Madeeha Syed

Coping with ambiguous grief can be challenging, as there is no clear endpoint to the grieving process

What is ambiguous grief?

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Explore the ambiguous nature of grief and its stages. Learn about mourning, ambiguous meaning in Urdu, and more. Meri Sehat is here to guide you.

What Is Ambiguous Grief?

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Iqra Mazhar

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Sunscreens: SPF Explained!

Introduction

<p>SPF (Sun Protection Factor) is the measuring factor for protection from the sun’s UVB rays. SPF 15 blocks 93% of UVB rays, and SPF 30 blocks 97% of the UVB rays. Moreover, SPF 50 blocks 98% of the UVB rays. Experts recommend using between SPF 30 and 50 for sufficient protection against the sun. However, for complete protection, you might want to go above SPF 50+.</p><p><br></p>

Understanding SPF In Sunscreens

<p dir="ltr">You also need to make sure that your <a href="https://merisehat.pk/article/retinoids-and-sunscreen-a-love-affair">sunscreen</a> is broad-spectrum, which means that it should have both UVA and UVB rays. Both UVA and UVB rays have overlapping effects. They can cause burns and premature ageing. However, UVA rays are for dark spots and fine lines, while UVB rays play a very significant role in the production of sunburns and cancer.</p>

<p dir="ltr">&nbsp;</p>

<p>Everyone who is under the sun should be wearing sunscreen, no matter what their skin tone is.</p>

<p>&nbsp;</p>

<h5><strong>How Much Sunscreen Do You Need?</strong></h5>

<p>You need half a teaspoon of sunscreen for your face and neck, and one ounce for your entire body. Since sunscreens break down with time, it is recommended that you re-apply it every two hours, and more frequently if you sweat a lot or if you are a swimmer. In both cases, your sunscreen breaks down faster. Moreover, the best practice is to use sunscreen at least thirty minutes before sun exposure.</p>

<p>&nbsp;</p>

<p dir="ltr">There are two types of sunscreens, mineral sunscreen and physical sunscreen. But which one is better? Both mineral and physical sunscreens absorb UV rays and help in preventing skin damage. However, mineral sunscreen also reflects some UV rays. So, the conclusion is that neither is better than the other because they both use different active ingredients. The actives in chemical sunscreens are avobenzone and homosalvate. Moreover, mineral sunscreens contain zinc oxide and titanium.</p>

<p dir="ltr">In addition to sunscreen, the American Cancer Society also recommends having a holistic approach to sun protection. They recommend wearing protective clothing, avoiding tanning beds, and seeking shade between 10 am to 4 pm. All of these can cause long-term skin damage and contribute to skin cancer.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Which Sunscreen Is The Best?</strong></h5>

<p dir="ltr">The best sunscreen is the one that you will want to wear every day. Sunscreens are available based on your skin type and complexion, which easily blend into the skin. There is a right pick for everyone.</p>

<p dir="ltr">&nbsp;</p>

<div>
<div class="container" style="max-width:1320px; padding:0px; width:966.007px">
<div class="content">
<div>
<h5>&nbsp;</h5>

<ul>
	<li>
	<h5><strong>Protects Your Skin</strong></h5>
	</li>
</ul>
</div>

<div>
<p dir="ltr" style="margin-left:0px !important; margin-right:0px !important">Sunscreens protect your skin from UV rays that are harmful to the skin because the depletion of the ozone layer has increased our chances of sun damage. Sunscreens block these rays, which reduces the likeliness of sunburn. Furthermore, look for a sunscreen that is no less than 30+ SPF to use every day. For full-body coverage, you will need to use at least one ounce of sunscreen.</p>

<p dir="ltr" style="margin-left:0px !important; margin-right:0px !important">&nbsp;</p>
</div>

<ul style="list-style-type:none !important; margin-left:0px !important; margin-right:0px !important">
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<ul>
	<li>
	<h5><strong>Lowers The Risk Of Skin Cancer</strong></h5>
	</li>
</ul>
</div>

<div>
<p dir="ltr" style="margin-left:0px !important; margin-right:0px !important">The most common form of cancer in the United States is skin cancer<sup><a href="#accordion">[1]</a></sup>. According to CDC, 71,943 people had been diagnosed with melanomas of the skin in 2013. In addition, 9,394 of them were fatal<sup><a href="#accordion">[2]</a></sup>. When you apply sunscreen every day, you reduce your risk of getting skin cancer to half.</p>

<p dir="ltr" style="margin-left:0px !important; margin-right:0px !important">&nbsp;</p>
</div>

<ul style="list-style-type:none !important; margin-left:0px !important; margin-right:0px !important">
</ul>
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<div>
<ul>
	<li>
	<h5><strong>Prevents Premature Aging Of The Skin</strong></h5>
	</li>
</ul>
</div>

<div>
<p style="margin-left:0; margin-right:0">UV rays damage the skin and cause photoaging. It is characterized by a thick and leathery look in addition to discoloration and breakdown of collagen which causes wrinkles or sagging. Studies say that those who apply sunscreen religiously before the age of 55 have 24% fewer chances of developing signs of ageing, compared to those who don&rsquo;t<sup><a href="#accordion">[3]</a></sup>.</p>
</div>

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<h3 dir="auto">&nbsp;</h3>
</div>

<div>
<ul>
	<li>
	<h5><strong>Maintains The Skin Tone</strong></h5>
	</li>
</ul>
</div>
</div>
</div>
</div>

<div>
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<p dir="ltr" style="margin-left:0px !important; margin-right:0px !important">Sunscreen protects the skin from discoloration and dark spots caused by sun damage. It helps you in maintaining a smoother and more even skin tone.&nbsp;</p>

<p>&nbsp;</p>
</div>

<ul style="list-style-type:none !important; margin-left:0px !important; margin-right:0px !important">
</ul>
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<p>It has been recommended that infants, seniors, and people who have had a history of skin cancer take extra precautions against skin cancer because their skin is vulnerable. Everyone should prioritize using sunscreen before stepping outdoors and avoid prolonged exposure to the sun. A wide-brim hat and ultraviolet protection clothing are also helpful in protecting against UV rays.</p>

<p>Infants have very sensitive skin. Therefore, babies under six months should avoid spending a lot of time under direct sun. Moreover, infants and toddlers who are older than six months with thinner skin should use sunscreen that contains zinc oxide and titanium oxide. Zinc and titanium do not irritate the skin because they don&rsquo;t penetrate it and sit on the surface instead, deflecting UV radiation.&nbsp;</p>

<p>&nbsp;</p>

Key Points

<ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;"><span style="font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline;">Sunscreens are important because UV rays penetrate deep into the skin, causing damage, wrinkling, and photoaging. All of which contribute to skin cancer. Moreover, UVB rays are the biggest contributors to skin cancer and are more prevalent during the day.</span></li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;"><span style="font-size: 1rem; letter-spacing: 0.2px;">SPF protects your skin from the sun, meaning if you’re using SPF 15, you can stay in the sun fifteen times longer compared to without protection.</span></li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;"><span style="font-size: 1rem; letter-spacing: 0.2px;">You should look out for sunscreens that provide broad-spectrum protection, are water-resistant, and have active ingredients. For example, zinc and titanium oxide.</span></li></ul><p><br></p>

[1] Guy Jr, G.P., Machlin, S.R., Ekwueme, D.U. and Yabroff, K.R., 2015. Prevalence and costs of skin cancer treatment in the US, 2002− 2006 and 2007− 2011. American journal of preventive medicine, 48(2), pp.183-187.

[2] US Department of Health and Human Services, 2014. Skin cancer as a major public health problem. In The Surgeon General's Call to Action to Prevent Skin Cancer. Office of the Surgeon General (US).

[3] Sander, M., Sander, M., Burbidge, T. and Beecker, J., 2020. The efficacy and safety of sunscreen use for the prevention of skin cancer. CMAJ, 192(50), pp.E1802-E1808.

[4] Gallagher, R.P., 2005. Sunscreens in melanoma and skin cancer prevention. Cmaj, 173(3), pp.244-245.

[5] Tavares, R., da silva Paulitsch, F. and Zhang, L., 2018. Use of sunscreen and risk of melanoma and non-melanoma skin cancer: a systematic review and meta-analysis. European Journal of dermatology, 28(2), pp.186-201.

Staff Writer

Humza Khizer

Baby Blues (Postpartum Depression): Is There A New Treatment?

Overview

<p>The entire process of pregnancy is very rewarding, but what happens after you have delivered the baby? Your body that has gone through so many constant changes over the 9 months, reverses them all to get you back to normal. This process often leads to postpartum <a href="https://www.merisehat.pk/disease/depression">depression</a>.</p>

<p>About 11% of women in the United States suffer from postpartum depression (PPD).<sup><a href="#accordion">[4]</a></sup>&nbsp;PPD affects not just the life of the mother but also the infant. If left untreated, it can get worse and affect your spouse or other people close to you. So far, the treatment used for PPD has been very generic; similar to that of major depressive episode (MDE) consisting of conventional antidepressants like SSRIs, benzodiazepines, and tricyclic antidepressants. FDA has recently approved the first-ever drug targeted toward treating postpartum depression.<br />
&nbsp;</p>

Understanding The Latest Treatment For Postpartum Depression

<p dir="ltr">Postpartum depression is best explained as a worsened form of postpartum blues or baby blues. Baby blues are experienced a few days after delivery. Some new moms, however, experience a much more severe case of baby blues that can be classified as postpartum depression and it can go on for over a year.<sup><a href="#accordion">[8]</a></sup>&nbsp;PPD is characterized by:</p>

<ul>
	<li>Feeling depressed and low</li>
	<li>Sleeping too little or too much</li>
	<li>Feeling tired all the time</li>
	<li>Doubting yourself as a mother</li>
	<li>Thinking that you do not want the baby</li>
	<li>Excessive crying</li>
	<li>Loss of appetite</li>
	<li>Anxiety and panic attacks&nbsp;</li>
	<li>Thoughts of harming yourself or the baby</li>
	<li>Unable to think clearly or make the right decisions</li>
	<li>Increased anger and irritability</li>
	<li>Overall reduced interest in everything</li>
</ul>

<p dir="ltr">If you or anyone that you know are facing any of these symptoms, immediately contact your physician and get yourself screened through the Edinburg Postnatal Depression Scale (EPDS). It is one of the most common and quickest screening tools with high accuracy and allows your physician to assess the situation better through the score.&nbsp;<br />
&nbsp;</p>

<p dir="ltr">A lot of factors contribute to postpartum depression.The biggest factor that is not only responsible for PPD but also for the baby blues is the drastic change in hormones. During pregnancy, your estrogen and progesterone levels are very high. As soon as the baby is delivered, these levels are dropped drastically.</p>

<p dir="ltr">Since estrogen is directly linked to increasing serotonin levels in our brain&nbsp;and progesterone is known for stimulating dopamine release, the decrease in the production of these hormones coupled with some underlying mental issues or previous history of depression or anxiety becomes the most common and the biggest cause of PPD.<sup><a href="#accordion">[2][3][7]</a></sup><br />
&nbsp;</p>

<p dir="ltr">While screening of postpartum depression can be done by several tools that are used for Major Depressive Episodes (MDE), the most universally acceptable tool targeted especially for PPD is Edinburgh Postnatal Depression Scale or EDPS. EDPS is a 10-item questionnaire with a response score of 0 to 3. If the total score is over 12, then there is a need for further in-depth assessment of the situation and severity of the condition.&nbsp;</p>

<p dir="ltr">PPD is best diagnosed by your medical practitioner through regular visits. Your doctor asks a series of questions every few days to assess your mental health and well-being. Another way to differentiate PPD from baby blues is to ensure that the patient has at least 3-5 of the symptoms that make up PPD. The generalized diagnostic criteria used for PPD are similar to the one used for Major Depressive Episode (MDE). Immediate attention is recommended to avoid any worsening of the symptoms and from transitioning of PPD to postpartum psychosis.<br />
&nbsp;</p>

<p dir="ltr">So far, the treatment of postpartum depression is similar to that of conventional major depressive disorder. Special attention is paid to the excretion of the drug and the concentration of the drug removed from the body through breast milk.</p>

<p dir="ltr">The following antidepressants are commonly used to treat postpartum depression due to their low levels of excretion in breast milk, making it safe for use if you are a breastfeeding mother:</p>

<ul>
</ul>

<ul>
	<li>Fluoxetine</li>
	<li>Paroxetine</li>
	<li>Sertraline</li>
	<li>Bupropion</li>
	<li>Amitriptyline</li>
	<li>Doxepin</li>
	<li>Desipramine</li>
	<li>Tranylcypromine</li>
	<li>Trimipramine</li>
	<li>Desipramine</li>
	<li>Paroxetine</li>
	<li>Escitalopram</li>
</ul>

<p dir="ltr">These antidepressants come with some common side effects that include nausea, vomiting, dizziness, sexual issues, diarrhea, blurry vision, weight gain, increased perspiration, etc.<sup><a href="#accordion">[6]</a></sup><br />
&nbsp;</p>

<p dir="ltr">Brexanolone (under the brand name of Zulresso) got approved by the FDA as the first drug targeted toward PPD. Brexanolone is approved with a Risk Evaluation and Mitigation Strategy (REMS) which means that it is currently a controlled medicine available through a restricted distribution channel to carefully assess the conditions of the patients throughout the treatment. The program is currently known as Zulresso REMS Program.<sup><a href="#accordion">[5]</a></sup>&nbsp;Currently, to get Brexanolone administered to you for treating your PPD, you are required to enroll in the Zulresso REMS program.&nbsp;<br />
&nbsp;</p>

<ul dir="ltr">
	<li>
	<h5><strong>Mechanism Of Action</strong></h5>
	</li>
</ul>

<p dir="ltr">Brexanolone is a synthetic form of allopregnanolone. Allopregnanolone is a neurosteroid. Neuroactive steroids are a group of substances that change a receptor&rsquo;s response to a stimulus by binding to them.<sup><a href="#accordion">[4]</a></sup>&nbsp;Allopregnanolone is best understood as a metabolite of progesterone, which is a GABA-A receptor agonist. This means that progesterone is responsible for increasing GABA functions.</p>

<p dir="ltr">The exact mechanism of the drug and of allopregnanolone is still unknown. Their enhancement of the functions of GABA (Gamma-aminobutyric acid) means that it will inhibit neuronal excitability by blocking messages that are sent to our nervous system with the help of certain stimuli. This not only aids in dealing with depressive triggers but also helps with anxiety.<sup><a href="#accordion">[1]</a></sup><br />
&nbsp;</p>

<ul dir="ltr">
	<li>
	<h5><strong>Dosage And Administration</strong></h5>
	</li>
</ul>

<p dir="ltr">Zulresso is administered intravenously. The dosage is determined by your doctor based on your weight and other factors. The drug is administered over a period of 2.5 days or 60 hours and requires constant monitoring due to the risk of unconsciousness.<sup><a href="#accordion">[5]</a></sup><br />
&nbsp;</p>

<ul dir="ltr">
	<li>
	<h5 dir="ltr"><strong>Adverse Effects</strong></h5>
	</li>
</ul>

<p dir="ltr">Since the drug is relatively new, there are a limited number of side effects reported so far. They include:</p>

<ul>
	<li>Dry mouth</li>
	<li>Dizziness</li>
	<li>Flushed skin</li>
	<li>Losing consciousness</li>
</ul>

<h5 dir="ltr"><strong>Important!</strong></h5>

<p dir="ltr">FDA has advised to stop the treatment of Zulresso if more serious side effects occur that may include the worsening of PPD and suicidal thoughts especially in women under the age of 25.<br />
&nbsp;</p>

<p dir="ltr">Current research suggests that brexanolone may interact with other CNS depressants like opioids and benzodiazepines and increase the severity of the adverse effects with regard to sedation. Alcohol consumption is also not advised due to similar reasons.</p>

<p dir="ltr">During the clinical trials, patients who were taking antidepressants also showed a more severe case of sedation as compared to the ones who did not or were a part of the placebo studies.<br />
&nbsp;</p>

Conclusion

<p dir="ltr">Considering the rapid onset of action with brexanolone especially when compared to the long-term treatments offered by conventional antidepressants, it is believed that brexanolone can take over the go-to therapy for PPD. However, a much more convenient way of administration would be through oral pills instead of I/V. There are still many concerns left that can only be answered through long-term data in a lesser restricted environment as opposed to a clinical trial setting.&nbsp;<br />
&nbsp;</p>

<ul>
</ul>

<ul>
	<li>Current antidepressant therapies employed for PPD are based on&nbsp;long-term treatment.</li>
	<li>Brexanolone&rsquo;s onset of action is fast and has shown significant improvement in women of all ages suffering from PPD.</li>
	<li>Some women under the age of 25 were observed to experience severe side effects that even led to the worsening of their PPD.</li>
	<li>The drug is still under strict observation with the help of the REMS program.</li>
	<li>Administration coupled with the duration over which it has to be administered can make it difficult to commercialize as compared to drugs that are available in the form of oral pills.&nbsp;</li>
</ul>

[1] Allen B, Vespa PM. Antiseizure medications in critical care: An update. Curr Opin Crit Care. 2019;25(2):117-125

[2] ATP Science, 2021. HOW DOES PROGESTERONE CREATE A DOPAMINERGIC RESPONSE?. [Online] .

[3] Debra Fulghum Bruce, P., 2020. Postpartum Depression. [Online].

[4] Fala, L., 2019. Approved by the FDA Specifically for Postpartum Depression in Adults. [Online]

[5] Federal Drug Administration, 2019. FDA approves first treatment for post-partum depression. [Online]

[6] Fields, L., 2021. Which Antidepressants Treat Postpartum Depression?. [Online]

[7] Matthew Hoffman, M., 2021. Estrogen and Women's Emotions. [Online]

[8] Mayo Clinic, 2022. Postpartum depression. [Online]

Umna Salah

<p dir="ltr">Ambiguous grief refers to a type of <a href="https://merisehat.pk/article/how-to-heal-from-grief">grief </a>that occurs when a person experiences a loss that is not clear-cut or easily defined. This can include situations where a loved one is missing, physically present but not emotionally available, or experiencing a major life change such as a debilitating illness. Coping with ambiguous grief can be challenging, as there is no clear endpoint to the grieving process. However, there are several strategies that can help individuals navigate this difficult experience.</p>
<quillbot-extension-portal></quillbot-extension-portal>

Coping with Grief

<ul dir="ltr">
	<li><strong>Acknowledge and accept the grief</strong></li>
</ul>

<p dir="ltr">The first step in coping with ambiguous grief is to acknowledge and accept the complexity of the situation. It&#39;s important to recognize that the grieving process may not follow a linear path and may be ongoing. This may include feelings of sadness, anger, frustration, and confusion. Allowing yourself to feel and express these emotions is an important part of the healing process.<br />
&nbsp;</p>

<ul dir="ltr">
	<li><strong>Find support</strong></li>
</ul>

<p dir="ltr">Another helpful strategy is to find support from others who understand the experience of ambiguous grief. This may include joining a support group or connecting with others who have gone through similar experiences. Speaking with a therapist can also be helpful, as they can provide a safe and non-judgmental space to process emotions and explore coping strategies.<br />
&nbsp;</p>

<ul dir="ltr">
	<li><strong>Find ways to honor</strong></li>
</ul>

<p dir="ltr">It&#39;s also important to find ways to honor and remember the person who is gone or the relationship that has changed. This may include creating a memory box or scrapbook, lighting a candle in remembrance, or finding ways to celebrate their life and legacy. Finding ways to incorporate the person or relationship into your daily life can help to maintain a sense of connection and prevent feelings of isolation or detachment.<br />
&nbsp;</p>

<ul dir="ltr">
	<li><strong>Practice self care</strong></li>
</ul>

<p dir="ltr">Practicing self-care is also essential when coping with ambiguous grief. This can include taking time for yourself to engage in activities that bring you joy or relaxation, such as exercise, meditation, or spending time in nature. It&#39;s also important to prioritize your physical health, such as getting enough sleep, eating a healthy diet, and avoiding harmful coping mechanisms such as substance abuse.<br />
&nbsp;</p>

<ul dir="ltr">
	<li><span style="color:#000000"><strong>Reframe the situation</strong></span></li>
</ul>

<p dir="ltr">Finally, it can be helpful to reframe the situation and find meaning in the experience. While ambiguous grief can be incredibly challenging, it can also provide an opportunity for personal growth and resilience. This may include finding new ways to connect with others, developing a greater sense of empathy and compassion, or deepening your spiritual or philosophical beliefs.<br />
&nbsp;</p>

<ul dir="ltr">
	<li><span style="color:#000000"><strong>Seek professional help</strong></span></li>
</ul>

<p dir="ltr">One important thing to keep in mind when coping with ambiguous grief is that there is no &quot;right&quot; or &quot;wrong&quot; way to grieve. Everyone&#39;s experience is unique and may require different strategies or approaches. It&#39;s important to allow yourself the time and space to process your emotions in a way that feels authentic and true to yourself.</p>

<p dir="ltr">In some cases, seeking professional help may be necessary to cope with the complex emotions and challenges associated with ambiguous grief. This may include speaking with a therapist who specializes in grief and loss, or seeking support from a grief counselor or support group.</p>

<p>&nbsp;</p>

<p dir="ltr">Coping with ambiguous grief can be a challenging and complex process. However, by acknowledging the complexity of the situation, finding support from others, honoring the person or relationship that has changed, practicing self-care, and finding meaning in the experience, individuals can navigate this difficult experience with greater resilience and growth. Remember that there is no &quot;right&quot; or &quot;wrong&quot; way to grieve, and it&#39;s important to prioritize your emotional and physical well-being as you navigate this journey.<br />
&nbsp;</p>