9 Surprising Complications of Type 2 Diabetes

Type 2 Diabetes Complications: More Than Just Heart Disease

Having diabetes isn’t a death sentence. In fact, an article published in September 2017 in the journal BMJ suggests that, with proper management and weight loss, you can effectively reverse symptoms of the disease. But on the flip side, poorly managed type 2 diabetes can lead to certain complications that can altogether result in increased medical costs, more stress, and potentially a reduced life expectancy. 

If you’ve been diagnosed with diabetes, you likely know the major complications for which having diabetes may leave you at risk: heart disease, kidney disease, neuropathy (or nerve damage), and amputations. But complications associated with poor blood sugar control can affect other parts of the body as well.

"When we talk about diabetes complications, we talk about it from head to toe," says Cathy L. Reeder-McIntosh, RN, MPH, a certified diabetes educator at Wake Forest Baptist Medical Center in Durham, North Carolina. "Even if you don't have perfectly controlled blood sugar, lowering your A1C level — which measures your average blood sugar level over the past two to three months — even a small amount helps reduce your risk of complications."

The A1C test is the most common diagnostic tool for type 2 diabetes, but its function doesn’t end there — for managing diabetes, these test results are crucial, too. The Mayo Clinic recommends getting the A1C test twice per year if you have been diagnosed with type 2 diabetes, don’t use insulin, and your blood sugar is within the goal range that you and your doctor have set.

But if you are on insulin or your blood sugar is poorly controlled, the Mayo Clinic recommends you receive the test four times per year. A normal A1C level is below 5.7 percent, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

To help lower your A1C and reduce your risk for type 2 diabetes complications, you can follow tried-and-true diabetes management advice, like adhering to your medication regimen, practicing portion control while eating a diabetes-friendly diet, and exercising regularly.

But even if you’re meeting your blood sugar level and A1C goals, it’s important to be aware of the potential diabetes complications that may affect you should your situation change. That’s because although taking certain steps to manage diabetes well can potentially lead to reversal, for many people, diabetes remains a progressive disease. Knowing how to spot the signs of all diabetes complications, regardless of their commonality, can be crucial for getting the proper treatment.

For one, your age and ethnicity may play a role in your risk for developing these issues, research suggests. According to a study published in September 2016 in The Journal of Clinical Endocrinology & Metabolism, people diagnosed with diabetes in midlife may be more prone to complications such as vision loss and kidney disease compared with people diagnosed with the disease while they are elderly, as middle-age people have more time to develop these problems than those who are diagnosed later in life.

And a review published in Clinical Orthopaedics and Related Research suggested minorities may be at a greater risk for amputations.

Whether it’s signs of neuropathy, heart disease, kidney disease, or other issues, like digestive problems, skin infections, or the like, some people won't make changes until they see signs of complications caused by years of high blood sugar, Reeder-McIntosh points out. To keep that from happening, you should be aware of all the potential diabetes complications. Following are nine you may not already know. 

Why Drinking Tea May Help Prevent and Manage Type 2 Diabetes

Drinking Tea for Diabetes: Green Tea or Black Tea?

When it comes to drinking tea for diabetes, Steinbaum says benefits are tied to all teas, but that green tea is the clear winner. "For one, when you drink green tea for diabetes, you will get a higher level of polyphenols than you would get in black,” she explains. It’s the polyphenols in fruits and vegetables that give them their bright colors. So, having more color means that green tea is richer in polyphenols. “Of the black teas, the more orange the color, the higher the polyphenols,” she adds.

    "Green tea is good for people with diabetes because it helps the metabolic system function better."

Suzanne Steinbaum, DO

Besides its color, green tea also contains higher polyphenol levels because it's prepared from unfermented leaves, "so it is really pure,” Steinbaum says. Black tea, on the other hand, is made from leaves that are fully fermented, which robs it of some nutrients. “Plus, some black tea varieties can have two to three times more caffeine than green, which isn’t good in excess,” she says.

Polyphenols: Beyond Drinking Tea for Diabetes

The benefits of tea are clear. But besides tea, a number of foods high in polyphenols also can help prevent and manage type 2 diabetes. “The fruits highest in polyphenols are berries, grapes, apples, and pomegranates — because of their rich color,” Steinbaum says. Broccoli, onions, garlic, tomatoes, eggplant, and spinach are also good sources, as are cranberries, blood oranges, blackberries, blueberries, raspberries, strawberries, rhubarb, lemons, limes, and kiwis. “We know red wine contains resveratrol, which is a polyphenol — the highest concentration is in Bordeaux,” Steinbaum says.

8 Ways to Squeeze Fitness Into Your Day

While I aim for 20 or 30 minutes of daily exercise, I never miss an opportunity to sneak in extra movement throughout the day. After all, your muscles have no idea if you’re in a fancy gym or in your kitchen — as long as you’re working them, they’ll get toned!

By doing little exercises throughout the day wherever you can — in the kitchen, in your car, while you brush your teeth, or while you're sitting at your computer — you’ll keep the oxygen flowing and stretch and tone your muscles.

 

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You’ll also boost your metabolism: Did you know you can burn up to 500 calories per day just by fidgeting? It’s true! I like to call these little movements "fidget-cizes." They take only one minute or less and they really do work! Fidget-cizes don't replace your regular workouts, but when life gets too hectic, use these moves as a way to squeeze in a little extra fitness all day long. Here are a few of my favorites. Give them a try!

  • Squeeze that butt: Do it in the elevator, as you're walking down the aisles of a grocery store, and while you're waiting in line at the bank. No one will know — and it's so effective!
  • Work those legs: Try doing leg lifts at your desk or squats while you brush your teeth at night.
  • Add some steps to your day: Whenever you can, sneak in extra walking. Park your car far away from the store, take the stairs instead of the elevator at work, or do a few laps of the mall before you shop this weekend. Every step counts!
  • Tuck that tummy: If you're relaxing in the living room in front of the TV, try lying on the floor or on a blanket and doing crunches. Make a deal with yourself that you'll do them throughout each commercial break. Easy!
  • Take a “dip” on the couch: Sit at the edge of the couch and place your palms down on each side of you. Move forward so that your body is off the couch, bend your elbows behind you, and lower your body toward the floor with your knees bent and feet together. Bend and extend your arms multiple times as you watch TV — you’ll lose that arm jiggle in no time!
  • Stretch it out: Tension can build up in the neck and shoulders simply from sitting at your desk, and it gets even worse as the long work day drags on. Stretching encourages those tense muscles to relax and counteracts any tightness from poor posture and tired muscles. Try doing my Shoulder and Chest Relaxer, One-Arm Reach, and Neck and Shoulder Release at your desk — you'll probably start an office trend!
  • Get firm on the phone: If you spend a lot of time on the phone like I do, don't just sit there — make it a workout by "pretending" to sit! Press your back flat against a wall and lower your body by bending your knees to a 45- to 90-degree angle. Hold the position for as long as you can.
  • Get lean while you clean: Did you know that by doing household chores — carrying laundry upstairs, vacuuming, making your bed, dusting — you can burn up to 400 calories an hour? You’ve got to do these tasks anyway, so you might as well turn on some music and think of it as exercise!

Go ahead: Turn idle time into exercise time and look for every opportunity to move your body. All of those little moments will add up to major health benefits — you’ll see!

Recognizing an Addiction Relapse

Treatment and recovery from an addiction to drugs or alcohol are steps in a lifelong journey. Unfortunately, 40 to 60 percent of drug addicts and almost half of all alcoholics will eventually go through a substance abuse relapse.

If someone dear to you has been in addiction treatment, it is important for you to be able to recognize if that person is relapsing as early as possible. This way, the problem can be addressed before it spirals out of control. Just because your loved one relapses does not mean that their addiction treatment has failed, however; it just means that the current treatment regimen probably needs to be reevaluated.

Addiction Relapse: Obvious Signs

"Most of the time the signs are so obvious," says Thomas Kosten, MD, Jay H. Waggoner chair and founder of the division of substance abuse at Baylor College of Medicine in Houston.

According to Dr. Kosten, the following are common indicators of a drug or alcohol addiction relapse:

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  • Alcohol is missing from the house.
  • Bottles of alcohol are found around the home.
  • Your loved one comes home obviously intoxicated.
  • Money is missing from bank accounts or stolen from friends or family member.
  • Medicine is missing from the house.

 

 

Addiction Relapse: Early Indicators

 

 

There are also signals from the addict that a relapse is just around the corner, when steps can be taken to prevent the relapse or at least address it in its earliest stages. Your loved one may exhibit the following emotions and behaviors:

  • Anxiety
  • Anger
  • Impatience
  • Extreme sensitivity
  • Moodiness
  • Not wanting to be around people
  • Refusing help
  • Not complying with treatment recommendations
  • Problems with sleeping
  • Appetite changes
  • Reminiscing about the past
  • Lying
  • Seeing friends that they've used drugs or alcohol with in the past
  • Talking about relapse

Addiction Relapse: Stepping in

When you suspect that your loved one has relapsed, Kosten says the best thing to do is tackle the issue head-on. He suggests that you start the conversation in the following way:

  • First, say to your loved one, “I think you’re using.”
  • If the person admits he is using again, then say, “We need to do something about this."
  • Kosten suggests that at this point you start setting limits by saying something such as, "Unless you get help, you will have to leave the house."

If your loved one is showing signs of an impending relapse but hasn’t yet relapsed, Kosten says that it is important to confront him first. Otherwise it is very unlikely that you are going to be able to convince him to get back into addiction treatment. Then you should encourage him to continue with treatment, talk to an addiction counselor or sponsor, and practice good self-care — that is, get enough sleep, eat well, and take steps to relieve stress.

If the addict refuses to talk with a professional or you feel that you need anaddiction expert to help you learn how to confront him, contact your local Council for Alcoholism and Drug Abuse. Or if you have access to the person’s doctor, addiction counselor, or sponsor, speak to that person about how you might deal with the situation.

diabetes type 2

There is a problem about diabetes type 2

 

 

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bad habit or not nutration food is a cause of diabetes

 

   
   

 

 

Teens and E-cigarettes

In Figure 2 Teen e-cig users are more likely to start smoking.
30.7 percent of e-cig users started smoking within 6 months while 8.1 percent of non users started smoking. Smoking includes combustible tobacco products (cigarettes, cigars, and hookahs).

Teens and E-cigarettes

In picture shows that "Teens are more likely to use e-cigarettes than cigarettes."

Past-month use of cigarettes was 3.6 percent among 8th graders, 6.3 percent among 10th graders, and 11.4 percent among 12th graders. Past-month use of e-cigarettes was 9.5 percent among 8th graders, 14.0 percent among 10th graders, and 16.2 percent among 12 graders.

Two times as many boys use e-cigs as girls.

How to Protect Yourself During a Mass Shooting

No one thinks they could be in this situation, but here's advice from safety experts if it happens.

Thursday, April 03, 2014

The headlines appear with unnerving frequency about mass shootings somewhere in the United States -- at a movie theater, a shopping mall, a school, a sporting event. Yesterday, a shooting tragedy took place at the Fort Hood military base in Texas, the second at this site since November 2009.

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Precisely how often mass shootings have occurred depends somewhat on interpretation. The Congressional Research Service, which defines a mass shooting as one that takes place in a relatively public place and results in four or more deaths, not including the shooter, identified 78 such shootings in the United States from 1983 to early 2013. A report by researchers at Texas State University, done after the killings at Sandy Hook Elementary School in Connecticut, used different parameters and identified 84 mass shootings from 2000 to 2010 by people whose main motive appears to have been mass murder.

Though the precise number of mass casualty shootings may be hard to determine, there's no disagreement that people today need to think about their safety whenever they go out in public, said Dennis Krebs, a retired captain and paramedic with the Baltimore County Fire Department and author of "When Violence Erupts, A Survival Guide for Emergency Responders" and the "Special Operations Mission Planning Field Guide." 

“If you at least think about what you would do if you were confronted with such a situation, it gives you an edge,” Krebs said. 

Life-Saving Tips in the Event of a Mass Shooting

Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University, said that people don’t need to panic or even fear going to public places to avoid mass casualty shootings. He does agree with Krebs though: In 2014, it’s worth giving some thought to how to protect yourself during a mass shooting. 

 

 

What you can do if faced with a mass shooting depends greatly on the situation and your physique and physical capabilities, Dr. Redlener noted. “If you’re small and alone or with your 1-year-old or your 14-year-old, it’s going to be different,” he said. “Everything about survival guidelines is dependent on the details of the particular situation.” 

However, experts in public safety do have advice on how to protect yourself and your loved ones in the event of a mass shooting.

Pay attention to your surroundings. No matter where you go, "be aware of your environment," Redlener said. "If you see something that looks suspicious or out of place, or you notice an unusual gathering of people, you can begin taking action prior to the event occurring." By being aware, you may be able to avoid the scene and not walk into trouble. “Situational awareness is something that police officers and the military are taught and trained to do,” he said. When you go to a mall or a movie, know where the nearest exits are. 

RELATED: Media Exposure to Traumatic Events Can Be More Stressful Than Being There

Flee if you can. If you’re caught in a mass shooting, “you want to get outside of the building as quickly as you possibly can," Krebs said. A lot of people freeze, but "that's the last thing you want to do,” he said. Urge any people you're with to come with you, but don’t waste precious time trying to persuade them to get out while you can. 

 

"If you see something... suspicious or out of place...you can begin taking action prior to the event."

Irwin Redlener, MDTWEET

 

David Reiss, MD, a San Diego psychiatrist, said that some training in the martial arts can help prepare you to deal with your body’s natural fight-or-flight response and not be paralyzed when faced with traumatic events from which you should flee. “To be aware of that response and have some training in dealing with it can be useful without going overboard,” he said. 

Leave your belongings behind. Drop whatever stuff you have with you -- packages, luggage, purse, or backpack. It will make your exit easier. Nothing is more important than your life, Krebs said. Video of the mass shooting at the Los Angeles airport in November 2013 showed people fleeing with their suitcases, but, as Krebs said, "there's nothing in that piece of Samsonite that’s worth your life." 

If you can’t run, hide. “You want to be in an area that allows you to be protected from the gunman or further mischief by the armed perpetrator,” said Stephen Hargarten, MD, MPH, professor and chairman of emergency medicine and director of the Injury Research Center at the Medical College of Wisconsin. Lock and barricade the doors to your hiding place. In one recent mass shooting at a mall, a store clerk was able to protect some shoppers by hitting the button for a gate in front of the store, sealing everyone inside, Krebs said. 

Once in hiding, be quiet. Shut off your cellphone. Instinct may tell you to keep it on and try to call for help, but a ringing phone could be dangerous if it attracts the shooter's attention, Krebs said. Call 911 for help only if and when it’s safe to do so. 

 

 

Try to avoid confronting the shooter. According to the U.S. Department of Homeland Security, taking any action against the shooter should be a last resort -- something you do only if your life is in imminent danger. But, if there's no other option, yell, act aggressively, or look around for something that might work as a weapon. 

Afterwards, exit carefully. Once the shooting has stopped and you are able to leave the building, go out with your hands up. Drop whatever you are carrying. “Police may not have a description of the suspect they’re after," Krebs said, "and if you come running out the door with something in your hand, you could end up getting hurt." 

Disaster Preparedness With Children 

Parents with young children should follow the same advice that flight attendants give passengers: Take care of yourself first because, if you don’t, you won’t be able to help your children, Dr. Hargarten said.

Before you're faced with a traumatic event, talk with your children about the best ways to handle such situations. What you say will depend on their age, but whatever you say, try not to frighten them unnecessarily. Emphasize that in an emergency situation like that, they would need to follow your directions, no questions asked. If you have to scream at your children, it could attract the attention of the shooter. 

As part of your family's disaster preparedness plan, decide where to meet if you get separated in an emergency -- even if it's a place you've been many times before. 

Dr. Reiss said you can’t anticipate mass casualty shootings and should not spend your days fretting over what you would do if you were caught up in one. “If you expect emergencies every moment of your day, it will ruin your life,” he said. It’s best to give it some thought but not let it overwhelm you

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Best Ways to Beat Dry Skin

Dry, itchy skin is no joke. Because skin is the body's largest organ (weighing about nine pounds), the frustration and discomfort that go along with dehydration can affect your daily existence, from your wardrobe to your social life. And if you happen to have a skin condition like eczema, you know from experience that flaky skin is no laughing matter.

However, you can fight flakiness and itchiness with a few important tips. Here, skin experts share their best advice for keeping your skin soft and supple.

Find the Right Exfoliator

Exfoliating can be beneficial for those who have dry skin because it helps the dead surface layers of skin cells to be shed, layers that can prevent moisturizers from being absorbed, says Doris Day, MD, a clinical assistant professor of dermatology at New York University Medical Center.

The key is to find the exfoliator that works best for your skin. Scrubs and alpha-hydroxy and beta-hydroxy acids are best for those who don't have sensitive skin. Those with sensitive skin can exfoliate with a home remedy that consists of a paste made from baking soda and water. “It’s great for your face or for rough patches like your heels, and nobody breaks out from it,” says Mona Gohara, MD, an assistant clinical professor of dermatology at Yale University.

Note that if you have any skin conditions, it’s best to check with a dermatologist before trying anything new. And beware of exfoliating too often because it can cause irritation.

Don’t Wash Too Often

 

 

Like exfoliating too much, washing too often can lead to dryness. “I usually tell people to use soap only where they need it — underarms, groin, hands and feet,” says Rebecca Baxt, MD, a dermatologist in Paramus, New Jersey.

Take a Lukewarm Shower

 

 

“Hot showers can strip the skin of oil and leave skin dry,” says Joshua Zeichner, MD, the director of cosmetic and clinical research in the department of dermatology at Mount Sinai Hospital in New York City. Although hot showers are relaxing, fight the urge to parboil yourself and use lukewarm water instead. Also, limit the length of your showers to 10 minutes or less.

Moisturize Every Day

Using a moisturizer daily is crucial to combating dry, flaky skin. “When the skin is dry, it needs to be hydrated from the outside in — drinking eight glasses of water is not enough,” says Dr. Day.

For the most effective moisturizer, look for ingredients, including ceramides, that help support and replenish lipids in the skin. Hyaluronic acid and glycerin, both humectants, help the skin attract water and hold in moisture. Additionally, Dr. Zeichner recommends that, to help seal in moisture, you apply moisturizer to damp skin after showering.

Mindfulness Therapy May Help Ease Recurrent Depression

Review of 9 studies suggests it helps patients better cope with troubling thoughts and emotions.

Mindfulness therapy may help reduce the risk of repeated bouts of depression, researchers report.

One expert not connected to the study explained the mindfulness approach.

"Mindfulness-based cognitive therapy enhances awareness of thoughts and emotions being experienced, and enables development of skills to better cope with them," said Dr. Ami Baxi, a psychiatrist who directs adult inpatient services at Lenox Hill Hospital in New York City.

In the new study, a team led by Willem Kuyken, of the University of Oxford in England, analyzed the findings of nine published studies. The research included a total of almost 1,300 patients with a history of depression. The studies compared the effectiveness of mindfulness therapy against usual depression care and other active treatments, including antidepressants.

After 60 weeks of follow-up, those who received mindfulness therapy were less likely to have undergone a relapse of depression than those who received usual care, and had about the same risk of those who received other active treatments, the team reported.

The study authors also believe that mindfulness therapy may provide greater benefits than other treatments for patients with more severe depression.

The study was published online April 27 in the journal JAMA Psychiatry.

"Mindfulness practices were not originally developed as therapeutic treatments," Richard Davidson, of the University of Wisconsin-Madison, wrote in an accompanying editorial. "They emerged originally in contemplative traditions for the purposes of cultivating well-being and virtue," he explained.

RELATED: 6 Depression Symptoms You Shouldn’t Ignore

"The questions of whether and how they might be helpful in alleviating symptoms of depression and other related psychopathologies are quite new, and the evidence base is in its embryonic stage," according to Davidson.

While this review is the most comprehensive analysis of data to date, it "also raises many questions, and the limited nature of the extant evidence underscores the critical need for additional research," Davidson concluded.

However, another psychologist said she is already using mindfulness therapy in her practice.

"I have increasingly incorporated mindfulness based-interventions into my work with children, adolescents and adults, and I've seen how it has improved treatment outcome and overall well-being in my clients," said Jill Emanuele. She is senior clinical psychologist at the Child Mind Institute in New York City.

Emanuele said there is growing evidence that the approach brings patients "increased awareness of emotions and thoughts, and the ability to more effectively regulate and cope with them."

The Role of Genetics in Depression

These new genetic discoveries may someday lead to new depression treatments.

 death thoughts, and more — you might ask yourself, "Why me?" Scientists are trying to answer that question.

Researchers know from twin and family studies that genetics does play a role in depression: You don’t actually inherit depression, but you may inherit genes that predispose you to the condition. If you have a parent or sibling with major depressive disorder, you are two to three times more likely to develop depression than someone with no family history. The risk is higher if family members developed depression early in life or experienced recurrent episodes of depression.

Risk Factors for Depression Vary

Having a genetic predisposition doesn’t mean you’ll become depressed. Environmental factors are also very important, says Mary Fristad, PhD, director of research and psychological services in the division of child and adolescent psychiatry at the Ohio State University in Columbus.

“Even if someone is ‘genetically loaded’ because they have multiple relatives with depression — and their partner is equally genetically loaded — raising a child in a calm, predictable, loving, nurturing, limit-setting household with good nutrition, plenty of exercise, adequate sleep, and participation in enjoyable activities might either prevent or delay the onset of depression,” she says.

Dr. Fristad doesn’t recommend genetic testing for depression. “The simplest and least expensive genetic test at present is to ask if anyone on either side of the family has depression,” she says.

But Chris Aiken, MD, director of the Mood Treatment Center and a clinical psychiatry instructor at the Wake Forest University School of Medicine, both in Winston-Salem, North Carolina, says one particular type of gene has been implicated in the development of depression — information that may be helpful to some people. It’s called the serotonin transporter (SERT); serotonin is a neurotransmitter that helps regulate levels of anxiety, depression, and irritability.

RELATED: How to Tell If It’s a Bad Mood or Depression

“You can have genes for either a short or long version of SERT,” says Dr. Aiken. “These genes predict whether people will get depressed in the face of stress. For people with the long-arm version of the gene, the risk of depression doesn't rise even after a major life stress, like divorce, grief, or job loss. For those with the short-arm version, the rate of depression goes up with each new stress."

“What's interesting is that people have the same rate of depression when they aren't under any stress — regardless of which version of SERT they have,” Aiken says. “It's only after major stress or childhood trauma that the two groups start to look different.”

Having the long form of the gene raises the risk of experiencing depression after stress, but you won’t automatically become depressed if you have that gene and undergo stress. Similarly, you can still get depressed with the short-arm gene after a stressful life event (i.e., having the gene is not totally protective). In a nutshell, having a particular form of the gene raises the risk of depression after stress but cannot 100 percent predict or prevent it.

According to Aiken, the short-arm SERT isn’t unique to depression: It’s also been linked to post-traumatic stress disorder, fear responses, and alcoholism.

New Genetic Markers for Depression Revealed

In a study published in July 2015 in Nature, scientists reported finding two genetic markers that appear to be clearly linked to major depression. Researchers sequenced DNA from about 10,600 Chinese women, half of whom had depression. Of that half, 85 percent had a severe type of depression called melancholia, described as a gloomy, foreboding feeling that robs people of their joy. They found two genetic sequences that seemed to be linked to depression and confirmed these correlations in an additional 6,000 subjects and controls.

Norman Sussman, MD, a psychiatrist and director of the Treatment Resistant Depression Program at NYU Langone Medical Center in New York City says the results of this study help validate the fact that depression really is an illness, not a psychosomatic disorder or weakness of character.

RELATED: The Real Monthly Cost of Depression

“I tell patients, depression is a medical disease," says Dr. Sussman. "Instead of [showing] physical symptoms (which they can also have), it primarily manifests through abnormalities in cognition and mood. You see things in a negative, hopeless way.”

The Nature findings also offer potential opportunity for treatment. Sussman says if we understand the mechanics of depression, it opens new pathways for drug development. Furthermore, says Aiken, knowing your genotype can also help you avoid wasting time with medications that are less likely to work. For example, people with short-arm SERT genes are less likely to respond to selective serotonin reuptake inhibitors, the most common type of antidepressant, but they may respond to other medications.

How You Can Prevent Depression Symptoms

There’s no medical test to diagnose depression, so health professionals rely on patients or family members to report symptoms. The American Psychiatric Association’s diagnostic guidelines say patients should not be diagnosed with depression unless they exhibit a persistently low mood or loss of interest in activities once deemed pleasurable or enjoyable, in addition to four or more symptoms of depression.

Depression symptoms might include loss of interest in activities once deemed pleasurable or enjoyable, significant weight loss or gain, lack of energy, feelings of worthlessness, or repeated thoughts of death or suicide.

RELATED: 5 Things Psychologists Wish Their Patients Would Do

At least 10 percent of Americans will eventually experience an incidence of major depressive disorder, the most serious type of depression. Other people have low-grade, chronic depression. “The difference is severity,” says Sussman. “People with chronic depression know they should be happier than they are.” 

The important thing to keep in mind is that depression is not inevitable — even if you’re genetically predisposed — and it is treatable.

“Studies show that people whose environments are loving, nurturing, structured, physically active, and have good social networks and friendships are protective for children with genetic risks for depression,” says Aiken.

Online screening tools, such as the Depression Wellness Analyzer and the Patient Health Questionnaire (PHQ-9), can help you evaluate whether you may have depression. Discuss the results with your physician so you can seek treatment if appropriate.

Psoriasis Linked to Higher Risk of Depression

People with psoriasis may be twice as likely to experience depression as those without the common skin condition, regardless of its severity, a new study suggests.

"Psoriasis in general is a pretty visible disease," said study author Dr. Roger Ho, an assistant professor of dermatology at New York University School of Medicine in New York City. "Psoriasis patients are fearful of the public's stigmatization of this visible disease and are worried about how people who are unfamiliar with the disease may perceive them or interact with them."

Genetic or biologic factors may also play a role in the link between depression and psoriasis, which requires more research, he said. Either way, the findings mean that all individuals with psoriasis could benefit from screening for depression, Ho said, and their friends and family members should be aware of the connection as well.

The findings were scheduled for presentation Thursday at an American Academy of Dermatology meeting in New York City. They have not yet been published in a peer-reviewed journal and should be considered preliminary.

Most people with psoriasis have red, raised patches of skin covered with silvery-white scales, the researchers noted. These patches usually appear on the scalp, elbows, knees, lower back, hands and feet.

The researchers analyzed the responses of more than 12,000 U.S. adults in the 2009-2012 National Health and Nutrition Examination Survey conducted by the U.S. Centers for Disease Control and Prevention.

Overall, nearly 3 percent of responders reported that they had psoriasis, and about 8 percent had major depression based on their answers to a depression screening assessment. Among those with psoriasis, 16.5 percent had sufficient symptoms for a diagnosis of major depression.

Those with any degree of psoriasis had double the odds of having depression even after taking into account their age, sex, race, weight, physical activity level, alcohol use and history of heart attack, stroke, diabetes and smoking, the researchers said.

Depression is one of several concerns that someone with psoriasis should look out for, said Dr. Delphine Lee, a dermatologist at John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, Calif.

"Patients with psoriasis should be aware that there are several other health issues associated with this condition, including cardiovascular and metabolic diseases, such as diabetes, as well as psychological or psychiatric disorders," Lee said. "To address your health beyond your skin is critical to maximizing a person's quality of life."

Several aspects of dealing with psoriasis may contribute to depression, said Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City.

RELATED: 7 Hidden Dangers of Psoriasis

What matters more than its severity is the location of flare-ups, she said. Some of her patients won't wear shorts if it's on their legs or won't go on dates because they're embarrassed about red spots on their skin, she added.

"Also, because it's a chronic illness, you don't know if it's going to get worse and you don't get to take a vacation from it either," Day said. "You're using topical treatments all year long, and as soon as you stop, it comes right back. It's very depressing, and it can affect your self-esteem and your quality of life."

Anxiety about how psoriasis and its treatment may affect your future health might also contribute to depression, Day explained.

"It's unsightly, it can be itchy, people are worried about it spreading to other parts of their body, they worry about the side effects of medication, they worry about psoriatic arthritis, they worry about taking medications when they're pregnant, and they worry about passing it along to their children," she said.

Day recommended that people with psoriasis seek mental health treatment to get to the bottom of their depression.

"It's about that emotional connection and finding out what about this condition is affecting someone in the way that it is," Day explained.

Not seeking help can make matters worse, said Dr. Tien Nguyen, a dermatologist at Orange Coast Memorial Medical Center in Fountain Valley, Calif.

"Psoriasis can cause severe emotional distress," he said, noting some patients may have suicidal thoughts or attempt suicide. "Stress is a known cause of exacerbation of psoriasis, so this will lead to a vicious cycle."

Day added that it's critically important to continue seeing a dermatologist to learn about new medications that become available.

"There are some really amazing new treatments that have a great safety profile that can have excellent clearance with lasting results," Day said.

The Calming Power of Nature

Spending time in nature eases depression, and could be a good supplement to medicine and therapy.

Remedies for depression abound, from medications to psychotherapy, or talk therapy. Having a range of treatment options is a good idea because no single treatment works equally well for each of the millions of U.S. adults with depression. Now researchers say a new therapy, proven to relieve depression, should be added to the mix as a supplement to established treatments. It's called nature.

Interacting with nature can have replenishing effects for those with depression, says Ethan Kross, PhD, associate professor of psychology at the University of Michigan and one of many experts who has studied the nature-depression link.

A little dose of nature helps us all recharge, but it may have special benefit for those who are depressed. "It seems that, from our work, the restorative effect of nature seems to be stronger for individuals diagnosed with depression," says Marc Berman, PhD, assistant professor of psychology at the University of Chicago. That might be because they feel mentally fatigued, and being in nature re-energizes them. However, Dr. Berman has a strong caveat: "We're not arguing that interacting with nature should replace clinically proven therapies for depression," he says. Nor should those with clinical depression try to treat themselves.

RELATED: How to Create a Depression Treatment Plan

However, Berman and others say, interactions with nature could serve as a very effective supplemental treatment.

What Nature-Depression Research Shows

Among the studies finding nature helps with depression:

Adults with depression who took a 50-minute walk in a natural setting for one research session and then a 50-minute walk in an urban setting for another research session were less depressed and had better memory skills after they took the nature walk.
Adults who moved to greener urban areas, compared to less green, had better mental health during follow-up three years after the move.
Those who took group nature walks reported less depression, less stress, and a better sense of well-being than those who didn't take nature walks, according to a study that looked at more than 1,500 people in a walking program.
Being outdoors and in nature boosts vitality, which experts define as having physical and mental energy. Those with depression often report fatigue and decreased energy. Researchers found the energy-boosting effect of nature was independent of the physical activity or social interaction experienced while outdoors.
How Nature Works Its Magic

The phenomenon of how nature helps improve depression is still being analyzed fully, Dr. Kross says.

One possibility, Berman says, is that interacting with nature helps due to the attention-restoration theory. "We have two kinds of attention," he says. "One is top-down (also called directed), the kind we use at work." Directed attention can be depleted fairly quickly, as you can only focus and concentrate for so long.

Another type of attention is bottom-up, or involuntary. "That's the kind automatically captured by things in the environment, such as lights or music." Involuntary attention is less susceptible to depletion. "You don't often hear people say, 'I can't look at this waterfall any longer,'" Berman says.

Why does nature hold this special effect? In a natural environment, we can choose to think or not, Berman says, and this choice is believed to help us rest our brains. You can then pay attention later, when you need to. "It is giving people more ability to concentrate, which is a big problem for those with depression," Berman says. Nature provides an effective setting for resting our brains, unlike urban settings. Even in the most peaceful urban environment, you have to pay attention to such things as traffic and stoplights.

Nature's replenishing effect is fairly instantaneous, Berman says. So if you're depressed and having an especially bad day, a quick dose of nature might help.

However, Berman cautions that anyone with clinical depression needs to be under a doctor's care, with supervision of all their treatments.

The Link Between Diet and Eye Disease

Eye disease is one of the most common causes of permanent disability in the United States. More than 20 million Americans age 40 and older have cataracts, and 10 million Americans age 60 and over have age-related macular degeneration (AMD). These eye diseases occur as we grow older, and proper nutrition may have some affect on both of them.

Cataracts develop on the lens of the eye when the proteins in the lens are damaged. These proteins are responsible for keeping the lens clear. When they become damaged, the lens becomes cloudy or opaque, and your vision may become blurry. You may also have poor night vision or double vision with cataracts. Cataract surgery is often necessary to remove and replace the damaged lens with an artificial lens.

AMD occurs when cells in the macula of the eye die. The macula is located in the center of the retina in the back of the eye, and is responsible for your sharp, central vision, which you need for reading and other tasks that require good eyesight. Once the macula is damaged, your vision is no longer clear, and you cannot make out fine details of objects. There is no cure for AMD, but proper nutrition may help prevent it from worsening.

Diet and Eye Disease: What Is a “Healthy Eyes” Diet?

According to Nelson, the nutrients associated with eye health are vitamins C and E; carotenoids, beta carotene, lutein, and zeaxanthin; omega-3 fatty acids; zinc; and vitamins B6, B9 (folic acid or folate), and B12.

“Antioxidants, especially lutein, help deter build-up of waste products in the retina, which in turn helps reduce your risk for AMD,” says Jennifer K. Nelson, MS, RD, director of clinical dietetics and associate professor of nutrition at the Mayo School of Health Sciences in Rochester, Minn. “Folate and vitamin B6 decrease the presence of the blood chemical homocysteine, which lowers your risk for AMD. Antioxidants also help prevent the cross linking of proteins in the lens which can cause cataracts.”


Here's a list of foods containing eye-healthy nutrients:

  • Fruits and vegetables (good sources of vitamins C and E)
  • Dark green vegetables such as kale and spinach (lutein, vitamin E)
  • Yellow and orange fruits and vegetables (beta carotene and zeaxanthin)
  • Anchovies, herring, mackerel, salmon, sardines, trout, tuna, and white fish (omega-3 fatty acids)
  • Beef, eggs, lamb, milk, peanuts, pork, and whole grains (zinc)
  • Bananas, chicken, dried beans, fish, liver, pork, and potatoes (vitamin B6)
  • Citrus fruits, fortified cereals, dried beans, green leafy vegetables, liver, mushrooms, nuts, and peas (folic acid)
  • Dairy products, eggs, meat, poultry, and shellfish (vitamin B12)

A diet high in refined carbohydrates, such as white rice, white bread, and pasta, may actually increase your risk of developing AMD. These foods have a high glycemic index, which means they are broken down rapidly into blood glucose or sugar. Choose breads and pasta made from whole grains and brown rice for your complex carbohydrates.

Diet and Eye Disease: Nutrition Supplements for Eye Health

 

In 2001, the National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific supplement of high doses of vitamin E, beta carotene, zinc, and copper may prevent intermediate AMD from progressing to the advanced stage. AREDS found no evidence that the supplement benefited anyone who showed no signs of AMD or those with early stage AMD. The AREDS-2 clinical trials are currently being conducted to look at the addition of lutein, zeaxanthin, and omega-3 fatty acids to the original AREDS formula.

For those with intermediate AMD who want to try the supplement formula, a discussion with your doctor is a must. “Because the AREDS-recommended supplement contains relatively high doses of antioxidants and zinc, you and your health care provider need to determine if the AREDS supplement is right for you,” cautions Nelson. “It is important that you do not self-medicate any supplements higher than the daily recommended intakes."

“We also need to look at the long-term effects of taking the AREDS supplement,” says Nelson. “For example, the AREDS formula has a very high level of beta carotene, which may increase the risk for lung cancer in smokers.” Nelson adds that eating a diet with plenty of green leafy vegetables, fish, and fortified cereals should make taking supplements for eye health unnecessary for most people.

“We’re only just beginning to look at nutrition and eye health, and it’s an exciting time because we have found such a link,” says Nelson. “A healthy diet is the foundation for healthy eyes.”

10 Ways to Fight Chronic RA Pain

The aches and pains of rheumatoid arthritis can be hard to overcome, but these strategies may help in treating chronic pain.

From fatigue to loss of appetite, rheumatoid arthritis (RA) can impact your life in a number of ways, but the most limiting symptom for many people is pain. Because that pain comes in different forms, you may need more than one strategy to relieve it.

“The primary cause of rheumatoid arthritis pain is inflammation that swells joint capsules," says Yousaf Ali, bachelor of medicine and bachelor of surgery, an associate professor of medicine at the Icahn School of Medicine and chief of the division of rheumatology at Mount Sinai West Hospital in New York City. Joint capsules are thin sacs of fluid that surround a joint, providing lubrication for bone movement. In RA, the body's immune system attacks those capsules.

The first goal of pain relief is the control of inflammation, Dr. Ali explains. “Inflammation can cause acute (short-term) pain or longer-lasting smoldering pain," he says. "Chronic erosion of joint tissues over time is another cause of chronic pain. But there are many options for pain relief.”

Getting RA pain under control may take some work. You may find that you'll need to take several drugs — some to slow the joint damage and some to alleviate joint pain. Alternative therapies, like acupuncture, combined with drugs may help you to feel stronger. It may take some time, too. Try the following strategies — with your doctor's supervision — to discover which are most effective for you:

Treatments and Strategies to Help Relieve Chronic RA Pain

1. Inflammation Medication "In the case of RA, all other pain-relief strategies are secondary to controlling inflammation," Ali says. The No. 1 option in the pain relief arsenal is to control inflammation with disease-modifying anti-rheumatic drugs, called DMARDs. These drugs, which work to suppress the body's overactive immune system response, are also used to prevent joint damage and slow the progression of the disease. DMARDs are often prescribed shortly after a diagnosis in order to prevent as much joint damage as possible.

"The most commonly used is the drug methotrexate," he says. It's administered both orally and through injections. Digestive issues, such as nausea and diarrhea, are the most common side effect of DMARDs, and of methotrexate in particular, if taken by mouth. Hair loss, mouth sores, and drowsiness are other potential side effects. Methotrexate, which is taken once a week, can take about five or six weeks to start working, and it may be three to six months before the full effects of the drug are felt; doctors may also combine it with other drugs, including other DMARDs.

"Steroids may be used to bridge the gap during an acute flare," adds Ali. "If flares continue, we can go to triple-drug therapy, or use newer biologic drugs that are more expensive but also effective.” The most common side effect of biologics are infections that may result from their effect on the immune system.

The next tier of pain relief includes these additional approaches:

2. Pain Medication The best drugs for acute pain, Ali says, are nonsteroidal anti-inflammatory drugs, called NSAIDs. Aspirin and ibuprofen belong to this class of drugs, as does a newer type of NSAID called celecoxib. While NSAIDs treat joint pain, research has shown that they don't prevent joint damage. In addition, NSAIDs may irritate the stomach lining and cause kidney damage when used over a long period of time.

"Stronger pain relievers, calledopioids, may be used for severe pain, but we try to avoid them if possible," says Ali. "These drugs must be used cautiously because of the potential to build up tolerance, which can lead to abuse."

3. Diet Although some diets may be touted to help RA symptoms, they aren’t backed by the medical community. “There is no evidence that any special diet will reduce RA pain," Ali says. But there is some evidence that omega-3 fatty acids can help reduce inflammation — and the joint pain that results from it. Omega-3s can be found in cold-water fish and in fish oil supplements. A study published in November 2015 in the Global Journal of Health Sciences found that people who took fish oil supplements were able to reduce the amount of pain medication they needed.

4. Weight Management Maintaining a healthy weight may help you better manage joint pain. A study published in November 2015 in the journal Arthritis Care & Research suggested that significant weight loss can lower the need for medication in people with RA. Among the study participants, 93 percent were using DMARDs before they underwent bariatric surgery, but that dropped to 59 percent a year after surgery.

5. Massage A massage from a therapist (or even one you give yourself) can be a soothing complementary treatment to help reduce muscle and joint pain. A study published in May 2013 in the journal Complementary Therapies in Clinical Practice involved 42 people with RA in their arms who received either light massage or medium massage from a massage therapist once a week for a month. The participants were also taught to do self-massage at home. After a month of treatment, the moderate-pressure massage group had less pain and greater range of motion than the others.

6. Exercise Although you may not feel like being active when you have RA, and it might seem that being active could put stress on your body, gentle exercises can actually help reduce muscle and joint pain, too. “Non-impact or low-impact exercise is a proven way to reduce pain," Ali says. "We recommend walking, swimming, and cycling.” In fact, one of the best exercises you can do for RA is water aerobics in a warm pool because the water buoys your body.

The Arthritis Foundation also notes that yoga is another option to help reduce RA pain, and traditional yoga poses can be modified to your abilities. Yoga may also help improve the coordination and balance that is sometimes impaired when you have the disease. When it comes to exercise, though, it’s also wise to use caution. Talk with your doctor if any workouts are making your pain worse, and, in general, put any exercise plan on hold during an acute flare.

7. Orthoses These are mechanical aids that can help support and protect your joints. Examples include padded insoles for your shoes and splints or braces that keep your joints in proper alignment. You can even get special gloves for hand and finger RA. A physical therapist can help you determine the best orthoses options for you.

8. Heat and Cold Heat helps to relax muscles, while cold helps to dull the sensation of pain. You might find that applying hot packs or ice packs, or alternating between hot and cold, helps reduce your joint pain. Relaxing in a hot bath can also bring relief, as can exercising in a warm pool.

9. Acupuncture This Eastern medicine practice, which has been around for centuries, is thought to work by stimulating the body's natural painkillers through the use of fine needles gently placed near nerve endings. “I have found acupuncture to be helpful for some patients, but the pain relief is usually not long-lasting,” says Ali.

10. Transcutaneous Electrical Nerve Stimulation (TENS) TENS is a form of therapy that uses low-voltage electric currents to stimulate nerves and interfere with pain pathways. “TENS is usually used for stubborn, chronic pain and not as a first-line treatment for RA,” Ali says. One of the benefits of this treatment is the low occurrence of side effects. If you're interested in trying it for pain relief, talk with your physical therapist.

Remember, you’re not alone — your doctor and specialists can help you find relief from chronic pain. If you’re experiencing more pain than before, or if pain is interfering with your ability to get things done, don’t hesitate to talk to your doctor. Ask your rheumatologist about pain relief options, like exercise, massage, yoga, and acupuncture, but remember that the first priority on your pain relief list should be to get RA inflammation under control.

What to Expect Before and After Bariatric Surgery

Bariatric surgery isn't a spur-of-the-moment operation. In fact, preparing for the procedure may begin a year or more before your surgery date, and lifestyle changes continue well after the surgery has been performed. Be prepared by knowing what will be asked of you every step of the process.

The Year Before Surgery

Leading up to the procedure, your surgical team will likely recommend becoming more informed about diet and exercise.The amount of time you spend in this stage depends on several factors, including your insurance and your team’s recommendations, says bariatric surgeon Ann Rogers, MD, director of the Penn State Hershey Surgical Weight Loss Program in Hershey, Pennsylvania.

Psoriatic Arthritis Types

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Learn About The Different Types

of Psoriatic Arthritis Today.

 

“There’s always some component of nutritional education and some expectation that patients will lose some weight in that program,” explains Dr. Rogers. The dietitians and others who work with you during this stage will send reports on your progress to your surgical team before you schedule your surgery date.

In this phase, you may need to make additional lifestyle changes as well depending on the program. Rogers’ program, for instance, requires smoking cessation, though other weight-loss surgery clinics do not.

The Week Before Surgery

The final days before your surgery can be extremely emotional, filled with excitement, nervousness, and anxiety. Taking these steps as you prepare for your surgery will ease tension and ensure that everything goes smoothly the day of your procedure:

• Read the materials from your clinic.

• Eat and drink as directed. “We have a preoperative diet for eight days, which consists of bariatric-friendly protein shakes,” Rogers says. “They are high in protein, and they do not have sugar.” Most programs have a preoperative diet, although the duration varies, she says. Make sure you understand how long that diet lasts and exactly what you can eat.

• Adjust medications as needed. Discuss how to manage any other conditions you might have, such as diabetes, with your weight-loss surgery team and your primary care physician.

 Meet with the anesthesiologist. Once your surgery date is scheduled, you'll also meet with the anesthesiologist, who will ask about your health history. Although patients will have lots of tests done and medical information detailed during the months before surgery, the anesthesiologist might ask for more tests, advises Rogers.

 Take a blood thinner. Clotting is a risk associated with surgery, says Rogers. Your doctor might recommend taking a blood-thinning medication before and after the surgery.

What to Pack

Rogers suggests taking the following items with you to the hospital:

 Instructions. Bring the manual or other instructions you’ve been given, as well as any preoperative paperwork.

• Identification. You’ll need it to check in.

• CPAP (continuous positive airway pressure) machine. If you've been using one for sleep, take it with you.

• Laptop and cellphone.

• Pajamas and toiletries.

• Pillow and blanket.  

The Day of the Surgery

What your weight-loss surgery will entail varies depending on the specific type of surgery you'll be having.

• Roux-en-Y: This procedure is also known as “gastric bypass.” Your stomach will be divided into a small top pouch and a larger lower pouch. Your small intestine will also be divided and the lower part raised up to attach to your new, smaller stomach. This procedure reduces the quantity of food you can eat at any given time.

• Sleeve gastrectomy: In this procedure, the majority of your stomach will be removed, creating a banana-shaped stomach.

• Biliopancreatic diversion with duodenal switch: In this procedure, a portion of your stomach is removed. The remaining portion is then attached to a lower segment of your small intestine.

 Banding: In this procedure, an inflatable band is wrapped around the upper part of your stomach, creating a small stomach pouch. The band can be adjusted as needed. 

9 Things You’ll Have to Do After Surgery

• Have a ride home in place. Expect to spend at least one night in the hospital, Rogers says. When you're discharged, you'll need to have someone drive you home.

• Prevent blood clots. You will need to adhere to strategies to prevent blood clots from developing. These include taking blood thinners and getting up and walking around while in the hospital and at home.

• Take pain medication. You'll probably get a prescription for pain medication. Laparoscopic surgery reduces pain and hospital stays, but you still may need prescription pain medication for a day or two after discharge, Rogers says.

• Anticipate constipation, as it's a byproduct of the pain medications and the surgery itself. Be sure to talk with your doctor or nurse about how to prevent constipation.

• Eat a restricted diet. Your diet will be restricted to liquid protein shakes for a week or so after the procedure, and then soft foods following that period. Most people can transition to eating food with texture after their one-month follow-up appointment. By three months you should be able to eat fruits and vegetables, Rogers says. The ASMBS recommends cutting down on carbohydrates and increasing protein.

• Drink lots of fluids. The ASMBS recommends at least 64 ounces, or 8 cups, of fluids daily.

• You may need to take supplements. Calcium, vitamin D, and B vitamins are among those your doctor might recommend.

 Exercise – but nothing too strenuous. Walking daily, starting the day you get home, is good for you, says Rogers. However, skip the gym until you have your doctor’s permission. You should be able to lift small weights, she says, but avoid heavy items.

• Plan on missing work for a while. People with desk jobs usually can go back to work in about three weeks, Rogers says. Those with physical jobs or jobs that require extended periods of sitting, such as driving trucks, will have to wait a longer period of time.

9 Best and Worst Milks for Your Heart

1 / 10   Not All Milks Are Alike

The milk aisle is changing, and has a growing number of options for what to pour on your cereal or drink down as a late-night snack. But what do the newer types of milk mean for your heart health if you have high cholesterol? Old-fashioned cow’s milk, for example, is loaded with calcium and vitamins A and D, which are all good for your heart and overall health. But the saturated fat in whole milk — and even in 2 percent milk — may counteract those health benefits. When you're trying to get to healthy cholesterol levels, you'll want to limit the amount of saturated fat in your diet.

Alternative milks can provide similar nutritional benefits if you're lactose intolerant, allergic to certain proteins in cow’s milk, vegan, or simply prefer something other than cow's milk. “People choose a milk based on tolerability and taste — in addition to health beliefs,” says Deborah Krivitsky, RD, director of nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital in Boston. “Each milk will provide different pluses and minuses.”

Expert Panel Recommends Questionnaire to Help Spot Depression

Part of your next visit to your family doctor's office should be spent filling out a questionnaire to assess whether you're suffering from depression, an influential panel of preventive medicine experts recommends.

What's more, people concerned that they might be depressed could download an appropriate questionnaire online, fill it out ahead of time and hand it over to their doctor for evaluation, the panel added.

In an updated recommendation released Monday, the U.S. Preventive Services Task Force urged that family doctors regularly screen patients for depression, using standardized questionnaires that detect warning signs of the mental disorder.

If a patient shows signs of depression, they would be referred to a specialist for a full-fledged diagnosis and treatment using medication, therapy or a combination of the two, according to the recommendation.

These questionnaires can be self-administered in a matter of minutes, with doctors reviewing the results after patients fill out the forms, said Dr. Kirsten Bibbins-Domingo, vice chair of the task force.

"This could be a checklist that patients fill out in the waiting room, or at home prior to the visit," she said. "The good thing is we have many instruments, measures that have been studied for screening for depression."

About 7 percent of adults in the United States currently suffer from depression, but only half have been diagnosed with the condition, said Bibbins-Domingo, who is a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco.

"We know that depression itself is a source of poor health," she said. "It leads people to miss work, to not function as fully as they might, and we know it is linked and associated with other types of chronic diseases."

It makes sense that family doctors perform front-line screening for depression, since they are more likely than a mental health professional to come across a person with undetected symptoms, said Michael Yapko, a clinical psychologist and internationally recognized depression expert based in Fallbrook, Calif.

"Only about 25 percent of depression sufferers seek out professional help, but more than 90 percent will see a physician and present symptoms and signs that could be diagnosed," said Yapko, who is not on the task force.

The panel has recommended regular depression screening for adults since 2002, but their guidelines currently urge doctors to ask two specific questions that provide a quick evaluation of a person's mood. The questions are, "Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"

The updated recommendation expands doctors' options for depression screening, adding commonly used questionnaires like the Patient Health Questionnaire, or PHQ-9.

The PHQ-9 is a list of 10 questions that focus on problems that a person might have experienced during the past two weeks, including poor appetite, low energy, sleep problems and a lack of interest in doing things.

"These are not instruments that diagnose depression," Bibbins-Domingo noted. "They give clinicians the first indication of something that should be followed up on."

RELATED: 10 Drug-Free Therapies for Depression

Yapko said that someone who wanted to could lie on the questionnaires and avoid having their symptoms detected, but he added that in his experience it's not a very likely scenario.

"When you have people who are suffering who genuinely want help, they're happy to give you as accurate a portrayal as they can give you," he said. "Generally speaking, the people seeking help want help and they want to do their best in filling these things out. That's what makes the test worthwhile."

The task force is an independent, volunteer panel of national experts that has been issuing recommendations on preventive medicine since 1984.

Yapko and Bibbins-Domingo said depression screening shouldn't eat into a doctor's time, since patients can fill out and score the questionnaires on their own.

Instead of wasting time reading magazines in the waiting room, patients "could be filling out an inventory that is self-administered, self-scored and wouldn't take any physician time at all," Yapko said.

Patients also could download and fill out a depression questionnaire at home and hand it in when they go to the doctor, but Yapko said patients should make sure they're using the form their doctor prefers.

"Which of the many inventories and questionnaires a doctor might wish to use is a matter of personal and professional judgment," he said. "So, a doctor would need to specify which form to obtain online and the patient would then need to remember to bring it in, not always easy when depression negatively affects your memory. Easier to have the form in the office and have them fill it out in the waiting room."

Yapko added that it's important that doctors who screen for depression follow up by referring patients to a mental health professional, rather than trying to diagnose and treat depression themselves.

"When physicians get a diagnosis of depression, their most immediate thing to do is prescribe an antidepressant," Yapko said, noting that more than 70 percent of antidepressants are prescribed by non-psychiatrists. "Only a minority of people walk out of a doctor's office with a referral to a mental health professional, a fact which drives me a little crazy."

New Cholesterol Drugs Vastly Overpriced, Study Contends

The list price of these newer drugs is upwards of $14,000 a year per patient.Getty Images
Are new medicines for people with out-of-control cholesterol wildly overpriced? It's a question that's sparking debate among consumers and providers of care.

Now, researchers at the University of California, San Francisco (UCSF) report that the price of these drugs -- called PCSK9 inhibitors -- would have to be slashed by a whopping 71 percent to be deemed cost-effective.

PCSK9 inhibitors are a relatively new class of medicines for treating patients whose LDL (bad) cholesterol isn't well-controlled on statins or who cannot tolerate statins. Lipitor (atorvastatin) and Crestor (rosuvastatin) are examples of first-line statins doctors typically prescribe to patients with high cholesterol.

The UCSF team didn't question whether these new medicines are effective in reducing heart attacks and strokes.

"These are super awesome drugs, they really work," said study co-author Dr. Kirsten Bibbins-Domingo.

But the price is "far in excess" of what would be considered a reasonable cost for the clinical benefit they provide, added Bibbins-Domingo, a UCSF professor of medicine, epidemiology and biostatistics.

The list price of these newer PCSK9 drugs is upwards of $14,000 a year per patient.

Dr. Kim Allan Williams, who was not involved in the study, is past president of the American College of Cardiology. He said some doctors have a difficult time with such studies because they compare patients' lives and "events" — such as heart attack and stroke — versus dollars spent on these medicines.

The new study doesn't change his view of the value of the PCSK9 inhibitor class.

"No one's giving those drugs unless the patient is incapable of getting to the target [level of LDL cholesterol]," said Williams, who is chief of cardiology at Rush University Medical Center in Chicago. "You're only going to use it for a situation where you have no choice."

RELATED: 8 Foods That Can Cause High Cholesterol

Because the study is based on list prices, not what patients actually pay, it's also "difficult to analyze the cost-effectiveness when [you] don't know exactly what the cost is," Williams added.

He said he's had patients with copays of $380 a month and others who had zero copays because the cost was completely covered by insurance. He worries, though, that poor patients may not be offered the same access to these medicines.

The CSF researchers designed the study to find out how much bang for the buck these drugs actually provide.

Their study updates a prior cost-effectiveness analysis using current list prices as well as results of a recent clinical trial. That trial demonstrated the clinical effectiveness of Repatha (evolocumab), one of two PCSK9 inhibitors approved by the U.S. Food and Drug Administration, in reducing the risk of heart attack and stroke.

Based on a simulation involving 8.9 million adults who would meet trial criteria, adding PCSK9 inhibitors to statins would prevent 2.9 million more heart attacks and strokes compared with adding Zetia (ezetimibe), another type of medication that blocks the production of cholesterol by the liver.

But the PCSK9 inhibitor class is not cost-effective based on a threshold of $100,000 for each life year gained, the study authors contend. They found that you would have to spend $450,000 per year to get one extra year of life per year.

"The price would have to be between $4,000 and $5,000 [per year] for it to be cost-effective," said Bibbins-Domingo. "If you look in other countries, in Europe, for example, that is in fact where this drug is priced."

Dr. Josh Ofman, senior vice president of global value, access and policy at Amgen Inc., the maker of Repatha, took issue with the findings. "We think that their model is deeply flawed," he said.

The study was based a 3 percent per-year rate of heart attacks and strokes, while other studies use much higher rates — more than three times higher — based on "real-world" data, Ofman said. The study is modeling a population that's not having many heart attacks and strokes, he said.

Ofman also questioned the threshold for determining cost-effectiveness that the UCSF researchers used. He said other organizations use a minimum of $150,000 per quality-adjusted life-year saved.

As for the price differential between the United States and Europe, Ofman cited many factors, from government price controls to how those countries price these drugs.

Amgen isn't alone in its criticism of how these medicines are valued. Earlier this month, several national provider and payer groups raised concerns about how the PCSK9 inhibitors are valued in a letter to the nonprofit Institute for Clinical and Economic Review, which assesses the value of new medicines.

More than a dozen organizations, including the National Forum for Heart Disease & Stroke Prevention, the American Pharmacists Association Foundation and the American Society for Preventive Cardiology, signed the letter citing concerns ranging from the types of patients that could benefit from these drugs to the importance of preventing heart attacks and strokes — not just deaths.

"The big controversy about all these types of analyses is what we're willing to value a patient's year of life at," Ofman said.

The new study was published in the Aug. 22/29 issue of the Journal of the American Medical Association.

Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

Model for a Hepatitis C Cure: Success in the Cherokee Nation

For 9 out of 10 American Indians, treatment led to a hepatitis C cure.

For most of the 3.5 million Americans living with a hepatitis C infection today, the promise of a cure is an empty one unless patients can get proper care. And deaths from hepatitis C keep rising, surpassing deaths from HIV.

Now, in a successful pilot program by the Cherokee Nation Health Services of northeastern Oklahoma, a May 2016 Centers for Disease Control and Prevention (CDC) report shows that curing hepatitis C is possible not only in clinical trials, but also in the larger population — even in remote and impoverished areas.

 

Local Hepatitis C Screening Success

American Indians and Alaska Natives have the highest rates of death from hepatitis C of any group in the United States, and also the highest number of new hepatitis C infections, according to the CDC, says Jorge Mera, MD, lead study author and director of infectious diseases at Cherokee Nation Health Services, though he says it’s not known why. “We made a great effort to detect hepatitis C virus-positive patients," he says. "Hepatitis C virus is known as the invisible epidemic — we tried to make it visible.”

To get more people screened, the health services implemented an electronic health record reminder to target everyone born between 1945 and 1965. The automatic alert prompted medical providers if the patient they were seeing that day was due for a hepatitis C screening test based on the patient's birthdate. This pilot program resulted in a fivefold increase in first-time hepatitis C testing between 2012 and 2015, from 3,337 people to 16,772 and included 131,000 American Indian people, mostly from rural northeastern Oklahoma.

The program educated healthcare providers on how important it is to identify these patients as early as possible, and to offer them treatment. It also informed them about the many ways people are exposed to hepatitis C, including by using or having used IV or intranasal drugs, having been incarcerated, or having received a blood transfusion before 1992. The CDC recommends testing for all people with such histories.

 

Progress in National Hepatitis C Screening

A report on a second, national initiative by the Indian Health Service (IHS) that ramped up hepatitis C testing in a similar way was also published in May 2016 in the CDC's Morbidity and Mortality Weekly Report (MMWR). As of June 2015, the number of people they had screened overall increased from 14,402 to 68,514 over three years, varying by region from 31 to 41 percent of people in the high-risk age group.

“The Indian Health Service’s screening rates for American Indian and Alaska Native patients in the [1945 to 1965] birth cohort have more than tripled since the national recommendations were released, greatly increasing the potential for early detection and follow-up for our patients living with hepatitis C infection,” says Susan Karol, MD, Indian Health Service chief medical officer and member of the Tuscarora Indian Nation in Niagara Falls, New York. The Indian Health Service provides healthcare for 1.9 million American Indian and Alaska Native people, including 566 different recognized tribes.
A Second Test for Active Hepatitis C

“Once patients were detected as HCV-positive, a confirmatory viral blood test was performed to make sure they had an active infection,” says Mera about his hepatitis C program. This test looks for RNA that’s proof of ongoing hepatitis C virus replication in the patient’s blood.

Of the 715 people who tested positive on the first screening test, 68 percent had an active infection. They were referred to one of five hepatitis C virus clinics set up by Cherokee Nation Health Systems, which had primary care providers who were specifically trained through the Extension for Community Healthcare Outcomes (ECHO) program. Outreach also included home visits to people who had hepatitis.
Access to Hepatitis C Drugs That Can Cure

A high proportion of the people who had an active infection — 57 percent — received antiviral drug treatment in this pilot program. Ninety percent were cured of hepatitis C.

“We don’t deny treatment to anybody because they’re depressed or have an alcohol dependence medical problem,” says Mera, though this is often a barrier to getting approvals for antiviral treatment. “We do offer and encourage them to be enrolled in a behavioral health program to address the other medical conditions. As long as they’re following up with the medical appointments and interested in HCV treatment, we will treat their hepatitis C virus.”

David Rein, PhD, program area director of the public health analytics division of NORC, an independent research institution at the University of Chicago, says access to hepatitis C care is improving for some. “In March, the U.S. Veterans Administration dropped all restrictions on treatment and began to provide treatment to any veteran in its system who is infected with the virus, regardless of how far the disease has progressed. Unfortunately, the VA is the exception and not the rule. Many state Medicaid programs and private insurance plans still place unnecessary barriers on treatment access.”   

Coverage to pay for medications is a barrier for many people with hepatitis C, notes a May 2016 editorial in The Journal of the American Medical Association.

The key to success, Mera says, is being relentless. “We have a wonderful group of case managers dedicated to hepatitis C treatment procurement,” he says. “They will work with the third party payers such as Medicaid, Medicare, and private insurance, and also with the patient assistance programs. Our case managers will not take no for an answer very easily, and will exhaust all the possibilities they have to obtain the medications.”
How to Cure Hepatitis C Across the United States

The three steps to a hepatitis C cure are to:

    Get screened to see if you’ve ever been exposed to the hepatitis C virus
    Get tested for active viral infection
    Get effective drug treatment

Yet half of Americans infected with hepatitis C don’t know they have it, while many of those who do know can’t get access to care or can’t pay for the antiviral medication they need.

A plan to cure hepatitis C is important because cases of infection have increased more than 2.5 times from 2010 to 2014, and deaths from hepatitis C are on the rise, exceeding 19,000 per year, according to the CDC's U.S. viral hepatitis surveillance report, published in May 2016.  

“Acute cases, which occur when a patient is first infected with hepatitis C, are increasing at an alarming rate, likely due to higher rates of injection drug use,” says Dr. Rein. But this group of people is not likely to develop symptoms of liver dysfunction for several decades.

“The record number of hepatitis C deaths that the CDC reported for 2014 is almost exclusively related to people who were initially infected with the disease in the 1960s, ‘70s, and ‘80s who developed chronic infections which gradually destroyed their livers over the course of decades,” he explains.

Rein and his colleagues had predicted in 2010 that deaths from hepatitis C would increase to 18,200 annually by the year 2020, peak at 36,000 in 2033, and kill more than one million Americans by the year 2060 if we didn't take action to prevent it. But the sobering reality is that the U.S. case numbers have already exceeded that prediction, with more than 19,000 cases in 2014.

“I still believe that is what will happen if nothing is done to address the epidemic,“ Rein says. “However, I’m both hopeful and confident in our healthcare system, and I believe that we’ll see vastly expanded testing and treatment, which will lead to dramatic reductions in deaths from hepatitis C in the years to come.”

More people, especially those born between 1945 and 1965, need to be tested for the hepatitis C antibody, he says. “Simply disseminating guidelines and providing reimbursement for testing is insufficient to assure that doctors test their patients. Interventions are needed to prioritize testing for hepatitis C.”

The Cherokee Nation group is now working with the CDC on a model that experts hope can be expanded throughout the country to lead people effectively from screening through to a hepatitis C cure.

What can help the model succeed? According to Mera, support, commitment, and trust:

    Political support (in the Cherokee Nation program, from the tribe’s chief and council)
    Commitment and trust from the administration to do the right thing to eliminate hepatitis C
    Dedicated and motivated team members who include primary care providers (nurse practitioners, physicians, pharmacists), lab technicians, nurses, administrators, behavioral health personnel, case managers, and clerks who understand the importance and urgency of hepatitis C screening and a cure

“My wish would be that patients would ask their medical providers to test them for HCV if they think they could have been exposed. This would increase screening, the first step in visualizing the invisible epidemic,” says Mera.

 

Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

8 Healthy Game Day Snacks for Football Season

1 / 9   Skip the Takeout and Whip Up These 8 Winning Snacks

Even if you're not a football fanatic, game day is always an excuse to watch a good matchup, spend time with family and friends, and especially to eat your favorite foods. Nachos, chili, cheese dips — your upcoming game-day gathering will probably boast some of the best non-holiday spreads of the year. Game on! This year, it’s not about what foods you should avoid; instead, we scoured our favorite blogs for healthier game day dishes that score major points for flavor, originality, and nutrition. One look at these winning recipes and you won’t want to order out.

Type 2 Diabetes Drug Helps Some With Chronic Depression

A new small study is adding evidence to the theory that insulin resistance may play a leading role in some people's depression.

The study found that a medication normally used to boost insulin sensitivity in people with type 2 diabetes appears to help ease the symptoms of chronic depression. And, the effect was strongest in people who were insulin-resistant but didn't have diabetes, the study found.

These findings "add to the neurobiological explanation of what's going on when people are depressed, and it should help de-stigmatize depression. It's a disease of the brain," said the study's lead author, Dr. Natalie Rasgon, a professor of psychiatry and behavioral sciences at Stanford University School of Medicine in California.

"Depression is kind of a catch-all term, like the common cold; it can have more than one cause," Rasgon said. "In this study, we saw two separate effects of the [drug]. In patients with insulin resistance, their insulin resistance improved, and their depression improved."

That may mean that insulin resistance is playing a significant role in the depression of these people, she explained.

But patients who weren't insulin-resistant also saw their depression improve during the trial.

"That speaks to a different mechanism. It could be an anti-inflammatory effect," Rasgon said.

Findings from the study were published Nov. 18 in Psychiatry Research. Funding for the study was provided by the U.S. National Institutes of Health. The researchers received no support from the makers of the drug, pioglitazone (Actos), which has U.S. Food and Drug Administration approval for use as a treatment for type 2 diabetes.

RELATED: Why Sugar Is Poison for Depression

Insulin is a hormone that allows the body and brain to use the sugar from foods as fuel. Someone who is sensitive to insulin uses the hormone effectively. Someone who is insulin-resistant doesn't use insulin well, and sugar is released into the bloodstream instead of being used to power cells in the body and brain. Insulin resistance can be a precursor to type 2 diabetes, the researchers said.

The study included 37 adults -- 29 women and eight men -- recruited at Stanford University. The study volunteers were between 21 and 75 years old. Their weight ranged from underweight to severely obese, the study authors noted. None had diabetes, but some were insulin-resistant or had pre-diabetes, the researchers said.

All of the study volunteers had depression for longer than a year. Despite standard treatments for the mental health disorder, they were still experiencing depression, the study authors said.

Rasgon and her team randomly gave the study volunteers 12 weeks of treatment with pioglitazone or an inactive placebo. People were allowed to stay on their current antidepressant treatment as well. Pioglitazone works by making people more sensitive to insulin, the researchers said.

All of the study participants were tested for depression and insulin resistance at the start of the trial, and again at the end.

People who were insulin-sensitive had improvements in their depression whether they were taking the drug or a placebo. But those who were insulin-resistant only saw improvement in their depression symptoms if they were taking the insulin-sensitizing drug. People who were insulin-resistant who took the placebo didn't get better.

The more insulin-resistant someone was, the better the drug worked on their depression, the study found.

The idea that insulin resistance could cause problems in the brain makes sense, Rasgon said. The brain uses a lot of glucose (sugar), so anything that makes it harder for the brain to get the glucose it needs could affect vital brain functions, such as controlling emotions and thinking, she suggested.

Whether it would be safe for people who don't have type 2 diabetes to take pioglitazone for long periods isn't known. Rasgon pointed out that the study was small and only done for 12 weeks. She hopes to be able to do a longer and larger trial.

"The data in this study is preliminary," said Dr. Eric Hollander, director of the anxiety and depression program at Montefiore Medical Center in New York City. "But it may eventually lead to a new paradigm that could be helpful in reducing the stigma of depression," he added.

"Mood disorders may be part of a systemic illness -- at least in a subgroup of depressed patients," he said.

Hollander suggested that improvements in insulin resistance or decreased inflammation may be what helped ease depressive symptoms.

Both experts said these findings suggest that any of the treatments for type 2 diabetes may also help people with longstanding depression. Treatments include other medications that improve insulin sensitivity, and even lifestyle factors, such as losing weight or exercising. Both of those lifestyle factors increase insulin sensitivity, too.

DIY Beauty Solutions

Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.
Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

The Real Monthly Cost of Depression

Six people reveal how much they spend to treat their depression, how they save money on medications, and more.

With an illness like depression, the cost of treatment often adds up to more than the price of medication alone. Untreated or undertreated depression can break the bank in the form of lost work, lost productivity, and hospital stays.

In fact, depression is estimated to have cost the U.S. economy more than $210 billion in 2010 (including the cost of comorbid, or simultaneously existing, conditions), according to a study published in 2015 in The Journal of Clinical Psychiatry. “The key to managing the cost of depression is managing depression itself,” says health economist Adam Powell, PhD, president of Payer+Provider, a Boston-based consulting firm that works with insurance companies and healthcare providers. “The direct cost American society spends on treating depression is far smaller than the indirect costs spent on its consequences.”

And the personal costs of effectively managing depression can add up, too. In addition to medication, many people with depression pay for therapy, top quality foods, gym memberships, yoga or mindfulness meditation classes, supplements, educational materials, or other goods and services that they feel help them manage the condition.

Here we share what six people with depression spend on the condition — including which costs they must absorb on their own — and how they cut corners to make ends meet.

Susan Hyatt, 56, Corporate Social Responsibility Advisor

Monthly Medication: $70

Additional Monthly Treatments: $420-$470

Net Monthly Out-of-Pocket Costs: $490-$540

Much of what business consultant Susan Hyatt of Denver pays to manage her depression and seasonal affective disorder (SAD) relates to keeping herself productive. And if her strategies to stay productive aren’t effective, she loses income and can’t pay for the things that help her feel and stay better. In addition to her medication — about $70 a month out-of-pocket for Wellbutrin (bupropion) and Oleptro (trazodone) — Hyatt spends about $100 to $150 on supplements and herbs each month, and a little more than $300 for exercise and other lifestyle activities that help keep her motivated to work.

For example, Hyatt, who founded the consulting company Big Purpose Big Impact, walks to Starbucks or another nearby coffee shop every day to work; her tab adds up to $4 to $8 a day. “The noise forces me to have to really concentrate to get anything done, and it works,” Hyatt says. “Once I go home, I can easily slide back into not being very motivated.”

RELATED: 5 Things Psychologists Wish Their Patients Would Do

Too little motivation becomes costly for an entrepreneur. Hyatt’s depression has caused her to miss phone calls about potential work or speaking opportunities on days when she avoids answering her phone. And as she finishes up her long-term contracts, she often finds it exhausting to apply for new ones, costing her potential income. That means she also can’t currently afford massage, acupuncture, and therapy — all of which have helped her manage her illness in the past. “Friends or family who haven’t had issues with depression or SAD may be sympathetic,” she says, “but they often can’t really get their minds around the fact that depression can be debilitating.”

Her best tip: When her Wellbutrin dosage was increased from 300 milligrams (mg) to 450 mg a day, her doctor originally prescribed three 150 mg tablets. But getting one 300 mg bottle and one 150 mg bottle saved her about $35 a month. If your doctor can similarly prescribe a specific dosage that is cheaper, the savings can add up.

Kathryn Goetzke, 44, Nonprofit Founder

Monthly Medication: $0 currently (previously up to $100)

Additional Monthly Treatments: $300-$700

Net Monthly Out-of-Pocket Costs: $300-$700

Kathryn Goetzke, who lives in San Francisco, can easily tick off the ways her depression has cost her: lost productivity, strained relationships, bad decisions, a poorly functioning immune system, and an inability to maintain boundaries. It’s also led to unhealthy habits, such as smoking, alcohol use, and overeating. But after dealing with all these ramifications of the illness, she’s now found that exercise and a healthy diet help her the most in dealing with the condition.

She avoids sugar, eats organic food, makes smoothies, and spends $75 a month on a gym membership, plus another $75 on exercise classes such as Spinning. Not included in her monthly costs is the $600 she paid for a Fisher Wallace Stimulator, an FDA-cleared wearable device that treats anxiety and depression by sending slight electrical pulses to the brain through two nodes that are attached to the temples; Goetzke uses the Stimulator twice a day.

The $150 a month she spends on supplements goes toward 5-HTP, omega-3s, vitamin D, GABA, Dr. Amen’s Serotonin Mood Support, and green powder — a supplement mixture of vitamins, minerals, probiotics, prebiotics, and other ingredients, depending on the manufacturer.

When Goetzke, who is also founder of the International Foundation for Research and Education on Depression (iFred), goes to therapy, it costs about $400 a month.

She emphasizes that depression is treatable, but many people require treatment beyond medication: Therapy is essential, she believes. And while Goetzke no longer needs medication, she would sacrifice anything for it when she did. “There is nothing more important than mental health,” Goetzke says. “I lost my dad to suicide and never want to follow in his footsteps.”

Her best tip: Goetzke has made a lot of changes to cut corners: she finds therapists covered by insurance, does workouts outside instead of taking extra gym classes, borrows books from the library, and quit drinking and smoking. But her biggest tip is to avoid making big decisions while you’re depressed.

“Give it a month to be sure it’s the right decision,” she says. “That’s really helped me avoid making expensive decisions that were more the depression talking than me.”

Maggie White, 34, Stay-At-Home Mom

Monthly Medication: $170

Additional Monthly Treatments: $500-$1,000

Net Monthly Out-of-Pocket Costs: $670-1,700

Although Maggie White, of Downers Grove, Illinois, spends $80 for Pristiq (desvenlafaxine) and $90 for Klonopin (clonazepam) each month, her other costs vary greatly depending on the month. She cares for five young children at home and needs to “keep [herself] as mentally healthy as possible” since her husband travels frequently, and her mental health affects her family, too.

Her therapy adds up to about $50 a month, and the $40 she spends on essential oils is worthwhile because the aromatherapy helps her feel better. When she can afford gym or yoga classes, they’re about $15 each, but most of her additional costs include organic foods and the $175 per month she spends on a range of supplements: vitamin D3, B-complex, B-12, magnesium/calcium, chromium, 80-billion live probiotics, flaxseed oil, potassium, zinc, and vitamin C.

“You cannot put a price on sound mental health,” White says. “If you’re walking around in that black, haunting fog so many of us know, there is no quality of life, no hope, no way to make healthy decisions, or even to know how to surround yourself with healthy people.”

Her best tip: With five kids, planning ahead and trimming the fat are the secrets to White’s household money management. Clothes are hand-me-downs or come from The Salvation Army; for food, she plans meals two weeks out and purchases only the exact groceries needed. Not only does the family skip restaurants, movies, and vacations, but they also don’t have cable TV or personal electronic devices. Instead, they watch old VHS tapes.

Lisa Keith, PsyD, Assistant Professor of Special Education

Monthly Medication: $80

Additional Monthly Treatments: $105

Net Monthly Out-of-Pocket Costs: $185

For Dr. Lisa Keith, of Fresno, California, health insurance helps tremendously with medication costs. The $80 she spends monthly on Cymbalta (duloxetine) and Abilify (aripiprazole) would cost closer to $1,000 per month if not for her insurance. In addition to the $30 she spends each month for a gym membership, $25 in co-pays for her psychiatrist, and $50 for multivitamins, iron, calcium and a few other vitamins, the Fresno Pacific University professor invested $150 in a blue light for light therapy.

“I have it good because I work full-time and have benefits,” Keith says, but those without insurance for medications are less fortunate. “I’ve spent tens of thousands of dollars over the years on medications, doctors, therapy … but the worst thing is that depression cost me a marriage. There’s no price on that.”

Her best tip: Find apps that help manage mental health effectively for you. Keith uses Headspace for meditation, Focus@Will for concentrating, and Spotify for custom music playlists.