Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Adolescent depression rates appear to be increasing, Elizabeth Tracey reports

FDA warnings about the danger of antidepressant medicines in adolescents may have made the problem worse, a recent study looking at suicides in this age group found. Karen Swartz, an adolescent depression expert at Johns Hopkins, cites another worrisome study.

Swartz: Another recent survey showed that 50% of 18-24 year olds hit the threshold for a depression screen, and 25% of them said  they thought about suicide in the last thirty days.  :11

Swartz says while the problem is acute, patience is needed in treatment.

Swartz: What often happens too is that someone will come into care, when their symptoms are bad, but the medicines frustratingly take a while to work, so it might be that their intensity of symptoms actually worsens, in the time that you’re waiting for the antidepressant to work, so someone might be okay, but then they get worse because their illness is getting worse, and the antidepressant hasn’t had a chance to work yet.  :23

Swartz notes close monitoring is key. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: An FDA warning may have contributed to depression-related death among the nation’s youth, Elizabeth Tracey reports

The FDA warned in 2003 that taking antidepressant medicines might contribute to suicidal thoughts and behaviors among children and adolescents, and required what’s called a ‘black box’ warning to clinicians who prescribe them about the possibility. Since then an excess of suicides has occurred. Karen Swartz, an expert in adolescent depression at Johns Hopkins, says the risk is not in taking an antidepressant.

Swartz: What’s more of a risk is that without careful close monitoring you might start an antidepressant but not continue it, or you might get just better enough that you’re actually at higher risk, because when you first get better you might be having thoughts but now you have enough energy to act on the thought. The way to handle this is to absolutely not not treat the depression, because many many more children will die because of depression that from any complications of antidepressants. The key is to make sure that when you’re starting an antidepressant that the young people have adequate follow up and close monitoring.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you have heart failure but not diabetes, should you consider a diabetes drug? Elizabeth Tracey reports

Medications for diabetes known as SGLT2 inhibitors have been shown to reduce hospitalization and death for people with one type of heart failure, even if they don’t have diabetes. Rita Kalyani, a diabetes expert at Johns Hopkins, says this is great news but comes with cautions about this class of medicines, especially for the risk of hypoglycemia, or low blood sugar.

Kalyani: They do have quite significant and quite good magnitude reduction in heart failure hospitalization. There’s great evidence now to suggest their benefit in this population. We do have to be worried about hypoglycemia. These are not a class of agents that have high risk of hypoglycemia, we don’t think about it as a major complication but it can occur, and so I think we need to better understand how do we monitor the risk of hypoglycemia in these patients that are using them when they don’t have diabetes?  :30

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Two diabetes drugs may benefit people with heart failure, Elizabeth Tracey reports

A diabetes drug with the tongue-twisting name ‘empagliflozin’ reduced both hospitalizations for heart failure as well as cardiovascular death in people with one type of heart failure, a study known by the acronym EMPEROR has found. Rita Kalyani, a diabetes expert at Johns Hopkins, says the results are consistent with previous research.

Kalyani: Some agents in the newer classes, GLP1 receptor agonists and SGLT2 inhibitors, have superiority in reducing cardiovascular events in those who are at high risk or have previous history of cardiovascular disease. What was interesting about the EMPEROR trial was that they were looking at heart failure hospitalizations or cardiovascular death in people who had diabetes or did not have diabetes. So it was exciting because it was not just people with diabetes but also people without.  :31

Kalyani says the benefit in those with heart failure but without diabetes was novel and needs to be confirmed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can a diabetes drug help reduce Alzheimer’s risk? Elizabeth Tracey reports

Metformin is the first line medication for type 2 diabetes, and now an Australian study has shown that people taking it experience less Alzheimer’s disease compared to those not taking the drug. Rita Kalyani, a diabetes expert at Johns Hopkins, says the observation fits with what’s known about diabetes.

Kalyani: The link with potential cognitive function has been recently reported. We know that people with type 2 diabetes also are at greater risk of developing dementia. Dementia has been called type 3 diabetes or insulin resistance of the brain, and we do know that there is insulin signaling and insulin receptors in the brain as well. So this recent study that reported the benefit of metformin potentially in cognitive function from a plausibility perspective, is not surprising.  :30

Kalyani says other studies have shown that metformin may also improve longevity, but it’s far too early to take the drug for either of these reasons in the absence of diabetes. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: People with diabetes may soon be able to inject insulin just once a week, Elizabeth Tracey reports

Many people with diabetes must use the drug insulin, which may require them to inject themselves daily or even several times a day to keep their blood sugar controlled. Now a new study demonstrates that a once a week formulation is safe and effective. Rita Kalyani, a diabetes expert at Johns Hopkins, explains the study.

Kalyani: It compared insulin glargine, which is the most prescribed basal insulin in the United States to a new insulin that was being studied in a phase two trial called insulin icodec. What makes is so exciting is that it’s given once weekly. We currently don’t have any insulins on the market that are given once weekly. We have some non-insulin injections that are given once weekly, and what we’ve seen is that there’s increased adherence. Patients like taking fewer injections, they like the flexibility.   :30

Cost of the once weekly insulin is yet to be revealed, Kalyani says, but notes that as with almost all new medications it is likely to be more expensive than alternative formulations. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Estimates are that about 10% of the US population has been exposed to Sars-CoV2, Elizabeth Tracey reports

Seroprevalence refers to looking for antibodies to an infection in a population, with the most recent study in the US finding that only 10% of us have antibodies to Sars-CoV2, and that’s a far cry from what most experts say is needed to slow down infections. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: There is evidence that people’s antibodies wane over time. Depending on when you do these seroprevalence studies you could be missing people who have been exposed to the virus, are no longer mounting antibody response. In most people there are other immune memory processes that would potentially protect you against another reexposure to the virus so it doesn’t tell the whole story to know what the seroprevalence rates are but I think it certainly tells us right now that we’re, despite the many infections that we’ve had across the US, we’re not anywhere close to being able to say that this pandemic is behind us.  :30

Garibaldi says many places throughout the country are once again reporting increasing rates of infection. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Volunteers in the UK plan to allow themselves to be infected with Sars-CoV2 following vaccination, Elizabeth Tracey reports

How can you tell if a Sars-CoV2 vaccine works? Most studies inject two groups of people, one of whom gets the vaccine and the other a placebo. Then researchers wait to see whether the vaccinated group experiences less infection than the other, a process that takes some time. Now researchers in the UK say they are planning to expose some of their vaccine volunteers to the virus to see if the vaccine works, called a challenge. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: It’s very difficult to do live virus challenges. This is something we don’t commonly do and there’s been a healthy ethical debate in the US about whether or not we would consider doing this for vaccine studies that are taking place here. Very interested to see what happens with those studies but there is, even though we do have some therapies against Covid-19 and we hope that these vaccines are going to be effective at providing at least some measure of protection there is some obvious risk to being in these types of studies, and very anxious to see what happens.  :29

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What accounts for an apparent decline in severity of Covid-19? Elizabeth Tracey reports

Numbers of people infected with Sars-CoV2 continue to rise nationally, yet the rates of hospitalization and death are largely declining, recent data show. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says one factor is simply a bigger denominator, with more younger people becoming infected, but there may be another factor involved.

Garibaldi: I think the other interesting question is whether or not the size of the exposure that you have actually correlates with whether or not you get disease in the first place number one, then number two whether or not you get really sick. For many other viruses it’s true that if you are exposed to a larger amount of virus you are at higher risk of getting infected and higher risk of developing severe disease. And there’s some emerging data that suggests in areas where people are more likely to be wearing masks and are more compliant with physical distancing that we’re seeing a decrease in the number of people who get hospitalized and a decrease in the number of people who die.  :34

So wear a mask, Garibaldi says. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How many people can be infected with Sars-CoV2 but not show symptoms? Elizabeth Tracey reports

One in three people who tested positive for Sars-CoV2 didn’t have any symptoms at diagnosis and never developed any, a recent study from South Korea found. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says there’s at least one takeaway from this study.

Garibaldi: That is the basic principle of why we all need to be wearing masks. If there’s no difference in viral shedding between someone who’s sick and someone who’s not, then we are not testing widely enough or frequently enough to know who the asymptomatic people are, we all have to be wearing masks. And not for your own safety but for the safety of the community. You’ve got to be wearing masks. And we have to be really careful in the winter because people start going inside and getting physical distancing fatigue and wanting to be with friends and family over the holidays. We have to be careful, we have to protect each other. We have to keep going.  :29

Garibaldi says that the majority of people in this study were young and therefore also at low risk for severe disease. He notes that this rate of asymptomatic infection is similar to other studies. At Johns Hopkins, I’m Elizabeth Tracey.