Educating people about the importance of mental health has been one of the best steps taken. Not so long ago, people did not believe in depression, let alone treat people who have depression correctly. But in recent years we have seen a rise in people who are taking mental health more seriously and working towards making their lives and the people around them better. We also have reached a point where we have medication and treatment options for not just people with depression, but anxiety, BPD, schizophrenia etc. And now FDA has broadened the variety of medicines that are available to people to fight depression! The U.S. Food and Drug Administration (FDA) has broadened its approval for Johnson & Johnson's nasal spray, Spravato esketamine, allowing its use as a monotherapy for severe depression, as announced by the company on Tuesday. This decision marks a significant development in the treatment landscape for individuals with major depressive disorder (MDD).

Spravato was first approved in 2019 to be used with regular antidepressants for people whose depression wasn't getting better with other medicines. It was like an extra treatment that acted almost like a strengthener. Later, it was also approved for people who were thinking about suicide or hurting themselves, because it can work quickly in those urgent situations. Now, doctors can give Spravato by itself, without the person having to take a regular antidepressant pill too. This is a big change and gives doctors and patients more choices.

What This Means For Patients

Experts suggest that with this approval they can now make more personalized medicine for their patients, as we know, everyone takes medicine differently and there is no one-way street for treatment. Doctors now have more ways to treat depression. Some people might do better with just Spravato, while others might still need other medicines too. This personalized way of treating people is really important because everyone's different. This change lets doctors choose the best treatment based on what each person needs, which could help people get better faster.

What Measures Have Been Taken For Patient Safety?

The FDA approved Spravato for use on its own because studies showed it works well in this way. People who used Spravato got better faster than those who didn't in clinical trials. The medicine works on a chemical in the brain called glutamate, which is involved in mood regulation. Spravato is related to ketamine, which is sometimes used illegally as a recreational drug. While both affect glutamate, they are not identical. The clinical trials provided the necessary evidence for the FDA to expand the drug's approved use.

Because Spravato has the potential for misuse and some side effects, it's only available through a special program called a REMS which is the Risk Evaluation and Mitigation Strategy program. The process here is that people who will be given the dose of medicine will be kept under close supervision. The doctors will check on them and their vitals every two hours and see how well the patients were responding to the medicine. This is to make sure it's used safely and to monitor for any adverse reactions, sometimes people don’t respond well to medication, it can also be dangerous if it reacts differently to others. The REMS program is a key part of ensuring patient safety and responsible use of this medication. This controlled distribution system helps to minimize the risk of misuse and ensures proper medical supervision.

Sometimes we all have to look for reasons to exercise. "Being healthy" may not be enough for many people, however getting rid of a constant source of discomfort may be just what you need to start exercising, more specifically walking.

A study published on June 13 in JAMA Network Open found that people who walked for about 100 to 125 minutes each day had a 23% lower chance of getting chronic low back pain compared to those who walked less than 78 minutes daily. Walking at a medium or quick pace also seemed to lower the risk of back pain, but not as much as the total time spent walking.

Chronic low back pain—pain that lasts for at least three months straight—is very common. It affects many adults and is expected to become even more widespread globally in the coming years. This is a significant finding because walking is an easy, cheap, and accessible activity that many people can do to help reduce the burden of back pain.

How Walking Time and Speed Directly Affects Back Pain?

The study looked at over 11,000 adults, around 55 years old on average, who lived in Norway. When the study began, none of them had chronic low back pain.

Participants wore devices that tracked their movement and how fast they walked for a week. This gave researchers much better information about their walking habits than simply asking them to remember.

The walking data was collected between 2017 and 2019. Then, from 2021 to 2023, researchers asked the participants if they had experienced any chronic pain or stiffness in their lower back. Basically, the study examined the link between walking and staying free of chronic low back pain.

It was found that walking less than 78 minutes per day was linked to the highest risk of chronic low back pain. From there, the findings showed:

• Walking between 78 and 100 minutes daily was linked to a 13% lower risk of chronic low back pain.
• Walking between 101 and 124 minutes daily was linked to a 23% lower risk of chronic low back pain.
• Walking over 125 minutes daily was linked to a 24% lower risk of chronic low back pain.

The research also showed that walking at a medium or quick speed (at least 2.8 miles per hour) reduced the risk of chronic low back pain by up to 18%.

Other studies have also supported the idea that walking can reduce pain, including one last year that suggested walking can increase the time between episodes of low back pain.

However, this new report has some limitations. Importantly, the study was done with adults in Norway. People in some parts of the world, like Europe, tend to walk more than people in other regions, such as the U.S. This means the results might not always apply to everyone around the world, especially since some populations are generally more active and healthier.

How Walking Helps Keep Back Pain at Bay?

Increases Movement and Reduces Stiffness

Walking helps you move more freely and makes your back less stiff. It strengthens core muscles, loosens connective tissues, and improves joint movement, leading to greater flexibility and less pain.

Boosts Blood Flow

Walking enhances blood circulation throughout your body. This delivers fresh, oxygen-rich blood to your back, which is crucial for reducing inflammation and promoting healing in the area.

Eases Strain

The combined benefits of walking, including improved movement and weight management, significantly reduce the stress and strain placed on your lower back, offering noticeable relief.

Improves Mood

Walking also offers a mental boost. Exercise releases "feel-good" chemicals, improving your mood and overall well-being. This can help ease the psychological stress often associated with persistent low back pain.

‘Inner Child’ is Health and Me's new mental health series where we deep dive into lesser-known aspects of child psychology and how it shapes you as you grow up. Often unheard, mistaken, and misunderstood, in this series we talk about the children’s perspective and their mental health, something different than you might have read in your parenting books. After all, parenting is not just about teaching but also unlearning.

Sometime 90 years ago, a psychologist proposed that birth order could have an impact on what kind of person the child becomes once they grow up. It is true, childhood, of course, shapes your personality as you grow up. But what does it mean to be the last one in the birth order?

It was the COVID-19 pandemic, when I started to jot down how I felt when suddenly I was home with my entire family under the same roof. Thanks to lockdown restrictions, I was again reminded that I am the youngest in the family. This is when I started writing a journal that I thought I would publish into a book once I finished it. I called it "To Be The Second Born". I jotted down my experience of being the youngest in the house, especially when everyone around me, including both my parents, are the oldest in their family.

Contrary to the belief that we are spoiled, I felt that we are often unheard and ignored, because we are always "too young" to be taken seriously. As a result, we revolt and are tagged as defiant. Five years down the line, my boss shared an Instagram reel that described how I felt. The reel went on to talk about how no one sees the struggle of a younger sibling. Or how everyone thinks they always got it easy. When, in reality, it is often because we are so used to being misunderstood that we shut ourselves down, not telling anyone about what is going on. Instead of fighting the 'defiant' tag, we start to live with it. We take responsibility, but never talk about it, because we know we will not be heard.

Watching that reel made me realize that it is not just me, but a lot of younger siblings who feel the same. While the book seems like a distant dream, a piece on it doesn't.

If you, too, feel the same, this one is for you.

ALSO READ: Inner Child: When the Bullied Turns Into A Bully – Psychology Of A Victim’s Defense Turned Attack

Too Young To Matter?

Krishna, 32, who is originally from Bihar, now in Pune, is the youngest of all the siblings. She has three older siblings, and she tells me that she often felt like a "stupid".

This is because her older siblings were very "authoritative". When asked why, she says, "I think culturally, we tend to equate age with wisdom and hence, anyone older than us automatically gets elevated to wiser in comparison."

She tells me that she, too, struggled putting her foot down and was often treated as a pushover. It was not until she turned 25 that she openly started to question whatever she was told. Before that, she used to hide things just to avoid confrontation.

The reaction was not pleasant. "There was a lot of gaslighting," she tells. However, she stayed firm and made it clear that she needs to be heard too, and should not be controlled.

To get a better understanding of why this happens, I spoke to Dr Rahul Chandok, who is a senior consultant and head of psychiatry at Artemis Lite, NFC, Delhi. Chandok explains, "When older siblings are in charge of younger ones and always telling them what to do or correcting them, the younger child may start to doubt themselves or feel bad about themselves. Being told what to do all the time can make it harder for them to think for themselves or trust their own decisions. As time goes on, they may start to hide their thoughts or not take the lead because they are afraid of being judged or criticized."

This dynamic can also make younger siblings more anxious or angry. Kati Morton, who is a licensed therapist and a public speaker renowned for her YouTube channel focused on mental health, points out that the youngest children might develop a heightened need for external validation to feel secure about their decisions and actions, potentially leading to anxiety about making mistakes or disappointing others.

Chandok explains that this is also true because of repeated invalidation. The reason why younger siblings may often feel like a pushover is because they have been constantly told that their opinions are wrong, "just because they are younger".

"Over time, such behaviors can hurt self-esteem, lower self-confidence, and make it hard to speak up for themselves in relationships or at work," explains Chandok.

But, Younger Siblings Are Perceived As Defiant And Indifferent

This is because people often get the wrong idea, explains Chandok. "If a child is always told what to do and never asked what they think, pushing back may be the only way they feel in control. If they don't follow directions, break rules, or act like they don't care, they might be trying to say, 'I want to be heard'," he explains.

However, not always are the relationships between a younger and older sibling as stringent. For instance, Ayush Upadhayay, 26, who has a three-year age gap with his older sibling, shares that while he has felt unheard, it has not always been a constant feeling. He tries to explain this and says, "They have responsibilities and feel that we are not yet ready for it."

When asked if that made him feel neglected or incapable, he said that earlier it used to make him feel that, however, now, he has confronted his older sibling. "Initially, she defended her behavior, later, she understood why I felt that way."

In Such Scenarios, What Can Families Do?

Families need to make room for everyone to have a say, no matter how old they are. Chandok also explains that families must encourage kids to talk to each other openly. This conversation must allow younger kids to be heard without being interrupted or judged. "Older siblings can make a big difference by asking for their opinions, respecting their choices, and not being bossy," says Chandok.

From a young age, parents too should encourage younger kids to make decisions, make choices, and not just praise them for following rules, but also being unique, thinking differently, even when their opinions may not match with the rest.

As the global temperatures continue to rise and extreme heatwaves become the new normal, the attention turns to a unexpected but critical health factor: how your prescription medications might be making the summer heat even more intolerable. While everyone knows to drink plenty of water and steer clear of the outdoors during the hottest part of the day, few recognize that prescriptions might be combating their body's cooling mechanisms.

For millions, dealing with the heat is more than a comfort issue—it's a health emergency, particularly for those on certain prescription medications. While dehydration, shade, and sunscreen are important, a lesser-known risk is from the medicine cabinet. Many medications regularly prescribed to millions of Americans can disrupt the body's natural cooling system, making it more difficult to cool down and heighten the risk of heat illness

Millions of Americans, especially those experiencing scorching heat domes in the eastern U.S., are more susceptible to heat illnesses. For those on medications that disrupt thermoregulation, the risks are even greater.

How the Body Regulates Heat?

The human body depends on a number of sensitive mechanisms to keep its internal temperature within a safe range. Sweating, blood flow to the skin, and sensitive fluid balance all dissipate heat. But certain drugs interfere with these mechanisms by changing the production of sweat, the way the blood circulates, or thirst and fluid retention. The consequence: a higher risk of overheating, dehydration, and potentially life-threatening heatstroke.

How Medication Undermines Body's Ability to Withstand Heat?

Below are five popular types of medications that disrupt your heat tolerance, and how you can get around them.

1. Antidepressants

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), are the most widely used medicines globally. Antidepressants act by modulating neurotransmitter levels in the brain, primarily serotonin and noradrenaline. They do affect other systems that regulate body temperature as well.

TCAs, for instance, can block acetylcholine, a neurotransmitter essential to sweating. This can result in diminished sweat, and the body is less able to cool itself on warm days. Ironically, both SSRIs and TCAs have the opposite effect on some users as well—up to 14% report this side effect—and stimulate sweat glands through excessive noradrenaline. This excessive sweating can contribute to dehydration if fluids aren't replenished.

In addition, SSRIs can interfere with the hypothalamus, the thermostat of the brain, and cause the signal to initiate sweating to be interrupted. Any disruption in sweating—either too much or too little—will make the body less able to deal with heat, increasing the danger of heat exhaustion or heatstroke.

2. Antipsychotics

Antipsychotic medication, prescribed to patients with schizophrenia and bipolar disorder, can also increase the danger of summer heat. They block dopamine, which has a side effect of impacting serotonin and interfering with the hypothalamus's function of detecting and responding to changes in temperature.

Individuals on antipsychotics can be as non-heated and non-thirsty as possible when their bodies are under pressure. This can cause plummeting blood pressure and impaired cardiac function. The body adapts by vasoconstricting and holding onto heat, further diminishing the sweat and cooling capacity. Most antipsychotics are also anticholinergic, inhibiting acetylcholine and making sweating even more difficult.

3. Heart Drugs

Cardiovascular medications are another important category that can disrupt heat tolerance. Beta blockers, used in heart failure and arrhythmias, slow the heartbeat and decrease the strength of heart contractions. Although effective for heart disease, these actions can restrict blood flow to the skin, lessening the body's ability to dissipate heat.

Diuretics, which are often prescribed to manage high blood pressure and heart failure, boost urine production and lead to dehydration and electrolyte imbalances—both of which make it more difficult to sweat effectively. Other medications for high blood pressure, including ramipril and losartan, can suppress the body's natural thirst drive by interfering with the body's fluid balance mechanism, increasing the risk for dehydration in hot weather.

4. Stimulants

Stimulant drugs like amphetamines used for ADHD can raise body temperature, enhance metabolism, and distort patterns of sweat. These medications target dopamine and noradrenaline, which can make cooling down more difficult, particularly after physical exertion or in hot weather. Stimulants can also suppress feelings of fatigue, leading people to overwork without perceiving the risk.

Interestingly, some studies indicate that individuals with ADHD who use stimulants can have a reduced risk for heat-related illness, perhaps as a function of reduced body weight or improved hydration practices. More research is necessary to verify this effect.

5. Insulin and Diabetes Medications

For individuals with diabetes, control of blood sugar during heat is tough. High temperatures dilate blood vessels, enhancing blood flow and accelerating the absorption of insulin. This may result in hypoglycemia (low blood sugar), with signs such as dizziness, perspiration, irritability, and even loss of consciousness or seizures.

Heat can also destroy insulin, reducing its effectiveness or rendering it dangerous. Insulin must be refrigerated until the time of use, and any alteration in color or cloudiness means it must be thrown away. Other diabetes medications, including sulfonylureas, may also predispose patients to sun sensitivity and dehydration.

How Are Medications and Sun Sensitivity Linked?

Aside from thermoregulation, various drugs heighten sensitivity to the sun. Antibiotics, antihistamines, oral contraceptives, and diabetes medications such as insulin may all augment the risk of heat reaction and sunburn. Always look for warnings regarding exposure to the sun on drug labels and take special precautions such as sunscreen and shade.

Outside of these five major categories, a number of other medications can make it more difficult to deal with the heat. Antibiotics, antihistamines, antifungals, and certain cholesterol-lowering statins all can raise sun sensitivity, increasing risk of sunburn or rash. Oral contraceptives and hormone therapies might also be expected to do the same.

Tip to Cope and Stay Cool This Summer

If you are on one of these medications, you do not have to endure summer. Begin by talking to your healthcare professional to learn your individual risk factors. Do not stop any prescribed drug without discussing with a doctor. Some major coping mechanisms include:

• Stay well hydrated unless otherwise instructed by your physician.
• Keep medications such as insulin and inhalers in a proper condition to continue being effective.
• Wear loose, light garments and broad-spectrum sunscreens.
• Avoid leaving your home during the 10 a.m. to 4 p.m. peak heat times.
• Watch for dizziness, confusion, nausea, or profuse sweating.

Does Heat Affect Mental Health?

Heat also affects mental health, whereas winter seasonal affective disorder (SAD) is more well-known, summer SAD may result from inadequate sleep and protracted heat exposure, aggravating depression and anxiety symptoms. Heat doesn't only impact the body—some individuals have summer-pattern seasonal affective disorder (SAD), with deteriorating depression or anxiety during extended, hot days. Inadequate sleep resulting from heat can also heighten these symptoms. Hydration, cooling down, and stress management practices such as deep breathing or meditation can assist with maintaining mental health during heat waves.

The Anxiety & Depression Association of America suggests staying hydrated, practicing mindfulness techniques for stress management, and getting proper rest. For individuals who are experiencing mental fatigue in the summer months, contacting a mental health professional is highly recommended.

As we endure increasingly hotter, longer summers, it is more important than ever to know how drugs interact with heat. From antidepressants to insulin, every drug has special risks related to thermoregulation, dehydration, and sun sensitivity.

For people on antidepressants, antipsychotics, cardiac medications, stimulants, or insulin, summer poses special challenges—but also the potential for proactive self-protection, see your physician or health care provider for further assistance.

Disclaimer: This article is for informational purposes only and does not substitute professional medical advice. Always consult your doctor before making changes to your medication or health routine.