IS THE OBESITY EPIDEMIC BEHIND THE RISE IN AUTISM? A Glasses on the Head Moment…

IS THE OBESITY EPIDEMIC BEHIND THE RISE IN AUTISM?

A Glasses on the Head Moment

By Sean Kenniff, MD

www.healthapalooza.com

Sometimes we just don’t notice the obvious, even if we are scientists. This is a tale of two epidemics.

Forty years ago we were a lean and robust nation. But at some point during the 1970s, our bellies and backsides began to steadily balloon, and our weight gain accelerated through the eighties and nineties. Today, two thirds of all American adults are overweight or obese according to CDC statistics. Nowhere is the obesity epidemic causing more concern than in the delivery room. Many normal weight women become overweight or obese during their pregnancies, and roughly 30 percent of women are overweight or obese at the time of conception. Obesity, at any point during pregnancy, places the health of the mother and her unborn baby in serious jeopardy.

If you were born in the 1970s your chances of developing autism were pretty slim—about 4 in 10,000. Today, 1 in every 110 children has an autism spectrum disorder (ASD). This dramatic rise in the number of children with autism is partly due to improved diagnostic methods and more inclusive diagnostic criteria. However, even by conservative estimates, the number of children with autism has significantly increased since the 1980s. Addressing the most recent rise, Dr. Catherine Rice from the CDC suggested the data was perplexing.

“These new numbers are concerning, and indicate that even more individuals, families and communities are struggling to find answers,” Rice said.

But are researchers asking the right questions? These two modern epidemics—obesity and autism—seem to have evolved in parallel and during the same time period. Could obesity be fueling the rise in autism?

If you are starting to put the puzzle pieces together, congratulations. Because it appears scientists have yet to do so.

Somebody Must Have Studied This Already…Right?

Using Medline, the database of scientific studies maintained by the National Library of Medicine, a search for “pregnancy obesity and autism” yields just five results. A search for “maternal obesity and autism” yields twenty-one results. In both searches none of the studies cited directly examines the possibility of a link between prenatal obesity and autism. Not to be sexist, a search for “paternal obesity and autism” proves equally fruitless. By contrast, a search for “pregnancy obesity and hypertension” yields 802 scientific studies—many of which are direct investigations into a link, and a search for “pregnancy obesity and risks” yields 2588 studies.

Why hasn’t the connection between autism and obesity been explored? For one thing, autism is not a single disease, and as such, it probably does not have a single cause. A combination of genetics and environmental factors is thought to play a critical role in increasing the risk of autism. The risk of obesity is also heavily influenced by genetics and the environment, but psychological and emotional factors are thought to be equally significant. With two such unpredictable and multifaceted disorders, it is difficult to pinpoint any correlation, says Dr. Jacob Seligsohn, a primary care pediatrician who also specializes in childhood autism at Joe DiMaggio Children’s Hospital and Pediatric Associates in Hollywood, Florida.  

“Autism is a very complex condition and simply two variables themselves—maternal obesity and autism—are hard to correlate with each other,” Dr. Seligsohn says.

Although the scientific evidence to support a link between obesity and autism is circumstantial, it is compelling. 

Though the World Health Organization does not track global statistics on autism, the available data suggests the world’s most overweight nations—namely the United States, the United Kingdom, and Australia—also have the highest prevalence of autistic disorders. And across the world as the rates of obesity have risen, so have the rates of autism.

It is well known that maternal obesity can have a devastating impact on the baby’s developing nervous system. Obesity during pregnancy raises the risk of hydrocephalus—or “water on the brain”—by 60 percent and it doubles the risk of neural tube defects, like spina bifida and anencephaly.

The rate of diabetes during pregnancy has doubled in recent years, and the obesity epidemic is believed to be chiefly responsible for the increase. Gestational diabetes doubles the risk of autism according to 2009 a meta-analysis published in the British Journal of Psychiatry. It’s possible that the high blood sugar levels or growth factor disturbances seen with diabetes may adversely affect the developing brain.

A November 2009 study published in the Journal of Child Psychology and Psychiatry found maternal obesity was associated with a two-fold increase in Attention Deficit Disorder in children. Interestingly the researchers found maternal obesity only increased the risk of inattentive behaviors in the children, not hyperactive behaviors. Most children with autism have difficulties maintaining attention.

It has also been recently discovered that obesity can impair the immune system, making expectant mothers more prone to infections. Infections during pregnancy—like CMV and rubella—can result in autistic behaviors in children.

Do Autism and Obesity Have a Common Enemy?

The sweetener high fructose corn syrup (HFCS) was rapidly introduced into the U.S. food chain between 1975—1985. While HFCS has long been a suspect in causing, or contributing to the obesity epidemic, the sweetener has never been connected to autism. But two recent studies from the Institute for Agriculture and Trade Policy (IATP) are raising some concerns. In the first study almost half of the commercially available HFCS samples they examined tested positive for mercury. In the second study the researchers found mercury in one-third of 55 popular consumer products that listed HFCS as the first or second ingredient. While neither study identified the form of mercury detected, methylmercury is known to impair neural development in the developing fetus, and exposure to the heavy metal has been implicated as an autism risk in the past. More recent studies however suggest there is no link between autism and mercury.

Obesity recently surpassed smoking cigarettes as the nation’s leading cause of preventable disease. Obesity is known to raise the risk of at least 30 other conditions—including heart disease and several types of cancer. Having excess fat tissue alters metabolism, impairs the immune system, increases levels of inflammation, and often renders important hormones ineffective. Any of these physiological disturbances could pose a theoretical risk to the brain of a developing baby.

“Because so much is unknown about autism, any reasonable hypothesis is worth exploring in my opinion,” says, Dr. Hannah Gardener, a neurologist and researcher at the University of Miami. “The intra-uterine environment has profound effects on so many aspects of health throughout the lifecourse.”

It is true that autism existed long before the obesity epidemic, and most overweight or obese parents will never have a child diagnosed with autism. Conversely thousands of children born to normal weight parents will be diagnosed with autism this year. It is not likely that obesity is solely responsible for the increased rates of autism seen over the last three decades.

But have you ever been looking for your sunglasses, or reading glasses, only to find them sitting on the top of your head? I have, and now that’s the first place I check. The simultaneous evolution and parallel course of these two epidemics points to a connection that deserves to be investigated.

Sean Kenniff, MD is a neurologist, television health journalist, radio host and author living in Miami, Florida. He can be reached at 786-360-2705. 

Jacob Seligsohn, MD is a pediatrician in Hollywood, Florida. He can be reached at 954-966-8000, or by visiting the Pediatric Associates website at www.pediatricassociates.com 

Dr. Hannah Gardener is a neurologist and researcher at the University of Miami. She can be reached at 305-243-9283, or by visiting the University of Miami Miller School of Medicine Website at www.med.miami.edu

DIET ADDICTION COULD BE DRIVING U.S. OBESITY EPIDEMIC, RESEARCH SUGGESTS…

DIETING MAY BE ADDICTIVE, PACK ON POUNDS

By Sean Kenniff, MD

Healthapalooza.com

Americans spend roughly $47 million dollars each year on Twinkies, and another $32 billion on pizza. That’s a lot of dough. So it is hard to imagine the kind of food that outsells all those pizzas and Twinkies combined. According to food industry statistics, diet products do just that. Each year U.S. consumers spend more than $40 billion trying to shake off the pounds with diet shakes, pills, and programs.

But take a look around, and take a good look in the mirror. Diets don’t work well for anybody—they don’t even work for rich and famous celebrities. After losing 160 pounds in 2005, talk show queen Oprah Winfrey regained all of her weight by 2009. Actress Kirstie Alley famously lost 75 pounds by using the diet program Jenny Craig. She gained it all back within three years. Dodger ex-manager Tommy Lasorda slimmed down using Slim Fast, and so did NFL Hall of Fame coach Bill Parcells. Both men saw weight loss victory quickly turn to defeat.

“While virtually all diets result in weight loss in the short term, 95-98 percent of people who go on a diet will gain the weight back,” says Judith Matz, co-author of The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self Care. “According to the research, two-thirds will end up heavier than their pre-diet weight.”

Matz says repeated phases of food deprivation, commonly called dieting, slows metabolism and makes our bodies store fat more efficiently. Recent evidence also suggests repeated dieting can alter brain chemistry in a similar fashion to drug or alcohol addiction.

“Diets give a high,” Matz says, “There is a virtuous feeling; you are on top of the world.”

So can you be addicted to dieting? And can a “diet addiction” be making you fatter?

The idea that a “diet addiction” could be driving our obesity epidemic is not a new one. Scientists have long known behaviors of yo-yo dieters—like food compulsions, obsessions, guilt, and shame, closely resemble the behaviors of relapsing addicts. What drives people to use drugs or alcohol in the first place, drives many others to extreme diets or eating disorders—genetics, emotional strain, mental illness, peer pressure and insecurity all playing important roles. Like alcoholics and drug addicts, dieters will often do destructive things to their bodies just to be thinner. Many abuse water pills, amphetamines, and laxatives to stay thin, or continue to smoke cigarettes out of fear that quitting will lead to weight gain. Still others resort to the dangerous bingeing and purging of bulimia.

But perhaps the most compelling evidence of diet addiction comes from experiments conducted by Dr. Pietro Cottone and Dr. Valentina Sabino at the Boston University School of Medicine. They studied the neurobiological responses of 155 rats. One group of rats was fed the standard, bland-tasting rat chow. Another group of rats was fed in diet cycles of standard rat chow for five days, followed by two days of a tasty, high sugar, chocolate flavored chow. The standard chow quickly became unacceptable to rats in the diet-cycled group, and they exhibited anxiety behaviors until they were able to get a fix of the chocolate chow. But when Dr. Cottone and Dr. Sabino examined the stress pathways in the brains of the rats, they found the “addictive” stress response was not caused by the tasty food, but rather by the deprivation phase. They found a key stress neurotransmitter, called CRF, was creating a negative emotional state nearly identical to that seen in animals withdrawing then bingeing on drugs or alcohol.

And it’s believed this same abnormal stress response could be one reason why so many people fail miserably on their diets, yet try and try again.

“CRF activation during abstinence from palatable foods induces a negative emotional state which is responsible for signs of anxiety and contributes to relapse to ‘forbidden foods,” Dr. Sabino said in a press release.

So how do you know if you are a diet addict?

ARE YOU A DIET ADDICT?

1.    Have you repeatedly tried and failed to control your weight with diets?

2.    Has dieting interfered with your life, social activities or employment?

3.    Do you have constant thoughts about dieting?

4.    Do you jump from diet to diet?

5.    Do you feel shame when you fail on your diet?

6.    Have you ever dieted dangerously?

If you answered yes to two or more of these questions you could be a diet addict.

But what about those people who are persistent and successful at dieting, like 65 year-old computer professional, Rose Lynn? She failed at Atkins, South Beach, and Weight Watchers, but recently lost fifty pounds on Nutra-System.

“I don’t believe the diets failed,” Lynn says, “I believe I failed to be ready and committed.”

Football Coach Jim Napoli lost forty pounds on the same diet program, after failing miserably on Atkins. “I lost weight, but I was mean as I’ve ever been, from the minute I woke up, until the minute I went to bed,” he says.

Funnyman and morning DJ Jeff Martin, who lost nearly thirty pounds on Quick Weight Loss, takes a more absurdist view on dieting, saying, “Try the garlic, limburger cheese, scallions, and red onion diet. From a distance, you will LOOK thinner.”

Will their success lead to long term weight loss? Matz says, slim chance—a two to five percent chance to be specific. Matz claims the secret to lifelong thinness is to break the diet addiction for good. Don’t avoid your favorite foods, because deprivation triggers overeating. Instead eat them in moderation. And honor your hunger. Hunger is your body’s natural way of telling you to eat. But be wary of emotional eating. If hunger is not your problem, then eating is not your answer.

Sean Kenniff, MD is a neurologist, television health journalist and radio host in South Florida.

To contact Judith Matz, or for more information about The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self Care, visit www.dietsurvivors.com or you can read her blog at www.dietsurvivorsgroup@blogspot.com

Dr. Pietro Cottone and Dr. Sabino Valentina can be reached by contacting the Boston University School of Medicine.

UNHEALTHY HOLLYWOOD! Healthapalooza’s Annual Report

Healthapalooza’s Annual Report

UNHEALTHY HOLLYWOOD

by Sean Kenniff, MD

Hollywood has always been a good place for bad behavior. But 2009 was especially tragic for Tinseltown, as a lot of Hollywood’s best had their worst and last moments. In June, David Carradine died under bizarre sexual circumstances in a Bangkok Hotel. Soon thereafter the King of Pop, Michael Jackson, went into cardiac arrest after receiving a deadly cocktail of potent prescription drugs. Adam Michael Goldstein, better known as DJ AM, suffered a fatal drug overdose in August. And most recently 32 year-old actress Brittany Murphy died under questionable circumstances. Forget falling stars, 2009 was a meteor shower.

All year the staff at Healthapalooza.com follows celebrity news, gossip, and tabloid rumors to bring you our annual report “Unhealthy Hollywood.” The winner of each category is dishonored with a “Healthapaloozer” award—perhaps the only award in Hollywood nobody wants to win.

In the category for SCARIEST SKINNY the nominees are…

1.    Lindsay Lohan

2.    Mishka Barton

3.    Keira Knightly

The Healthapaloozer goes to Mishka Barton! According to the British tabloid The Daily Mail, the 5’9” Barton was a curvy size 12 last year. Now she appears sickly and skeletal. Barton denies having an eating disorder, and credits her dramatic weight loss to a new obsession with pilates.

Important Fact: The eating disorders, anorexia nervosa and bulimia, are the deadliest forms of mental illness. In women, anorexia raises the risk of death 12 times.

In the category for FRIGHTENINGLY FAT the nominees are…

1.    Kirstie Alley

2.    John Goodman

3.    Aretha Franklin

The Healthapaloozer goes to Aretha Franklin! Lately the “Queen of Soul” has been looking more like the “Dairy Queen of Soul.”

Important Fact: Being overweight or obese raises the risk of heart disease, high blood pressure, stroke, diabetes, and many forms of cancer. There are more than 4 million Americans weighing over 300 pounds.  

In the category for MOST TOXIC BODY the nominees are…

1.    Amy Winehouse

2.    Artie Lange

3.    Courtney Love

The Healthapaloozer goes to Amy Winehouse! The singer claims she has been drug free since January 2009, but her erratic behavior is raising a lot of doubts. Winehouse was arrested two times in 2009 for alleged assaults, and in late December she collapsed and was treated at a hospital for “nervous exhaustion.” Amy, it looks like it might be time to say “Yes, Yes, Yes,” to rehab.

Important Fact: The most common addictions in the U.S. are to legal substances, namely alcohol and tobacco. In terms of dollar amounts, more cocaine is sold each year in the U.S. than Starbuck’s coffee.

In the category for MOST LIKELY TO CONTRACT AN STD the nominees are…

1.    George Michael

2.    Tiger Woods

3.    Warren Beatty

The Healthapaloozer goes to George Michael! Tiger Woods had at least 11 mistresses, and Warren Beatty is rumored to have slept with nearly 13-thousand women over his acting career, but singer George Michael appears to be the riskiest sex seeker. In 1998 the Grammy winning superstar was nabbed by police engaging in a “lewd act” in a public toilet, and he recently admitted to The Guardian that he smokes seven joints a day and engages in casual sex about twice a week with men other than his boyfriend.

Important Fact: Drug use increases the risk of contracting an STD. So does having sex under the influence of drugs or alcohol, or having sex with someone who is under the influence of drugs or alcohol. The more sexual partners you have, the higher your risk of an STD.

In the category for MOST FROZEN FACE the nominees are…

1.    Joan Rivers

2.    Kenny Rogers

3.    Kathy Griffen

The Healthapaloozer goes to Joan Rivers! Joan Rivers clearly suffers from the “Frozen Face Syndrome.” With her facial muscles paralyzed by Botox, and skin stretched paper thin, the funny lady can hardly crack a smile.

Important Fact: Nearly 12 million cosmetic surgeries were performed in the U.S. in 2007. Two thirds of cosmetic surgery patients are repeat patients.

In the category for MOST DANGEROUS DIET the nominees are…

1.    Rihanna

2.    Britney Spears

3.    Miley Cyrus

The Healthapaloozer goes to Miley Cyrus! Sultry songstress Rihanna supposedly orders pizza, lasagna, and french fries before her concerts. Britney Spears reportedly kicked her junk food habit to slim down for her Circus tour. But Miley Cyrus is allegedly addicted to junk food. While staying at a hotel in December 2009 Life and Style reported Cyrus ordered seven burgers and cheese fries, and she washed it all down with an Oreo milkshake.

Important Fact: A study conducted in 2000 found junk food raises the risk of heart disease in TEENS!

In the category for UNHEALTHIEST MOVIE the nominees are…

1.    Taking Woodstock

2.    Paul Blart: Mall Cop

3.    The Hangover

And the Healthapaloozer goes to The Hangover! No doubt The Hangover was a comedy hit, but the bachelor party booze bonanza flick features almost every kind of unhealthy behavior—drugs, anonymous sex, over drinking, grand theft, taser demonstrations, and being punched by Mike Tyson.

Important Fact: Recently studies have found hangovers impair judgment and memory, and they are a leading cause of work absences and lost productivity. Another recent study found driving with a hangover is 4-times more dangerous than driving sober.

In the category for UNHEALTHIEST TELEVISION PROGRAM the nominees are…

1.    Rock of Love with Brett Michaels

2.    The Simpsons

3.    More to Love

And the Healthapaloozer goes to Rock of Love! Homer Simpson is a drunk-driving donut-eating dimwit who chokes his son, Bart, in fits of rage, but even he could not beat the unhealthy behaviors featured on VH1’s Rock of Love with Bret Michaels.  On the show chain-smoking boozed-up bimbos compete for the affection of Bret Michaels, the former frontman of the rock group Poison. 

Last but not least, the EVEL KNIEVEL LIFETIME ACHIEVEMENT AWARD FOR DEATH DEFYING LIVING goes to…Artie Lange! Howard Stern’s hysterical sidekick, and author of the book, Too Fat to Fish, is dangerously fat, and has a long history of drug and alcohol abuse. He was recently hospitalized for undisclosed reasons. Get well, Artie, and stay well.

Carnal Knowledge: Things About Sex You Probably Don’t Know

Carnal Knowledge: Ten Things You Probably Don’t Know About Sex

By Sean Kenniff, MD

Despite the sexual revolution of the 1960s and 1970s and recent scientific advancements, there is still a lot of mystery surrounding everyone’s favorite physical activity. And if you think you know everything about sex, think again. Take a look at these ten sex headlines you might have missed. 

SEX AND THE CITY

People living in New York City have twice the number of sex partners as the average American. NY’s Daily News took a look at the sex lives of the Sex and the City Characters to see how they compared to the real thing. In the 94 episodes of six seasons the four main characters managed to bed 94 men and one woman.  Samantha was the most prolific lover, shagging 41 men and 1 woman. Carrie hooked up with 18 men and so did Charlotte. Miranda bedded 17 men. When these fictitious sexual patterns were compared to similar groups of real NY City women, those numbers were right on target.

DIRTY WORDS

The word pornography is a combination of the Greek word for prostitute, or “porno”, and the word “graphia” which means writing. So literally pornography originated as writings about prostitutes.

BREAST IMPLANTS ARE LINKED TO SUICIDE

Several studies have documented an increased risk of suicide in women who have breast implants. A Swedish study published in 2007 found women with breast implants were nearly three times more likely to commit suicide compared to women without the implants. According to the study the increased suicide risk did not appear until 10-years after the breast augmentation surgery. But twenty years after the surgery the researchers found the rate of suicide in women with implants was six times the expected rate. Some studies have found women with breast implants also have triple the risk of dying from drugs or alcohol.

SIZE MATTERS

The largest medically verified human penis measured almost 14 inches. The shortest ever recorded was 0.39 inches long, or just about one centimeter. Today normal size is said to be between five and seven inches. Rorqual whales have the largest penises of any animal; 10-feet long, and 1-foot in diameter. But compared to body size the unassuming barnacle has the largest endowment, with a penis up to 42-times its own body length (below).

MINUTE MEN…AND WOMEN

A 2008 survey of U.S. and Canadian sex therapists say “satisfying sex” lasts anywhere from three-to-thirteen minutes. 7-to-13 minutes was declared “desirable”, whereas 1-2 minutes was deemed “too short”, and more than 14 minutes was deemed “too long”.

VIRGINITY GENES?

Genes may play an important role in determining the age at which a person first engages in sexual intercourse according to a 2009 study. Researchers from California State University in Fullerton studied 48 pairs of twins who were raised apart and found the age of virginity loss was roughly 33% due to genetic influences. Previous studies have found a gene, called DRD4, is associated with impulsiveness, increased risk-taking behavior and a lower age at first intercourse. June is often cited as the most common month for loss of virginity (all those proms and weddings).

RED WINE MAY BOOST A WOMAN’S LIBIDO

Doctors from the University of Florence in Italy say a glass or two of red wine may boost a woman’s level of sexual interest. They studied more than 800 normal women and found women who enjoyed drinking 1-2 glasses of red wine had higher levels of sexual desire compared to women who drank other forms of alcohol or those who abstained. It is possible compounds in red wine increase blood flow to key areas.

HANGING CHADS

In most men the left testicle hangs lower than the right testicle, and although the reason is not entirely clear it makes a lot of practical sense. The oval shape of the testes and their different heights may prevent them from banging into each other when men walk. Both testicles rise with physical exertion or sexual intercourse for the same reason. The cremaster muscle is responsible for this reflex. Plus being further apart may keep the testicles cooler which is important for sperm production.

300 ORGASMS A DAY!

Women suffering from a rare condition called Persistent Sexual Arousal Syndrome, or PSAS, can have 300 orgasms each day or more. The orgasms in women with PSAS are usually unrelated to sexual activity or sexual thoughts, and they often occur at inappropriate and embarrassing times. In fact the orgasms come so frequently they cease to be pleasurable. Brain abnormalities have been found in some cases, but the cause of most cases remains a mystery.

FERTILE STRIPPERS MAKE MORE MONEY

New Mexican psychologist Geoffrey Miller studied female strippers and found they earn more tips in the week before their period than any other time during the menstrual cycle. This is the time of peak fertility, and Miller theorizes pheromones are signaling the men and causing them to tip larger amounts. In fact during peak fertility exotic dancers made twice as much money as they did when they were menstruating. The same study also found women on ‘the pill’ did not experience the monetary increase during this most fertile time.  

The “I Do” Blues: Postnuptial Depression

THE “I DO” BLUES: Postnuptial Depression

By Sean Kenniff, MD

  A wedding is usually one of the most joyous days in a young couple’s life; a time to celebrate love and hope for a lifetime of happiness. But for some newlyweds the big day is soon followed by a big letdown. 

  “It should be described as the day the prince falls off his horse, and we change from girls into women,” one blogger writes. 

  “What begins the day after marriage? Misery,” replies another. 

  In many cases once the honeymoon is over, humdrum reality sets in, and that can leave unprepared couples coping with postnuptial depression-also called the ‘I Do Blues’. 

  “Building a happy, productive partnership is not easy.  The unrealistic expectations set up by our culture, media images of connubial bliss, romantic novels and song lyrics soon prove to be impossible to create, and reality then sets in,” says Dr. Tina Tessina.

  Dr. Tessina, better known as “Dr. Romance,” is a distinguished California psychotherapist and author of the book, Money Sex and Kids: Stop Fighting About the Three Things That Can Ruin Your Marriage. She says both men and women are at risk of postnuptial depression, because their expectations are often out of step with day-to-day marital life. 

  “Any situation in which the expectations are unrealistic can be considered a ‘set up’ for disappointment, which some people experience as depression,” she says. 

  In the months leading up to the wedding day the bride and groom often become the gravitational center of activity for family and friends. Some couples, especially the brides-to-be, spend so much time planning a wedding that they often fail to plan a survival strategy for the days afterwards; and when the wedding day spotlight disappears, so can a sense of purpose.  

  “People who are emotionally resilient rise to this challenge and work together to solve the problems and improve the relationship.  Those who are not resilient sink into despair and depression, and stop trying,” Dr. Tessina says. 

Signs of postnuptial depression may include

• 1. Lack of energy
• 2. Emotional withdrawal
• 3. Lack of sexual intimacy
• 4. Feelings of hopelessness, or despair
• 5. Frequent crying
• 6. Sleeplessness

  Roughly half of all U.S. marriages end in divorce, so it is normal to have some reservations about the sustainability of a new marriage, or suitability of a new spouse. It’s also difficult for some to move from the ‘me’ mindset of being single, to the ‘we’ mindset of being married. Unfortunately few people want to talk about postnuptial depression for fear it might trigger some trouble-in-paradise rumors, but experts say couples should communicate their difficulties to each other, and a professional. Antidepressant medications can help in severe cases, but most cases of postnuptial depression can be treated effectively with psychological therapy.

  “Counseling will also help you handle situations more effectively,” Dr. Tessina says, “and help you not create more drama and dysfunction in the relationship. “ 

  The best way to avoid postnuptial depression is through careful planning and maintaining perspective. First try not to put overblown significance on the wedding day. Certainly it is an important day, but it is still just another day. Before the big day it may help to delegate wedding responsibilities wherever you can, think about having a less lavish reception, try to avoid obsessions or being a perfectionist, and talk to friends and family about your stress. 

  It’s important to remember loving relationships are like flowers; they blossom quickly, need constant care and change with the seasons. Just watch out for the thorns and expect bees. 

Sean Kenniff, MD is a neurologist, radio host, and television journalist in Miami, Florida. 

Tina B. Tessina, PhD, also known as ‘Dr.Romance’, is a licensed psychotherapist in Southern California with over 30 years of experience counseling couples and individuals. She is the author of thirteen books on relationships including Money, Sex and Kids: Stop Squabbling About the Three Things That Can Ruin Your Marriage. Dr. Tessina also writes the Dr. Romance blog, and is a Relationships Expert for Redbook Love Network, Divorce360.com, and she answers relationship questions at Yahoo! Personals. She can be reached by visiting her website  http://www.tinatessina.com