This is the Health Show, a presentation of national productions.
Plustridium defecil is not only very difficult to say, it can be deadly.
This gut infection has been in the news without breaks in hospitals and nursing care facilities
in the U.S. and Canada.
And now there's a study that says if you are depressed, you have a much higher risk of
getting infected.
On today's health show, we'll talk to the lead author of this study about depression and
infection.
We'll also hear a group of women speaking about their diagnosis of chronic fatigue syndrome
and what this controversial condition has done to their lives.
And then commentary from a middle-aged man juggling his doctor visits with the rest of his
life.
I'm Dr. Nina Sachs.
I'm Bob Barrett and this is the Health Show.
According to a study from the University of Michigan, adults suffering from depression
who take certain types of antidepressants have an increased risk of developing Plustridium
defecil, a serious bacterial infection that's responsible for more than 7,000 deaths each
year in the U.S.
The study also suggests that those who are widowed or who live alone are also at higher
risk.
The study was published in BioMed Central's Open Access Journal BMC Medicine.
Here to talk about the findings is Dr. Mary Rogers, the lead author of this study and
a research assistant professor in internal medicine at the UM Health System and at the
VA and Arbor Healthcare System.
We spoke earlier and I started by asking her about C-Diff.
Well, it's a gastrointestinal infection and it's caused by a bacteria that forms spores.
It's normally associated with health care.
So patients who end up in the hospital or a skilled nursing facility are at risk.
And it's one of those gut infections that occurs sometimes after you take antibiotics.
Because the antibiotic sometimes will get rid of the good bacteria as well as some of
the bacteria that are causing problems.
And this disruption in the communities, the bacteria in your gut has an influence on
your risk of growth of this organism.
So we were looking at the bacterial content of the gut and the relationship that had to
this particular infection, the posterior difficile infection, and other things that are related
to the patient, like patient characteristics or other things that could help us predict
why these people get this type of infection.
It has kind of a high fatality rate.
So there are people that do die from this infection and it's relatively, it's not too common,
but it is one of those more commonly fatal bacterial infections in the hospital.
And it seems to happen in bunches.
You're right, it can occur in outbreaks, right?
Now in this study you found that it looks like adults with depression are more apt to
come down with this infection.
Right, we were lucky because we have a number of different databases.
And one of the nice databases that we have is a population-based study, the Health and
Retirement Study.
And that is a representative sample of older Americans in the United States.
And that study is used for a lot of different things.
But one nice thing about having that type of information is that you are less likely to
be just looking at a selected few people.
You are more likely to get a general idea of what's happening in the population.
In the United States here it's hard to get those population national figures because
we don't have one overarching system except for perhaps Medicare, so for older folks.
So we linked the Health and Retirement Study data and they are interviewed every two
years.
We linked it with Medicare data where we could follow their hospital visits and when they
went to the doctor and when they went to the emergency room.
And we could see when they developed C-difficial infection.
And when we looked at the data from that population, yes, we found that people who had the diagnosis
of major depression or they had other kind of depressive disorders.
Also if they were feeling sad, there were certain questions on the questionnaire that we
could look at that kind of corroborated our findings.
If they were feeling sad or if they had emotional, nervous or psychiatric problems, they were
more likely to have had clusteredium difficile infection.
And we also had a variety of different other social factors in the questionnaire.
So we looked at marital status and people who were widowed were also more likely to have
C-difficial infection and people who lived alone were also more likely to have it.
So we were kind of seeing a pattern there.
We hear so much now about the microbiome in the gut.
Is there something, is there a thought there that perhaps that microbiome was being affected
by depression?
Yeah, actually not from our study, I looked at it in a different way, but there have been
studies that have actually had directly looked at this.
There was a study that looked at the microbiota of depressed patients and they did show that
they had different types of bacteria than people who don't have depression.
And there is a whole host of other research that shows that having depression and bereavement
causes changes in your gastrointestinal system, both studies in animals as well as humans.
So there's enough of other evidence here to show that this might be something that really
could be happening.
In your study, you found that people who were taking two common antidepressants were also
twice as likely to test positive for C-dif.
Is that something that's going to be looked into even further?
Yes, those are new findings.
And so we're going to have to look into that a little bit deeper.
We do have information regarding their gut bacteria, so we'll be looking at whether there's
a relationship there with taking these medications.
If that affects the bacteria in their gastrointestinal system, but yes, we did find a few associations.
I say they're a little bit tentative now because once new findings come out, we're not
quite sure if it's that particular medication itself until we have enough other studies to
be more conclusive.
There was a group of Canadian pharmacists that found that antidepressants in general were
more common in people with C-difousyl infection.
So we were working on their original finding and they and their articles, they didn't make
too much about it because it was unexpected and they didn't know whether that was real
or not.
So we wanted to look it into it further.
So our results show there's likely to be a connection there, but we're not quite sure
with what combination of antidepressants might be a concern.
For the patients mostly hospital patients.
The hospital study, we actually did two studies and that are reported in the article here.
And actually if you want to go on the site, you can download the entire PDF for the study,
the nice thing about open access journal.
But the second study was hospital based and it was a wide range of patients.
So everyone who developed C-difousyl infection during a certain time period or was tested
for it, everyone was included.
So the range for age was very wide.
We had some infants in there all the way up to people that were close to 100.
So it was a wide variety of different types of patients.
Some of them were receiving surgery and were in for more minor reasons.
Some were in for various serious reasons.
We tried to adjust for other factors as well to see if that made a difference.
And it seemed to be kind of a robust finding.
The first study, however, was of a population that wasn't necessarily hospitalization.
So the first study in the health and retirement study, that large population based one in the
med- using Medicare data.
And that, they could have had clustering of difficile when it was diagnosed at the doctor's
office or the emergency room or in a hospital or an nursing home or wherever.
So that captured the wide variety of types of people.
So that's more akin to what your risk would be in the general population.
Whereas the second study was more reflective of hospital population.
So what next, where do you go from here with this research?
Actually, we do have information regarding the gut bacteria.
And because we're funded by NIH for that, we'll be looking at whether there are associations
with particular types of antidepressants and if certain antidepressants influence the
growth of certain types of bacteria.
So we'll look into that further.
We have also the opportunity of looking at a number of different databases.
If we can see as well, if depression is a problem in other age groups, it would be nice to
look at other age groups as well because we looked here in older Americans for the first
study.
But depression is something that occurs in other adults as well, middle age and younger
age individuals.
And it would be nice to see those same relationships hold.
Dr. Mary Rogers is a research assistant professor and internal medicine at the University of
Michigan Health System and at the VA and Arbor Healthcare System.
Still to come, women living with chronic fatigue, immune dysfunction are calling themselves
the canaries in the coal mine.
We'll hear more next on the health show.
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This is the health show.
I'm Bob Barrett.
And I'm Dr. Nina Sacks.
Chronic fatigue and immune dysfunction syndrome is a difficult condition to diagnose.
Getting a diagnosis is a time consuming process, which is generally arrived at by excluding
other illnesses with similar symptoms and comparing a patient symptoms with a 1994
international case definition.
But to people living with these symptoms, life can be an even bigger struggle no matter
what the diagnosis.
Independent producer Brianna O'Higgins spoke with four women about life with CFIDS.
I remember when I was lying in bed one day listening to the radio and there was a story
about a young man who had died of AIDS.
And I just started weeping and I could not figure it out.
Why am I crying about this man that I don't even know?
And then suddenly I realized I wasn't crying for him.
I was crying for me.
He at least died and got out of it.
I pictured that my life would be in this bed forever.
They had no comprehension of how far beyond fatigue this actually was.
This was like a little mini death.
My name is Susan Shaqt and I have chronic fatigue syndrome.
My name is Lily Berry and I was diagnosed with chronic fatigue and immune dysfunction syndrome.
My name is Anna and I was diagnosed with chronic fatigue syndrome.
My name is Judith Lopez and my diagnosis at this point is chronic fatigue, immune dysfunction syndrome.
Do you know how it feels when you go down with the flu, how everything aches, the back,
the neck, just unbelievable fatigue and tremendous difficulty concentrating?
Saving exhaustion, sleep problems, severe joint pain, the aches, severe headache,
falling asleep and staying asleep.
Migrating muscle and joint pain.
There's a lot of brain fog we call it.
I was told invariably that there was no such condition and that I was imagining what was
going on.
I had one cardiologist just laugh at me and tell me that I was making all this up.
Oh, that I was doing too many things and I needed to just rest and recuperate and it
could just be a virus, could take a couple more weeks to get over it.
He tested me for Epstein Bar Virus.
They did a mono test.
We rolled out Lyme disease, we rolled out thyroid disorders.
There's an old Victorian term called Neurosthenia, something applied to fainting Victorian
ladies.
He put me on antidepressants.
They were very big on depression.
And do you just need some antidepressants maybe?
Maybe there's something going on in my head that's complicating this.
I really felt like I had brought this on on myself.
When I was diagnosed for sure, it was definitely a relief.
At first I felt very vindicated, although I thought the name was ludicrous.
They don't understand that there's a whole cluster of things that are going on physically
that is more than exhaustion.
Fatigue seems like such a weak word.
Oh yeah, I've been fatigued too.
Yeah, I'm chronically fatigued, but the syndrome is something completely different.
I didn't know what to do about my job.
Could I keep my job?
Could I get a leave of absence?
Could I work part-time?
I had just gotten this employment and I was very excited about it.
And I also knew that if I didn't keep up my, and no appearances at work, I was going
to lose this job.
I would go into a classroom and at the lunch break when everybody went off to lunch, I would
have to lie down on the floor to rest.
So I finally said, you know, I can't continue this anymore.
Eventually I went out and applied for disability.
I finally did get social security, and that has been a tremendous blessing.
I would be on the streets if it weren't for that.
And one time I became aware that there was a very high suicide rate among people with
this condition.
Because really, what are you going to do?
You can't work.
Your finances are in a mess.
Your partner has probably fed up and ready to leave you.
You can't pay your bills, and you feel horrible every day.
I keep talking about this sadness.
It was a tremendous sadness.
Terrible, terrible grief, horrible grief.
I mean, I had wanted to have children, and I realized I would never have children.
And that, you know, my odds of recovery were almost nil at that point.
And then I went through a very difficult period of adjusting to the idea that maybe this
was it.
This is how I would live the rest of my life.
And I tried lots and lots of things.
I tried acupuncture.
Chinese herbs.
Natural remedies and supplements.
Nothing like sugar, no alcohol.
Homeopathy, chiropractic, rectupressure, supplements.
Fish oil, and those amegas.
You know, trying to eliminate wheat, eliminating dairy.
Something like 4,000 different studies in the last few years, just on chronic fatigue
syndrome.
Trying to figure out really what the etiology is.
I do have thoughts on how this comes about.
It would be an interesting question.
Did I have a lot of stress?
Or is it that my body had a particular weakness in the area of managing stress?
I think has to do with the change of the environment around us.
That we have to deal with things that we're not really designed or equipped to deal with.
In the form of a lot of chemicals, toxins, things in our food, things that we breathe,
encounter.
Definitely there's some triggers.
There's a main triggers, usually a virus like mono or Epstein Bar virus.
Or some kind of trauma.
I think we have something specific to offer the world, which is where the canary is in
the mind.
You know, they used to send a canary down into the coal mines before they would send
the miners down.
And if the canary died, then there was a gas leak.
And if the canary was all right, then the coal miners could go down and do their mining.
We're saying everybody else is thinking, oh, spray this place with red.
Get rid of the ants.
But we are the people who are going to know better.
And we're the people who are going to keep bringing it to people's attention until we get
the message told.
And when we do, we're going to make it better, not just for ourselves, but for everybody
else at the same time.
So maybe we have a mission.
We're going to be the canaries and say, quick, get the oxygen.
Don't stay down in this mine.
That's my feeling on my very good days.
Because that's our job.
We have a kind of a job to do.
And we've all got to stay alive and keep doing it.
This piece was produced by Brianna O'Higgins.
There is more information about this condition at CFIDS.org.
We meet a lot of people in our lives, some in passing, some who make a huge impact.
But our friend, Judalablang, reminds us that seeing a lot of those people involves appointments
and health insurance.
I scour my daily planner, review my calendar, and stack up appointment cards which form a
leaning tower on my desk.
The cards are tangible reminders of my upcoming doctor visits, meetings that must be scheduled,
be fird, reviewed.
Looking at my schedule, week by week and month by month, the appointments spread out toward
the horizon like a line of planes circling above, waiting to land at Logan Airport.
One a week and no more, I tell myself, trying not to be snowed under by the need for preventative
maintenance and medical interventions to keep my body from collapsing in on itself.
The relentless march of time, I think of a line of Marines, Jack Boots on Asphalt, keeping
time as they stride forward.
HEP 2-3-4, and my body falls in line with them, bringing up the rear, marching in only
one direction.
Like them, I move forward, do as I'm told, obey.
There are monthly and yearly check-ups, check-ins with those specialists I did not know, and
could not name until I reached my fifties and the terrain of middle age, when all things
can possibly go wrong and many do.
I have an audiologist and an auto-layeringologist to manage my sudden hearing loss, a cardiologist
for my labial blood pressure, a dermatologist to follow up on my superficial malignant melanoma,
a periodonist for skin grafts and bleeding gums.
I learn new words, jargon, specialties.
My health insurance carrier or lack of provider, as I think of them, does not cover hearing
aids because they are expensive.
I dodge in and out of doctor's offices, soundproof booths, labs, where blood is taken and
analyzed.
A bone spur appears in the joint where my big toe joins my right foot, and I need something
called a chilectomy.
A podiatrist joins my expanding core of crack physicians, along with my primary care
man, a holistic sort, whose stress is surgery only as a last resort.
I concur, slip orthotic supports into my running shoes, and head toward the gym three or four
times a week.
I jog on treadmill, plot on stairmaster, and lift weights, determined to hold my ground.
Years like last month, when I chalked up another birthday, another ring around the trunk
of my physical body, I sensed the futility of running in place.
Yet I can think of no other option except for giving in, a surrender that may come later
but will not come now, not while I navigate this middle passage, determined to make
the most of the time, and the body I have left.
Judah LeBlanc is a writer and storyteller based in Boston.
The second edition of his memoir, Finding My Place, One Man's Journey from Cleveland to
Boston and Beyond, is available on his website, Judah LeBlanc.com.
That's all the time we have for this week's health show.
If you'd like to listen again, join us online at healthshow.org.
You can explore the archive for any programs you might have missed or would like to hear
again.
You can also subscribe to our podcast, that's healthshow.org.
Want more?
Then follow us on Facebook.
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And if you have any questions or comments about the program, send them in.
Our email address is letters at healthshow.org.
I'm Bob Barrett.
And I'm Dr. Nina Sacks.
Stay healthy and be sure to join us next time for another edition of the health show.
Dr. Nina Sacks is a practicing member of the American College of Gastroenterology.
Bob Barrett is producer of the health show.
Dr. Alan Shartock is executive producer.
The health show is a presentation of national productions, which is solely responsible for
its content.
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