Mental health

The Dark Side of AI in Mental Health

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— High demand for AI training data may increase unethical practices in collecting patient data

A photo of a box of tissues and a glass of water sitting on a coffee table in a therapists office.

With the rise in patient-facing psychiatric chatbots powered by artificial intelligence (AI), the potential need for patient mental health data could drive a boom in cash-for-data scams, according to mental health experts.

A recent example of controversial data collection appeared on Craigslist when a company called Therapy For All allegedly posted an advertisement offering money for recording therapy sessions without any additional information about how the recordings would be used.

The company’s advertisement and website had already been taken down by the time it was highlighted by a mental health influencer on TikTokopens in a new tab or window. However, archived screenshots of the websiteopens in a new tab or window revealed the company was seeking recorded therapy sessions “to better understand the format, topics, and treatment associated with modern mental healthcare.”

Their stated goal was “to ultimately provide mental healthcare to more people at a lower cost,” according to the defunct website.

In service of that goal, the company was offering $50 for each recording of a therapy session of at least 45 minutes with clear audio of both the patient and their therapist. The company requested that the patients withhold their names to keep the recordings anonymous.

The website stated that the company was committed to providing “top-quality therapy services” for individuals. And the recordings would be used by its research team “to learn more about approaches to mental healthcare.”

There were no further details about how the company planned to use those recordings, and they did not respond to requests from MedPage Today to clarify their business model.

However, experts suggested this is just one example of an unexpected incentive created from the growth of AI in mental healthcare.

John Torous, MD, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston, told MedPage Today that misuse of patient data related to AI models is an “extremely legitimate concern,” because large language models are only as good as their training data.

“Their chief weakness is they need vast amounts of data to truly be good,” Torous said. “Whoever has the best data will likely have the most practical or — dare I say — the best model.”

He added that high-quality patient data is likely going to be the limiting resource for developing AI-powered tools related to mental healthcare, which will increase the demand and, therefore, the value of this kind of data.

“This is the oil that’s going to power healthcare AI,” Torous added.

“They need to have millions, if not billions, of examples to train on,” he added. “This is gonna become a bigger and bigger trend.”

Torous highlighted that mental healthcare technology companies have already been caught crossing this line with unethical use of patient-facing AI tools.

For example, in early 2023, nonprofit mental health platform Kokoopens in a new tab or window announced that it used OpenAI’s GPT-3 to experiment with online mental health counselingopens in a new tab or window for roughly 4,000 people without their informed consent. The announcement, which came from the CEO Rob Morris’ X (formerly Twitter) accountopens in a new tab or window, highlighted the lack of understanding around ethical concerns related to patient consent from these companies, Torous said.

Another example, he noted, came when users of the text message-based mental health support tool Crisis Text Lineopens in a new tab or window learned that the company was sharing their data with a for-profit AI sister companyopens in a new tab or window called Loris.ai. Eventually, the company ended the relationship after substantial backlash from its usersopens in a new tab or window.

While concerns around patient data persist, there are also notable clinical implications for patient care and safety, according to Jacob Ballon, MD, MPH, of Stanford University in California.

“I would not want someone to do AI therapy on its own,” he told MedPage Today, adding that people seek out psychotherapy to help with complex, sometimes life-threatening, mental health conditions. “These are serious things that people are dealing with and to leave that to an unregulated, unmonitored chatbot is irresponsible and ultimately dangerous.”

Ballon added that he doesn’t think AI models are capable of producing the nuanced expertise needed to help individual patients address their unique mental health concerns. Even if a company could train their AI chatbot on enough high-quality patient data, it would not be able to appreciate the complexity of each patient, he noted.

Despite those concerns, Torous thinks there will be growth in companies attempting to train AI models on patient data, whether it is collected ethically or not.

“There’s probably going to be this whole world where I wonder if patients are going to be pressured or cajoled or convinced to give up their [personal health data],” he said, predicting that the market for patient mental health data will only continue to grow in the coming years.

How Air Pollution Affects Our Brains

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An expert Harvard panel discusses the links between air pollution and dementia, learning, mental health, and mood.

How air pollution impacts our brains
At Harvard, an expert panel discussed how air pollution affects dementia, learning, mental health and mood.

Emerging evidence shows that exposure to air pollution increases the incidence and progression of Alzheimer’s, Parkinson’s, and other neurocognitive diseases, according to Francesca Dominici. She spoke as part of a panel on how air pollution affects the human brain, held February 27 at the Harvard T. H. Chan School of Public Health (HSPH). Dominici, one of world’s leading data scientists studying the health effects of fine particles, was joined on the panel by Joseph Allen, an expert on indoor air pollution; Maite Arce, president and CEO of the Hispanic Access Foundation; and Marc Weisskopf, who studies the biological mechanisms that make PM 2.5 (particles that are 2.5 microns or smaller in diameter) deadly. The group discussed both outdoor and indoor air pollution, the physiological pathways particles travel within the human body, their mental health effects, the elevated impacts on underprivileged groups in the United States, and the Environmental Protection Agency’s (EPA) new fine particle regulations.

Dominici, the Gamble professor of biostatistics, population, and data science, has been working with HSPH colleagues to analyze the healthcare records of millions of Americans in the Medicare and Medicaid programs, and linking them to each person’s long-term exposure to fine particle pollution. “What we are finding, with enormous statistical power,” she said, “is that long-term exposure to fine particulate matter increased the incidence of hospitalization for Alzheimer’s disease.” It also accelerates the progression of the disease, as well as the rate of hospitalization and mortality from all causes.

Why are fine particles so biologically dangerous? “The exploration of air pollution and the brain is relatively new,” Weisskopf said. The “wealth of data” and research documenting the cardiovascular effects of inhaled fine particles, much of it conducted at HSPH, sparked interest in the possibility that the brain, which is “hugely dependent” on the blood supply, might also be affected, he continued. Particles can generate inflammatory immune responses in the systemic circulation, according to Weisskopf, Drinker professor of environmental epidemiology and physiology, which can then affect the brain. But fine particles may be able to reach the brain directly, he continued: “When you breathe in through your nose, you’re smelling things because you have neurons that are kind of sticking out in the world, exploring it that way. And we now understand that some particles, or aspects of particles, can actually get transported directly back into the brain—skipping the lungs and the cardiovascular system.” The precise biological pathways, he said, are an active area of research.

Air pollution also affects mental health, explained associate professor of exposure assessment science Joseph Allen. An HSPH program studying the research into this link, largely in children, he said, has found that “air pollution is linked to anxiety and suicide ideation, as well as pediatric hospitalizations for pediatric disorders.”

Allen’s own work focuses on indoor air quality. One of his double-blind studies of office workers introduced chemicals off-gassed by dry cleaning and dry-erase markers into environmentally controlled workspace. During such exposure, office workers performed worse on tests of cognitive function, such as seeking and utilizing information, as well as on tests of strategic decision-making, and response to a crisis. A second study that assessed the impact of air pollution penetrating a building from outside and affecting workers at their desks demonstrated similar outcomes. As Allen summarized the research, “In all these dimensions—in office workers, university workers, kids in elementary school, high school students—we see over and over the impacts of air pollution on the whole range of mental health, from anxiety all the way through higher order cognitive function.”

Sabrina Shankman, a Boston Globe reporter who moderated the event, then asked about the disparate impact of air pollution on communities of color. Dominici recalled that in one of her studies of air pollution by U.S. census tract, published three years ago in Nature, she and her colleagues found higher percentages of underrepresented minorities in the most polluted areas. Such pollution has decreased substantially due to the Clean Air Act, she noted—but strikingly, the racial disparities crossed socioeconomic lines. “Very surprising to me,” Dominici said, “was that high socioeconomic status black Americans” were exposed to higher levels of air pollution than the “lowest socioeconomic status white Americans.” She continued, “That tells you a lot about systemic bias and racism.” The reason, she believes, is less pressure from local communities on siting decisions and less attention to enforcement of EPA fine particle regulations. Such disparities are not just artifacts of historic practices such as redlining. “A study that we are conducting right now on exposure to air pollution from cryptocurrency data mining, which is not regulated in the United States,” Dominici said, indicates that the buildings that house these energy-intensive operations tend to be located in lower socioeconomic status and underrepresented minority neighborhoods, where there is less knowledge and pressure from citizens and local governments.

Maite Arce, of the Hispanic Access Foundation, has been trying to change that dynamic in Latino communities through a program called “The Air That We Breathe.” The effort has recruited citizen scientists from 12 communities who are talking about air pollution and learning from experts in air quality. The program is deploying sensors in churches to monitor and report local air quality; the data gathered are then entered into an online map. Because “we’re starting at zero in terms of the knowledge” about PM 2.5, Arce said, local leaders are developing materials tailored to the needs of their primarily Spanish-speaking or immigrant communities. They’re disseminating that information through “sermons…, film screenings, roundtables, community workshops, radio and social media.” And they help residents prepare to react on days of poor air quality through masking or staying indoors. Parents understand that airborne pollution “may increase respiratory infections in children, which can lead to symptoms like asthma, and that can lead to school absences,” she reported. But the understanding that proceeds from this public health education is “eye-opening for them, and makes them feel that urgency to take action,” Arce said, “…to really urge for policy change.”

The conversation then turned to the new EPA fine particle regulations, which reduce the standard for U.S. air pollution from 12 micrograms of particles per cubic meter of air to nine. Dominici called this “the biggest public health victory in a long time” and expressed pride in HPSH’s instrumental role in the decision, stretching from the early “Six Cities” study 30 years ago to the most recent research. States will have to develop action plans and examine the inventory of local sources of particle pollutants, from traffic, industry, or power plants, she explained. The result will be “longer life for everybody, so it’s really good, a fantastic victory.”

On the other hand, there is no safe level of particle pollution—the cleaner the air, the healthier are the people who breathe it, the data show—so the standard could have been lower. “One might ask, well, why not zero?” she asked. “But that is nearly impossible because there is always going to be some background fine particulate matter.” Dominici characterized the new standard—nine micrograms per cubic meter—as “a compromise between the science and the political landscape.” Weisskopf, who served on the panel that recommended the new standard, provided some insight into “how the sausage gets made.” Some of the decision-makers on the panel argued for a higher number, while he and other public health advocates pushed for lower exposures. Paradoxically, a lot of the best data showing the health benefits of even lower exposures come from Canada, which has cleaner air than the United States. But the panel favored U.S. evidence, so demonstrating the value of an even better standard was difficult. The World Health Organization, he noted, suggests a target of five micrograms of fine particle pollutants per cubic meter.

Given that context, Allen segued to the “major disconnect” between the legally enforceable limits on particles outdoors, and those applying indoors. The Occupational Safety and Health Administration (OSHA) standard for workplaces, currently 5,000 micrograms per cubic meter, is more than 500 times the outdoor standard. That limit is “grossly out of date,” he said, a fact that OSHA acknowledges. The agency does enforce lower standards for chemicals, silica, asbestos, and other hazardous materials, but lacks the legal authority to set standards outside the workplace. In other words, Allen said, there is no national indoor air quality standard for all the places where OSHA doesn’t have oversight: classrooms, offices, and so on. Nor are there sufficient data about the long-term effects of indoor air pollution—even though that is where most exposures occur, because people spend most of their time indoors. “A loose collection of researchers” is trying to raise funds for such studies, he reported, but with no encompassing regulatory authority to enforce standards it’s unclear how such data might be used.

Well-designed buildings can cut indoor exposure to dangerous levels of outdoor air pollution to well below the EPA standard, as occurred during last summer’s wildfires. Allen said that even retroactively fitted high quality air filters can dramatically improve indoor air in schools, offices, and homes during such events, which are expected to increase in frequency with climate change. Weisskopf added that more research is also needed on the toxicity of various indoor air pollutants; a recent study implicated wildfire smoke, which can penetrate indoors, in dementia. More work needs to be done to assess the toxicity of other types of particles, he emphasized, because their chemical composition varies depending on their source (a gas stove, an oil-filled cooking skillet, a farm engaged in agricultural burning, or something else entirely), as may the physiological effects.

Shankman brought the event to a close with a final question for each of the panelists: “If you could change one thing today to improve air quality what would it be?”

  • “Expand the number of citizen scientists in the most affected communities,” Arce said.
  • “Get the standards changed for how we design and operate buildings,” Allen said.
  • “Shut down all the coal-fired power plants,” Dominici said.
  • “Lower the [EPA] standard further,” Weisskopf said.

And with that, the audience dispersed, trading the well-ventilated environs of HSPH for the ambient air of Huntington Avenue and the nearby Mission Hill neighborhood.

Closing the global gap in adolescent mental health.

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Effective and sustainable interventions to address the global burden of mental disorders in children and adolescents require evidence-based research that fully acknowledges the social, cultural and economic challenges.

People experience substantial physical, social and psychological transformations during adolescence that are linked to susceptibility to both positive influences and negative influences. Adolescents in low- to middle-income countries (LMICs) are particularly vulnerable to adverse and traumatic experiences, as they often must deal with negative socioeconomic, cultural, political and environmental circumstances.

At the end of 2023, the World Health Organization (WHO) and UNICEF published their first psychological intervention, called Early Adolescent Skills for Emotions (EASE)1, for young adolescents affected by distress. The WHO–UNICEF EASE intervention addresses a major unmet need for new approaches to the prevention or treatment of mental health conditions in the global adolescent population. Although considerable research already exists on the effectiveness of psychological interventions for young people, these data are almost entirely from high-resource settings and high-intensity interventions delivered by mental health professionals2. Given that 90% of the world’s 1.2 billion adolescents live in LMICs3, more evidence is needed to show how these interventions can be implemented in these settings, in which healthy development is often threatened by rapid social and economic change, exposure to conflict, increased urbanization, the widening gap between rich and poor, and gender disparities.

Major challenges limit the capacity to effectively deliver mental health interventions in LMICs. Governments and donors in these regions have not made the psychosocial well-being and development of children and adolescents a priority, and investment has often been inadequate and misplaced. This has resulted in a lack of specialists, with the average number of psychiatrists who specialize in treating children and adolescents being less than 0.1 per 100,000 in LMICs3, which is 100 times less than the median in the United States4. The lack of investment also limits the capacity of frontline workers, such as community-based workers, who are not equipped to address the toll of mental health across multiple sectors, including primary healthcare, education, social protection and child protection. Even when interventions are available, stigma and discrimination against children and adolescents with mental health conditions and their families act as a barrier to accessing treatment options5. Children and adolescents with mental health conditions also face the risk of human rights violations, including unequal access to education and health services, unnecessary separation from caregivers, institutionalization, exposure to violence and neglect5. Finally, comprehensive age- and sex-disaggregated data on child and adolescent mental health and development are lacking in most LMICs, where only 2% of the mental health data available is on children and adolescents3. Without data, it is difficult to know which interventions should be scaled up to give more young people access to the support they need.

Priorities must focus on closing the research gaps in epidemiology, intervention and implementation approaches to improve child and adolescent mental health in low-resource settings. Epidemiological studies using standardized methods and International Classification of Diseases criteria need to be done to determine the extent or severity of untreated mental disorders in adolescents living in LMICs, as has been done for adults6. Interventions must be designed to be delivered at low cost by non-specialists, and at scale, such as lay-counselor-delivered interventions for adolescent mental health problems in schools in low-income areas in India7. Collaborations with local stakeholders, community leaders and people with lived experiences are needed in order to design interventions that are culturally acceptable and address the challenges of the community. Finally, a bigger focus on implementation research is needed to better understand the feasibility, acceptance and cost of an intervention within the setting before implementation. For example, a recent implementation trial demonstrated the feasibility and acceptance of a newly developed internet-based application in helping to close communication gaps for Farsi- or Arabic-speaking refugees receiving inpatient treatment for depression, anxiety disorder or post-traumatic stress disorder in Germany8. These implementation studies should also look at the effectiveness of interventions across Sustainable Development Goal outcomes beyond health, such as school achievement, employment and gender equity.

Studies indicate that local data have a decisive role in modifying professional practice in health care. A large survey found that healthcare providers in LMICs believe that research done and published in their own country is more likely to change their clinical practice than is research generated in high-income countries9. Despite that, only about 10% of randomized controlled clinical trials of mental health in children and adolescents are in LMICs, with the vast majority focusing on psychopharmacological interventions10. The lack of high-quality studies assessing psychosocial or combined treatments for childhood mental health conditions, particularly in LMICs, is particularly relevant, as these interventions require culture-specific evidence.

The switch to delivering mental health services or interventions through digital platforms has the potential to make health, education and social service systems more effective, efficient and equitable, and expand access to children and adolescents who have typically not been reached by conventional means. Reports show that an increasing number of people in low-resourced settings are finding ways to access the internet, particularly through mobile devices. Pilot studies have highlighted the feasibility and acceptance of video-conferencing-based platforms used by psychiatrists for diagnosis or follow-up care for people with depression and other mental disorders in Somaliland, South Africa and India11. A guided, internet-delivered cognitive behavioral treatment for anxiety and depression yielded high remission rates in resource-constrained settings in two Latin American countries12, and online-video-game-based interventions are promising strategies for supporting depression treatment in young female adolescents13. These technologies may be able to address some of the major challenges in LMICs, including a lack of frontline workers and/or specialists, and the reluctance of some to seek services because of stigma, long travel distances or out-of-pocket expenses.

Failure to adequately meet and protect the mental health and psychosocial well-being needs of children and adolescents in LMICs now could put an entire generation at risk, with profound social and economic consequences over the long term.

Sleep, Circadian Rhythm, and Mental Health

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Summary: A new study highlights the critical link between sleep, circadian rhythms, and psychiatric disorders, suggesting that disturbances in sleep and internal body clocks can trigger or exacerbate mental health issues. The research underscores the prevalence of sleep-circadian disturbances across all psychiatric disorders, pointing to the need for holistic treatments that address these factors.

The review emphasizes the potential of new therapeutic approaches, such as light therapy and cognitive behavioral therapy for insomnia (CBT-I), to improve mental health outcomes. This work, incorporating insights from an international team, marks a step forward in understanding and treating psychiatric conditions by focusing on sleep and circadian science.

Key Facts:

  1. Prevalence of Sleep-Circadian Disturbances: Sleep and circadian rhythm disturbances are commonly found across psychiatric disorders, with significant impacts on conditions like insomnia, bipolar disorder, and early psychosis.
  2. Potential Mechanisms: The review explores mechanisms such as genetic predispositions, exposure to light, and changes in neuroplasticity that contribute to the link between sleep-circadian disturbances and psychiatric disorders.
  3. Therapeutic Approaches: Highlighting the effectiveness of treatments like light therapy and CBT-I, the review suggests targeting sleep and circadian factors could lead to innovative treatments for psychiatric conditions.

Source: University of Southampton

Problems with our sleep and internal body clock can trigger or worsen a range of psychiatric disorders, according to a new review of recent research evidence.

The review, published today [19 February] in Proceedings of the National Academy of Sciences (PNAS), suggests gaining a better understanding of the relationship between sleep, circadian rhythms and mental health could unlock new holistic treatments to alleviate mental health problems.

This shows a man sleeping.
Cognitive Behavioural Therapy for Insomnia (CBT-I) has been shown to reduce anxiety and depressive symptoms, as well as trauma symptoms in people experiencing PTSD.

“Sleep-circadian disturbances are the rule, rather than the exception, across every category of psychiatric disorders,” says Dr Sarah L. Chellappa from the University of Southampton, senior author of the review. “Sleep disturbances, such as insomnia, are well understood in the development and maintenance of psychiatric disorders, but our understanding of circadian disturbances lags behind.

“It is important to understand how these factors interact so we can develop and apply sleep-circadian interventions that benefit the sleep and mental health symptoms of patients.”

An international team of researchers from the University of Southampton, Kings College London, Stanford University and other institutions explored recent evidence on sleep and circadian factors, focusing on adolescents and young adults with psychiatric disorders. This is a time when people are most at risk of developing mental health disorders and when disruption to sleep and circadian rhythms are likely to occur.

Insomnia is more common in people with mental health disorders than in the general population – during remission, acute episodes and especially in early psychosis, where difficulty falling and staying asleep affects over half of individuals.

Around a quarter to a third of people with mood disorders have both insomnia and hypersomnia, where patients find it hard to sleep at night, but are sleepier in the daytime. Similar proportions of people with psychosis experience this combination of sleep disorders.

Meanwhile, the few studies looking at circadian rhythm sleep-wake disorders (CRSWD) suggest that 32 per cent of patients with bipolar disorder go to sleep and wake later than usual (a condition called Delayed Sleep-Wake Phase Disorder). Body clock processes (such as endogenous cortisol rhythms) have been reported to run seven hours ahead during manic episodes and four to five hours behind during the depressive phase. Timing is normalised upon successful treatment.

What are the mechanisms?

The researchers examined the possible mechanisms behind sleep-circadian disturbances in psychiatric disorders. During adolescence, physiological changes in how we sleep combine with behavioural changes, such as staying up later, getting less sleep on school nights and sleeping in on weekends.

Dr Nicholas Meyer, from King’s College London, who co-led the review said: “This variability in the duration and timing of sleep can lead to a misalignment between our body clock and our sleep-wake rhythms can increase the risk of sleep disturbances and adverse mental health outcomes.”

Researchers also looked at the role of genes, exposure to light, neuroplasticity and other possible factors. Those with a genetic predisposition towards a reduced change in activity levels between rest and wake phases are more likely to experience depression, mood instability, and neuroticism. Population-level surveys show self-reported time outdoors was associated with a lower probability of mood disorder. Sleep is thought to play a key role in how the brain forms new neural connections and processes emotional memories.

New treatments

Dr Renske Lok, from Stanford University, who co-led the review said: “Targeting sleep and circadian risk factors presents the opportunity to develop new preventative measures and therapies. Some of these are population-level considerations, such as the timing of school and work days, or changes in the built environment to optimise light exposure. Others are personalised interventions tailored to individual circadian parameters.”

Cognitive Behavioural Therapy for Insomnia (CBT-I) has been shown to reduce anxiety and depressive symptoms, as well as trauma symptoms in people experiencing PTSD.

In unipolar and bipolar depression, light therapy (delivered on rising in the morning) was effective compared with a placebo. Using it in combination with medication was also more effective than using medication alone. Other findings suggest light is effective in treating perinatal depression.

The timing of medication, meals and exercise could also impact circadian phases. Taking melatonin in the evening can help people with Delayed Sleep-Wake Phase Disorder to shift their body clock forward towards a more conventional sleep pattern and may have beneficial effects in comorbid psychiatric disorders. Nightshift work can adversely affect mental health but eating in the daytime rather than during the night could help, with research showing daytime eating prevents mood impairment.

The review also points to innovative multicomponent interventions, such as Transdiagnostic Intervention for Sleep and Circadian dysfunction (Trans-C). This combines modules that address different aspects of sleep and circadian rhythms into a sleep health framework that applies to a range of mental health disorders.

Dr Chellappa said: “Collectively, research into mental health is poised to take advantage of extraordinary advances in sleep and circadian science and translate these into improved understanding and treatment of psychiatric disorders.”

Diet and Mental Health: These Women Changed Their Diets to Manage Their Anxiety and Depression.

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by Rachael Schultz

•••••

Medically Reviewed by:

Nicole Washington, DO, MPH

•••••

•••••

Science agrees that food can be a powerful tool for people dealing with depression and anxiety.

When Jane Green was 14 years old, she was walking offstage from a tap dance competition when she collapsed.

She couldn’t feel her arms, her legs, or her feet. She was hysterically crying, and her whole body was hot. She was gasping for breath.

Green blacked out for 10 minutes. When she came to, her mom was holding her. It took 30 minutes for her heart rate to calm down enough so she could breathe.

Green was having a panic attack — her first one, but not her last. Her parents took her to the doctor, who diagnosed her with anxiety and depression, and handed her a prescription for an antidepressant.

“I’ve had good times, but I’ve also had really low points. Sometimes it got to the point where I didn’t want to live anymore,” Green shares with Healthline.

More doctors’ visits also revealed she had an irregular thyroid, which didn’t help with her anxiety. She started seeing a therapist at 20, which helped — but only so much.

At 23, after a particularly hard visit with her doctor, who told her there was nothing that could be done about her symptoms, Green had a meltdown in front of her friend Autumn Bates.

Bates was a nutritionist who overcame her own anxiety issues by changing her diet. She convinced Green to switch up her diet to see whether it made her feel any better.

Green already ate a fairly balanced diet, but dinner was often takeout. Sugar was a daily must-have, with candy throughout the day and ice cream at night.

Her new diet guidelines encouraged more vegetables and healthy fats, medium amounts of protein, and cutting back on refined grains, dairy, and sugar.

Green started reaching for nuts as a snack, stuck to salmon or homemade burgers with veggies for dinner, and savored the small piece of dark chocolate she ate for dessert.

The changes were tough at first. But she soon noticed her energy levels soaring.

“I wasn’t focusing on what I couldn’t eat — I was focusing on how great I felt physically, which made me feel better mentally and emotionally,” she adds. “I stopped getting the crazy highs and lows from sugar. I actually have bowel movements now, which makes such an impact on my mood.”

As for those anxiety attacks? “I haven’t had an anxiety attack in months,” Green says. “I’m completely off my antidepressants, which I 100% attribute to my diet and lifestyle changes.”

It’s important to remember that stopping any medication, including antidepressants, without consulting your doctor first may not be safe. If you’re considering making changes to your diet and medication, talk with your doctor to determine whether reducing or stopping your medication may be an option for you.

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Are certain diets better for mental health?

“Changing your nutrition can be a great addition to traditional therapy, like CBT and medication, [but it] comes at a much smaller cost and can be a great way to self-care,” says Anika Knüppel, a postdoctoral researcher in nutritional epidemiology at the University of Oxford and contributor to the European MooDFOOD program, which focuses on preventing depression through food.

There are two ways nutritional interventions may help mental health: by increasing healthy habits and reducing unhealthy ones. For the best outcome, you have to do both, says Knüppel.

Research has shown the most support for two diets: the Mediterranean diet, which emphasizes more healthy fats, and the DASH diet, which focuses on reducing salt.

Try it: Mediterranean diet

  • Get your starch with whole grains, starchy vegetables, and legumes.
  • Fill up on plenty of fruits and veggies.
  • Focus on eating fatty fish, like salmon or albacore tuna, in place of red meat.
  • Add in healthy fats, like raw nuts and olive oil.
  • Enjoy sweets and wine in moderation.

The Mediterranean diet is more about what you’re adding in: fresh fruits and vegetables, protein-rich legumes, and fatty fish and olive oil (high in omega-3s).

In a 2016 study with 11,800 people, researchers found that those who followed the Mediterranean lifestyle closest were 50% less likely to develop depression than those who didn’t follow the diet as well.

And in 2018, a study in older adults found that following a Mediterranean diet was related to the absence of depression.

A 2020 review suggested that the Mediterranean diet has potential to benefit overall health as well as reduce symptoms of depression. They suggest further research on the role of diet in the treatment of depression.

Another review from 2022 suggested the potential of the Mediterranean diet to reduce both the risk and severity of depression symptoms in young people.

Try it: DASH diet

  • Embrace whole grains, vegetables, and fruit.
  • Get protein from chicken, fish, and nuts.
  • Switch to low fat or nonfat dairy.
  • Limit sweets, sugary drinks, saturated fats, and alcohol.

Alternatively, the DASH diet is about what you’re taking out, namely salt, alcohol, foods high in saturated fats, and sugar.

A 2017 study that Knüppel led analyzed the sugar intake of more than 23,000 people. Researchers found that men who ate the most sugar — 67 or more grams a day, which is 17 teaspoons of sugar (or just under two cans of Coke) — were 23% more likely to develop common mental disorders over 5 years than participants in the bottom third who logged fewer than 40 grams of sugar a day (10 teaspoons).

And, a 2021 study reports that among older adults, those who closely followed the DASH diet were less likely to develop depression over 6.5 years compared with those who followed a typical Western diet.

A 2021 study that looked at 181 women between the ages of 18 and 25 suggested the DASH diet may have a bidirectional relationship with mental well-being.

This means that there may be mental health benefits to this style of eating, but better mental health also means eating in this way is more likely. They also noted that higher adherence to the diet was associated with reduced stress and less difficulty falling asleep.

A 2023 review of the existing studies on the DASH diet and mental health found that it’s likely that the diet has beneficial effects, but study results offer inconsistent evidence. They suggest additional quality, focused research to evaluate the true effectiveness.

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Are there foods that may help with depression?

Following a balanced diet may be associated with a lower risk of depression, according to a 2018 meta-analysis. However, researchers point out that the evidence is not consistent, and that eating “unhealthy” foods is not associated with a higher likelihood of depression.

Still, it may not hurt to add these nutritious foods to your regular diet.

Fruits and vegetables

A 2020 review of studies evaluating fruit and vegetable consumption and mental health in adults found that the majority of studies indicated a positive influence. They suggest a general recommendation to consume 5 servings of fruit and vegetables daily.

A 2015 review of studies on diet and depression found that 75% of the diet programs that resulted in an improvement in depression outcomes recommended eating a diet high in fiber, fruits and vegetables, or both.

These foods are high in vitamins and minerals, which may be helpful in preventing symptoms of depression.

Vitamin-rich foods

A 2021 review of research found that people with depression may consume less essential vitamins and minerals. Researchers noted that vitamin A, vitamin C, and vitamin E help the body protect the brain from disorders such as anxiety, depression, and cognitive decline.

Foods high in vitamin A include:

  • oily fish like salmon, bluefin tuna, and king mackerel
  • liver, such as beef liver, lamb liver, and liver sausage
  • cod liver oil
  • butter
  • cheese

Foods high in vitamin C include:

  • chile peppers
  • guava
  • fruit like strawberries, blackcurrants, kiwis, and oranges
  • herbs like thyme and parsley
  • greens like mustard, spinach, and kale
  • vegetables like broccoli and Brussels sprouts

Foods high in vitamin E include:

  • sunflower seeds
  • nuts, like almonds, hazelnuts, Brazil nuts, and peanuts
  • cooking oils, like wheat germ oil, sunflower oil, and almond oil
  • abalone
  • goose meat

Low levels of vitamin D are found to be correlated with depression. Foods high in vitamin D include:

  • fortified foods, like nondairy milks and cereals
  • egg yolks
  • fatty fish like salmon and mackerel

Finally, eating foods high in vitamin K was associated with lower symptoms of depression. These foods include:

  • leafy greens
  • nuts
  • broccoli
  • Brussels sprouts
  • cabbage

Tea

A 2018 study of older adults found that drinking tea daily may be associated with a lower risk of depression.

A small 2021 study of 491 adults found that consumption of black tea, up to 4 cups, or caffeine intake between 450 and 600 mg, may help protect against depression. It’s a good idea to speak with your doctor if you’re going to be consuming more than 400 mg of caffeine daily, as there may be health risks.

Foods high in omega-3s

A 2019 meta-analysis found that omega-3 supplements may be effective at reducing symptoms of depression.

Foods high in omega-3s include:

  • salmon
  • anchovies
  • walnuts
  • flaxseed
  • chia seeds

Foods containing vitamin B12

A 2020 review of research found that lower levels of vitamin B12 may be associated with an increased risk of depression.

Foods high in vitamin B12 include:

  • clams
  • salmon, sardines, trout, and tuna
  • beef
  • fortified cereal
  • fortified nutritional yeast
  • fortified nondairy milk
  • dairy products
  • eggs

Foods containing magnesium

A different 2020 review of research found that magnesium supplements may benefit people with anxiety. However, more research is needed to support this.

Foods containing magnesium include:

  • dark chocolate
  • avocados
  • nuts
  • beans, lentils, and chickpeas
  • whole grains
  • tofu

Herbs and spices

A 2021 review of research found that in low-income countries, certain whole plant extracts may help reduce symptoms of depression. These include:

Learn more about herbal supplements for depression and anxiety.

Going sugar-free to fight depression and anxiety

Simply removing sugar has been life changing for Catherine Hayes, a 39-year-old Australian mom who was in and out of mental health counseling offices, and on and off antidepressants for the better part of her life.

“My moods would be up and down — mostly down. I had feelings of not being good enough, and some days I wanted to die. Then there was the anxiety to the point I couldn’t leave my house without becoming violently ill,” Hayes explains.

It wasn’t until she realized how much it was affecting her family, and that she wanted to get better for her kids, that she started looking at alternative therapies. Hayes started doing yoga and found the book “I Quit Sugar.”

At the time, Hayes was eating packets of cookies with coffee in the afternoon and craving dessert before she even ate dinner.

“My new way of eating consisted of lots of greens and salads, healthy fats, protein from meat, switching sweet dressings for olive oil and lemon juice, and limiting fruits to those with low fructose like blueberries and raspberries,” she says.

Giving up sweets wasn’t easy. “In that first month of coming off sugar, I was tired with headaches and flu-like symptoms,” Hayes said.

But at the 1-month mark, everything changed. “My energy levels picked up. I was finally sleeping. My moods weren’t as low. I was happier, and the anxiety and depression just didn’t seem to be there,” Hayes says.

Now, years after going sugar-free, she’s been able to taper off her antidepressants. “It’s not for everyone, but this is what worked for me,” Hayes says.

If you’re considering stopping your antidepressants

Always consult with your doctor first. Stopping medication may not be safe or appropriate, so it’s important to work with your doctor to determine whether reducing or stopping medication may be an option for you. You should never stop antidepressant medications on your own.

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How do diet and nutrition affect mental health?

Since we don’t have all the answers, biologically, behind anxiety and depression, there’s no clear reason why changing your diet can’t change your mood, Knüppel says.

But we do know a few things.

“Vitamins in the body help the function of enzymes that enable reactions such as the synthesis of serotonin, which plays an essential role in our happiness,” Knüppel explains.

Meanwhile, 2019 research found that too much sugar is linked not only to the development of anxiety and depression but also to cognitive impairments and a reduction in the brain’s ability to develop new connections when learning or after injury.

There’s also emerging research that suggests our gut plays an important role in mental health.

“The microorganisms in our gut can communicate with the brain and several systems that could play a role in depression and anxiety, and the composition of the gut microbiota is influenced by nutrition,” Knüppel adds.

Michael Thase, MD, psychiatrist and director of the Mood and Anxiety Program at the University of Pennsylvania, says there are a few other factors at play here.

In his estimation, “When you treat depression with medication, the actual ‘magical’ chemical ingredients matter maybe 15%. It’s really the process of working with a doctor and finding the motivation to recognize the problem and take steps toward fixing it that counts for most of the good.”

“You can get that much of the good in a non-medication intervention that includes diet, exercise, and talking [with] someone,” he says.

Working toward getting the nutrition you need certainly counts as self-care for depression. “Your spirits pick up and that’s an antidepressant,” Thase adds.

You can take medication for depression, attend therapy, and also try these complementary approaches to help improve your mental health.

Knüppel says, “Diet is a great way of active self-care and self-love — a key in cognitive behavioral therapy (CBT), which is often used to treat anxiety and depression. I believe seeing oneself as worthy of self-care and therefore worthy of being fed with nutritious food is a great step.”

Why certain foods are mood-boosting

  • Some enzymes found in food can boost serotonin levels.
  • Sugar is associated with depression and anxiety.
  • Emerging science shows gut health plays a role in anxiety.
  • Eating healthy foods is a great way to practice self-care, which is important in CBT.
  • Taking active steps to eat a nutritious diet can increase motivation.

Should you try it?

No treatment is perfect, and no treatment works for everyone, Thase states. Both Thase and Knüppel agree that if you have depression or anxiety, your first step should be getting help from a mental health professional.

But trying out nutritional changes in parallel with whatever steps you and your doctor decide may potentially bolster the improvements.

Still, Thase says diet isn’t a silver bullet for anxiety and depression.

“I’m all in favor of helping people take a look at their fitness and diet as a holistic plan to help recover from depression, but I wouldn’t count on it solely,” Thase says.

For some, nutritional intervention may work wonderfully as a primary treatment. But for others, including people with specific disorders like bipolar disorder or schizophrenia, nutritional interventions are more complementary to other treatments, like medication, Thase explains.

And even though Thase doesn’t incorporate nutritional interventions with his patients, he adds that he could see this becoming another tool for psychiatrists and other mental health professionals to consider in the future.

In fact, there’s a field called nutritional psychology that’s gaining steam.

“There is a real movement toward mindfulness and holistic approaches in our culture right now, and in psychiatry, there’s a movement toward personalized medicine, in the sense that our patients are the captains of their own ship and their own treatment planning,” he explains.

As people become more interested in alternative therapies like this and continue to see results, you may see more mainstream doctors writing prescriptions for healthy foods in the future.

Running Versus Antidepressants: Which is More Effective for Mental Health?

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A study, the first of its kind, has delved into comparing the effects of antidepressants and running exercises in treating anxiety and depression. It yielded some interesting results.

Running to fight depression

Study Details

Participants in the study were 141 patients who were diagnosed with either depression, anxiety, or both. They were given a choice: take SSRI antidepressants or engage in group-based running therapy, both lasting for 16 weeks. 

Perhaps surprisingly to some, a majority (96 participants) chose running over medication (45 participants).

While 82% of the participants in the antidepressant group adhered to their medication intake, only 52% of the running group managed to stick to the exercise regimen. This is noteworthy considering the initial preference for exercise over medication.

By the end of the trial, roughly 44% of participants from both groups experienced improvements in their anxiety and depression levels. 

However, those who chose running also displayed better physical health indicators such as weight loss, reduced waist circumference, improved blood pressure, and heart functionality. On the contrary, those on antidepressants witnessed a slight dip in these physical health markers.

Professor Penninx’s Take

The study was presented by Professor Brenda Penninx from Vrije University, Amsterdam, at the European College of Neuropsychopharmacology’s (ECNP) conference in Barcelona.

Penninx stated that the team intended to observe how either therapy affects overall health, not just mental well-being. She further noted that despite the evident benefits of exercise, it might be challenging for some to maintain the regimen. Encouragement and adequate supervision, as was provided during the study, seem essential for successful adherence.

She also stressed that while antidepressants are safe and often effective, they might not be the best fit for everyone. The study suggests that we need to consider exercise therapy more seriously as a potential treatment method.

It’s also essential to recognize the possible side effects of antidepressant treatments. Especially in patients with heart issues, it’s crucial to consider the physical health implications of these medications.

Expert Commentary

Dr. Eric Ruhe from Amsterdam University Medical Centres highlighted the importance of the findings and added a word of caution. He said that while the study’s results are intriguing, the fact that patients chose their preferred treatment might introduce some bias in the comparison. 

It’s essential to note that the participants in the antidepressant group were, on average, more depressed, potentially affecting their likelihood of adhering to exercise.

Ruhe also stressed the difference in adherence rates, suggesting it’s often harder for individuals to change lifestyle habits compared to just taking a pill. This insight has broader implications for healthcare, emphasizing the importance of finding effective ways to encourage and sustain healthy behaviours.

In summary, while both running and antidepressants offer benefits for mental health, it is essential to consider the broader picture. Taking into account the physical benefits, personal preferences, and potential side effects will ensure that each patient receives the most appropriate and effective care.

Withdrawal symptoms from antidepressants can last over a year

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We must rethink the “chemical imbalance” theory of mental health.

In her book, “Blue Dreams: The Science and Story of the Drugs That Changed Our Minds,” psychotherapist Lauren Slater discusses psilocybin and MDMA as potential treatments for depression. Sadly, she hasn’t tried either given her longstanding antidepressant usage. As she told me in 2018, psychedelics are contraindicated to Prozac. Yet she sees hope in this class of drugs for a wide range of mental health treatments.

After I described the psychedelic experience, she replied,

“I can imagine them very vividly, but it’s not the same as actually getting to take them. I think if I could actually get to take a psychedelic, a lot of what I fear would go away. And I think I would be a better person because of it. But I do understand I have a sort of intuitive understanding of what they do.”

Slater has been taking antidepressants for decades. While aware of the problems with long-term usage, she is unable to withdraw given the crippling side effects. This is a serious problem for millions of antidepressant users, as detailed in a new review published in the journal Psychotherapy and Psychosomatics.

Written by University of Florence Associate Professor of Clinical Psychology, Fiammetta Cosci, and Maastricht University’s Guy Chouinard, the review points out popular antidepressant and antipsychotic medications, including SSRIs and SNRIs, exhibit more severe withdrawal symptoms than benzodiazepines (such as Valium and Xanax), Z-drugs, and ketamine.

Benzodiazepines were first synthesized in 1955. This class of tranquilizers took the place of Meprobamate (Miltown), which is considered one of the world’s first blockbuster drugs. As Miltown lost favor due to a growing population of addicts, benzos took its place in psychiatry offices. By the late seventies, benzos were the world’s most prescribed medications despite growing evidence of their addictiveness and side effects. By contrast, SSRIs and SNRIs are generally considered less damaging than benzos—an assessment that must now be reconsidered.

With the global antidepressant market expected to reach $28.6 billion this year, pharmaceutical companies go to great lengths to downplay the long-term effects of these drugs. Slater writes that lithium showed clinical efficacy in treating depression but has never been approved by the FDA (except for manic-depressive disorder). The real issue: you can’t patent an element.

In the review, Cosci and Chouinard categorize withdrawal symptoms into three groups. University of West Georgia instructor of psychology, Ayurdhi Dhar, breaks them down:

“New withdrawal symptoms and rebounds are short-lived, temporary, and reversible. However, new withdrawal symptoms are new for the patient (nausea, headaches etc), while rebound symptoms refer to the sudden return of primary symptoms that are often more severe than pre-treatment. Persistent post-withdrawal disorder refers to ‘a set of long-lasting, severe, potentially irreversible symptoms which entitle rebound primary symptoms or primary disorder at a greater intensity and/or new withdrawal symptoms and/or new symptoms or disorders that were not present before treatment.’”

Each class of drugs cited in the review produce some withdrawal symptoms. Benzos and Z-drugs can cause confusion, sweating, rebound anxiety, and psychosis, generally lasting between two to four weeks (though in some cases, impaired cognition can last longer). Ketamine, the first psychedelic approved for clinical use in America, can produce rage, tremors, palpitations, and hallucinations, though the effects are short-lived: three days to two weeks.

The authors find that SSRIs, SNRIs, and antipsychotics have the worst record for withdrawal symptoms. Antidepressants can produce pain, numbness, depression, stroke-like symptoms, and much more. With SSRIs, impaired memory, sexual dysfunctions, panic attacks, and pathological gambling can continue for a year after discontinuation even if the patient tapers off slowly.

In 2014, Professor Peter C. Gøtzsche of The Nordic Cochrane Centre in Copenhagen published an article highlighting the dangers of antidepressants (featured in Robert Whitaker’s “Anatomy of an Epidemic”). Gøtzsche calls for psychiatrists to abandon the longstanding myth of the chemical imbalance theory of the brain. He believes popular pharmacological interventions are the true source of imbalances.

“We have no idea about which interplay of psychosocial conditions, biochemical processes, receptors and neural pathways that lead to mental disorders, and the theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted. It is very bad to give patients this message because the truth is just the opposite. There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance, an artificial condition that the brain tries to counteract.”

As the #BLM protests are exposing more than ever, systemic issues around inequality and racism create the environmental conditions for mental health problems to manifest. Chemical imbalances are a symptom; writing a script does not treat the cause of depression or anxiety.

While a certain percentage of depressed and anxious patients will benefit from short-term usage of prescription medication, mounting evidence against their long-term use, as detailed in this new review, must force the medical establishment to rethink its approach. The for-profit health care system has failed us too long. We can no longer afford to pay its toll.

Running Versus Antidepressants: Which is More Effective for Mental Health?

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A study, the first of its kind, has delved into comparing the effects of antidepressants and running exercises in treating anxiety and depression. It yielded some interesting results.

Running to fight depression

Study Details

Participants in the study were 141 patients who were diagnosed with either depression, anxiety, or both. They were given a choice: take SSRI antidepressants or engage in group-based running therapy, both lasting for 16 weeks. 

Perhaps surprisingly to some, a majority (96 participants) chose running over medication (45 participants).

While 82% of the participants in the antidepressant group adhered to their medication intake, only 52% of the running group managed to stick to the exercise regimen. This is noteworthy considering the initial preference for exercise over medication.

By the end of the trial, roughly 44% of participants from both groups experienced improvements in their anxiety and depression levels. 

However, those who chose running also displayed better physical health indicators such as weight loss, reduced waist circumference, improved blood pressure, and heart functionality. On the contrary, those on antidepressants witnessed a slight dip in these physical health markers.

Professor Penninx’s Take

The study was presented by Professor Brenda Penninx from Vrije University, Amsterdam, at the European College of Neuropsychopharmacology’s (ECNP) conference in Barcelona.

Penninx stated that the team intended to observe how either therapy affects overall health, not just mental well-being. She further noted that despite the evident benefits of exercise, it might be challenging for some to maintain the regimen. Encouragement and adequate supervision, as was provided during the study, seem essential for successful adherence.

She also stressed that while antidepressants are safe and often effective, they might not be the best fit for everyone. The study suggests that we need to consider exercise therapy more seriously as a potential treatment method.

It’s also essential to recognize the possible side effects of antidepressant treatments. Especially in patients with heart issues, it’s crucial to consider the physical health implications of these medications.

Expert Commentary

Dr. Eric Ruhe from Amsterdam University Medical Centres highlighted the importance of the findings and added a word of caution. He said that while the study’s results are intriguing, the fact that patients chose their preferred treatment might introduce some bias in the comparison. 

It’s essential to note that the participants in the antidepressant group were, on average, more depressed, potentially affecting their likelihood of adhering to exercise.

Ruhe also stressed the difference in adherence rates, suggesting it’s often harder for individuals to change lifestyle habits compared to just taking a pill. This insight has broader implications for healthcare, emphasizing the importance of finding effective ways to encourage and sustain healthy behaviours.

In summary, while both running and antidepressants offer benefits for mental health, it is essential to consider the broader picture. Taking into account the physical benefits, personal preferences, and potential side effects will ensure that each patient receives the most appropriate and effective care.

The Mental Health Effects of Acne Are Very, Very Real

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Feeling bad about breakouts isn’t shallow—especially if they’re messing with your quality of life.

conceptual image of colorful face

Bright red zits between my eyebrows have immediately thrown me into a downward spiral of hopelessness and panic. Dark spots across my chin were the very reasons I wouldn’t let a soul—not even my boyfriend at the time—see me without color-correcting concealer in high school.

As someone who dealt with persistent acne in my teens (and still does, at 25), let me tell you that it controlled my entire life—whether I was ditching school because I was too sad to get out of bed or making a habit of avoiding eye contact with anyone and everyone. If you can relate to any of these experiences, I don’t have to convince you that constantly battling breakouts can do a number on your mental health.

“I also had terrible acne as a teenager, and the impact it made on my life was so significant,” Ife Rodney, MD, board-certified dermatologist and founding director of Eternal Dermatology Aesthetics in Fulton, Maryland, tells SELF. “I was so stressed. It really messed up my self-esteem.”

Breakouts aren’t just a teen issue, of course, but regardless of when—or how—they show up, take it from me and the experts: Their impact isn’t only skin deep.

Here are some of the ways acne can hurt your mental health

It can shatter your confidence.

As a dermatologist, Dr. Rodney says many of her patients with active acne or scarring feel insecure and embarrassed about the way they look.

This self-consciousness can be so intense that you might avoid having your picture taken on your family’s annual beach vacation, for instance. Or, perhaps you have a mini breakdown after examining your hormonal cysts under the unforgiving glow of fluorescent fitting-room lighting. One 2011 study even found that folks with moderate to severe acne were less likely to pursue romantic relationships.

“Worrying about your skin might seem like a superficial concern, which is one reason why many people feel embarrassed opening up about it,” Dr. Rodney says. “But the fact of the matter is, it does affect your quality of life, and for that reason, it should be taken seriously.”

It can cause you to isolate yourself from even your favorite people.

If you’re anything like me, you might be convinced that everyone is zeroing in on those flesh-colored bumps or dimpled, ice-pick scars. So naturally, the solution to escaping any unwanted stares, double takes, or perceived glares of disgust is isolating yourself—which might include canceling plans at the last second or holing up until your skin is magically “better.”

Staying home once or twice isn’t necessarily a warning sign that acne is ruining your life. But if withdrawing during “bad skin days” becomes a habit, that means those stubborn zits are controlling your daily choices and relationships, Shasa Hu, MD, board-certified dermatologist and assistant professor at the University of Miami Miller School of Medicine, tells SELF. Hiding from the world might seem like a harmless way to protect your well-being, but research shows that social support can improve mental health and self-esteem. I also know from experience that connecting with loved ones can make a big difference in how you’re feeling about your skin.

It can make you depressed.

We’re not just talking about one gnarly zit cropping up before a big work presentation and putting you in a crappy mood (though to be clear, that’s miserable too). Sometimes acne can make you feel so overwhelmingly sad that you become clinically depressed.

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There’s plenty of evidence that folks with acne are more likely to develop depression compared to those without the condition (two to three times more likely, according to one study). This connection makes sense, since not wanting to be seen or hating the way you look is a heavy emotional burden to bear, and it can make even the simplest tasks (like getting out of bed, taking a shower, or dragging yourself to work) feel impossible, Dr. Hu says.

In extreme cases, some people may also have thoughts of suicide, research shows. “I have a lot of patients come in and say they’ve tried everything—every product, every dermatologist, every prescription medication,” Dr. Rodney adds. “So there can be this feeling of hopelessness when you feel like you’ve tried everything and nothing is working.”

What to do when acne is destroying your mental health

It’s no surprise that treating your acne can help your skin and your mood, and seeing a dermatologist (if you can) is a great place to start. These pros can assess your breakouts, recommend the best over-the-counter and/or prescription treatments, and offer some much-needed peace of mind, Dr. Hu and Dr. Rodney say.

But even if you have research-backed ingredients and highly educated experts on your side, it can still take months—years, even—to figure out what works best for your particular skin and get the results you’re after, both dermatologists note.

There are ways to feel better in the meantime, though—and stepping away from the mirror (especially if it’s a magnifying one) is an excellent first step, according to Dr. Hu. “It’s more harmful to focus on every single pore and black dot,” she says. In other words, zeroing in on your zits can make the issue seem bigger in more ways than one. And whatever you do, try your best to avoid picking at your bumps in an attempt to flatten them or make them go away ASAP. This, Dr. Rodney says, can lead to more inflammation and cause stubborn scars, which will probably make you feel even worse.

And if your acne is getting in the way of your daily functioning—as in, you’re skipping work or regularly experiencing symptoms of depression like hopelessness or irritability—it might be time to find a therapist you click with. These mental health professionals can teach you tools to manage your mood as you work on clearing your complexion.

I know how much it sucks—I really do. But if you’re going to take anything from this article, I hope it’s this: Don’t make the same mistake I did for years and let your acne completely rule your life, if you can help it. Celebrate the small victories (like an annoying nose pimple finally giving in) and, most importantly, try to focus on the things and people that make you so damn happy, you forget about your appearance, even if just for a moment. These little perspective shifts helped me finally feel okay about my skin during the angriest of flare-ups—better than any cleanser or spot treatment could.

7 Signs That Your Mental Health Needs Attention

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mental wellbeing

You know when a cold is coming on thanks to telltale symptoms like a sore throat, cough, or a stuffy nose. But you may not be quite so attuned to the signs of oncoming mental unwellness.

Burgeoning depression, mounting anxiety, and unresolved trauma all manifest in physical and behavioral symptoms that can be missed or dismissed if we don’t know what to look for.

Knowledge is power: When we understand the warning signs, we can prepare for rather than react to psychological issues. Not all of these are certain indicators of a mental health crisis, but they may be something to keep an eye on.

1) You’re Sleeping Poorly

More, less, or bad sleep is both a symptom and cause of mental health issues. When we’re depressed, anxious, or reeling from stress, our sleep often suffers. Conversely, inadequate rest impairs a range of cognitive and physiological processes essential to mental well-being, including attention, emotional regulation, and problem-solving skills, leaving us vulnerable to anxiety and depression.

Excessive sleep can also be cause for concern. Hypersomnia characterizes roughly half of major depressive episodes. Especially if you remain unrested even after sleeping in, consider this a red flag.

Persistent nightmares are another sleep-related warning sign. If they involve images or sensations reminiscent of a traumatic experience and leave you feeling distressed throughout the day, nightmares may be a sign of posttraumatic stress disorder.

2) Your Stomach Feels Off

Like sleep, gastrointestinal issues can both cause and result from psychological distress. That’s because the GI system and the brain are closely connected, each sending and receiving messages related to emotions (I just can’t seem to digest anything, says the gut, which the brain interprets as The things I used to enjoy don’t feel good anymore) and perceived threats (That doesn’t seem safe! says the brain; I’d better clench up, replies the gut).

The gut–brain connection can be acutely obvious, as when we feel nauseous before a big event, but chronic distress may fly under the radar. It’s crucial not to dismiss cramps, indigestion, bowel issues, and other GI concerns as purely physiological, especially if you can’t identify an obvious trigger such as a change in diet or medication.

3) Your Eating Habits Change

Thanks in part to the gut–brain connection, psychological distress can also impact appetite. Roughly half of those who suffer from major depressive disorder experience decreased appetite; about a third notice their appetite increase.

Depression can also influence which foods we crave. Because carbohydrates trigger serotonin release, we are more likely to reach for carb-heavy comfort foods like pasta, cookies, or potato chips when we’re depressed.

Poor eating habits can also be a sign that you aren’t addressing stress in a healthy way. Most of us have engaged in stress eating, and studies have shown it’s a real thing.

4) You Can’t Get Motivated

Amotivation is a hallmark of several mood disorders — two weeks of this condition meets the clinical threshold for a symptom of major depressive disorder. Lack of motivation seems to stem from difficulties honing attention and shaking off rigid or critical self-talk (I’m just going to fail, so why bother trying?).

Procrastination in response to activities you genuinely dislike — scheduling a dentist appointment, filing taxes — should be little cause for worry. But struggling to keep up with the daily responsibilities of life for several weeks may be a sign of mounting mental unwellness.

5) You Don’t Enjoy Things That Usually Matter to You

Depression saps the joy from life, which is why anhedonia, a term that translates to “without pleasure,” is considered one of the most reliable symptoms of depression.

It’s not entirely clear what causes anhedonia, but some studies have linked depression with reduced reward sensitivity. This means that things that would normally make us feel good, such as time with loved ones or a favorite hobby, don’t release as much dopamine when we’re feeling depressed.

The inability to enjoy life’s pleasures for more than a week or two should be considered a warning of depression.

6) You Don’t Feel Like Leaving the House

Isolation can signify a variety of mental health issues, depending on the context. Staying home due to lack of motivation or the sense that you won’t enjoy yourself may be a sign of depression, especially if it’s accompanied by negative beliefs about yourself (No one would want to hang out with me anyway).

Isolating out of fear that something bad might happen is a feature of certain anxiety disorders including social anxiety disorder, which involves fear of judgment or ridicule from others, and agoraphobia, which involves fear of being unable to escape from or get help in a dangerous situation. (For more information on this disorder, see “What Is Social Anxiety Disorder?“)

Isolation can also be a response to trauma. We’re prone to avoiding situations that remind us of a traumatic experience, even if we don’t always consciously recognize it.

7) You’ve Been Snappy Lately

It’s easy to blame a short temper on external factors — a bad boss, traffic, bills. But finding yourself constantly on edge, frustrated, or angry may be a sign of underlying psychological concerns.

Studies suggest that chronic stress and worry can impair functioning in the prefrontal cortex, the part of the brain responsible for crucial executive functions, including attention and emotion regulation. Hence our tendency to feel edgy when we’re anxious.

Irritability may also signify depression. Anger is more emotionally accessible than sadness for some of us — adolescents are particularly prone to acting irritated when they’re actually depressed — which is why persistent irritability merits a closer look.

These signs need not always be a cause for alarm, since emotions such as grief can also cause sleep problems, appetite changes, and lack of motivation. But these signs are an opportunity to consider whether all your needs are being met. Are you getting enough exercise, rest, or connection? When was the last time you took a day off?

If you notice these signs and feel like you may need help, invest in self-care: a cup of tea, a long walk, saying no to something you don’t really have time for — whatever it means to you. Think of self-care as the chicken soup for your emotional well-being. And reach out to people you love and trust: Connection is one of the most powerful protective measures we can take.

Warning Signs of Something More Serious

Symptoms that suggest someone is losing touch with reality, like hearing or seeing things that aren’t really there, or losing control over their basic faculties, such as struggling to form coherent sentences, may be signs of what’s known as psychosis.

These symptoms are common in disorders such as schizophrenia but can also manifest following a brain injury or other medical condition, or after acute or prolonged substance use.

In these instances, it’s important to seek professional medical support as soon as possible.