Purported Medical Uses
Glaucoma: but even ophthalmologists do not recommend it due to systemic lowering of blood pressure, which ultimately can harm the eye.
Appetite: available as maranol.
Pain – multiple alternatives, without associated risks
Risks of Marijuana
Overdose—Spike in ER visits in Colorado since legalization
Risk of low birth weight babies if used by pregnant mothers
Cognitive/Brain Development. Lowered IQ, average of 8 points [makes them below 70% of their peer group, and is noticeable to their close acquaintances].
Association with Psychosis—doubled risk, earlier onset (by 4 years), worsened outcome
Addiction (1 in 6), use of other drugs
Poor outcome: regular use doubles the risk of early school-leaving (before 15 years old); using before age 15 raises risk of not finishing high school by 5.6
Responsible for 17% of cases of failure to graduate from high school, attend college, and attain a degree
Anxiety, low mood, and paranoia
Addiction: 1 in 10 users develops dependence
Car accidents: Doubles risk for car crash
Cardiovascular risk (confounded due to co-occurrence with tobacco smoking); dose-response relationship between cannabis use and mortality in patients who have had heart attack over 4 hears.
Quadruples risk of heart attack of people who have had a heart attack
Doubled risk of chronic bronchitis
Lung cancer – difficult to quantify due to confounding with tobacco use
Anxiety, low mood, and paranoia
Doubled risk of suicide
Cognitive impairment: attention, memory, verbal learning. Dose dependent.
Testicular cancer—2-3 x increase
Of note, cannabis dependence and adverse effects have been reported in the Netherlands – where cannabis has been decriminalized for 40 years.
Prevention or delay of cannabis use in adolescence will have broad health and social benefits.
Working on a film series with director Andres Lopez, to educate teens about the cognitive damage done by marijuana. Here is some of the data: http://www.drugabuse.gov/publications/drugfacts/marijuana
Discussing the importance of treating depresssion.
It’s not just Yogi Bear who wants to sleep through the winter. Many young adults and women also want to hibernate, and they sleep more, gain weight, crave carbs, and get depressed.
In 1984, this condition was given a name: Seasonal Affective Disorder, which gave experts the appropriate acronym SAD. Predictably, people start feeling worse in September as days get shorter, and then start feeling better in the spring with more light.
As with all psychiatric issues, there are many overlapping causes. Genetics is clearly a factor. Primitive biology, and the melatonin we produce ourselves, is involved. So are chemicals in the brain such as serotonin and its close relatives, norepinephrine and dopamine. For any given person, one or more of these factors might be more important than the others, but they all play a role.
Not surprisingly, SAD is more common where the light changes more dramatically with the seasons: in New Hampshire, 10 percent of people suffer from SAD, but in Florida, only 1 percent of people have it.
Treatment is the same as for other mood disorders, and you should see your doctor. He or she may recommend medication and/or therapy, especially cognitive-behavioral therapy.
Unique to SAD, however, there is the option of light therapy, often added on to medication treatment. One of the most popular forms of light therapy is a small, notebook-sized blue light, to use every morning for about a half hour, as determined by your doctor. It is not like those big lights from the ‘70’s, that used to give people sunburns.
Light therapy is thought to help regulate the melatonin in the brain, and help “reset” some of the hormones that slow people down when they have SAD. It tricks the brain into believing that the days aren’t in fact getting shorter, so it does not have to respond in its usual fashion. Most people only have to use it for a few months, not for the whole winter.
Intense exercise is also likely to help. Biking for 45 minutes, most days of the week, can make a difference, especially if it is done outside.
Some of the therapy specifically goes against the biological pull of those with SAD to hibernate. Patients are encouraged to schedule pleasant activities, just as they would schedule appointments. Here in San Francisco that might involve going to the outdoor ice rinks, or to the pumpkin patches. Ongoing wintertime interests that can be sustained are ideal. That could be joining a biking or running club, taking a knitting or photography class, or volunteering once a week. Clearly cognitive-behavioral therapy is best done with a professional.
While SAD is difficult, it is one of the few mental illnesses involving a cycle that can be predicted, and thus, prevented. Once it is diagnosed, it is important to anticipate each winter, and get ahead of the curve by taking very good care of yourself.
Holiday Stress—aggravations and how to relieve them
Laura Davies, MD
The holiday season is about to consume us. “Happy Holidays!” will be on every storefront, in every other song, and is already gracing the catalogs clogging our mailboxes (and the junk in our inboxes). It’s a great sentiment, but sometimes much easier said than done. In some ways the expectation of a happy holiday leads people to a stressed, guilt-filled holiday.
Ideas about traditions, assumptions about how to spend time with family and loved ones and expectations about gifts often lead to us burning the candle at both ends, feeling bad and then rewarding ourselves in unhealthy ways by over-spending, overeating, and over-drinking. This can have bad effects on our health—weight gain, higher death rates for heart disease, DUI’s, and anxiety.
There is even a special name for a heart arrhythmia: “holiday heart syndrome.” Too much alcohol can actually change the way our heart beats and can land us in the Emergency Room. Especially over the holidays, people delay coming to the ER, but as always waiting for treatment can raise the risk of death. Over Christmas and New Year’s there are increases in the rates of people who are dead on arrival at the ER or who die while in the ER. Even in California, there is a 1/3 higher rate of heart-related deaths over the holidays than from June to September.
Fortunately, for most of us it will not be that life-threatening or dramatic, but the lesson is the same: listen to your body.
The first step in taking care of yourself is to devote 15 minutes to writing down your priorities. Once you’ve ranked sleep, children, nutrition, partner, extended family, traditions, travel, exercise, shopping, etc., it will be easier to develop a schedule and a budget. That may sound overwhelming, but in fact getting it all on paper is often the first time that people see that their expectations are not aligned with reality, and that they do have to make choices, rather than attempt to race around to every single event. Time, money, and energy are all limited quantities, and knowing this going into the holidays is the best way to decrease your stress and really appreciate the events you decide to pursue.
Typically, we gain about 1.1 pounds each holiday season that we never lose. We don’t have to swear off delicious chocolate and peppermint treats, but moderation is certainly a good idea. There is no reason to wait for January 1 to start exercising regularly or eating healthily (reasonable portions and plenty of fruits and vegetables). There is nothing like a walk along Crissy Field for visitors, or, for the adventurous, a dip in the bay at the South End Rowing Club.
Another way to avoid weight gain is by moderating alcohol intake. The CDC (Center for Disease Control) and the US Department of Health and Human Services define moderate drinking as “no more than one drink a day for most women, and no more than two drinks a day for most men,” and two solid days per week without any alcohol. Troublesome drinking is more than three drinks in a night for women, or more than five for men. If statistics aren’t helpful, try remembering that last hangover—not fun.
Money is a huge stressor over the holidays, especially during a recession. Easy ways to remove guilt about not buying a gift include thinking about what the activity or item means to the person you are doing it with. We all know that toddlers invariably like the boxes more than the toy itself. A favorite aunt might prefer to make cookies or go shopping one on one rather than receive another scarf.
If there are several “can’t miss” parties on one night, elect to divide and conquer, spending meaningful time with friends, rather than racing around as a couple. If you need to rest, do. That may mean only attending part of a party, or not making the annual 3 hour drive to the country.
Just because it is the holidays, you do not have to sport a perma-grin. Life continues on, and losses can feel much worse when it seems that everyone else is surrounded by big, happy families.
Tradition is a very good thing. It ties us to our past and gives us a sense of meaningful connection. What part of your tradition speaks to you? If it’s the meal, is it specific dishes or just preparing food lovingly? Other people might prefer just spending time with loved ones, taking a walk, doing crafts, drinking coffee or playing board games. Feel free to rethink your timetables. Just because the department stores put their decorations up the day after Halloween, or your family used to get the tree the weekend after Thanksgiving does not create a mandate for you to follow.
Just because it’s labeled “the holidays” doesn’t bring any guarantee of fun or relaxation. That is up to us—and sometimes means saying no to social gatherings or traditions that no longer speak to us.