Health Matters: How are we treating the Zika virus?
Q. I know that Zika virus infection during pregnancy can cause severe problems in the baby. Has any new treatment for Zika been discovered?
A. Zika is caused by a virus that is transmitted to people mainly by the bite of a certain type of mosquito and, in some cases, through sexual contact with an infected individual. Zika infection has been reported in 75 countries, including the United States. Zika infection in a pregnant woman can lead to a variety of problems in the baby, especially an underdeveloped brain and a small and malformed skull (the technical term is microcephaly). Although we don't yet know for sure, it is likely that some milder effects may not become apparent until the baby is older. Currently, there is no effective treatment for Zika infection once it occurs. The best preventive approach is to stay out of high-risk areas or to use insect repellent if visiting risky areas. A major worldwide effort is underway to develop an effective treatment for Zika viral infection, but this undertaking is going to be challenging because we don't really understand how the virus causes the various associated malformations in babies. Another challenge will be that any new drug that shows promise in the laboratory will need to undergo a clinical trial in infected pregnant women. But a new drug may have its own associated toxicities, and we will have to carefully balance the risks of Zika infection with the uncertain risks of using a new and unproven drug. (Older readers might remember the terrible side effects of thalidomide in the 1960s).
Q. As I've gotten older, I seem to be prone to depression. My doctor prescribed a medication that seemed to help but caused intolerable side effects. Any thoughts?
A. Unfortunately you're not alone. About 1 in 6 adults older than 55 years of age has significant depressive symptoms, and some are severely depressed. Older adults are about twice as likely to have depression as younger people. Why some people like you develop depression later in life despite not having problems before is not clear, but likely contributors are loss of social contacts with aging through the passing away of friends and family members or the result of hearing loss, and the development of health problems, including cognitive dysfunction and dementia. Drug therapy often helps older patients with depression, but they are particularly susceptible to side effects. Because medicines can interact with each other and cause side effects, there are tools available to help identify and prevent such adverse interactions. One consideration for you is to retry the medicine but in a lower dose. There are also different types of antidepressants that may not have the same side effects. Other options that seem to help include psychotherapy, psychological and exercise therapy, and even shock therapy in severe cases. Combining medications and psychotherapy is often recommended as more effective. Many older people with depression receive no treatment at all, which is doubly unfortunate because such people often suffer for years, and treatment with medication with or without other supportive measures often improves the quality of life and reduces the depressive symptoms of those affected.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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