TIME Aging

These Common Mood Changes Can Signal Early Alzheimer’s

The vast majority of people with Alzheimer’s disease will experience changes like depression and anxiety. But a new study published in the journal Neurology shows that behavioral changes like these start well before they begin to have memory loss.

The researchers looked at 2,416 people over age 50 without cognitive issues. After following them for seven years, researchers found that 1,218 people developed dementia.

Those with dementia had twice the risk of developing depression earlier—far before their dementia symptoms started—than people without the disease. They were also more than 12 times more likely to develop delusions. The symptoms appeared in consistent phases: first, irritability, depression, and nighttime behavior changes; followed by anxiety, appetite changes, agitation and apathy. The final phase was elation, motor disturbances, hallucinations, delusions and disinhibition.

Though the researchers were able to make the connection, they still cannot confirm for certain whether the changes in the brain that cause one shift in behavior are the same changes that cause memory loss. But understanding when symptoms related to Alzheimer’s disease appear could one day lead to earlier interventions.

Read next: The Science Behind Why Dogs Might Just Be Man’s Best Friend

TIME mental health

The Link Between Mental Trauma and Diabetes

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Women with more PTSD symptoms appear to be at a higher risk for Type 2 diabetes, a new study says

Women with symptoms of post-traumatic stress disorder (PTSD) have a two-fold increased risk for type 2 diabetes, according to a new study.

“When we are under stress we are more likely to get sick, but women with PTSD are in this extreme stress response a lot of the time,” says study author Karestan Koenen, an epidemiology professor at Columbia University’s Mailman School of Public Health. The new study, published in the journal JAMA Psychiatry, looked at 49,739 women participating in the Nurses’ Health Study II to assess the link between PTSD symptoms and type 2 diabetes over 22 years. They found that women with the most symptoms had double the risk of developing type 2 diabetes, and that the association increased based on the number of symptoms women experienced.

“It’s so important that people understand PTSD isn’t just in veterans. Most PTSD is just in regular people in the community,” says Koenen. One of the most surprising findings in the study was that using antidepressants and having a higher body mass index (BMI) accounted for about half of the increased risk for type 2 diabetes in women with PTSD. Past research has linked PTSD to having a higher BMI, with some research suggesting that elevated stress response could result in cravings for highly caloric food and lead to weight gain.

The antidepressant link is the most unexpected. An obvious explanation for the link is that some antidepressants cause weight gain, but the researchers argue weight gain isn’t caused by all antidepressants and therefore cannot account for all of the effect. “It’s probably one of the most interesting findings and I don’t have a good explanation for it,” says Koenen.

The researchers say it’s possible that extreme stress can cause changes in the regulation of the body’s immune system, inflammation markers and hormones, which could contribute to the onset of type 2 diabetes.

Ultimately, Koenen believes the study is important because it provides further evidence that medicine can benefit from a more holistic look at patients that includes not just disease but also mental health and psychology. “Our health care system acts like the brain and the body are two separate things. This is just one of hundreds of studies that have now shown that mental health affects physical health and mental health,” she says. “We need a more integrated medical system where the mind and body are worked on together.”

Koenen, who used to work in veterans affairs, says veterans have been asking for such care for a long time, with studies and surveys showing patients often ask for alternative services like yoga. “Patients understand this but the medical system hasn’t caught up,” she says.

TIME Morning Must Reads

Morning Must Reads: January 5

Capitol
The early morning sun rises behind the US Capitol Building in Washington, DC. Mark Wilson—Getty Images

Cops Protest Mayor at Funeral

Dozens of New York City police officers turned their backs toward Mayor Bill de Blasio during services to honor and remember a police officer who was killed Dec. 20—denying a request from NYPD chief Bill Bratton not to use the funeral as a protest

Most Cancer Beyond Your Control

Researchers have found that bad luck plays a major role in determining most types of cancer, rather than genetics or risky lifestyle choices like smoking

Boston Bombing Trial Begins

Jury selection begins Monday in the trial of one of the accused Boston Marathon bombers, Dzhokhar Tsarnaev, nearly two years after the attack

Weather Hampers AirAsia Search

The AirAsia salvage operation shifted Monday to focus on recovering the aircraft’s flight-data recorders, otherwise known as black boxes, but blustery weather continues to undermine search efforts in the Java Sea

Palace Denies Prince Andrew Had Sex With Teen

Buckingham Palace has issued a second, strong denial of claims by a Florida woman who says she was forced to have sex with Prince Andrew when she was a teenager. The woman claims she was loaned out to wealthy and powerful men, including the Duke of York

Bitter Cold Temperatures Blast U.S.

Dangerously cold arctic air masses and snow were moving across the U.S. on Sunday night, bringing the most bitterly cold temperatures so far this winter. Parts of 14 states from Washington to Ohio were under weather advisories thanks to the fast-moving storm

Cowboys Beat Lions After Controversial Call in 4th Quarter

The Detroit Lions were leading 20-17 in the fourth quarter but a bizarre piece of officiating turned into a huge benefit for the Dallas Cowboys, who will now head on to Green Bay for a divisional-round matchup with the Packers

U.K. PM Says Obama Calls Him ‘Bro’

David Cameron is so chummy with Barack Obama that the U.S. President calls him “bro,” the U.K. PM says, adding that the relationship between 10 Downing Street and 1600 Pennsylvania Avenue is “stronger than it has ever been”

Depression Could Be More a Physical Than Mental Condition

A growing number of scientists are coming to the conclusion that depression is a physical condition as much as it has to do with the mind. The starting point for the theory is that everyone feels down when they are ill

New U.S. Sanctions on North Korea

Here are three things to know about new U.S. sanctions against North Korea over a cyberattack on Sony Pictures, whose movie depicting the fictional assassination of North Korea’s leader has infuriated Pyongyang, which denies responsibility for the attack

ESPN Anchor Stuart Scott Dead at 49

The SportsCenter host, one of ESPN’s most recognized personalities who helped the network build its brand, died on Sunday after battling cancer. “He leaves a void that can never be replaced,” said ESPN president John Skipper

Meth Seizures at U.S.-Mexico Border Set New Records

Methamphetamine seizures along the California-Mexico border accelerated to unseen levels in the fiscal year 2014, as drug trafficking organizations sought to benefit from the cost advantages of producing the drug south of the U.S. border

TIME mental health

Depression Could Be More a Physical Than Mental Condition, Say Scientists

The starting point for the theory is that everyone feels down when they are ill

A growing number of scientists are coming to the conclusion that depression is at least as much a physical condition as it has to do with the mind.

One explanation is inflammation, which is caused by a part of the immune system that gets called into action when the body suffers a wound, the Guardian reports.

A set of proteins called cytokines sets off this inflammation in the body. This process is why people tend to feel down when they fall ill.

And so scientists think the brain may be tricked into feeling depressed through a process akin to an allergic reaction.

Read more at the Guardian

Read next: Most Cancer Is Beyond Your Control, Breakthrough Study Finds

Listen to the most important stories of the day.

TIME

7 Mental Health Resolutions for 2015

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Here's how to take care of your mind this new year

When it comes to New Year’s resolutions, our self-improvement efforts often focus on getting a better body. And we ignore that other, equally important part of our wellbeing: our mental health.

Certain health hazards come with warnings, like cigarettes or alcohol, but less obvious ones, like loneliness and rejection, can take just as great toll, says psychologist Guy Winch, author of Emotional First Aid: Healing Rejection, Guilt, Failure and Other Everyday Hurts. Research shows social isolation is linked to shorter lifespans, yet we often ignore our emotional hygiene. “If our dental hygiene were as poor as our emotional hygiene, we’d be all gums and no teeth,” says Winch.

This year, prioritize your mind as well as your body, and make a resolution for better mental health. Here are some of Winch’s tips for prioritizing your emotional hygiene in the new year (and all year long).

1. Pay attention to emotional pain. Psychological pain is much like physical pain—if something hurts for more than a few days, you need to do something about it. If you experience rejection, failure, or have a bad mood that lingers too long, don’t ignore it.

2. Take action when you feel lonely. Chronic loneliness is devastating to your emotional and physical health because it increases your chances of an early death by 14%. Therefore, when you feel lonely, actions like reaching out to family members, connecting with friends or joining a dating website can help. Make a list of people who you’ve been close to in the past (use your phone book, social media friends, and email contacts) and reach out to one of them each day to chat or to make plans. It will feel scary and risky to take those kinds of steps, but that’s what you need to do to break the cycle of disconnection and end your emotional isolation.

3. Stop your emotional bleeding. Psychological wounds tend to create vicious cycles that get worse with time. Failure can lead to feelings of helplessness that in turn can make you more likely to fail again in the future. To break the negative cycle of failure, find ways to gain control of the situation. Our minds are not as reliable as we tend to think, so ignore misleading feelings from your gut that tell you to give up, and focus on the aspects within your control, such as your preparation, planning, effort and execution.

4. Protect your self-esteem. Your self-esteem is like an emotional immune system—it can increase your resilience and protect you from stress and anxiety. Good emotional hygiene involves monitoring your self-esteem and boosting it when it’s low. How? Avoid negative self-talk that damages it further—despite how tempting it might be to indulge these kinds of thoughts at times.

5. Revive your self-worth after a rejection. It’s very common to be self-critical after you get rejected. It’s an unfortunate reaction, since that’s when your self-esteem is already hurting. You’re most likely to call yourself names, list all your faults and shortcomings and generally kick yourself when you’re already down. The most important thing you can do after getting rejected is to treat yourself with the same compassion you would treat a good friend. Make sure your inner voice is kind, understanding and supportive.

6. Battle negative thinking. When something upsetting happens, it’s natural to brood over it. But replaying the scene over and over in your mind will not give you much insight or closure. The best way to break a brooding cycle is to distract yourself with a task that requires concentration, like a game on your cell phone, a quick run or a crossword puzzle.

7. Be informed on the impact of common psychological wounds and how to treat them. You know how to treat a cut or a cold, so you should also know how to treat rejection, failure, loneliness, guilt and other common emotional wounds. By becoming mindful about your psychological health and adopting habits of good emotional hygiene, you will not only heal your psychological injuries when you sustain them, but you will elevate your entire quality of life.

For more tips, watch Winch’s Tedx Talk on how to practice emotional hygiene.

TIME mental health/psychiatry

Why Some Antidepressants Make You Feel Worse Before Better

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There’s a paradoxical period when a person first starts an antidepressant: they may actually begin to feel worse before feeling better. The underlying cause of this phenomenon is a bit of a mystery, but a new study from researchers at Otto-von-Guericke University in Germany explains why this might occur.

The gap between starting an antidepressant and feeling its positive effects—a time period that’s typically a couple weeks but may last up to a month—can sometimes be characterized by an increased risk for harmful behaviors. Researchers have previously speculated that when a person starts an antidepressant, they may suddenly have a surge of energy they didn’t have before. If that person is suicidal, the effect may provide enough energy to act upon their feelings.

The controversial idea caught on. A decade ago, the U.S. Food and Drug Administration (FDA) issued a “black box” warning—the most stringent of warnings—on all antidepressants warning of possible suicidal thoughts and behaviors. As TIME recently reported, many psychiatrists were (and still are) upset by the label, arguing that it’s led to a drop in antidepressant use among patients. Physicians, fearful of the risks, may also be deterred from prescribing them.

MORE: Do Depression Drugs Still Need Suicide Warnings?

In the new report, published in the journal Trends in Cognitive Sciences, the researchers reviewed several recent studies and found that the issue may stem from an effect of the most commonly prescribed antidepressants: selective serotonin reuptake inhibitors (SSRIs). SSRIs release two chemicals in the brain that kick in at different times, causing a period of negative effects on mental health, the authors report. The first chemical is serotonin, which is released very soon after an SSRI is taken but might not lessen depressive symptoms until after a couple of weeks. The second chemical is called glutamate, which can take a few days longer to be properly released. According to the new study, the serotonin neurons send off a dual signal to the two chemicals, causing the variant time frames for the chemicals, and therefore the problem period.

“There’s a lot you can do [in this period] and it’s important to let patients know that,” says Dr. Donald Malone, chair of the department of psychiatry and psychology at Cleveland Clinic. (Malone was not involved in the new study.) “It doesn’t typically last longer than the first week. But you may need to go down on the dose or switch medications. We’ve always prepared patients for how it can go, and that this was the beginning.”

Depression itself—not an antidepressant—is the greatest risk factor for suicide, and these new findings provide new insight for what patients can expect at the start of their treatment.

MONEY Health Care

5 Ways to Save on the Mental-Health Care You Need

Group therapy can be 50% less expensive than one-on-one sessions.

Get the treatment you need at a price you can handle.

Affordable mental-health care has been easier to come by in recent years. Insurance coverage, once riddled with onerous caps and restrictions, is now more widely available. “Things have gotten better for many,” says Andrew Sperling, director of federal advocacy at the National Alliance on Mental Illness.

Still, paying for care can be a challenge. The high out-of-pocket costs that you’re facing for all your health care extend to behavioral coverage too. And low reimbursement rates and billing hassles have led many therapists to not take insurance. A study published last year in the journal JAMA Psychiatry found that only 55% of psychiatrists accept private insurance; for all other medical specialties, that figure is 89%.

Here’s what you need to know about finding the best treatment at the best price.

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MONEY

Insurance Options are Better

Under a 2008 law that took effect in 2010, health plans offered by large employers that include mental-health coverage must treat it like other medical care. So a plan can’t cap annual visits or impose prior authorization rules for behavioral health if it doesn’t do the same for other illnesses, says Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law. Co-insurance rates have to be the same too. As the graphic above shows, the parity law hasn’t discouraged employers from offering coverage.

Any individual plan you buy on a state insurance exchange must include mental-health coverage; it’s one of the 10 essential benefits required by Obamacare. The provision in the law that lets children stay on a parent’s health plan until age 26 is another boon, since most major psychiatric conditions show up in late adolescence or early adulthood, notes Debbie Plotnick, senior director of state policy at the nonprofit Mental Health America.

Medicare coverage is also better. As of 2014, benefici­aries are responsible for only 20% of mental-health costs, down from 50%.

Your Employer Can Often Help

Especially if you have a high-deductible health plan, start with your company’s employee assistance program, says Kathleen Mahieu, leader of behavioral-health consulting at benefits consultancy Aon Hewitt.

About three-quarters of employers offer an EAP. These programs typically provide five or six sessions of no-cost counseling, even for family members. That’s enough for some people to resolve their issues, says Katherine Nordal, the American Psychological Association’s executive director for professional practice. An EAP can help you find a provider or connect you with other mental-health resources. “It’s a one-stop shop,” says Mahieu. And, she adds, EAPs pride themselves on confidentiality. Your boss won’t know, and you don’t even have to give your name.

Your Bill is Negotiable

When your therapist isn’t in your insurance network, you’ll have to pay upfront and submit the bills for partial payment (assuming you have out-of-network coverage) or, if you’re in an HMO, pay in full. Even if you are reimbursed, you won’t get back, say, 70% of the bill. You’ll get 70% of what the insurer considers “reasonable and customary,” leaving you on the hook for the rest.

If you can’t find an appropriate provider in your plan, ask your insurer to negotiate what’s known as a single-case agreement with someone who’s not in your network, says Barbara Griswold, a licensed marriage and family therapist in San Jose. That would let you to pay the in-network rate.

You can also ask about a reduced fee, says Griswold. “Almost every therapist has a sliding scale,” she says. Be realistic about what you’ll be able to afford and how long you’re likely to want therapy.

You Have Other Ways to Save

A university with a graduate psychology program may have a clinic, says the APA’s Nordal. Care is provided by doctoral trainees who are supervised by licensed psychologists. In an urban area, you may be able to find postgraduate training programs in psychoanalysis or cognitive behavioral therapy for experienced psychologists, says Geoffrey Steinberg, a licensed psychologist in New York City. (Google “training clinic” and the specialty you’re looking for.)

Another option: Ask your therapist if your condition might benefit from group therapy led by an experienced psychologist, which can be 50% less expensive than one-on-one sessions. Says Steinberg, “Group is so underrated and can be so valuable.”

Know Which Treatment Is Best for You

“No single therapy works for everybody,” says Renée Binder of the University of California at San Francisco’s School of Medicine. Consider these approaches for five common conditions.

1. Mild to moderate depression: Go for cognitive behavioral therapy (CBT). “A therapist works with you to break negative thought patterns by teaching specific skills,” says Binder. You might learn, for example, to ID overly critical self-talk (“Everything I do gets screwed up”) and reframe it in a positive way (“I flubbed a presentation, but I know I can rock it next time.”)

2. Severe depression: Combining antidepressants with CBT is better than meds alone, a recent Vanderbilt University study found. You need to see an MD or a psychiatric mental-health nurse practitioner for the prescription, but you can get therapy from a social worker or a psychologist.

3. Social anxiety: Your best bet is either CBT or psycho­dynamic therapy (in which you explore how your past experiences and unconscious affect you). In a study published in July in the American Journal of Psychiatry, these methods were equally effective at easing social anxiety.

4. Panic attacks: CBT is usually the treatment of choice. Some research suggests psychodynamic therapy may also work: A Weill Cornell Medical College study found that 12 weeks of biweekly sessions significantly reduced symptoms in more than 70% of patients. Medications may also be used.

5. Trauma: Look for a therapist who offers trauma-focused CBT or EMDR, which stands for eye movement desensitization and reprocessing (you’re asked to recollect the event while doing a motor task such as side-to-side eye movements). “Antidepressants and anti-anxiety meds are helpful in the short term, but therapy works to change thought patterns long term,” says Binder.

 

TIME Mental Health/Psychology

Most People With Depression Aren’t Getting Treatment, Survey Finds

The latest depression report shows that the majority are suffering in silence

The latest statistics on depression in the U.S. don’t paint a picture of progress, though the condition is common. Nearly 8% of Americans over age 12 have recently been depressed, finds the new report from the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, but the vast majority aren’t actively getting treatment.

Of those surveyed between 2009 and 2012, about 3% with depression reported having severe symptoms, and nearly all of these people (90%) said their depression made it difficult to work, go to school or participate in their normal activities at home and in other social settings.

Women are more likely than men to be depressed at any age, and women between 40 and 59 years old had the highest rates of depression among the adults studied. While the survey did not delve into the possible reasons for depression, other studies suggest that for many women in this age group, the pressures of balancing work and family responsibilities, including children as well as aging parents, may lead to added mental health burdens.

Poverty seems to be a factor in depression as well. Those living below the federal poverty level were more than twice as likely to be depressed than those living above the line; this trend applied regardless of race or ethnicity.

But what was most concerning to study co-author Laura Pratt, an epidemiologist at the NCHS, was that 65% of people with severe symptoms of depression were not getting help from a mental health professional. “The fact that people aren’t getting treatment is disturbing,” she says. “People with severe depression should be getting therapy from a mental health professional, and they should also in a lot of cases be on a more complicated medication regimen that requires a psychiatrist to treat them. The fact that only 35% have seen a mental health professional in the last year was pretty alarming.”

The data should raise awareness about the prevalence of depression, she says, and hopefully stress the importance of encouraging those with depression to seek help. “It’s serious, it really affects your life and we need to figure out a way to get people treated appropriately,” she says.

TIME Innovation

Five Best Ideas of the Day: December 2

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Let’s push for more college-educated cops.

By Keli Goff in the Daily Beast

2. As strongmen — often U.S. allies — attempt to lock up lifetime power, an African democracy movement takes shape.

By Mark Varga at the Foreign Policy Association

3. Being connected is more of a good thing than a bad thing.

By Mathew Ingram in GigaOm

4. Beyond diamonds: Conflict minerals are a growing blight. Enforcing a global standard can stop abuse.

By Michael Gibb in Project Syndicate

5. Changing the way we classify psilocybin — magic mushrooms — could open the door to research and new treatments for depression.

By Eugenia Bone in the New York Times

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Mental Health/Psychology

Suicide Risk Drops 26% After Talk Therapy

Suicide is a problem with few concrete preventive solutions, but a new study in Lancet Psychiatry finds that intervening with talk therapy after a suicide attempt seems to have some amazing long-term effects.

Researchers from Johns Hopkins Bloomberg School of Public Health looked at data from about 65,000 people who had attempted suicide between 1992-2010 in Denmark. The country opened suicide clinics in 1992 and provided them nationwide in 2007, and some of the people had gone to one of these clinics and received 6-10 sessions of talk therapy. The rest of the people did not.

When the researchers analyzed the data after a 20-year follow-up, those who had received the talk intervention fared much better. They repeated acts of self-harm less frequently and had a lower risk of death by any cause, including death by suicide.

After five years, there were 26% fewer suicides in the group who received therapy than in the other group. About 145 suicide attempts and 30 suicides were prevented in the talk therapy group, the researchers estimated.

“People who present with deliberate self-harm constitute a high-risk group for later suicidal behavior and fatal outcomes, so preventive efforts are important; yet, implemented specialized support after self-harm is rare,” the researchers wrote in the study.

Though the study had a long follow-up period and population size, it was not a randomized controlled trial, but such an intervention would be ethically impossible, the study authors write. “These findings might be the best evidence available and provide a sound basis for policy makers who wish to limit suicidal behavior and fatal events in an accessible high-risk group, which, in many countries, receives little support.”

 

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