Women and Mental Health

May 1-7 has been Mental Health awareness week.

One in three Americans struggles with mental illness but the rate is much higher in women.  Research shows that women are 40% more likely to develop depression than men.  It is not clear why mental illness is more common among women but doctors have come up with a number of possibilities.

Discrimination, Trauma and stressful life experiences

Trauma is common among women with half of them experiencing some form of trauma in their lifetime.  One in four women have faced an attempted or a completed sexual assault.  Reportedly, one in three are abused by a domestic partner.  Gender discrimination, violence and mistreatment undermine a woman’s mental health.  Stress is a predictor of mental illness.  Women juggle housework, kids even while working fulltime.  They report that they have to work harder to get the same credit as men and worry about the gender wage gap.  They have to deal with sexual harassment and discrimination in workplaces where these are commonplace.  These challenges can significantly affect a woman’s ability to cope and her self-esteem.

Hormonal Issues

Women produce lower quantities of serotonin than men due to differences in hormone levels and this deficiency can lead to mental health issues such as depression and anxiety.

Pregnancy, Birth and Parenting

41% or women suffer from some form of postpartum depression.  Some of them are overwhelmed by the demands of parenting, especially in the early days.  I remember that there were times when I felt that I was drowning–in over my head.  Once I even cried out while I was holding my toddler.  Thankfully I had God and a very supportive partner.  It helped when he came home and I had an adult to talk to. Not all women are as blessed.  Research shows that women who don’t have supportive partners, experience traumatic births, live in poverty or a highly stressed will most likely develop postpartum depression.  

Gender bias is another problem women face.  Some research suggests that doctors tend to label women’s symptoms as emotional while taking the men’s symptoms more seriously.  So, a woman who reports that she is experiencing chronic pain to her doctor might be labeled as depressed.  This happens because we live in a world where gender discrimination exists and women are seen as more emotional and less rational.  

In many countries, the way health workers spoke to the women made it difficult for them to disclose their psychological and emotional distress.  And when they worked up the courage to disclose their problems, they were either over-treated or under treated by many of the health workers.

I read in an article in The Globe And Mail that women are getting the prescription that is available more often than the treatment they need.  They are getting medication to solve their problems even when science finds that treatments such as psychotherapy is equally or in some cases more effective without the side effects.  Bias in mental health care is a hindrance to women, preventing them from getting the proper help they need.  Not much effort goes into researching how drugs affect female patients.  While drug companies like to bombard women with their pills, most of their clinical trials have been dominated by men.  And the ironic thing is that the disorders most commonly diagnosed in women such as depression, anxiety and insomnia are the ones most likely to respond to therapy.  Most women are likely to prefer therapy over drugs.  

According to Dr. Marina Morrow, a Simon Fraser University psychologist who studies gender and mental health, “Women aren’t getting access to the range of care they need.”  She believes that an effective approach to this would be to include medication when necessary but in also offer therapy, peer support and pinpoint what social circumstances lead to the illness.

It has been argued that therapy is the safer, more effective and cheaper choice.  The authors of a 2015 study by Canadian and U.S. researchers concluded that, “There remains no sound justification to prescribe drugs without first trying therapy.  Dr. Cara Tannenbaum, scientific director of the CIHR Institute of Gender and Health, believes that “the way we fund therapies in Canada does not make sense right now.”  She wrote a letter to Quebec’s health minister to make the point that even if 20 per cent of seniors with insomnia received Cognitive Behavioral Therapy (CBT) with is used to treat insomnia, the cost-savings to the system could be in the hundreds of millions, based on the potential falls that would be avoided.  Therapy saves on costly and debilitating falls and hip fractures.  

We live in a country where medication is favored over psychotherapy and women are more likely than men to be prescribed antidepressants and sedatives as seniors and as a result they are at a higher risk of suffering from adverse effects.  Hopefully more women and those in the medical profession will speak out against the bias that is prevalent in the mental health care.  Doctors and those in the health care system need to give women more choices when it comes to treatment.  It’s their health so they should have the right to determine how they want to proceed once they have been diagnosed.

Women and Shingles

I found out last week that my mother who suffers from Parkinson’s has Shingles.  From what I have seen of Shingles it looks very painful.  I wanted to find out more about it so I decided to surf the Internet and get as much information as I could.

What is Shingles?

Shingles, also known as herpes zoster or just zoster, occurs when a virus in nerve cells becomes active again later in life and causes a skin rash.

The virus that causes shingles, the varicella-zoster virus, is the same virus that causes chickenpox. It is a member of the herpes virus family. Once you have had chickenpox, varicella-zoster virus remains in your body’s nerve tissues and never really goes away. It is inactive, but it can be reactivated later in life. This causes shingles.

Doctors aren’t sure how or why the varicella-zoster virus reactivates, but they believe your immune system’s response to the virus weakens over the years after childhood chickenpox. When the virus reactivates, it travels through nerves, often causing a burning or tingling sensation in the affected areas. Two or three days later, when the virus reaches the skin, blisters appear grouped along the affected nerve. The skin may be very sensitive, and you may feel a lot of pain.

If you have had chickenpox, you are at risk of developing shingles. However, the virus doesn’t reactivate in everyone who has had chickenpox. Shingles most often appears in people older than 50 and in people with weakened immune systems. If you are having treatment for cancer, for example, you are more likely to get shingles. People with HIV commonly get shingles, which is often one of the first signs that the immune system is in trouble.  Your chances of getting shingles increase as you get older, although the disease can occur at any age. When shingles appears in children, which is uncommon, it usually is very mild. Up to 20% of people in the United States develop the disease at some point (Women’s Health).

None of my sisters nor I ever have Chicken Pox as a child but later when we as adults, my sister and I got it from our mother.  I still have the marks.  I am hoping that I am one of the people in whom the virus does not reactivate.

 

Recently I have seen a commercial where a person has Shingles and it looks painful.  The rash on one side of  the man’s body looked red and very painful.  When I browsed the Internet, I saw pictures that made me cringe.  How those people must have suffered.  I think of my mother and I hope and pray that she isn’t in much pain.

What are the symptoms?

Pain

Symptoms of shingles are similar in men and women. The first and most common symptom of shingles is usually pain. This pain typically occurs before any rash is present and is sometimes called the warning stage of shingles. Women often describe a tingling, burning pain or an area of intense sensitivity on their skin. This often happens in a small area that is on one side of the body only. The pain may be mild or intense enough to require treatment with painkillers. The pain may last for a few days, may come and go or may be constant. It may continue once the rash and blisters form and usually lessens when the rash disappears.

Rash and Blisters

Another symptom of shingles is a rash that turns into fluid-filled blisters. This usually appears a few days or a week after skin pain starts. The blisters form a crusty scab in about 7 to 10 days and typically clear up in 2 to 4 weeks. The difference between the rash of chickenpox and that of shingles is that shingles usually appears on one side of the body only. Shingles commonly appears in a belt-like band around the midsection, corresponding to skin along the path of one nerve. Sometimes the rash appears on one side of the face and follows the major facial nerve, or it can involve more than just a single area of skin. Some cases of shingles have only a few or even no blisters. A shingle diagnosis can be missed in this case. Shingles without any rash or blisters is called zoster sine herpete.

Other Symptoms

Once the rash appears, women sometimes report flu-like symptoms, such as headache, upset stomach, fever and chills. About half of the people who have rash along the facial nerve experience eye complications. These complications are generally seen as inflammation of different parts of the eye and may involve a mucus or pus-like discharge and sensitivity to light. Eye problems from shingles are very serious and should be evaluated by a doctor immediately. Some women experience a condition called postherpetic neuralgia. This condition is pain that continues even after the shingles rash is gone. The pain has been described as a constant burning that hurts to the touch or pressure from clothing. It usually resolves on its own, but resolution can take 6 months to a year or even longer (Live Strong).

 

Shingles and pregnancy

Pregnant women can get shingles, but it is rare. While chickenpox can pose a very serious risk to a fetus, there is almost no risk to the fetus if the mother gets shingles. The symptoms of shingles are the same in pregnant and non-pregnant women. Any area of skin that has pain, tingling, itching or burning — even without a rash or blister — should be brought to the attention of a doctor, as this could be the early stages of shingles (Live Strong).  Thankfully, I got chickenpox years before I got pregnant.

 

Does Shingles affect women differently from men? According to Centers for Disease Control and Prevention (CDC):

• Most, but not all, studies found that more women than men develop herpes zoster [1,2]; the reason for a possible difference between women and men is not known.
• Some studies conducted in the United States and elsewhere found that herpes zoster is less common in blacks (by at least 50%) than in whites.[3]

 

How is Shingles Treated?

Self-care

If you develop the shingles rash, there are a number of things you can do to help relieve your symptoms, such as:

• keeping the rash as clean and dry as possible – this will reduce the risk of the rash becoming infected with bacteria
• wearing loose-fitting clothing – this may help you feel more comfortable
• not using topical (rub-on) antibiotics or adhesive dressings such as plasters – this can slow down the healing process
• using a non-adherent dressing (a dressing that will not stick to the rash) if you need to cover the blisters – this avoids passing the virus to anyone else

Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching.

If you have any weeping blisters, you can use a cool compress (a cloth or a flannel cooled with tap water) several times a day to help soothe the skin and keep blisters clean.

It’s important to only use the compress for around 20 minutes at a time and stop using them once the blisters stop oozing. Don’t share any cloths, towels or flannels if you have the shingles rash.

Antiviral medication

As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting 7 to 10 days. Commonly prescribed antiviral medicines include aciclovir, valaciclovir and famciclovir.

These medications cannot kill the shingles virus, but can help stop it multiplying. This may:

• reduce the severity of your shingles
• reduce how long your shingles lasts
• prevent complications of shingles, such as postherpetic neuralgia (although the evidence for this is uncertain)

Antiviral medicines are most effective when taken within 72 hours of your rash appearing, although they may be started up to a week after your rash appears if you are at risk of severe shingles or developing complications.

Side effects of antiviral medication are very uncommon, but can include:

• feeling sick
• vomiting
• diarrhoea
• abdominal (tummy) pain
• headaches
• dizziness (NHS Choices)

 

Can Shingles Be Prevented?

Currently, there is no way to predict an outbreak of shingles.  Researchers have shown that giving older people a stronger form of the chicken pox vaccine used for children can boost the type of immunity believed necessary to hold the virus in check. Zostavax, a shingles vaccine developed by Merck, has been approved by the FDA. An initial study in people with HIV showed that Zostavax was safe and effective (The Body).

 

Is Shingles Contagious?

Shingles is not contagious (able to spread) in the sense that people who are exposed to a patient with shingles will not “catch shingles.” Anyone who has already had chickenpox or has received the chickenpox vaccine, and is otherwise healthy, should be protected and at no risk when around a patient with shingles. However, people who have never had chickenpox and have not received the chickenpox vaccine are susceptible to infection by a patient with shingles. These susceptible people, if exposed to the shingles virus, will not develop shingles, but they could develop chicken pox. However, people who have never had chickenpox and have not received the chickenpox vaccine are susceptible to infection by a patient with shingles. These susceptible people, if exposed to the shingles virus, will not develop shingles, but they could develop chicken pox. Such susceptible individuals include babies, young children, and unvaccinated individuals, so people with shingles are actually contagious for VZV infections in the form of chickenpox. Consequently, these individuals may get shingles at a later time in life, as can anyone who has had chickenpox. Covering the rash that occurs with shingles with a dressing or clothing helps decrease the risk of spreading the infection to others. Pregnant women are not unusually susceptible to shingles but if shingles develops near the end of pregnancy, the fetus may be harmed (eMedicineHealth).

 

Vaccines for Shingles

The shingles vaccine (Zostavax) is recommended for adults age 60 and older, whether they’ve already had shingles or not. Although the vaccine is approved for people age 50 and older, the Centers for Disease Control and Prevention isn’t recommending it until you reach age 60.

The shingles vaccine is a live vaccine given as a single injection, usually in the upper arm. The most common side effects of the shingles vaccine are redness, pain, tenderness, swelling and itching at the injection site, and headaches.

Some people report a chickenpox-like rash after getting the shingles vaccine.

Although some people will develop shingles despite vaccination, the vaccine may reduce the severity and duration of it.

The shingles vaccine isn’t recommended if you:

• Have ever had an allergic reaction to gelatin, the antibiotic neomycin or any other component of the shingles vaccine
• Have a weakened immune system due to HIV/AIDS or another disease that affects the immune system
• Are receiving immune system-suppressing drugs or treatments, such as steroids, adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), radiation or chemotherapy
• Have cancer that affects the bone marrow or lymphatic system, such as leukemia or lymphoma
• Are pregnant or trying to become pregnant

The cost of the shingles vaccine may not be covered by Medicare, Medicaid or insurance.  Check your plan (Mayo Clinic).  One of my co-workers got the vaccine this year and recommends that I get one too.

 

 

Is there a Cure?

There is no cure for shingles, but treatment can help ease your symptoms until the condition improves. In many cases, shingles gets better within around two to four weeks.  However, it’s still important to see your GP as soon as possible if you recognize the symptoms of shingles, as early treatment may help reduce the severity of the condition and the risk of potential complications (NHS Choices).

 

Caring for Shingles

How to care for a Patient with Shingles

If you are helping to care for someone with shingles and particularly if they are elderly, then here are some ideas to make life more comfortable for them:

• As soon as the rash appears and has been diagnosed as shingles, start treatment. If treatment can be commenced within two or three days of the outbreak, the shingles will be less severe and there is less chance of the patient going on to suffer from postherpetic neuralgia.
• You cannot catch shingles by touching the sore skin or the bed or chair where the person has been lying or sitting so if wearing less clothing will make the patient more comfortable then encourage this. Some people with shingles are very sensitive to touch so try to touch only the side of the body that does not have the rash.
• You can catch chicken pox from a person with shingles blisters so keep anyone who has never had chicken pox away from the patient.  (This particularly applies to pregnant women where there is a danger to the unborn fetus).
• Relieve any discomfort with cool compresses unless your patient finds it makes the pain worse.
• Look for ways to relieve the stress of the pain for your patient such as meditation or listening to soothing music.
• Make sure your patient has a pain reliever if necessary and you may need a prescription for something to help insomnia if this is a problem. In some cases, the pain can be very severe and with such pain, it is hard to find a comfortable position whether sitting, lying down or walking around.  Your patient needs as much sleep as possible.
• Constant pain can affect your patient’s appetite – try to encourage your patient to eat well (you may need to provide extra tasty treats).
• Constant pain can also make your patient cross, sad or depressed – this will need extra patience and kindness on your part (Healing Natural Oils).

My mother is doing well.  She is on an anti-viral drug and not in any pain.  I was relieved to find out that her blisters are on her arm and not on her face.  She is frustrated because she is quarantined but the nursing home has to do what is best for all the residents.  I hope she gets better soon.  In the meantime, my family and I will do as she requested and stay away.

If you have a loved one who has Shingles, call them often.   Hearing from you may bring them some comfort.

 

Sources:  Live Strong; Women’s Health; Mayo Clinic; The Body; CDC; eMedicine Health; Healing Natural Oils