I was diagnosed with Barrett’s oesophagus in 2017 (and a hernia before that) and have been taking omeprazole ever since. Could it have caused the crippling depression that rules my life?
Lynda Hammett, Peterborough.
Dr Martin Scurr replies: Omeprazole is prescribed for acid reflux, which will be a consequence of your long-standing hernia – chronic acid reflux can lead to Barrett’s oesophagus, a change in the lining of the oesophagus due to the acid exposure.
This is associated with a heightened risk of cancer of the oesophagus, although the risk itself is low – affecting 1 to 5 per cent of patients with the condition over a ten-year period.
Nevertheless, it’s essential to continue suppressing gastric acid secretion.
Omeprazole is a type of proton pump inhibitor (PPI) drug and studies of PPIs show regular use cuts the risk of Barrett’s oesophagus by about 70 per cent.
Your concern about omeprazole and depression is not misplaced. A 2018 study found a significant association between PPI drugs and increased reports of depression and anxiety.
It’s not clear why, but one reason might be reduced vitamin B12 absorption – gastric acid helps to release B12 from proteins in food, so lowering it can affect this.
Furthermore, reduced gastric acid is also associated with changes in the gut microbiome – the community of microbes that live there and that play a role in health and may also influence mood. But there are many reasons why people develop depression, including genetics.
Chronic acid reflux can lead to Barrett’s oesophagus, a change in the lining of the oesophagus due to the acid exposure
My advice is to remain on omeprazole, but start taking vitamin B12 and probiotic supplements. Do also ensure that your diet contains fermented foods such as kefir and yoghurt.
And please seek effective help for your depression – it’s rarely as simple as finding the right pills to take, but that’s a subject for discussion another time.
I am 69 and desperate to have the shingles vaccine that’s being rolled out on the NHS, as I’ve seen the terrible effects this infection can have. But I’m told I’m not allowed it until I turn 70. Why is this?
Liz Gudgion, Lincoln.
Dr Martin Scurr replies: The pain and distress of shingles is not to be underestimated. It’s very common, too – one in four people over 50 will experience it. Its medical name is herpes zoster and it’s a complication of suffering from chickenpox earlier in life: effectively, the virus goes into hiding in the nerves and re-emerges opportunistically if your immune defence is weakened (for example, when you are run down).
The vaccine you mention, Shingrix, comes in two doses and is licensed for the over-50s. It’s safe and effective, especially for people who have compromised immunity – such as those receiving chemotherapy.
But, as you say, it’s not freely available and the NHS currently only offers it to those aged 70 to 79, and over-50s with severely compromised immunity.
We are told this is due to ‘resource planning’ – weasel words for cost containment – and that certain constraints (apparently to do with logistics, workforce capacity and funding) mean expensive vaccines have to be prioritised for high-risk groups.
Yet it’s odd, is it not, that none of these constraints applies to the ever-expanding immunisation programme for children?
Many of us who are caring for patients feel aggrieved that
Shingrix is not universally available to all over 50s, and I strongly disagree with the Government’s policy, which flies directly in the face of medical ethics.
In the meantime, you could consider paying for it privately – it costs about £230 for each dose (you do need the two) and is available on the High Street.
