Jan 05

Photo src: thetastingnote.com

Viagra, the popular anti-impotence drug, may stop working for many patients after 2 years, the results of a study suggest.

Dr. Rizk El-Galley of the University of Alabama at Birmingham and colleagues interviewed 151 men who had filled prescriptions for Viagra. Overall, 74% reported that 25 milligrams (mg) to 100 mg of the drug enabled them to initiate and maintain erections sufficient for intercourse.

The improvement rate ranged from 50% for patients with impotence caused by diabetes, to 78% for those with no specified reason for impotence, to 100% for those with suspected leakage in their veins.

3 years later, the investigators re-interviewed 82 of the men, of whom 43 were still using the drug. Sixteen of those 43 (37%) said they had needed to increase the dose by 50 mg to achieve an adequate erection. It had taken between 1 and 18 months for the treatment to lose its effects. There was no correlation between the need to increase the dose and frequency of use.

‘In general, 81% of patients who were still receiving treatment were satisfied, and 92% were able to achieve and maintain erections sufficient for sexual intercourse in more than 50% of attempts,’ El-Galley and colleagues wrote in The Journal of Urology.

Of the 39 patients who had stopped taking Viagra, 28 had initially reported a good response. Fourteen of those patients who stopped said the drug no longer worked, and six said they had regained the ability to have spontaneous erections.

There is notable disappointment about the fading powers of the ‘blue miracle pill’ in the professional world. ‘According to my observations, Viagra only helps half of all patients with erectile dysfunction caused by physical factors’, P. Derahshani, head of the urology department of the K√∂lner Klinik am Ring (Cologne, BRD) reports. A potential health-risk lies in the fact that for patients showing habituation effects, the dose can only be rised by the ones who have previously used 25 or 50mg, while for doses above 100mg, the risk of side effects such as circulatory weakness, nausea or headaches increases remarkably.

No substitute for psychotherapy or sex therapy

“One should not forget that Viagra is only indicated for erectile dysfunction for those men whose potency problems have physical causes,” the Viennese urologist Werner Reiter of the impotence clinic at the Vienna General Hospital said in an interview with the “S√ľddeutsche” (SZ). Especially in older men who smoke a lot and suffer from high blood pressure or heart disease, Viagra often loses its effect after prolonged dosing. In men with stable health, on the other hand, there is rarely a (physiological) habituation effect.
“If the impotence is caused by mental factors, Viagra will just cover up the first symptoms for a while,” warns Reiter. For long term success, these patients could only be helped with psychotherapy or sex therapy.

Health risks often underestimated

Fatally, many men ignore or underestimate the risk of self-medication. But an alarming number of 40 percent of the men who visit a doctor because of erection problems, suffer from arteriosclerosis of the coronary arteries (which may, but is not always the cause of erectile dysfunction). Impotence ‘may nevertheless be a sign of a disease or an incipient disease. However, to simply cover up symptoms and to look away from the real causes, has never worked out on the long run, neither in medicine nor in psychotherapy,” says sex therapist Karl F. Stifter. It is important to keep the whole person in mind, which in this case would mean to check for physiological causes of the erectile dysfunction before considering any medication.

Underestimated by many men is the risk of suffering a heart attack. Like most drugs that interfere with the blood circulation of the body, Viagra & Co. involve special risks for patients (sometimes unknowingly!) suffering from heart conditions. In particular, patients who are taking nitroglycerin or blood pressure lowering drugs, which also relax the smooth muscles, may not take the pills to avoid potentializing their effects. Together with medications containing nitrate (eg for angina pectoris), the drug may lead to a fatal drop in blood pressure and heart diseases in men with circulatory failure. An examination by a physician is therefore absolutely necessarily before taking them.

In fact, no other medications are responsible for as many deaths due to negligent use as the new “erection helpers”. Worldwide, 616 deaths after taking Viagra were reported during the first 3 years after its introduction alone. The easy availability of the tablets over the Internet or on the black market poses a big problem, because they are extremely inviting for self-medication, and there is a relatively high risk to purchase harmful imitations. The ‘copycat’ market of the tablets, mainly India and China, is hard to control, with all the associated risks for the end user. Often enough the tablets are also not only taken at a far too young age, but also abused as kind of a ‘lifestyle drug’, completely ignoring the impact on the cardiovascular system – and probably also the production of our endogenuous ‘drugs’ that help to build and maintain an erection, as the study mentioned above could indicate.

So there is reason to expect a massive increase of the number of ‘Viagra Veterans’ during the next years who suffer from what I’d call ‘multisystemic erectile dysfunction’: psychogenic erectile dysfunction by men who furtheron developed organically caused erectile dysfunction either from resistance against the drug or by underproduction of endogenous drugs from longterm use of the supplementary drugs). These men may well find themselves suck in a dead end once they reach an age (or have to deal with side effects of physical illnesses) involving a natural decrease of the erectile function without many remaining options to treat their impotence.
It has been proved that in the vast majority of men under the age of 50, erection problems are caused psychologically – but even (and especially) at a higher age, a medical examination is necessary before starting to take medication. If there is no clear evidence for a physical cause, in the interest of one’s health (and perhaps also to keep the “Viagra trump card” for more difficult times), it is recommended to seek counsel from a sex therapist or psychotherapist rather than to reflexively grab one of the readily available “blue pills”.

(Sources: Reuters.com; Rizk El-Galley et.al., “Long-Term Efficiacy of Sildenafil and Tachyphylaxis Effect” in: The Journal of Urology – September 2001 (Vol. 166, Issue 3, Pages 927-931); Image source: creakyeasel.com)

Aug 05

“What can I do, it’s in my genes!” In recent years, this has become a standard explanation for many of the health problems we have to face in our lives. Indeed, there are few human diseases without scientific studies trying to pinpoint ‘genetical causes’ as the root. Consequently, there are efforts to find genetic roots of mental problems as well. But 150 years after Mendel (the ‘father of modern genetics’) had outlined his ‘Laws of Inheritance’, we have still to see significant therapies that could wipe out major human burdens like cancer, addictions, diabetes or violence by purely genetical means. This is not to say that genetic science doesn’t have potential; but all the other influential factors should not be forgotten.

One of the weirdest aspects of the notion that all things human are genetically predetermined is that it takes everyone completely out of the context of their environment. We might as well not put personal or societal energies into trying to improve ourselves or others, because it’s inevitable and unchangeable anyway… But in fact there is just a very small number of very rare diseases that are truly genetically determined. Most complex conditions like ADHD, schizophrenia, a tendency to violence or addiction might have a predisposition that has a genetic component, but a predisposition is not the same as a predetermination. Genes just seem to give us different ways of responding to our environment. Some of the childhood influences and the method of child rearing in turn also affect gene expression; they can actually turn on or off various genes to put us on a different developmental track which may suit the kind of world we’ve got to deal with.

For example, a study done in Montreal with suicide victims looked at autopsies of the brains of these people and it turned out that if a suicide victim had been abused as a child, the abuse actually caused a genetic change in the brain that was absent in the brains of people who had not been abused. That’s an epigenetic effect: an environmental impact that is capable to either activate or deactivate certain genes.

So, in adaptation to the famous quote of Shakespeare, “There are more things in heaven and earth than are dreamt of in our scientific world.” And there are more things we can do to change ourselves than we might imagine.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Jul 22
Das Erleben von Gewalt belastet nicht nur die Seele von Kindern, sondern beeintr√§chtigt offenbar auch die k√∂rperliche Gesundheit. Bei jungen Menschen aus Stadtvierteln mit hoher Kriminalit√§tsrate kommt es h√§ufig zu St√∂rungen in der Produktion des k√∂rpereigenen Hormons Cortisol, wie eine Studie an der Harvard School of Public Health ergab. Derartige √Ąnderungen an der Cortisolproduktion und -regulierung als Folge von Stress k√∂nnen jedoch das Immunsystem schw√§chen und erh√∂hte Fettablagerungen im Bauchbereich zur Folge haben, welche wiederum h√§ufig zu Erkrankungen der Herzkranzgef√§√üe oder Diabetes f√ľhren.

Das Hormon Cortisol wird vom Stressreaktionssystem des Körpers reguliert. Der Cortisolspiegel ist in der Regel morgens am höchsten und fällt im Verlauf des Tages ab. Die Wissenschaftler untersuchten nun an Burschen und Mädchen aus Gegenden mit hoher Kriminalitätsrate den Einfluss posttraumatischer Stresssymptome wie mangelnde Konzentrationsfähigkeit, Schlafstörungen und schlechte Erinnerungen auf den täglichen Cortisolspiegel.

Das Ergebnis: Zwischen dem Erleben von Gewalt im direkten Umfeld und der St√∂rung der Stressbahnen im K√∂rper gibt es eine Verbindung. Je mehr die untersuchten Kinder unter den Stresssymptomen litten, desto st√§rker war die Cortisolproduktion beeintr√§chtigt und desto h√∂her war der Cortisolspiegel √ľber den Tag hinweg, vor allem am Nachmittag und am Abend, wie die Forscher berichteten.

(Quelle: Suglia et al. in: Posttraumatic Stress Symptoms Related to Community Violence and Children’s Diurnal Cortisol Response in an Urban Community-Dwelling Sample. International Journal of Behavioral Medicine, 2009; DOI: 10.1007/s12529-009-9044-6)

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06.01.16