Medications for Depression

Treat the underlying cause. Sometimes, there is a medical problem causing or worsening the depression. If so, the obvious first step is to treat that underlying condition.
St. Johns Wort is a widely marketed herbal antidepressant. Scientific studies so far have yielded mixed results as to whether or not this herb really works, but it is probably helpful for at least some patients with mild to moderate depression. The most common side effect is sun sensitivity.
Selective serotonin reuptake inhibitors (SSRIs). Serotonin is a neurotransmitter--a chemical that carries messages from one nerve to another. Patients with depression often have low levels of serotonin in their brains, and SSRIs work by improving that chemical imbalance. Examples include Fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®), and fluvoxamine (Luvox®). This is probably the most commonly used class of antidepressants today.
The most common side effects of SSRIs are increased appetite (leading to weight gain) and sexual dysfunction (reduced libido, erectile dysfunction, difficulty achieving orgasm). Bear in mind that all of these symptoms are also common in depressed patients who aren't taking medication. Also, many people have no side effects (or only mild ones), so an SSRI might actually improve some of these symptoms for you.
Some SSRIs, especially paroxetine, tend to cause a little sedation—which can help those with insomnia. Others, like sertraline and fluoxetine, tend to increase levels of energy—which is helpful for people battling fatigue or "brain fog." Citalopram and escitalopram tend not to cause either effect. For some patients, it makes sense to take a sedating medication in the evening or a stimulating one in the morning. Be aware that these are general tendencies and you will need to determine for yourself what effect any one of them has on you.
Serotonin/norepinephrine reuptake inhibitors (SNRIs). These medicines are similar to SSRIs, but they also increase brain levels of norepinephrine, another neurotransmitter that tends to be low in the brains of depressed patients. Examples include venlafaxine (Effexor®), desvenlafaxine (Pristiq®), and duloxetine (Cymbalta®). Their side effect profiles are similar to the SSRIs, except that all of the SNRIs tend to cause stimulation rather than sedation. Venlafaxine may also raise the blood pressure by about 5-10 points, which may be useful for people with low blood pressure, but a problem for those with hypertension. Duloxetine does not affect blood pressure. Desvenlafaxine is relatively new, and it is not clear if it has any effect on blood pressure or not. In addition to treating depression, the SNRIs are often helpful in controlling nerve pain.
Bupropion (Wellbutrin®, Budeprion®). This antidepressant has a mechanism of action that is completely different from the SSRIs and SNRIs, and it also has a very different side effect profile. Bupropion is one of the few antidepressants that don't tend to cause sexual dysfunction. In addition, it does not increase the appetite—it may even help people lose weight—and has been shown to help people quit smoking.
The most common side effect of this medication is a feeling of overstimulation, which often improves after the first couple of weeks of therapy. The most serious risk with bupropion is that it increases the chance of developing a seizure. The good news is that seizures are very rare in patients taking bupropion, and can usually be prevented by following a few simple guidelines. Patients with a prior history of head injury or seizure disorder should not take bupropion. Combining bupropion with alcohol also increases the seizure risk, so you should not drink alcohol while on this medication. Of course, alcohol worsens depression, so depressed patients are well advised to go alcohol-free, anyway. Finally, I always prescribe the most extended-release forms of bupropion (Wellbutrin XL®; Budeprion XL®), which reduce the seizure risk by avoiding the high blood levels of the drug that can occur with the rapidly absorbed dosage forms.
Tricyclic antidepressants (TCAs). This is one of the oldest classes of antidepressant medications. There are at least a dozen drugs in this category. Some examples include amitriptyline (Elavil®), nortriptyline (Pamelor®), and imipramine (Tofranil®). Trazodone (Desyrel) is a closely related medication that can be thought of in the same class with the TCAs. These drugs are not often used as primary treatment for depression anymore, because the newer medications discussed above usually have fewer side effects. However, some patients still respond better to the TCAs than any other type of antidepressant. Low-dose TCAs are often very powerful when used in combination with one of the newer drugs to boost the overall antidepressant effect.
Like most other antidepressants, the TCAs may cause increased appetite and sexual dysfunction. Other common side effects include dry mouth, constipation, and difficulty urinating, but these are usually less severe with lower doses. All of the TCAs are sedating, and depressed patients with insomnia often benefit from adding an evening low-dose TCA to their other antidepressant medication(s). Palpitations and slow or rapid heartbeats can also occur, but those are rare when lower doses are used. Patients with known (or a predisposition to) irregular heartbeat may need to avoid TCAs.
In addition to treating depression and insomnia, the TCAs can also help to prevent migraines and control nerve pain.
All of these antidepressants are generally effective and safe, but individual results vary widely, and you may need to try various doses of several different medications before finding the right one for you.

Is Your Caregiver Keeping You from Getting Your Annual Mammogram?

A recent study has confirmed that when physicians and caregivers are not culturally sensitive when communicating with economically disadvantaged African-American women, those health professionals may in fact be discouraging the women from getting their annual screening mammograms.
The study, published in the Journal of General Internal Medicine, confirmed that African-American women, when they go to a healthcare facility, often perceive the caregivers as being disrespectful or as giving inadequate or incomplete explanations about mammography screenings. The study went on to say that these women are also concerned that, should they ever be diagnosed with breast cancer, they wouldn't receive correct and needed treatment anyway.
The end result of all this is that these women are not bothering to get their mammograms—a calamity that needs fixing. African-American women have a 35 percent higher mortality rate from breast cancer than do Caucasian women. (In Chicago, as a matter of fact, their mortality rate is 73 percent higher!)
If you know of someone not getting their annual mammogram, for whatever reason, please help educate them about the value of screening mammography for early identification of breast cancer, so more women can survive this disease. In most cases, we can save their life (as well as their breasts.)
Most states offer free screening mammograms, too, so lack of insurance is no longer a barrier for getting the proper screening needed.
Tell me your take on this issue.

Memory Decline

Question: I have noticed a sharp decline in my long-term memory for the past two years, even more since I became pregnant and had a child. I had made major changes in my life and had started to live in the present, mostly, and enjoy and make the best of everyday. As time progressed, I noticed that my memory of the past was fading, and even when I could remember I chose not to dwell on it, whether it was good or bad. It had already taken place, and I had to go through that process to get here. Is this normal for people that are trying to become more evolved, or is it something else?
Answer: Many people notice that their memory changes as they live a more conscious and present life. As the awareness becomes more freed from past conditioning, the memory patterns associated with that conditioning also change. They become more faint and we are less identified with them, as you have already noticed. For some people, this can be a little disorienting or even disconcerting because they are afraid they are losing their memory. Generally, people find that they may not carry around all the information and memories in their mind to access it at any time like they used to, but when they need to remember something, then it is there. It is more in the spirit of living life spontaneously and in the moment, instead of life being dictated from the past.

Sleeping Less: What to Do About It

Generally, it has been assumed that the need for sleep does not decrease with age, but rather that other factors gradually come to interfere with our ability to sleep through the night.
Older individuals, for instance, are at greater risk not only for developing medical and psychiatric disorders but also for taking medications that can disrupt sleep. In spite of these influences, however, it may be that an actual biological deterioration of the sleep drive might also be playing a role.
A new study published in the journal Current Biology has been able to shed some light on this puzzle of sleep and aging. The researchers, who wanted to determine the maximal sleep capacity of both young and older persons, arranged for groups of younger adults (ages 18 to 32 years) and older adults (ages 60 to 76 years) to lie in bed for 12 hours during the night and for another 4 hours in the afternoon.
The subjects tended to sleep significantly longer at the beginning of the experiment, presumably because they were making up for a sleep debt accrued during their usual daily sleep routines. When the sleep patterns stabilized, however, the younger adults were capable of sleeping for much longer times — an average of 8.9 hours daily — than were the elderly people, who got only 7.4 hours daily. This 1.5-hour difference in maximal sleep capacity is impressive.
If your biological drive for sleep seems to have decreased, make sure that you are following the kinds of routines and behaviors that will give you the best chance of getting as much refreshing sleep as possible. Here are some examples of good sleep hygiene:
Make sure that you're going to bed early enough to allow yourself to get an adequate night's sleep.
As your bedtime approaches, develop a relaxing routine in the evening — don't keep busy until the moment before you expect to fall asleep.
Avoid watching TV in bed.
Sleep in a cool, relatively dark room.
Consider going to sleep to the sound of white noise, either from a bedside fan or a machine that generates calming sounds.
Increase your exercising, but don't do it so near to bedtime that it gets your adrenaline flowing and keeps you awake.
Limit your daily intake of caffeinated beverages and avoid them completely after lunchtime.
Avoid alcoholic beverages

America's Healthiest Restaurants

Eating out invariably raises a number of tricky questions: sit-down or drive-thru? Burgers or pizza? Thin or stuffed crust? Choosing one over the other could mean saving hundreds of calories in a single meal, and up to 50 pounds of flab in the course of a year and countless health woes over the course of a lifetime. That’s why Eat This, Not That! launched an investigation and put 66 major chain restaurants under the nutritional microscope—so that you and your family can continue to eat out, but do so knowing the types of insider tips and savvy strategies that can help melt fat all year long. And the good news is that many fan favorites scored top marks! To separate the commendable from the deplorable, we calculated the total number of calories per entrée. This gave us a snapshot of how each restaurant compared in average serving size—a key indicator of unhealthy portion distortion. Then we rewarded establishments with fruit and vegetable side-dish choices, as well as for providing whole-grain options. Finally, we penalized places for excessive amounts of trans fats and menus laden with gut-busting desserts. What we ended up with is the Eat This, Not That! Restaurant Report Card, which will show you how all of the nation’s largest eating establishments stack up nutritionally.Check out those restaurants that scored a B+ or higher:
A-Chick-fil-ABetween the breakfast and lunch menus, there are only two entrées at Chick-Fil-A that break 500 calories, a rare feat in the fast-food world. What this means is that you can't possibly do too much harm—especially if you stick to the chicken. And unlike the typical fast-food chain, Chick-Fil-A offers a list of sides that goes beyond breaded and fried potatoes and onions. (Just beware the large cole slaw, which adds an extra 600 calories to your daily intake!) That's why we dub the Atlanta-based chicken shack one of our all-time favorite fast-food restaurants.Also, be sure to check out our exclusive list of the best and worst restaurants for kids to find out why Chick-fil-A receives an even higher grade when it comes to kids’ meals.SURVIVAL STRATEGY: The worst thing you can do is supplement your meal with a milkshake—not a single cup has fewer than 600 calories. And instead of nuggets or strips, look to the Chargrilled Chicken Sandwiches, which average only 320 calories apiece.A-SubwayA menu based on lean protein and vegetables is always going to score well in our book. With more than half a dozen sandwiches under 300 calories, plus a slew of soups and healthy sides to boot, Subway can satisfy even the pickiest eater without breaking the caloric bank. But, despite what Jared may want you to believe, Subway is not nutritionally infallible: Those rosy calorie counts posted on the menu boards include neither cheese nor mayo (add 160 calories per 6-inch sub), and some of the toasted subs, like the Meatball Marinara, contain hefty doses of calories, saturated fat, and sodium.SURVIVAL STRATEGY: Cornell researchers have discovered a “health halo” at Subway, which refers to the tendency to reward yourself or your kid with chips, cookies, and large soft drinks because the entrée is healthy. Avoid the halo, and all will be well.Along those same lines, try to avoid anything from this indispensable list of the 14 worst “healthy” foods in America, too. They'll trip you up--and easily expand your waistline.
A-Jamba JuiceJamba offers a viable and tasty solution to the dearth of fresh fruits and vegetables in the American diet: Stick it all in a blender and let us slurp it up. But make this your rule: If it includes syrup or added sugar, it ceases to be a smoothie. Jamba Juice makes plenty of real-deal smoothies, but their menu is sullied with more than a few faux-fruit blends. Just make sure you choose the right one.SURVIVAL STRATEGY: For a perfectly guilt-free treat, opt for a Jamba Light or All Fruit Smoothie in a 16-ounce cup.And unless you're looking to put on weight for your new acting career, don't touch the Peanut Butter Moo'd. On this shocking list of the 20 Unhealthiest Drinks in America, it sits worryingly close to the top. (You’ll be amazed by what’s number one!) A-Au Bon PainSure the menu has its pitfalls, but what menu doesn't? The bottom line is that Au Bon Pain combines an extensive inventory of healthy items with an unrivaled standard of nutritional transparency. Each store has an on-site nutritional kiosk to help customers find a meal to meet their expectations, and the variety of ordering options provides dozens of paths to a sensible meal. SURVIVAL STRATEGY: Most of the café sandwiches are in the 650-calorie range, so make a lean meal instead by combining a hot soup with one of the many low-calorie options on the Portions menu. And if you must indulge, eschew the baked goods in favor of a cup of fruit and yogurt, or serving of chocolate-covered almonds. B+Boston MarketWith more than a dozen healthy vegetable sides and lean meats like turkey and roast sirloin on the menu, the low-cal, high-nutrient possibilities at Boston Market are endless. But with nearly a dozen calorie-packed sides and fatty meats like dark meat chicken and meat loaf, it’s almost as easy to construct a lousy meal. SURVIVAL STRATEGY: There are three simple steps to nutritional salvation: 1) Start with turkey, sirloin, or rotisserie chicken. 2) Add two noncreamy, nonstarchy vegetable sides. 3) Ignore all special items, such as pot pie and nearly all of the sandwiches. B+Cici’s Pizza BuffetCici's began in Texas in 1985 and now boasts more than 600 locations, proving definitively that Americans love a good buffet. The good news for our waistlines is that the crust is moderately sized, and the pizza comes in varieties beyond simple sausage and pepperoni. But if you check your willpower at the door, you're probably better off skipping the pizza buffet entirely. SURVIVAL STRATEGY: It takes 20 minutes for your brain to tell your body it's full, so start with a salad and then proceed slowly to the pizza. Limit yourself to the healthier slices like the Zesty Vegetable, Alfredo, and the Olé, which is a Mexican-inspired pie with only 108 calories per slice. B+McDonald’sThe world-famous burger baron has come a long way since the days of Fast Food Nation—at least nutritionally speaking. The trans fats are mostly gone, the number of gut-wrecking calorie bombs are now fewer than ever, and the menu holds plenty of healthy options such as salads and yogurt parfaits. Don't cut loose at the counter just yet, though. Too many of the breakfast and lunch sandwiches still top the 500-calorie mark, and the dessert menu is fodder for some major belly-building. SURVIVAL STRATEGY: The Egg McMuffin remains one of the best ways to start your day in the fast-food world—feel free to use it as a replacement option for any of these eight worst fast food breakfasts in America!
As for the later hours, you can splurge on a Big Mac or a Quarter Pounder, but only if you skip the fries and soda, which add an average of 590 calories onto any meal. B+Taco BellTaco Bell combines two things with bad nutritional reputations: Mexican food and fast food. The result should be horrendous, yet somehow it works out so that a little prudence at the ordering window can bag you a meal with fewer than 500 calories. The potential for belly-building is still there, but the calorie bombs are generally easy to spot. And to limit the chances of a mistake, Taco Bell reengineered some of its classic items and listed them under the Fresco Menu for a savings of up to 10 grams of fat per item. SURVIVAL STRATEGY: Grilled Stuft Burritos, anything served in a bowl, and anything prepared with multiple "layers" are your worst options. Instead, order any combination of two of the following: crunchy tacos, bean burritos, or anything on the Fresco menu.B+Wendy’sScoring a decent meal at Wendy's is just about as easy as scoring a bad one, and that's a big compliment for a burger joint. Options such as chili and baked potatoes offer the side-order variety that's missing from less-evolved fast-food chains like Dairy Queen and Carl's Jr. Plus they offer a handful of Jr. Burgers that don't stray far over 300 calories. And for our money, the ¼-lb single is one of the best substantial burgers in the industry. Where they err is in their recently expanded line of desserts and a lackluster selection of beverages. But you're happy just drinking water, right? SURVIVAL STRATEGY: The grilled chicken sandwiches and wraps don't have more than 320 calories, which is less than even a small order of French fries. Choose the chicken or a small burger and pair it with a healthy side, and then hit the door before you receive the 500-calorie penalty for giving in to your Frosty hankering.
You can check out the complete Eat This, Not That! Restaurant Report Card here.
Want to avoid some of the biggest fast-food weapons of mass inflation? Make sure you’re armed with this comprehensive list of the 20 worst foods in America in 2009.
Also, enjoy delicious low-calorie fast-food meals by familiarizing yourself with this great list of the Best Fast-Food Meals Under 500 Calories!Finally, sign up for your FREE Eat This, Not That! weekly newsletter or subscribe to the new Eat This, Not That! premium website. You’ll get thousands of useful tips, tricks, and secret insights into everything going on in the world of food and nutrition—so that you can stay lean for life while still enjoying all of your favorite foods. It’s like having a personal nutritionist on call 24 hours a day!
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Fish may be brain food for teenage boys

Swedish researchers found that among nearly 5,000 15-year-old boys they surveyed, those who ate fish more than once per week tended to score higher on intelligence tests three years later.
The findings, published in the journal Acta Pediatrica, add to evidence that fish may indeed be brain food.
Researchers believe that the omega-3 fats found in fish -- particularly oily fish like salmon, mackerel and, to a lesser extent, albacore tuna -- are important to early brain development and to maintaining healthy brain function throughout life.
Past studies have found, for instance, that children whose mothers who ate fish regularly during pregnancy tend to have higher intelligence scores than their peers, and older fish-eaters have been shown to have a lower risk of cognitive impairment.
The new study appears to be the first large-scale one to look at the effects of fish on teenagers' intelligence, lead researcher Dr. Maria Aberg, of Goteborg University, told Reuters Health.
This is important, she explained, because the late-teens are a critical period for the brain "plasticity" that underlies intelligence and emotional and social behavior. Plasticity refers to the brain's ability to reorganize the connections among cells in response to normal experience, like learning a new skill, or to injury.
The findings are based on data from 4,792 male adolescents who completed detailed questionnaires on diet and lifestyle when they were 15 years old, then underwent standard intelligence tests when they were 18.
On average, Aberg's team found, those who ate fish more than once per week scored higher than those who ate fish less than weekly. This remained true when the researchers accounted for several other factors that influence both children's diets and their intelligence scores -- like parents' education levels and the family's socioeconomic status.
"These findings are significant," Aberg said, "because the study was carried out between the ages of 15 and 18, when educational achievements can help to shape the rest of a young man's life."
It's too soon to make specific diet recommendations for teenagers, according to the researcher. "But for the time being," she said, "it appears that including fish in a diet can make a valuable contribution to cognitive performance in male teenagers."
SOURCE: Acta Pediatrica, March 2009.

Enough of the puff: tax may cut smoking rates

Expansion of a popular public health insurance program for lower income children is being financed by an increase in the federal excise tax on a pack of cigarettes of about $1.01 per pack, up from the current 39 cents on a $4.35 pack.
Smoking kills about 440,000 Americans annually and costs the nation $193 billion in medical expenses and lost productivity, said Dr. Terry Pechacek of the U.S. Centers for Disease Control and Prevention's Office on Smoking and Health.
"There is almost unanimous agreement across the scientific community and policymakers that raising the price of cigarettes in whatever fashion has a consistent effect on reducing smoking rates, increasing the quit rate among adult smokers and preventing the initiation of regular smoking by children and young adults," Pechacek said in a telephone interview.
Danny McGoldrick, the Campaign for Tobacco-Free Kids advocacy group's vice president for research, said the formula is simple: as prices rise, fewer people buy cigarettes.
McGoldrick forecast the tax hike will persuade just over 1 million current smokers to quit and prevent 2 million children from starting. These changes will avert about 905,000 smoking-related deaths and save $44.5 billion in healthcare expenses over time, McGoldrick predicted.
President Barack Obama signed the expansion of the State Children's Health Insurance Program on February 4. President George W. Bush had twice vetoed the bill, which also raises federal taxes on cigars and other tobacco products.
The industry is unhappy. Higher prices will lead to at least a 10 percent decline in cigarette sales and could put 117,000 people out of work, said Thomas Briant, executive director of the National Association of Tobacco Outlets.
LOST JOBS
Briant, whose group represents the operators of 2,500 retail stores, tobacco wholesalers, cigarette manufacturers and others, decried "the single largest tax increase on a product in the history of the United States."
"There's going to be an immediate drop-off in sales because of that tax increase as of April 1," Briant said. "We expect the fall-out from that in terms of job losses to take about six to nine months from that date."
Retail store clerks and cashiers, truck drivers who deliver cigarettes, warehouse workers, sales representatives and others may lose jobs, Briant said.
U.S. smoking rates have been declining slowly for decades. The CDC's most recent data showed about 19.8 percent of U.S. adults -- 43.4 million people -- were smokers in 2007.
Smoking rates vary by state -- from a high of 28 percent in Kentucky to a low of 12 percent in Utah. Rates are often higher where state tobacco taxes are lower. The average state tax is $1.32 per pack, ranging from a low of 7 cents in South Carolina to a high of $2.75 in New York state.
State taxes have more than doubled in the past six years and more states and localities are banning smoking from public places like office buildings, restaurants and bars.
Daniel Smith, president of the American Cancer Society's Cancer Action Network, said the next important step is for Congress to give the U.S. Food and Drug Administration power to regulate tobacco products. The FDA already oversees drugs, medical devices, most foods, cosmetics and animal drugs.
A House of Representatives panel approved the long-stalled measure on March 4. It still needs passage by the full House and Senate. "This is the year to make it happen," Smith said.
(Editing by Maggie Fox and Todd Eastham)

Exposure to Peanuts May Build Tolerance to Allergy

However, the researchers, from Duke University Medical Center and Arkansas Children's Hospital, cautioned that the approach is still experimental and should not be tried by parents on their own.
"This is not something to be done at home," said Dr. Wesley Burks, chief of the division of pediatric allergy and immunology at Duke and a co-author of the research. "It truly is an investigational study."
But the children in the study did build long-term tolerance, with the researchers documenting key immunologic changes reflecting a lack of allergic response.
Burks and his colleagues were expected to present their findings Sunday at the American Academy of Asthma, Allergy & Immunology meeting, in Washington, D.C.
About four million American have allergies to foods, and tree nut allergies, including peanut allergies, are the most common. For the highly allergic, exposure to even a trace amount of peanuts can provoke a life-threatening reaction. Nearly half of the 150 deaths attributed to food allergies each year are caused by peanut allergies, according to background information in the study.
For the study, which began five years ago, Burks and his colleagues gave children with a history of peanut allergy gradually larger daily doses of peanut protein, while other allergic children were given a placebo. The starting doses were very small, as little as 1/1000th of a peanut. The doses increased until the children ate the equivalent of up to 15 peanuts a day about 10 months later, and then they stayed on the daily therapy while they were monitored.
Nine of the 33 children participating in the study have been on maintenance therapy for more than 2.5 years, and four of them were able to discontinue the treatment and eat peanuts, the researchers said.
When the researchers tracked immunologic changes -- specifically levels of an antibody called immunoglobulin E, which the body makes in response to allergens -- they found the levels had declined to nearly nothing at the end of the trial.
"I think what has been shown in this [research] is that the threshold [at which allergic reactions begin] really can change with treatment," Burks said.
Changing the threshold is valuable, he said, because it could mean that if a child with a peanut allergy accidentally ate something with peanut in it, he may have no reaction. "If you do that alone, you give the family comfort," he said.
Still to be answered is whether doctors can "make the disease go away," Burks said, adding that his research will continue.
The concept of exposing an allergic person to small amounts of the allergen isn't new, of course, said Dr. Scott Sicherer, associate professor of pediatrics and chief of the division of pediatric allergy and immunology at Mount Sinai School of Medicine in New York City.
That's the idea behind allergy shots.
"I think this [Duke-Arkansas] is very promising, the results," added Sicherer, who's also chairman of the American Academy of Pediatrics' Section on Allergy and Immunology.
Funding for the study was provided by the U.S. National Institutes of Health, the Food Allergy & Anaphylaxis Network, the Food Allergy Project, the Gerber Foundation and the Robins Family Foundation.

Report says 3 percent in DC have HIV or AIDS

The findings in the 2008 epidemiology report by the D.C. HIV/AIDS Administration point to a severe epidemic that's impacting every race and sex across the population and neighborhoods.
Scheduled to be released Monday, the report says that the number of HIV and AIDS cases jumped 22 percent from the nearly 12,500 reported in 2006. Almost 1 in 10 residents between ages 40 and 49 are living with HIV, and black men had the highest infection rate at almost 7 percent.
The report says that the virus is most often transmitted by men having sex with men, followed by heterosexual transmission and injection drug use.

Making a Change: Attitude is Everything

1. Understand the power of attitude. Keith Harrell writes, “Your attitude is a powerful tool for positive action.” When you embark on a mission to improve your health, your attitude about how you approach this goal can be even more important than the plan itself. Even the healthiest meal plans have fallen by the wayside when the planner's deep-down attitude was a feeling of doom and gloom or a lack of confidence. Going into your mission with a can-do attitude is key to success in anything in life, including weight loss.
2. Choose to take charge of your life. Keith Harrell again: “To transform your attitude into action, you must accept responsibility for what goes on inside your mind by monitoring your internal dialogue.” One of my favorite yoga teachers mentioned just last month that the average person has about 60,000 thoughts a day, most of them negative, and most of them repetitions of the same few thoughts! How are your thoughts? Could they be more positive? How could you quiet the little A.M. radio that is constantly chattering inside our minds? Meditation, deep breathing, yoga, or relaxing music can all help here.
3. Identify through self-awareness those attitudes that are holding you back and the ones that are propelling you forward. It’s easier said than done, but since life only happens in the present, try to focus on the here-and-now and let go of beliefs—and even relationships—that are holding you back. Such self awareness can be vital in your making huge leaps to a more positive lifestyle, happiness, and success. Mr. Harrell suggests creating “a private-life game plan” by writing out specific goals for our lives.
4. Reframe that bad attitude. Mr. Harrell suggests that negative attitudes, such as anger, can be transformed into gratitude and forgiveness by shifting our perspective. Letting go of not only past regrets but also angst about the future is key to optimizing your contentment. I’ve read a few books by the Dalai Lama where he deals with how to find happiness and peace in life, and gratitude seemed to be a common thread. If we can’t feel gratitude for where we are now, regardless of our discontents—perhaps about our weight or our current position in life—then future success will be limited, at best.
5. Find your purpose and passion. Understanding the importance of living your life with purpose and passion—that is, having a personal vision—is critical to achieving success. It’s easy to get into a rut in life, whether it’s a dead-end job you dread or a relationship that’s been dead for some time. The alternatives—change and fears of not finding another job or relationship—are scary; however, life is too short to linger in situations that are stagnant.
Bringing it back to weight loss These same principles apply to your diet. Are you eating fast foods because they’re convenient and easy and then feeling sluggish and kicking yourself afterward? Consider meeting with a registered dietitian to get a fresh start on your eating and your overall health. You also might want to check out alternative medicine, such as acupuncture or yoga, or visit a holistic counselor. A life coach might help you find just the direction you’re looking for to help you meet goals that you have not even realized you had. Go for it, my dear readers! In the future, I’ll include Keith Harrell's remaining 5 life-changing steps to turning attitude into action. I hope you’ll join me!

The Side Effects of Antidepressants

The testing that is performed in humans during clinical trials confirms whether medications are doing the positive things they are supposed to be doing. These clinical investigations also help predict the negative side effects that future patients may experience. "Adverse events" are the undesired things that researchers keep track of while medications are being tested in people. Adverse events can be mild or severe, and they can be common or rare.
So, like all medications for all disorders, antidepressants have some desired actions and some potentially undesirable actions. Side effects are the actions we don't like, although occasionally what is good for one person may be bad for another. Some antidepressants, for example, increase appetite and cause weight gain, which may be very beneficial for some patients, but a huge problem for others. Sedation from some antidepressants can help with insomnia, but also can lead to undesired sleepiness during the day for some people.
The side effects of antidepressants may be minor and easy to tolerate, or they may be so severe that people stop taking the medications. Many people experience no side effects with antidepressants, but, very rarely, side effects can be fatal. Usually side effects are considered to be direct effects of the drugs, but people sometimes have allergic reactions (mild or severe) to these medications that are really caused when the body's immune system reacts abnormally to the presence of the drug.
Some antidepressant side effects are relatively common, while others almost never occur. Some of the side effects are similar for most antidepressants or for major classes of the drugs, while others occur only with individual medications. When people are taking two or more medications, drug-drug interactions can sometimes cause problems, even when the drugs are being taken for entirely different conditions.
The list of possible antidepressant side effects is extremely long. Relatively common problems with the tricyclic antidepressants (TCA), for example, include dry mouth, blurred vision, constipation, and sedation.
More common problems with the selective serotonin reuptake inhibitors (SSRIs­) such as Prozac include insomnia, gastrointestinal symptoms such as nausea, and sexual dysfunction problems such as decreased arousal and difficulty achieving orgasm.
If you are taking an antidepressant, make sure you know about the common side effects for that particular drug and what symptoms you should ask your doctor about if they should appear. Be sure to talk to your doctor or other health care providers about any concerns you have about your medications in general, and make sure that anyone prescribing medications for you knows all the other medications you are taking.
And please remember: If you are having difficulty with one antidepressant, don't give up on all of them. There are many different choices and so it is likely that one will help you without causing bothersome side effects.

Five Steps to a 5-Star Body

Sleep! Try to catch 7 to 9 hours each night. This, I know from personal experience, can seem like an unrealistic goal, but the amount of research that supports the connection between shut-eye and health makes me shoot for this star every day. For starters, catching enough zzz’s can help you lose weight. In a study of more than 68,000 women, those who dozed seven hours a night weighed 5.5 pounds less than women who slept five hours or less. Ample sleep encourages your body to make more of the fullness hormone leptin and less of the hunger hormone ghrelin, so you’re not as hungry. Snoozing can also curb anxiety and depression, both of which can lead to emotional eating. As if that’s not enough reason, too little rest can cloud moral judgment, too. Try going to bed just 30 minutes earlier each night to see how much you’ll benefit.
Exercise! Yes, breaking a sweat can help you lose weight, but it can also curb cravings, help you live longer, reduce stress, undo some of the damage of eating fatty foods—and those are just a few of the benefits. Aim for 30 minutes a day—even a walk counts toward your tally—and give yourself a star each time you fulfill that goal with any one of your favorite workouts.
Eat right! No, you don’t have to count calories. You can eat healthy and have delicious, filling and satisfying meals (snacks, too!). If you’re doing the 2009 SELF Challenge, give yourself a star for every day that you eat according to the Challenge meal plan and log your meals in your online food diary. If you’re not doing the Challenge, you can still snag a star when you’ve eaten in a way that makes your body feel good—and you feel proud. For me, that’s when I opt for yogurt with berries rather than a muffin at breakfast, have a salad with tofu for lunch and choose salmon over steak at dinner, then skip the ice cream pig-out late at night. Yes, it’s that simple! I’m not perfect, and there are definitely days when I have a second glass of wine or a too-generous square of my favorite dark chocolate bar, but I find that once I start building that five-star day, I get invested in it and want to keep it up.
Stretch! Limbering up is a way to thank your muscles for all the hard work they do for you each day. It can also help you increase your overall range of motion, making exercise seem less difficult. And when workouts are less daunting, you’ll not only enjoy them more, but you also will probably do them more often, too! To me, yoga and pilates count, as does just stretching at the kitchen counter as I watch the headlines in the morning. No need to set aside a huge block of time! However you choose to go Gumby, give yourself a star for treating your body to a break.
Talk yourself up! This might be the most important part of the five-star plan: Giving yourself a well-deserved pat on the back for simply being strong, smart and healthy. Even on days when you only notch one or two other stars, take a moment to give yourself credit for being a truly amazing human being. Talking yourself up carries over to other areas of your life: Not only will you feel more confident, but research shows you will also get sick about 30 percent less frequently, stave off emotional eating and reduce your cancer risk. There are plenty of other reasons to celebrate your body. Pretty impressive for a few pats on the back!
Create your own five-star days: When you join the Challenge, you can use our free online logs to track the stars you earn each day. Counting stars is motivating, and rewarding yourself for smart, healthy behavior is more inspiring than the negative mind-sets required by most "diets." I had to create a system in my own head that was simple, easy to track and optimistic. The best part is that you get to start fresh every day, so even if you only manage one or two stars one day, you can stay with it by going to sleep early and telling yourself, like Scarlett O’Hara, tomorrow is another day!

What Is a Denture?

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position. Complete dentures are either "conventional" or "immediate." A conventional denture is placed in the mouth about a month after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed. The drawback behind an immediate denture is that it may require more adjustments after the healing has taken place.

Who needs a denture?
Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

What happens when you get a denture?
A dentist can make a full conventional denture when all teeth have been lost or all extraction sites have healed (up to eight weeks or longer.) The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient's final denture is placed, following any minor adjustments. New denture wearers need time to get accustomed to their new "teeth" because even the best fitting dentures will feel awkward at first. While most patients can begin to speak normally within a few hours, many patients report discomfort with eating for several days to a few weeks. To get accustomed to chewing with a new denture, start with soft, easy-to-chew foods. In addition, denture wearers often notice a slight change in facial appearance, increased salivary flow, or minor speech difficulty.

How do you care for a denture?
A denture is fragile, so it is important to handle it with care. Remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpastes. Never use harsh, abrasive cleansers, including abrasives toothpastes, because they may scratch the surface of the denture. Don't sterilize your denture with boiling water because it will cause it to become warped. If you wear a partial denture be sure to remove it before brushing your natural teeth. When not in use, soak it in a cleanser solution or in water. Get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.

Should a denture be worn at night?
While you may be advised to wear your denture almost constantly during the first two weeks- even while you sleep-under normal circumstances it is considered best to remove it at night. Research has shown that removing the denture for at least eight hours during either the day or night allows the gum tissue to rest and allows normal stimulation and cleansing by the tongue and saliva. This promotes better long-term health of the gums.

Continue seeing your dentist regularly
It is important to continue having regular dental checkups so that a dentist can examine oral tissues for signs of disease or cancer. As of aging, your mouth will continue to change as the bone under your denture shrinks or recedes. To maintain a proper fit over time, it may be necessary to adjust your denture or possibly remake your denture. Never attempt to adjust a denture yourself and do not use denture adhesives for a prolonged period because it can contribute to bone loss. When in doubt, consult your dentist.

Are there any alternatives to dentures?
Dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. Strategically placed support, or implants, can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble the "feel" of real teeth. Dental implants are becoming the alternative of choice to dentures, but not everyone is a candidate for implants. Call your dentist for advice.
Last Updated: January 1, 2003