Sons of smokers may be more prone to addiction-like behaviors, memory problems and anxiety, Univ. of Pennsylvania study says

The study found no effect on daughters. (iStock Photo)

If you're a parent who smokes, your sons may be more susceptible to addiction-related symptoms, memory problems and anxiety, says a new study from researchers at the University of Pennsylvania. The study is another caution about tobacco for Kentuckians, about 25 percent of whom smoke, the second highest rate in the nation.

The researchers found an association between parental tobacco use and rates of "addiction-like behaviors, cognitive impairments, and anxiety-like behaviors" in sons, a Penn news release says. The researchers did not find a similar association in daughters. The study is published in the journal Molecular Psychiatry.

Heath D. Schmidt, the paper's lead author, explains that understanding the biological effects of tobacco use is necessary understand how to children can inherent their parents' drug use. He notes that these studies' findings "highlight vulnerable populations at risk for developing nicotine dependence, cognitive impairments, and/or mental health disorders.”

Had Covid-19? You're 60% more likely to have mental illness, study finds; researcher says it shows disease isn't 'like the flu'

Los Angeles Times photo

People who've had Covid-19 have a 60 percent higher chance of experiencing mental health problems, including anxiety, depression, and thinking of suicide, as well as drug and alcohol abuse and disturbances in sleep and cognition.

The results come from a study by researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. Using anonymous data from the VA, the nation’s largest integrated health-care delivery system, the researchers compared the mental-health outcomes of more than 150,000 patients who had mild or severe Covid-19 cases from March 1, 2020 to January 15, 2021, with the outcomes of two control groups: one of more than 5.6 million patients who did not have Covid-19 during the same time period, the other of more than 5.8 million people who were patients from March 2018 to January 2019, well before the pandemic. The study is published in the BJM (British Medical Journal).

People diagnosed with Covid-19 were 60% more likely to suffer from mental-health problems than those who were not infected, leading to an increased use of prescription medication to treat such problems and increased risks of substance-use disorders including opioids and non-opioids such as alcohol and illicit drugs, the study found.

“People need to know that if they have had Covid-19 and are struggling mentally, they’re not alone, and they should seek help immediately and without shame,” said Ziyad Al-Aly, the study's lead author. “It’s critical that we recognize this now, diagnose it and address it before the opioid crisis snowballs and we start losing more people to suicide.”

Al-Aly continued, “Our findings suggest a specific link between SARS-Co-V-2 [the novel coronavirus] and mental-health disorders. We’re not certain why this is, but one of the leading hypotheses is that the virus can enter the brain and disturb cellular and neuron pathways.”

To better understand whether the increased risk of mental-health disorders is specific to Covid-19, the researchers also compared the Covid-19 patients with 72,207 flu patients, including 11,924 who were hospitalized, from October 2017 through February 2020. Again, the risk was significantly higher in those who had mild and serious Covid-19 infections.

“My hope is that this dispels the notion that Covid-19 is like the flu,” Al-Aly said. “It’s so much more serious.” He stressed the importance of identifying and treating mental-health disorders in Covid-19 survivors.

“Our goal was to provide a comprehensive analysis that will help improve our understanding of the long-term risk of mental-health disorders in people with Covid-19 and guide their post-infection health care,” added Al-Aly. “Studies on Covid-19 and mental health have been limited by a maximum of six months of follow-up data and by a narrow selection of mental-health outcomes; for example, examining depression and anxiety but not substance-use disorders.”

Suicide, ideas of it, depression, and anxiety have affected more Kentucky students since the Covid-19 pandemic began

Kentucky Youth Advocates image

By Melissa Patrick

Kentucky Health News

Kentucky's students are experiencing more anxiety, depression and ideas of suicide in the pandemic, and schools need more resources to help them, mental-health experts told state legislators Oct. 5. 

Before the Interim Joint Committee on Education, they called for putting more mental-health professionals in schools, giving teachers more first-aid training in mental health, and programs that would help students be more resilient and keep them from taking their own lives, an increasing problem.

“The needs are many, but the resources are few,” Marsha Duncan, a social-emotional learning specialist for LaRue County Schools, told the committee.

Among Kentuckians under 25, deaths by suicide increased 11% in 2020, according to state-provided data. Emergency-room visits related to self-harm were 5% below historical averages last year, but hospitalizations for self-harm rose 8%. Figures for 2021 are not yet available. 

One three-month period in the last year had a youth suicide rate 57% higher than the previous year, said Linda Tyree, crisis response director for the Green River Regional Educational Cooperative, which serves 45 school districts.

The Bowling Green-based co-op has crisis teams that are typically called in when there is a death or serious injury of a student or staff member, but during the pandemic they've been called in for issues of anxiety, depression and having ideas of suicide, Tyree said.

 

"When students transitioned to remote learning, we know there was a lot of exposure to trauma, to stress, family stress, even exposure to pornography when they're learning online," she said. "So all of these things just compound the problems of adolescence that are just part of normal growing up." 

Amy Riley, a school counselor in Mercer County, told the legislators, "The isolation of the Covid pandemic has had a profound effect on the mental health of my students and students across the state."

In her Mercer County Intermediate School in Harrodsburg, "There were weeks this past spring, shortly after returning from virtual learning, that we would assess two to three students a day for viable suicidal threats," Riley said. "Just this morning, I had to do a suicide risk assessment on a 9-year-old in my school before I came to this hearing today."

She said the reasons for these suicidal threats include unmanageable anxiety, home problems and often loneliness. 

Duncan, of LaRue County, added grief to the list of things students are dealing with, and not just for those who have died of Covid-19. 

"Grieving for these students has taken on a grief of the loss of the normal … fun, activities and programs that are offered and provided at the schools," Duncan said. "Dealing with the lack of consistent routines has been detrimental to the mental health of our students."

Similar issues are reported around the world. A global analysis of 29 studies that included more than 80,000 youth, published in JAMA Pediatrics, found that anxiety and depression has doubled in children and adolescents over the course of the pandemic. It also found they occurred more later in the pandemic, in older adolescents and in girls. 

Duncan said it has been "impossible" to meet students' mental-health needs during remote learning and "extremely difficult" under the hybrid model. She said access to mental-health professionals in her small, rural community is limited, as are the funding sources to pay for it, which makes school-based mental-health care vital. 

In a survey conducted by The Prichard Committee Student Voice Team, Kentucky students expressed a desire for increased access to mental-health services. 

Asked open-ended questions about what challenges they were facing in the pandemic, 15% of the students reported a concern related to mental health. Among that group, 35% said they wanted mental-health services but did not have access to them. That's 5% of the total. The share of students who wanted but lacked access to mental-health services was 15% during the pandemic and 10% before it.

Another indicator that young people are struggling with their mental health is the increase in mental-health screenings done by youth at MHAScreening.org. 

According to data provided by Mental Health America of Kentucky, there has been a 191% increase in  voluntary mental-health screenings among the state's 4- to 10- year-olds, from 23 done in the first half of 2020 to 67 in the first half of 2021. Among 11-to-17-year-olds, the increase was 231%, from 1,077 to 3,562.  

"These screening increases reflect anecdotal evidence that our children and youth have been negatively affected by the pandemic," Marcie Timmerman, executive director of MHA, said in an e-mail. 

Rep. Shane Baker, R-Somerset, asked what parents, educators and the community could do. Riley said all students should receive support through a "tier one" program, and Tyree agreed. 

"We don’t want to be reactive. We want to be proactive," Tyree said. "Tier one means that every single student, every kindergartner, every first grader that comes in the door, before they ever show any kind of problems or at-risk behavior, we’re already talking about articulating their feelings, how to be socially acceptable with the way that they address those feelings, how they can regulate themselves and have social regulation."

Riley wrapped up her prepared comments with a plea for more mental-health professionals in schools.

“It is my earnest plea that when making crucial funding decisions, you not forget the mental health needs of Kentucky students,” she said. “Any money and resources spent on mental health needs in Kentucky schools is money that will have an infinite return for the investment.”

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

Even with Kentucky's anxiety and depression rates dropping since January, the state still ranks ninth for this measure in the U.S.

image: pulichealthnotes.com

By Melissa Patrick
Kentucky Health News

While rates of anxiety and depression in Kentucky are among the top 10 states in the nation, the good news is that since January, those rates have dropped. Those findings are consistent with what is going on across the nation, according to an analysis of Centers for Disease Control and Prevention data. 

"Our team of analysts found that while anxiety and depression levels increased during the first year of the pandemic, they have decreased dramatically throughout 2021," says the Quote Wizard report. "We found that nationwide, the number of people dealing with anxiety or depression increased by 6.3% in 2020 and has decreased by 23% throughout 2021." 

In Kentucky, that rate dropped 19% throughout 2021, with 34% of people in Kentucky reporting symptoms of anxiety or depression -- the ninth highest rate in the nation.

Marie Timmerman, executive director of Mental Health America of Kentucky, said she wasn't surprised by these results, pointing to all of the uncertainty that Kentuckians experienced at the height of the pandemic as the likely cause for the increase in symptoms of depression and anxiety. 

"The coronavirus pandemic exacerbated the mental-health and substance-use-disorder pandemic in Kentucky," Timmerman said in an e-mail. "I'm not surprised that anxiety and depression symptoms were going down as vaccines were becoming more widely available over the spring and summer months." 

The Quote Wizard analysis did not address substance-use disorders, but the state's latest overdose report found that drug-overdose deaths in Kentucky rose 49% in 2020.

The analysis also looked at rates of anxiety and rates of depression in each state separately. In Kentucky 30% of people surveyed in August reported experiencing anxiety, a drop of 19% since the beginning of the year. The highest this rate has been in Kentucky during the pandemic is 38%, the report says. 

Twenty-four percent of Kentuckians reported being depressed in August 2021, a drop of 22% since January. During the pandemic, the highest this rate got was 31%. 

Nationwide, women reported having higher anxiety and depression levels than men, while older and more educated Americans have some of the lowest levels, says the report. 

The researchers note that the decline in the number of people experiencing symptoms of anxiety and depression coincides with a decline in the number of coronavirus cases and the easing of lockdown restrictions. 

However, with the current surge in cases and subsequent restrictions -- whether required or suggested -- they also note that only time will tell if this new round of cases and restrictions will lead to an increase in anxiety and depression levels. 

Timmerman encouraged Kentuckians to take a free Mental Health America of Kentucky mental health screening if they are concerned about their mental health. Click here for the link. For more resources or information, reach out to mhaky@mhaky.org or call 859-684-7778. 

"It's okay to have bad days," she said. "It's a real concern, though, when bad days become bad weeks that interfere with your ability to work or to attend to the activities of daily living. If you're not sure if your mental health symptoms are a result of the day-to-day stress or are something more, a mental health screening is a great way to find out." 

Study shows a link between frequent exposure to insecticides and a higher risk of depression and anxiety in Ecuadorian teenagers

Teenagers with frequent exposure to the most widely form of insecticide may have an increased risk of depression, according to a study published in the International Journal of Hygiene and Environmental Health.

The study was conducted in Ecuador by Dr. Jose Suarez-Lopez, an assistant professor at the University of California-San Diego. He and colleagues "have been tracking the development of children living near agriculture in the Ecuadorian Andes since 2008," a university press release said. "Ecuador is the world’s third-largest exporter of roses, with much of the flower production located near the homes of participants. Like many other agricultural crops, flowers are routinely sprayed with organophosphate insecticides, which are known to affect the human cholinergic system, a key system in the function of the brain and nervous system."

Researchers measured blood levels in 11- to 17-year-olds of an enzyme that is inhibited by organophosphates. Studies in mice had shown that reduced levels of the enzyme were linked to "behaviors of anxiety and depression in mice, and a few existing studies in humans have also suggested such a link," the release says. "However, pesticide exposure assessment in past studies had been only established by self-report of exposure and not using biological measures."

The study found that teens who had reduced enzyme levels, suggesting greater exposure to , showed higher-than-normal symptoms of depression. "The association was stronger for girls, who comprised half of all participants, and for teens younger than 14," the release says. It quotes Suarez-Lopez:  “Agricultural workers and people in these communities have long offered anecdotal reports of a rise in adolescent depression and suicidal tendencies. This is the first study to provide empirical data establishing that link using a biological marker of exposure, and it points to a need for further study.”

National survey finds many Americans can't identify mental-health problems, and even some who do are unfamiliar with treatment

By Melissa Patrick
Kentucky Health News

Fewer than half of Americans recognize symptoms of anxiety, and many don't know what to do about it, even when they recognize them. And most don't know that prescription drug abuse is a treatable problem.

These were just some of the findings in a federally funded study conducted by Michigan State University that looked at mental-health literacy around four major issues: anxiety, depression, alcohol abuse and prescription drug abuse. It's timely, since May is Mental Health Awareness Month.

Sheila Schuster

"I think that Kentucky has a poor level of health literacy, period, and I would say probably, as the case is nationally, also a poor understanding of mental-health issues," Sheila Schuster, of the Kentucky Mental Health Coalition, said in a telephone interview. She noted that often, Kentucky adults and children alike, tend to use the catch-all phrase "my nerves are bad" to describe any state of poor mental health.

Participants in the study were asked to read short stories about each of the four issues and then asked questions about the stories. Nearly 4,600 people participated in the national, web-based survey.

It found that 54 percent of the participants were not able to recognize the symptoms of anxiety, while 46 percent could. Those who recognized the symptoms were more likely to recommend professional help over self-help strategies, and were also less likely to feel stigma.

Stigma about anxiety remains strong, with 63 percent of the respondents having some level of stigma toward anxiety and 73 percent of them reporting that this stigma exists in their communities.

Anxiety symptoms include restlessness, fatigue, worry, difficulty in concentration, muscle aches, and changes in sleeping patterns.

The study also looked at depression. Nearly one in five Kentucky adults at some time in their life have been told by a health-care provider that they are depressed, according to polling by the federal Behavioral Risk Factor Surveillance System. Nationally, 16 million adults reported they had a "major depressive episode" in 2015.

Symptoms of depression include difficulty concentrating, fatigue, hopelessness, insomnia, overeating, undereating, muscle aches and sadness.

Study participants were better able to identify depression than anxiety, with 69 percent of them correctly identifying the condition, half again as much as the percentage who could identify anxiety. Again, those who recognize the symptoms of depression were much more likely to recommend professional help than those who didn't recognize the symptoms.

A recent Kentucky Health Issues Poll found that nearly half of Kentucky adults know someone who has a serious problem with depression and nearly 70 percent of those polled said they knew who to contact for services for treatment.

Asked about stigma from depression, 62 percent of the respondents expressed some level of stigma about the condition and 71 reported some stigma in their communities.

"Stigma toward people with depression is a huge barrier to treatment, as individuals do not discuss their depressive symptoms, and are therefore unable to get the help they need. Almost 60 percent of individuals who have depressive symptoms do not seek treatment," says the report.

Schuster, a retired clinical child psychologist, said fear of being labeled and fear of stigma often keeps individuals from seeking treatment for any kind of mental health care.

"We see that in the local communities, small-town communities where people are reluctant to be seen going into the community mental health center," she said. "If it was just a doctor's office building or a health center where services were co-located, where you could get physical and mental health services, people would probably be more likely to go in."

The study also looked at alcohol abuse and prescription-drug misuse.

More than three out of five respondents (63 percent) were able to identify alcohol abuse, which affects almost 16 million Americans; 37 percent were not able to identify it.

Two-thirds of those who correctly identified alcohol abuse recommended self-help strategies instead of recommending professional help, suggesting that many might not be aware that professional help exists for this condition.

About half (51 percent) of respondents who couldn't identify alcohol abuse recommended professional help, while 35 percent of this group recommended self-help strategies.

Symptoms of alcohol abuse include spending a great deal of time obtaining and using alcohol; failing to fulfill obligations at work, home or school due to alcohol use; and continuing to use alcohol despite its negative impact.

Prescription drug abuse is a huge problem in Kentucky. In the survey, 68 percent could correctly identify it, but nearly one-third couldn't.

Signs of prescription drug abuse include taking higher doses than prescribed, excessive mood swings, changes in sleeping patterns, poor decision-making and seeking prescriptions from more than one doctor.

And like alcohol abuse, those who recognized prescription drug misuse were much more likely to recommend self-help strategies than professional help, whereas those who did not identify the misuse were more likely to recommend professional help than self-help.

"Nearly eight in 10 people don’t recognize prescription drug abuse as a treatable problem," says the release.

"I'm not sure that people really understand what an addiction is, as opposed to thinking well, they just made a bad choice or they aren't right with God, or those kinds of things," Schuster said.

Individual and community stigma for alcohol abuse and prescription drug misuse was about the same, 77 percent for individuals and 80 percent and 82 percent respectively for communities.

"There is more talk about the addiction issues than there has been, so in some ways there is a lot less stigma about say, that person has an opiate addiction or is on heroin," Shuster said. "I'm not sure it's any better on the mental-health side. . . . If you see people who are agitated, very anxious or very depressed, I think people tend to shy away from them. They don't want to engage with them. They don't want to talk about it. So, I'm not so sure that that is any better than it has been."

Mark Skidmore, one of the researchers, said the survey aims to give health officials and policymakers a better understanding of where to target education and prevention efforts for these major societal issues. The study is funded by the U.S. Department of Agriculture and the Substance Abuse and Mental Health Services Administration.

Schuster said parents need to start talking to young children about how they react to things and help them learn how to better define their emotions. "We really need to educate our kids as much in health topics, both physical and mental health, as we do on pure education topics," she said.

"It would be really helpful if we developed a curriculum where we [encourage] people to ask questions about their mental health, their spiritual health if you will, their behavioral health as well as about their physical health. . . . [to have a] pretty simple check-list of things to at least acquaint people with some of their symptoms" so they would better know when to get help.

Most primary-care physicians and nurse practitioners, don't ask patients, "How are things with you? What's going on in your life? What kind of stress are you under? How are things now compared to six months ago? What is your outlook for the future?" Schuster said. "I don't think they are taking the time to look at that, and yet we know that I think it's 80 percent of the doctor visits are for symptoms that are much more psychological than organic in nature. We need to focus on the whole person."

Almost half of U.S. women have higher stress during the holidays; here are a few tips to minimize it

With the holiday season come parties, shopping, entertaining, baking, decorating, gift giving, travel, holiday events, holiday cards to send, family traditions, family gatherings and the list goes on. Sounds like fun, doesn't it? Or maybe not, maybe it sounds like stress.

Almost half of all women in the U.S. report experiencing higher levels of stress during the holidays, and about one-third of men do, Beth A. Collins Sharp, director, Division of Program Innovation for the Health and Human Services Office of Women's Health, writes on their blog.

And stress, she writes, can lead to high blood pressure, heart disease, depression, anxiety, obesity, abnormal heart beat, menstrual problems, and acne and other skin problems. She also notes that a recent survey found women are more likely than men to experience these physical symptoms.

Her advice to reduce this stress: "Give yourself permission to stop at least one thing this year."

For example, she writes, only bake one kind of cookie, instead of six; don't do holiday cards unless you love sending them; scale back on the decorations - don't put up a tree if you hate doing it; don't shop in the mall if you hate crowds, do it online; or don't attend holiday parties if you don't enjoy them.

And what should you do if you are feeling stressed? "Run away," Sharp writes.

"Current holiday traditions are a perfect storm for stress: an abundance of bright blinking lights, crowds and traffic, high-fat meals and treats, overspending, and constant fast-paced music (often with jingle bell beats). Your senses become overloaded and sometimes you need to get away and rest," she says.

She then offers a few specific ways she and her family have reduced their holiday stress such as drawing names for the adults and only buying gifts for the children; gathering on a day that works best for everyone, instead of trying to see everyone on the actual holiday; shifting to an informal potluck style meal; and not making anyone feel guilty for bringing store-bought items

"Instead of feeling stressed, we feel thankful and happy," she writes. "And for that we're grateful all year round."

Seniors get a lot of anti-anxiety drugs, sometimes in dangerous combination with narcotics; Ky. ranks third in the nation in that

When Medicare's drug program, called Part D, was put into place more than a decade ago, Congress decided to not pay for anti-anxiety medications. In 2013, when Medicare started paying for them, the program went from spending nothing for these medications to paying more than $377 million, Charles Ornstein and Ryann Grochowski Jones report for ProPublica, a nonprofit, investigative news organization.

Using anti-anxiety drugs in combination with narcotics increases the risk of overdoses, but Kentucky has many doctors who prescribe a lot of both. More than 100 Kentucky doctors each wrote at least 1,000 prescriptions for both types of drugs in 2013, according to data compiled by ProPublica.

That ranked Kentucky third in the nation, trailing only Florida and Alabama. Other southeastern states dominated the top 10. California, the nation's most populous state, ranked eighth; Tennessee was fourth and Ohio was ninth.

ProPublica has an application that lets you look up, by doctors' names, cities or ZIP codes, the number of Medicare claims they filed in 2013, the amount of money, the number of patients and the number of prescriptions for brand-name drugs.

The anti-anxiety drugs, some known as benzodiazepines, include popular tranquilizers such as Valium, Xanax and Ativan. 

Lawmakers initially chose to keep them out of Medicare Part D because they had been linked to abuse and an increased risk of falls among the elderly. Doctors kept prescribing them to Medicare enrollees, who found other ways to pay for them.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, ProPublica found. Generic versions of Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam) were among the top 32 most-prescribed medications in Medicare Part D that year.

The American Geriatrics Society "discourages the use of benzodiazepines in seniors for agitation, insomnia or delirium because they can be habit-forming and disorienting and their effects last longer in older patients." The society does say the drugs "are appropriate to treat seizure disorders, severe anxiety, withdrawal and in end-of-life care," ProPublica notes.

One geriatric psychiatrist told ProPublica that the drugs are a "very real safety concern" for the elderly, and that he and others in his field don't use them as a "first-, second-, or third- line of treatment." Some geriatric psychiatrists have voiced concerns that these drugs are now being used instead of antipsychotics, since Medicare has pushed to reduce the use of antipsychotics, particularly in nursing homes, because of their risks.

Several doctors who rank among Medicare's top prescribers of the drugs told ProPublica that any risks of anti-anxiety drugs are outweighed by their benefits. One said that the drugs worked well for his patients, many of whom were trying to kick addictions to narcotics, but struggled with anxiety and depression.

However, ProPublica also found that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, which increased the risk of misuse and overdose. That's where Kentucky ranked third.

Dr. Leonard J. Paulozzi, a medical epidemiologist at the federal Centers for Disease Control and Prevention, co-authored an analysis showing that benzodiazepines were involved in about 30 percent of the fatal narcotic overdoses that occurred nationwide in 2010, ProPublica reports.

Feeling exhausted and not sure why? Ask your health-care provider to check your vitamin B12

Some doctors are adding a vitamin B check to their standard "baseline" workup, especially vitamin B12, the one most commonly deficient, Dr. Leigh Erin Connealy reports for Newport Natural Health.

"By some estimates, up to 40 percent of the population does not have sufficient levels of B12," Connealy writes.

The B vitamins work together as a family to  perform many important functions throughout the body, such as helping to convert our food to fuel, allowing us to stay energized through the day, helping maintain heart health, preventing birth defects, creating red blood cells or assisting with the production and repair of DNA, to name a few.

Vitamin B12, or cobalamin, keeps our blood, nervous system and heart healthy. It is found primarily in animal-sourced foods—all meats, dairy products, eggs, and shellfish. Liver, sardines, and salmon contain the greatest amount.

Image from webmd.com

While it is not uncommon for vegetarians and vegans to have low levels of B12, Connealy says that even meat eaters can lack it, usually because of poor absorption.

Absorption issues in younger people are often caused by acid-blocking medications, disorders such as Crohn's disease, leaky gut, diarrhea and other gastrointestinal problems.  Older people with a condition called hypocholorhydria, where the stomach does not produce enough acid to help with the absorption of nutrients, can have low levels as well, Connealy notes.

B12 deficiency can cause a wide variety of debilitating symptoms ranging from exhaustion and lethargy to depression, anxiety, memory loss, confusion, and other Alzheimer’s-like symptoms.

WebMD adds rapid heartbeat and breathing, pale skin, sore tongue, bleeding gums, stomach upset and weight loss and diarrhea or constipation to the list of symptoms.

Connealy notes that there are differing recommendations for the amount of B12 that should be in a supplement. The Dietary Reference Intake recommends between 2-3 micrograms daily, while the Center for Food Safety and Applied Nutrition recommends 6 mcg daily, based on a 2,000-calorie diet.

Connealy recommends the higher dosage, especially since "absorption problems are so common with age" and "it's nearly impossible to overdose." She also recommends B12 injections for severe deficiencies. In particular, she says that vegetarians, vegans and those age 50 and older should take an oral B12 supplement every day.

Tips on getting around or through the 'holiday blahs'

The holidays are supposed to be the happiest time of the year, but for many it is a time of sadness and anxiety, Sarah Elizabeth Richards writes for the Daily Burn.

"There's so much emphasis on family and celebration, but it's hard if you're dealing with difficult memories or reminders that you're not close to your family,"  Sharon Melnick, author of Success Under Stress: Powerful Tools for Staying Calm, Confident and Productive When the Pressure's On, said, writes Richards. "It can feel like there's a big gap between what other people are experiencing and what you're experiencing."

Not only do holidays provide normal stresses like added financial burdens, gift giving and family and social expectations, add in cold weather and a lack of sunlight and you have created perfect conditions for a "world-class funk," she writes.

But there is a difference between seasonal affective disorder (SAD), which is estimated to affect up to 20 percent of Americans and the "holiday blahs," Richards notes.

"It's important not to classify all winter doldrums as SAD," Sarah Eckfeldt, a psychotherapist in New York City, told Richards. "Many people experience a drop in mood in anticipation of the holidays because they might be sad over a recent breakup or spending the first holiday after the death of a loved one and could benefit from talking to a therapist."

The good news is that the "holiday blahs" tend to go away after the season is over. Richards offers some tips to survive the season if you find yourself with a case of these "blahs."

• Seek social support. Make plans with a small group of friends, put a few events on your calendar to look forward to or explore a new activity that you have been interested in.
• Get to the gym. Make yourself go, even if you don't feel like it.
• Don't look at Facebook. Connect with your friends via phone or text message, talking only to the people who will lift you up.
• Reframe your thinking. Find opportunities to volunteer. Spend time doing what you enjoy.
• Remember that the holiday season will soon pass, You just have to make it to Jan. 2 and the season will be over.

"If you struggle with serious and continuous depressive symptoms, be sure to reach out to a healthcare provider to discuss your condition," Richards writes.