s

For 18 years, Kumar Rajan, associate professor of internal medicine at Rush University Medical Center, and his colleagues followed 2,125 elderly people with an average age of 73 and who did not dementia. Every three years, the researchers gave the volunteers mental skills tests, and then compared these results over time.

When the looked at the group that went on to receive an Alzheimer’s diagnosis, they found that these people showed lower scores on their tests throughout the study period. In fact, their scores steadily declined with each test. For each unit that the scores dropped on the cognitive tests, the risk of future Alzheimer’s increased by 85%.

MORE: Many Doctors Don’t Tell Patients They Have Alzheimer’s

Rajan stresses that the results only link cognitive testing scores on broad, group-level risk, and can’t be used to predict an individual’s risk of developing the disease. For one, more research will be needed to find the range of decline that signals potential Alzheimer’s dementia. But the findings do set the stage for studying whether such a non-invasive, easily administered test can, or should be, part of a regular assessment of people’s risk beginning in middle-age.

That way, he says, people may have a longer time period in which to hopefully intervene to slow down the disease process. Rajan plans to study whether brain-stimulating activities like crossword puzzles or learning a new language and social interactions can improve the test scores, and in turn slow the time to diagnosis of Alzheimer’s. At the very least, he says, the current data shows that there is a longer window of time in which people might be able to intervene in these ways and potentially delay Alzheimer’s most debilitating effects.

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