MONEY Health Care

The 7 Biggest Health Problems Americans Face—And Who is Profiting

Bottles of prescription medicine in cabinet
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Here are the most-prescribed drugs in America.

Americans include two health-related issues among the 10 most important problems facing the U.S., according to a recent Gallup survey. Healthcare in general ranked fourth on the list, with Ebola coming in at no. 8. But is Ebola really among the biggest health problems for Americans? Not when we look at the chances of actually being infected.

So, what are the actual biggest health problems that Americans face? One way to answer this question is to look at what drugs are prescribed the most. Here are the seven top health problems based on the most-prescribed drugs in the U.S., according to Medscape’s analysis of data provided by IMS Health.

1. Hypothyroidism

AbbVie’s ABBVIE INC. ABBV 3.3287% Synthroid ranks at the top of the list of most-prescribed drugs. Synthroid is used to treat hypothyroidism, a condition caused by an underactive thyroid gland.

The American Thyroid Association estimates that 2%-3% of Americans have pronounced hypothyroidism, while 10%-15% have a mild version of the disease. Hypothyroidism occurs more frequently in women, especially women over age 60. Around half of Americans with the condition don’t realize that they have hypothyroidism.

2. High cholesterol and high triglycerides

Coming in at a close second on the list is AstraZeneca’s ASTRAZENECA PLC AZN 0.4716% Crestor. The drug is used to help control high cholesterol and high triglyceride levels.

According to the American Heart Association, nearly 99 million Americans age 20 and over have high cholesterol. Elevated cholesterol levels are one of the major risk factors for heart attacks and strokes. The problem is that you won’t know if you have high cholesterol unless you get tested — and around one in three Americans haven’t had their cholesterol levels checked in the last five years.

3. Heartburn and gastroesophageal reflux disease

AstraZeneca also claims the third most prescribed drug in the nation — Nexium. The “purple pill” helps treat hearburn and gastroesophageal reflux disease, or GERD, also commonly referred to as acid reflux.

Around 20% of Americans have GERD, according to the American Society for Gastrointestinal Endoscopy. A lot of people take over-the-counter medications, but that’s not enough for many others. Medscape reported that over 18.6 million prescriptions of Nexium were filled between July 2013 and June 2014.

4. Breathing disorders

The next two highly prescribed drugs treat breathing disorders. GlaxoSmithKline’s GLAXOSMITHKLINE PLC GSK 0.0431% Ventolin HFA is used by asthma patients, while the company’s Advair Diskus treats asthma and chronic obstructive pulmonary disease, or COPD.

More than 25 million Americans have asthma. Around 7 million of these patients are children. Meanwhile, COPD, which includes chronic bronchitis and emphysema, ranks as the third-leading cause of death in the U.S.

5. High blood pressure

Novartis NOVARTIS AG NVS -0.3044% claims the next top-prescribed drug with Diovan. The drug treats high blood pressure by relaxing and widening blood vessels, thereby allowing blood to flow more readily.

Around one-third of American adults have high blood pressure. Many don’t know that they are affected, because the condition doesn’t usually manifest symptoms for a long time. However, high blood pressure can eventually lead to other serious health issues, including heart and kidney problems.

6. Diabetes

Several highly prescribed drugs combat diabetes, with Sanofi’s SANOFI S.A. SNY 1.2454% Lantus Solostar taking the top spot for the condition. Lantus Solostar is a long-acting basal insulin that is used for type 1 and type 2 diabetes mellitus.

According to the National Diabetes Statistics Report released in June 2014, 29.1 million Americans had diabetes in 2012. That’s a big jump from just two years earlier, when 25.8 million Americans had the disease. Diabetes ranks as the seventh leading cause of death in the U.S.

7. Depression and anxiety

Eli Lilly’s ELI LILLY & CO. LLY 0.8383% Cymbalta fell just below Lantus Solostar in number of prescriptions. Cymbalta is the leading treatment for depression and generalized anxiety disorder.

The Anxiety and Depression Association of America estimates that 14.8 million Americans ages 18 and older suffer from a major depressive disorder each year. Around 3.3 million have persistent depressive disorder, a form of depression that lasts for two or more years. Generalized anxiety disorder affects around 6.8 million adults in the U.S.

Common thread for common diseases

One thing that stands out about several of these common diseases affecting millions of Americans is that many people have one or more of these conditions — but don’t know it. This underscores the importance of getting a checkup on a regular basis.

Regardless of what the Gallup survey found, the odds of you getting Ebola are very low. On the other hand, the chances of you or someone in your family already having one of these seven conditions could be higher than you might think. Perhaps the truly biggest healthcare challenge facing Americans is knowing the status of their own health.

TIME Mental Health/Psychology

Do Depression Drugs Still Need Suicide Warnings?

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It's been 10 years since the FDA put a black box warning on antidepressants, saying they can cause suicidal thoughts and behavior. But the psychiatry community never fully agreed. What now?

The so-called “black box” is the most severe warning label issued by the Food and Drug Administration (FDA), and for the past decade, antidepressants have been among the drugs that bear them. That means the pills come with a notice cautioning users that the drugs may increase the risk of suicidal thoughts and behaviors in children and young adults. But now, many experts say it’s time for the black box to go: that the warnings overstate the real risk and may deter doctors from prescribing them to people who could benefit from being on antidepressants. Depression, after all, is the biggest risk factor for suicide.

“There’s absolutely no evidence that [the boxed warning] has done any good. There’s certainly credible data that it’s done harm,” says Dr. Richard Friedman, a professor of clinical psychiatry at Weill Cornell Medical College who recently wrote an op-ed calling for the removal of the black box in the New England Journal of Medicine (NEJM). Dr. Marc Stone of the FDA, meanwhile, wrote a companion critique in NEJM, and tells TIME the data suggesting the black box should be removed is “extremely questionable; virtually meaningless.” Evidently, even experts disagree.

TIME spoke to 17 leaders in the field of psychiatry to get their take on the black box warning on antidepressants: 11 said the warnings should be removed; two think the media has overblown the suicide risk posed by antidepressants, resulting in more panic than is necessary; and four support the box’s place on Rx drugs. Among those four, three were involved in the FDA’s decision to issue the black-box warning 10 years ago.

Back in 2004, the FDA was prompted to look into the effects of antidepressants after data emerged linking the drug Paxil to suicidal thoughts. An FDA committee then analyzed existing data about suicidal thoughts in people on antidepressants. There were no actual suicides among children in the clinical trials, but there was a slight increase in what is called “suicidality”—suicidal thoughts and behaviors. The rate of suicidality was 4% among patients taking an antidepressant compared to 2% taking a placebo. Ultimately, the committee deemed it enough of a risk to tack on the boxed warning.

The FDA’s boxed warning for the antidepressant Lexapro FDA

“I recognized there could be a chilling effect on prescribing, but I thought it was important to get the message [about possible side effects] out. At least that’s certainly what I felt at the time,” says Dr. Wayne Goodman, chair of psychiatry at Mount Sinai Hospital, who led the FDA committees back in 2004.

Studies have shown that antidepressant use and prescriptions did drop after the warnings were added. In June 2014, Harvard researchers published a study in the BMJ linking awareness of the warning to a decrease in antidepressant use and simultaneous increase in suicide attempts among young people. All the data, however, is observational. Data does show that from 2000 to 2009, suicides have gradually increased.

But back in the early 2000s, says Goodman, the FDA’s hands were tied. Worry about antidepressants and suicide became hugely politicized. Goodman, who says he’s open to revisiting the issue, still vividly remembers family members’ graphic testimonies. “[My mother] completely transformed into an emaciated woman who paced the floors, picked her skin, barely slept, and struggled to perform the simplest tasks like cooking a meal,” reads the transcript of one woman’s testimony of how her mother hung herself after just 10 weeks on antidepressants. The committee heard nearly 80 similar claims.

The FDA’s intention at the time was to quell public fear and to ensure that doctors and patients to have a discussion about risks, and make sure physicians monitored their patients during vulnerable periods, particularly during the first few months when some people get worse before they get better. “The intention was never to discourage appropriate use,” says Dr. Thomas Laughren, former director of the FDA’s Division of Psychiatry Products, who remembers being booed and hissed at professional meetings after the decision.

Still, not every expert agrees the pills are a panacea. “I’m 70 years old, I’ve been practicing for a long time,” says Dr. Norman Sussman, a psychiatry professor and clinician at New York University. “I’m not enamored by these drugs. They have their limitations and they really don’t work for most people, but the ones they work for best are the ones who are the most seriously depressed.” While the drugs may not be for everyone, most of the experts TIME spoke with agreed that the warnings deter depressed people from taking drugs that could improve their wellbeing.

“We don’t want wild and crazy prescribing, but we don’t want good clinicians afraid to use useful drugs,” says Dr. Mark Riddle, Professor of Psychiatry and Pediatrics and Johns Hopkins. “Though I am generally a cautious person and most of my research is on side effects, I think the FDA needs to back off a little.” The FDA does not currently have plans to revisit the warning.

 

TIME Mental Health/Psychology

4 Ways Being Lonely Can Affect Your Health

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Research consistently shows that lonely people have a higher risk of heart disease

When you’re lonely, you may look for friends in all sorts of unexpected places. At least, that’s the conclusion of a recent study in Psychological Science that found that folks who felt socially disconnected—aka lonely—were more likely to view a doll’s face as human.

But the health implications of being lonely go much further. “People who are lonely have more physical and mental health problems than those who feel connected to others,” explains Bruce Rabin, MD, director of the University of Pittsburgh Medical Center Healthy Lifestyle Program. Here, four ways loneliness affects your health:

You’re more likely to be down in the dumps

The more lonely you feel, the more likely you are to have depressive symptoms, according to research at the University of Chicago.

“When you’re lonely, brain hormones associated with stress such as cortisol become active, which can cause depression,” Rabin explains. “In fact, for mild and moderate depression social interaction is even more effective at alleviating symptoms than a prescription antidepressant.” One 2009 Colorado State University study found that the more positive social interactions people with depression had, the more improvement in symptoms they experienced.

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You’re less likely to take care of yourself

Research shows you’ll eat less healthful fare if you frequently dine solo: Single and widowed men and women 50 and older, for example, eat fewer veggies daily than married or cohabiting counterparts. “If you’re cooking for other people, you’re more likely to prepare a healthier meal that contains a range of foods—a meat, a starch, a vegetable—than if you’re just throwing together something for yourself,” Rabin points out.

Folks who are lonely are also more likely to be physically inactive, according to a 2009 study published in the journal Health Psychology.

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You may be more susceptible to heart disease

Middle aged adults who live alone have a 24% increased risk of dying of heart disease, according to a 2012 Harvard study. “Research has consistently shown lonely people have a higher risk of heart disease, and it’s for many reasons,” Rabin says. “Since they don’t have social support, they’re more susceptible to the effects of stress, which increases the likelihood of getting heart disease. We know elevated stress hormones increase the accumulation of cholesterol deposits in the heart. Secondly, if they’re lonely they’re less likely to be physically active or eat properly. And finally, if they don’t feel well, they’re much less likely to confide that in someone who will insist that they go to the doctor to get checked out.”

HEALTH.COM: 12 Signs You May Have an Anxiety Disorder

You could have a weaker immune system

Loneliness can strain the immune system, according to Ohio State University research presented in 2013. People who were lonely produced more inflammation-related proteins in response to stress than folks who felt more socially connected. Inflammation is linked to numerous health conditions including heart disease, Type 2 diabetes, arthritis, and Alzheimer’s disease.

What to do about it

Joining a bevy of social groups isn’t necessarily the best way to combat loneliness. “It’s important to note that someone can be alone, or have only a handful of close friends, and not be lonely,” Rabin stresses. “Or you can be a social butterfly and out with friends every night of the week and still feel isolated.” His advice? Volunteer. Doing good deeds for others will lift your mood, and you’ll most likely meet kindred spirits that you can cultivate a real connection with—which in turn will leave you feeling less lonely.

HEALTH.COM: 12 Ways We Sabotage Our Mental Health

This article originally appeared on Health.com

TIME Economy

How We Underestimated the ‘Black Tuesday’ Stock Market Crash

Black Tuesday
From the Nov. 4, 1929, issue of TIME TIME

The "Black Tuesday" stock market crash that precipitated the Great Depression happened on this day 85 years ago

It was pretty impossible not to notice that something bad had happened: in the days leading up to Oct. 29, 1929, the stock market was already reeling from a series of smaller sell-offs leading up to “Black Tuesday,” the day commonly used to mark the onset of the Great Depression.

But with only a few days of hindsight to put that event into perspective, it was pretty easy not to see how bad things were.

TIME was one of the outlets that made that very miscalculation. Reporting on the stock market in a Nov. 4, 1929, article, TIME recounted that the liquidation of stocks that day “might technically be termed orderly but was certainly extremely depressing.” (That take now seems ironically apt.) But the sell-off was balanced out by plenty of “don’t panic” speechifying — President Hoover said that Industry in the nation was “sound.” By the end of the day, TIME reported, “it seemed again that the worst was past.”

A move by the country’s biggest bankers to shore up the market by purchasing stocks had, it appeared, worked. Along with the lack of hindsight, that effort was partly to blame for the miscalculation. For example, a few days before Oct. 29, the broker Richard F. Whitney had personally stopped a panic by buying shares of U.S. Steel at 15 points above its market value; at a time when the whole banking industry seemed ready to take such extraordinary measures to save the economy, and when the market had done so well for so many years, optimism would have been easy. (Whitney later became president of the New York Stock Exchange. After that, in 1938, he went to jail for grand larceny.)

“Hysteria, it was hoped, had met its master in the Banking Power of the U.S.,” TIME wrote. That quote would later make it into TIME’s 75th-anniversary run-down of the most off-the-mark statements in the magazine’s history, alongside predictions that war would end in the 20th century and the sincere belief that the media would stay out of Bill Clinton’s personal life.

Even a week after the crash, when the economy was the Nov. 11, 1929, cover story, the gist of the story was that the valiant bankers who had banded together to keep things orderly had prevented the worst of possible outcomes. (This version of history, while incorrect in its optimism, may well be true nonetheless; it’s always possible that the Great Depression could have been even worse than it was. As long as The Hunger Games is still fiction, that will always be true.) As TIME reported:

Monday, Nov. 4, when the Exchange re-opened there were more sellers than buyers but none were frenetic. Toward noon prices climbed, then dropped again. In general stocks closed lower than Thursday. U. S. Steel closed at 180, Radio at 43¼, General Motors at 45¼. The market except at the very opening was dull as though it were tired. But it seemed to rest securely. Stock Exchange Governors ordered the Exchange closed after 1 o’clock Wednesday, Thursday, Friday; all day Saturday. Tuesday was a legal holiday (election day). Thus was further rest insured.

Friday there were no quotations nor Saturday for the Exchange was closed. Clerks who had passed many a sleepless night, slept, then returned to clean up the greatest amount of work which brokerage houses have ever had in so short a time. In the hurly-burly many an error had been made. The clerks had to discover them, rectify them. But in the Stock Exchange Friday and Saturday there was quiet.

Thus did Confidence win its subtle race against Panic.

But not everyone was having trouble seeing what was about to happen. The following letter ran in the Dec. 2, 1929, issue:

stock market letter
From the Dec. 2, 1929, issue of TIME

Read Niall Ferguson’s comparison between 1929 and 2008 here in TIME’s archives: The End of Prosperity?

Read more: A Brief History of the Crash of 1929

Photos: The Crash of ’29

TIME Exercise/Fitness

The Drug-Free Way to Fight Depression

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A 50-year study shows that physical activity may help fight the disease

Exercise can do a lot of physical good, from making hearts healthy to keeping weight down—and now there’s strong new evidence that it can give a mental boost as well.

In a study appearing in JAMA Psychiatry, researchers from the UK and Canada found that people who were more physically active throughout most of their adult years experienced fewer depressive symptoms than those who were less active. That finding is familiar, but these results are extremely affirming because they involved both a large number of same-aged people—11,000, who were born the same week in March 1958—and a long period of time—50 years.

The volunteers answered questions about how many times they exercised a week on average at four points during the study: when they were 23, 33, 42 and 50 years old. They also took standardized tests that measured depressive symptoms such as depressed mood, fatigue, irritability and anxiety.

At every stage, those who reported more physical activity also had fewer depressive symptoms. What’s more, those who became more active between the recordings also showed fewer signs of depression. That means someone who exercised more each week at 42 than they did at 33 also benefited from having fewer depressive symptoms at 42. In fact, getting more physically active at any age—going from never working out to working out three times a week—lowered the chances of depression by 19% five years later.

The results add to previous studies that found similar associations between exercise and lower depression rates among younger and older people, but this study shows that the connection exists throughout adulthood.

Understanding the link could help doctors better treat both obesity and depression; with some people, depression could be a barrier to becoming physically active, while with others, being overweight could feed into cycle of depression. “Our study suggests that practitioners helping patients to recover from depression might address activity within their treatment plan for lifestyle factors,” the authors write.

TIME Mental Health/Psychology

Why Schools Should Screen Their Students’ Mental Health

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Two new reports argue for in-school mental health screenings

Schools should be a first line of defense for catching young people at risk for mental health issues from depression to ADHD, a pair of new reports says.

Kids and adolescents spend a significant amount of their time in school, yet providing mental health screenings and care is not an overarching requirement for many schools. “We need to think about how to embed mental health services so they become part of the culture in schools,” says study author Dr. Mina Fazel, a child psychiatrist at the University of Oxford. “It will take a commitment from health and education.”

The reports, published in The Lancet Psychiatry, looked at programs already implemented in both high-income schools and middle- and low-income schools. The authors made suggestions for both education systems. For instance, schools could conduct school-wide screenings by asking teachers to identify at-risk kids for further evaluation, or health counselors could be trained to spot both physical and mental issues by looking for visible signs like weight fluctuation or bullying. If treatments like cognitive behavioral therapy were included in a school’s health offerings, Fazel believes mental health problems could be caught early and treated.

“If we made mental health part of the usual health system of a school, then it becomes more normal…and hopefully it will then be easier to access it,” says Fazel. According to data presented in the reports (which is UK-specific but also looks at U.S. programming), about 75% of adults who access mental health treatment had a diagnosable disorder when they were under age 18, but in high-income countries, only 25% of kids with mental health problems get treatment.

Stigma is largely to blame for a lack of participation in mental health care. “[Mental health] is the service that people seem to know least about, seem to fear accessing most, and think they will be negatively viewed by their peers or their teachers or their families if they access those services,” says Fazel.

Some schools in the U.S. and abroad have had success with mental health screenings and programs, but implementation still hasn’t been made a standard, which Fazel thinks is a lost opportunity. By prioritizing mental health in a child’s early years, more people will get the treatment they need early on.

TIME

5 Signs You Should See a Doctor for Depression

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Feeling down every so often is a normal part of life. But when you’re gripped by an unrelenting sadness or hopelessness that keeps you from going about your usual routine, it’s time to pay attention: it’s the hallmark sign of clinical depression, and an estimated 7% of adults will experience it, according to the National Institute of Mental Health. Even with this telltale sign in place, it’s tough for a depressed person to know if she really has the disease. “Almost all of the symptoms of depression on their own are experienced by everyone at one time or another,” explains Jennifer Payne, MD, director of the Women’s Mood Disorders Center at Johns Hopkins University in Baltimore. If you’ve been dealing with the following symptoms every day for two weeks, and they’ve impaired the way you usually function (for example, prevented you from working, being a responsible parent, or seeing friends), it’s time to check in with your doctor.

HEALTH.COM: 10 Things to Say (and Not to Say) to Someone With Depression

You’re eating more (or less) than usual

Depression leaves you withdrawn and checked out, and that can manifest as a loss of appetite. “If your brain is preoccupied with negative thoughts, you may forget to eat or lose interest in cooking or preparing meals,” says Yvonne Thomas, PhD, Los Angeles-based psychologist specializing in depression and self-esteem. On the other hand, sometimes the disease kicks in the opposite effect, making you hungry and driving you to overeat. “The mix of emotions that tend to accompany depression—sadness, pessimism about the future, and low self-esteem—can compel you to try to soothe your feelings with food binges,” says Thomas.

You’re sleeping too much or too little

Some people with depression find themselves snoozing under the covers more; the disengagement and dip in energy make you fatigued, says Thomas. “Sleeping more is also a way depressed people escape from their sadness; it becomes a refuge,” she adds. Others with depression experience restless or interrupted sleep or even insomnia—they’re too wired by obsessive thoughts or ruminations to wind down and score the seven to eight hours per night most adults need. Thing is, not only can sleep changes be a tipoff to the disease, but they also make it worse. When you’re not getting the proper amount of shuteye, your body’s internal clock gets out of sync, and you’re even more tired and unfocused…and less able to cope.

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Small things agitate you

It’s a sneaky sign few people recognize: depression can show up as heightened irritability, says Jennifer Wolkin, PhD, clinical assistant professor in the department of psychiatry and anesthesiology at New York University’s Joan H. Tisch Center for Women’s Health. You might feel cranky and grumpy; little things that normally wouldn’t register set you off and leave you snapping at friends and coworkers. Part of the prickliness may be the way depression exacerbates normal hormonal swings. But it could also be triggered by the weight of so many heavy emotions. “When people are in physical pain, they often get angry and irritated easily, and it’s the same with psychological pain—you don’t feel good or like your usual self, and that saps your patience and puts you more on edge,” says Thomas.

You can’t concentrate or focus

Forgetting work deadlines or when to pick up your kids from a playdate? Feel like your mind resembles an out-of-focus photo, and the fuzziness has made a dent in the way you weigh choices and make decisions? That’s your brain on depression. Being preoccupied with thoughts of sadness and emptiness can plunge you into a head fog that affects your job, memory, and decision-making skills, says Wolkin. In turn, that unfocused thinking can lead you to make poor choices or take on unhealthy, risky behavior.

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You don’t enjoy the things that once made you happy

You used to hit happy hour with your favorite group of coworkers, but for the last few weeks, you’ve been ducking out. Or you always looked forward to your nightly run, but these days, you can’t muster the interest. Not taking part in things you once enjoyed because they no longer give you pleasure is a telltale sign of depression. “A person who is simply blue might skip a few outings, then get back in the swing of things,” says Wolkin. “But depression makes you apathetic about activities and hobbies that once gave you joy, and that makes you isolate yourself.” It sets up that vicious cycle: depression robs you of your ability to derive pleasure from experiences, so you stop doing the very things that could brighten your mood.

HEALTH.COM: 12 Ways to Improve Your Concentration

10 Signs You Should See a Doctor for Depression originally appeared on Health.com.

TIME Heart Disease

People Without Friends Have Worse Outcomes After Heart Attack

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The importance of friends for heart health

Without the support of friends and family, you’re less likely to emerge from a heart attack healthy.

A study in the Journal of the American Heart Association analyzed the responses of 3,432 heart attack patients on their levels of social support one month and then a year after a heart attack. One-fifth of them had low social support—meaning they felt that they didn’t have friends or family they could confide in or lean on for emotional or financial support—and during their recovery this group showed lower mental functioning, worse quality of life and more depressive symptoms. The effect affected men and women equally.

MORE: A Happy, Optimistic Outlook May Protect Your Heart

Encouraging social support isn’t usually seen as a top priority for heart attack recovery, but this is just one more piece of evidence that it should be: one study showed that within six months of having a heart attack, depression increased the risk of death from 3% to 17%.

MORE: A Link Between Anxiety and Heart Attacks

“We shouldn’t just be concerning ourselves with pills and procedures,” said Harlan Krumholz, MD, the study’s senior author and director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, in a statement. “We have to pay attention to things like love and friendship and the context of people’s lives. It may be that these efforts to help people connect better with others, particularly after an illness, may have very powerful effects on their recovery and the quality of their lives afterwards.”

TIME Mental Health/Psychology

9 Natural Treatments You Didn’t Know Actually Work on Depression

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Here are some treatments for depression that are not antidepressants

Depression is a tricky disease to treat, in part because it manifests so differently in those it afflicts. But promising new research shows there may be options outside the pill bottle and off the couch at a therapist’s office. That’s not to say you should stop taking prescribed antidepressants or break up with your therapist, but if you’d like to consider alternative treatments, read on.

TMS
A recent study on a kind of therapy called transcranial magnetic stimulation (TMS), which uses magnetic pulses to alleviate depression, showed that after a year of treatment, 68% of adult patients had improved depression symptoms and 45% had complete remission. Currently, TMS is used among patients who do not respond well to antidepressants, but some experts think the therapy could one day be used as a first-line treatment. In TMS, a large magnet is placed on the left side of a patient’s head, and magnetic pulses stimulate the under-active areas of the patient’s brain that are involved in mood regulation. The patient is awake the entire time, and there are few reported side effects aside from headaches in some. Other research published in August showed TMS could also have positive benefits for memory.

Acupuncture
Acupuncture is becoming an increasingly mainstream way in the U.S. to treat a wide variety of ailments from chronic pain to anxiety. The research to support its use for mental health disorders is still mounting in the West, but it’s thought that by inserting needles into parts of the body to manipulate energy can reduce tension. The National Center for Complementary and Alternative Medicine (NCCAM) notes that it’s still unknown whether acupuncture’s effects as a therapy are placebo.

Interpersonal therapy
Interpersonal therapy focuses on patients’ relationships with other people and how an individual may be struggling with connections and communication. It’s commonly recommended for young people, and is typically viewed as a short-term depression treatment. It’s also thought to be helpful for when marriage problems arise. According to the National Health Service (NHS) in the U.K., some research has suggested it could be as effective as antidepressants in certain cases, though more research is needed. Some studies show it can work as a first-line treatment, and it’s usually given in 12- to 16 one-hour weekly sessions.

Exercise
Scientists are increasingly showing that exercise improves mental health. For instance, Jasper Smits a psychologist with a clinic in Dallas has long recommended that therapists use exercise therapy for people who are not responding to other forms of treatments. In 2012, a clinical trial of heart failure patients found that regular exercise help alleviate depressive symptoms. It’s believed that exercise increases hormones like serotonin and dopamine in the brain, subsequently making people feel better.

Exposure therapy
For depression symptoms that may be related to other mental health issues like phobias and obsessive compulsive disorder, exposure therapy can help patients become more accustomed to and comfortable with things that used to bring them fear and anxiety. For example, if someone is afraid of flying, they my build up to taking an actual trip on a plane by starting with simply looking at images of airplanes. Johns Hopkins researchers report that it’s typically very successful if people can find the right therapist they can trust.

Mindfulness
Plenty of research supports meditation as a possible treatment for depression and anxiety. The mechanism is not entirely understood, but if a person can be acutely aware of what is happening in the present moment, the thought it is that they can relax and gain more focus. As TIME reported in January, many many cognitive therapists have started recommending it for patients as a way to deal with their anxiety and depression since it can mitigate stress.

Eye Movement Desensitization Reprocessing (EMDR)
According to the Anxiety and Depression Association of America, eye movement desensitization and reprocessing, or EMDR, “seems to have a direct effect on the way that the brain processes information… It helps a person see disturbing material in a less distressing way.” It’s still considered a fairly new type of therapy. As a patient goes through an unpleasant memory, they may watch moving lights, listen to tones and feel taps on their palm. It’s primarily used to treat PTSD, and still needs a lot more efficacy evidence. EMDR has had it’s share of controversy among researchers who question whether it really works.

Electric shock treatment
Also known as electroconvulsive therapy (ECT), shock treatment is fairly common treatment in which electric currents are passed through the brain and trigger seizures. It’s believed that the shocks interfere with brain chemistry that might be out of wack. ECT is considered much safer today than it was in the past–which too high doses were given resulting in negative side effects like memory loss and physical injury.

Cognitive behavioral therapy (including online and over the phone)
People are likely familiar with cognitive behavioral therapy, which is a talk therapy usually recommend for patients with moderate to severe depression. The idea behind cognitive behavioral therapy is to help patients understand the events or emotions behind their current status, and figure out ways to mitigate how they’re feeling day-to-day. Some recent research has suggested that cognitive therapy can work even if it’s not necessarily done face to face. In 2012, a study compared face-to-face therapy to therapy done over the phone and found that phone therapy was just as effective, and patients were more likely to stick with it. Some therapists will even do sessions via video chat, like Skype.

 

TIME Mental Health/Psychology

4 Things People Don’t Tell You About Major Weight Loss

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Losing weight and getting healthier should be a good thing…right? Well, as Rosie O’Donnell told ABC News, shedding a lot of pounds may not instantly change your life for the better.

O’Donnell recently returned to hosting The View after leaving the talk show in 2007. She suffered a heart attack in 2012 and since then, she had a procedure known as a vertical gastric sleeve and dropped 50 pounds. Unlike a gastric bypass, which re-routes how your stomach processes food, a vertical sleeve gastrectomy removes a large portion of the stomach, leaving it about the size of a banana, according to the National Institutes of Health.

It’s hard to imagine seeing any downsides to slimming down, especially since people who are overweight are more prone to serious health conditions like heart disease and diabetes. Still, O’Donnell says it took some adjusting to get used to her new body.

“Everyone assumes that obese people would just be jumping for joy that they were healthier and thinner,” O’Donnell told ABC News. “But it’s also filled with a lot of emotional turbulence you wouldn’t expect.”

In fact, a UK study published in the journal PLOS One found that losing weight may not alter your mood the way you might expect. Of the 1,979 overweight and obese participants, 14% lost at least 5% of their initial body weight. After controlling for factors like serious health issues and major life events, researchers found more than half of the people who lost weight were more likely to report being depressed.

That may be because weight loss doesn’t address any underlying problems you may have. “Sometimes other things are making you unhappy, and the expectation that weight loss will fix it doesn’t pan out, which makes you even more unhappy,” says Gail Saltz, MD, Health‘s contributing psychology editor.

Here are some surprising things people might not think about when it comes to losing weight:

You may not be prepared for increased attention

Not many people may have gone out of their way to talk to you when you were overweight, and the attention that may come with your new look could be shocking at first. “Some people keep weight on unconsciously to protect themselves from intimacy with others,” Dr. Saltz says. This is especially true in settings of sexual intimacy. The fear of being hit on or being sexual with others may terrify some so much it causes them to regain the weight, Dr. Saltz says.

Your partner may not be supportive

O’Donnell says her partner encouraged her to be healthy, but that may not be the case for everyone. “A lot of marriages break up once one person gets healthy,” she told ABC News. Your partner might feel threatened by your weight loss for a number of reasons. A big one is they’ll fear others will want you or you’ll look better than them, Dr. Saltz says. Your shaping up forces your significant other to think about their own health choices, which they may not be prepared to handle. Another problem: Your partner may worry about how your personality might change. “You feeling great, sexy, or confident could shift the balance of the relationship,” Dr. Saltz says. “They fear losing the identity of the more confident one or losing the upper hand.” Many of these challenges could apply to friendships, too.

Your clothing options may feel scary

It’s not uncommon to feel unsure about shopping outside of plus size stores or sections. “It may be unexpected to feel nervous and conflicted about styles you might not have worn before because they are body revealing,” Dr. Saltz says. After losing weight, you may not know how to react to clothes that fit your body in new ways—not to mention the hefty price tag that comes along with buying a new wardrobe.

Your body might not match your expectations

Being thinner doesn’t mean your body will look “perfect” to you now. Loose skin, a flat behind, and sagging breasts are all changes that might accompany weight-loss procedures or lifestyle changes that help you shed a lot of pounds. Those changes won’t go away overnight either. And when your reflection doesn’t match what you imagined, you may feel more disappointed that there’s no healthy lifestyle change to fix the problem right away, Dr. Saltz says.

This article originally appeared on Health.com.

More from Health.com:

12 Ways We Sabotage Our Mental Health

11 Reasons Why You’re Not Losing Belly Fat

How to Do the Perfect Squat

19 Medical Tests All Adults Need

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