TIME Innovation

Five Best Ideas of the Day: December 17

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

1. Independent and third party candidates could break D.C. gridlock — if they can get to Washington.

By Tom Squitieri in the Hill

2. A new software project has surgeons keeping score as a way to improve performance and save lives.

By James Somers in Medium

3. The New American Workforce: In Miami, local business are helping legal immigrants take the final steps to citizenship.

By Wendy Kallergis in Miami Herald

4. Policies exist to avoid the worst results of head injuries in sports. We must follow them to save athletes’ lives.

By Christine Baugh in the Chronicle of Higher Education

5. Sal Khan: Use portfolios instead of transcripts to reflect student achievement.

By Gregory Ferenstein at VentureBeat

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/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

How Your Cell Phone Distracts You Even When You’re Not Using It

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Why you might want to get it out of eyesight

Even if you go all day without touching your cell phone once, just having it visible nearby may distract you from complex tasks, according to new research in the journal Social Psychology.

In the first part of the study, which looked at a group of more than 50 college students, participants were asked to complete different motor tasks with the study leader’s cell phone visible. In the second, participants completed motor tasks with their own cell phones visible. Performance on complex tasks suffered in both conditions when compared to control groups with no visible cell phone.

The sight of a cell phone reminds people of the “broader social community” they can access via texting and the internet, says study author Bill Thornton.

MORE: Why People Text And Drive Even When They Know It’s Dangerous

“With the presence of the phone, you’re wondering what those people are doing,” says Thornton, a University of Southern Maine professor. “Even if it’s just mental, your focus is not on the task at hand, whether it be trying to write an article, get this spreadsheet set up, or just socializing; your mind is elsewhere.”

While performance on complex tasks suffered, the presence of cell phones did little to keep people from successfully finishing easy tasks. Thornton says the same applies to texting while driving.

“You could probably text and drive somewhat safely if you’re on a straight road, and there’s no traffic, and you take your time,” says Thornton. Of course, those conditions rarely exist.

The study builds on previous research that suggests that having your cell phone out reduces the quality of social interaction, even if you don’t engage with your phone. Having the phone out stifled “interpersonal closeness and trust” and kept study participants from feeling empathy for one another, a 2012 study in the Journal of Social and Personal Relationships found.

“Mobile communication devices such as phones may, by their mere presence, paradoxically hold the potential to facilitate as well as to disrupt human bonding and intimacy,” it concluded.

Cell phones play a significant role in today’s social engagement, but Thornton nonetheless suggests that people just put the device away for awhile. “I’m not sure how many people’s text messages are that important,” he said. “Unless you’re an advisor to the president and we have a national emergency, you can wait an hour to get a text.”

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.”

 

TIME mental health

Women in Positions of Power Show More Signs of Depression Than Men

A study found that women in the workplace experience more symptoms as they gain job authority, while the opposite is true for men

Symptoms of depression become more prevalent for women as they obtain job authority but less prevalent for men, a new study from the University of Texas at Austin suggests.

Researchers looked at 1,300 middle-aged men and 1,500 middle-aged women for the study, “Gender, Job Authority and Depression,” which appears in the December issue of the Journal of Health and Social Behavior. Women with the ability to affect pay and fire and hire others had more symptoms of depression than women without such authority. Men with similar authority at work had fewer symptoms of depression than those without, the study reports.

“What’s striking is that women with job authority in our study are advantaged in terms of most characteristics that are strong predictors of positive mental health,” said sociologist Tetyana Pudrovska. “These women have more education, higher incomes, more prestigious occupations, and higher levels of job satisfaction and autonomy than women without job authority. Yet, they have worse mental health than lower-status women.”

One explanation is that women face more stressors at work when in positions of power because they are faced with overcoming more stereotypes and resistance to their leadership. Men, on the other hand, don’t appear to face such obstacles.

“Men in positions of authority are consistent with the expected status beliefs, and male leadership is accepted as normative and legitimate,” Pudrovska said. “This increases men’s power and effectiveness as leaders and diminishes interpersonal conflict.”

TIME Research

Having A Sense of Purpose Helps You Live Longer

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A meaningful life is a longer life

People who think their life has meaning and purpose die later than people with a lower sense of personal wellbeing, according to a new study.

About 9,000 people over age 65 were followed for eight and half years as part of a study published in the Lancet. Researchers measured their wellbeing by giving them a questionnaire that gauged how much control they felt they had over their own life, and how much they thought what they did was worthwhile. The participants were then split into four groups, ranging from the highest to lowest levels of wellbeing.

Happier people tended to outlive their less fulfilled peers. Over the eight years, just 9% of people in the highest wellbeing category died, compared to 29% in the lowest category. Previous research has linked happiness to a longer life, and this new finding adds to the theory.

MORE: Here’s Where People Are Happiest Growing Old

“There is quite good evidence from studies of people in nursing homes showing that those who have something to do and look forward to tend to be in a much better state,” says study author Andrew Steptoe, director of the University College London Institute of Epidemiology and Health Care. “I think one of the fundamental ideas is that of autonomy and sense control of their life. People can feel life is just rushing by, or once they quit working their purpose can narrow to some extent.”

Steptoe says it’s possible to engineer environments that encourage greater wellbeing, like bringing pets into nursing homes or having residents partake in gardening. Increasing meaning during the day might just increase lifespan, too.

TIME Aging

Here’s Where People Are Happiest Growing Old

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Happiness rises consistently from the mid-40s onward in the U.S.

Will you get happier as you grow older? That might depend on where you live, according to a new Lancet study.

On average, people in high-income English-speaking countries tend to maintain higher levels of wellbeing, but that experience isn’t consistent over time. As people in these countries age, life satisfaction tends to follow a U-shape. In their young days, people report being happy, but that feeling declines as they face increased responsibilities in their 20s and 30s. Finally, happiness rises consistently from the mid-40s onward.

Reported happiness trends look completely different in former Soviet countries, Sub-Saharan Africa and Latin America. Happiness remained consistently low in Sub-Saharan Africa. Happiness began high in Latin America and declined slightly before leveling off in people’s 40s. In Russia and elsewhere in Eastern Europe, people see a precipitous decline in happiness as they age: it starts high, but dips consistently as they grow old.

“It’s not a great surprise that the elderly in those countries are doing really badly relative to the young people,” says study author Angus Deaton, a Princeton University professor. “The young people can do all sorts of things…whereas the old people have no future, and the system they believed in all their life is gone.”

The study also evaluated differences between regions in other metrics of wellbeing, like emotions and physical conditions. And there’s some good news for everyone: In most regions, people reported fewer emotional issues as they grew older.

“Many people have hypothesized that you just get emotionally more skilled when you get older,” says Deaton. “You make mistakes, and you learn.”

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.

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