Most American parents say they might have trouble distinguishing between a teen’s typical mood swings and possible signs of depression, a new survey finds.

The nationwide poll of 819 parents with at least one child in middle school, junior high or high school found that while one-third were confident they could detect depression in their children, two-thirds said certain things would make it difficult.

Dramatic changes

About 30% of parents said their child is good at hiding feelings and 40% said they struggle to differentiate between their child’s normal mood swings and signs of depression, according to the C.S. Mott Children’s Hospital National Poll on Children’s Health at the University of Michigan.

“In many families, the preteen and teen years bring dramatic changes both in youth behaviour and in the dynamic between parents and children,” poll co-director Sarah Clark explained in a university news release.

“These transitions can make it particularly challenging to get a read on children’s emotional state and whether there is possible depression,” she added.

“Some parents may be overestimating their ability to recognise depression in the mood and behaviour of their own child,” Clark noted. “An overconfident parent may fail to pick up on the subtle signals that something is amiss.”

The poll also found that one in four parents said their child knows a peer or classmate with depression, and one in 10 said their child knows a peer or classmate who died by suicide.

Rising rates of suicide

The suicide rate among US children and young adults aged 10 to 24 rose 56% between 2007 and 2017, according to the US Centers for Disease Control and Prevention.

“Our report reinforces that depression is not an abstract concept for today’s teens and preteens, or their parents,” Clark said.

“This level of familiarity with depression and suicide is consistent with recent statistics showing a dramatic increase in suicide among U.S. youth over the past decade. Rising rates of suicide highlight the importance of recognizing depression in youth,” she said.

Potential signs of depression in children include sadness, isolation, anger, irritability and acting out.

Many parents in the survey believe schools should play a role in identifying potential depression, with 70% supporting depression screening starting in middle school.

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For Meghan King Edmonds, stress has affected her eating habits.

Shortly after posting a family photo on Friday with daughter Aspen, 3, and 1-year-old twin sons Hart and Hayes, the former Real Housewives of Orange County star, 35, replied to a fan who expressed concern over the mom of three’s appearance.

“You look very skinny. I know you have a lot on your plate. And I can only imagine how hard it is to juggle it all,” the fan wrote to the reality star, who has been open about her ongoing divorce from estranged husband Jim Edmonds. “Take care of yourself momma, you can’t pour from an empty cup. Sending you love.”

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Responding to the social media user, King Edmonds agreed that she was “too thin.”

“I’m a stress non-eater,” she explained, adding, “I’m working on it.”

On Thursday, Meghan revealed on her Instagram Stories that she was heading to the airport to pick up her children after having been apart from them while she worked to get her “long term” rental home in Los Angeles ready for their arrival.

During that time, Aspen, Hart and Hayes stayed with Jim, 49, in St. Louis, Missouri. Jim previously revealed that he had moved into his and Meghan’s newly-completed mansion by himself amid their divorce.

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Before touching down in Los Angeles, Jim shared a photo with his children, sharing that they were off to see mommy.

“The littles are getting big. Headed to Cali to see mommy and get Hart a little bit more treatment,” Jim wrote. Hart has sought treatment in California after being diagnosed with “irreversible brain damage” earlier this year.

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On Nov. 8, just two weeks after reportedly filing for divorce from Meghan following his sexting affair and amid rumors that he had an affair with their former nanny, Jim revealed that he was moving into the St. Louis home, which had been under construction for two years.

Both Jim and their former nanny denied having a sexual relationship.

Despite the circumstances, Jim and Meghan are reportedly committed to co-parenting their children, according to Bravo. The former couple has agreed to joint custody of their kids.

Jim and Meghan split in October after five years of marriage.

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I’ve been sick my entire life, and no one could tell me why. I was 54 years old when I was finally diagnosed with an invisible illness last year.

For years, I had tried to explain what was going on to doctor after doctor. I had these really weird symptoms, so doctors had these really weird responses. They would get mad at me, blame me. I could see them rolling their eyes, hear them sighing. It was all very unprofessional. They would look at me like I was wasting their time. To be fair, they didn’t understand.

I remember once trying to describe muscle spasms or cramps I was having. I was in huge amounts of pain from these spasms all over my body. The doctor told me, “They’re not cramps or spasms. You’re perfectly normal.” I knew this was not normal. But rather than admitting there’s something wrong but we don’t know what it is, the default was to say I was normal.

I hid as much of my disease as I could. I pretended to be normal. The person I was projecting on the outside was very different from me on the inside.

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A lifetime of symptoms—with little help

My mom had mysterious symptoms of her own. She always had problems going to doctors; they couldn’t work out what was wrong with her—or with me. She had taken me to many doctors, but when my symptoms got worse when I was 10, a doctor told her for the first time it was probably all in my head.

Frustrated that neither of us could get a diagnosis, she gave up on taking me to the doctor—they did nothing to help. Test after test after test showed nothing was wrong.

From her own experience, my mom knew some ways to help me, at least a little. For example, years before, she had worked out on her own that to manage her symptoms, she needed to eat sugar basically all the time. She made me eat this way too.

I was always cold; my body couldn’t maintain its temperature. I was always dressed way too warm for what anyone else thought was appropriate, so it seemed like almost on a daily basis people would make derogatory comments or make fun of me for being overdressed.

I was always smart, but I had trouble learning; sometimes words sounded jumbled. Even today, it’s hard to retrieve information I know. Throughout my career, there have been gaps in my progress where I’ve struggled with my health and hardly accomplished anything.

During my postdoctoral work, I got really, really sick. I was so weak I couldn’t exercise—at times I could hardly walk. I had been diagnosed with asthma, but it turned out that my breathing problems were due to muscle spasms. I had also been having seizures and what’s called “metabolic crashes” at home. I had even lost some short-term memory.

One doctor I saw around this time brought a psychiatrist into the room to talk to me without asking me first. I refused to talk to her because I knew this was a physical problem. The doctor made a permanent record in my file that I was a patient with a psychological problem. He made it clear he thought I was wasting his time: He told me no one would believe me, and that if I wanted to pursue treatment for a physical problem, I’d have to go to doctors outside of my university’s system. I was a student and couldn’t afford to do that.

Because I looked normal, and because my symptoms didn’t make sense within the medical framework we knew at the time, my husband of nearly 20 years sided with the doctors. It didn’t matter that I was saying I had these symptoms: the tests weren’t proving anything. He didn’t understand why I couldn’t, say, go out for a hike for hours without eating. He didn’t want to stop for food and rest. He didn’t understand why I was so cold or sometimes couldn’t walk. He thought I was having emotional tantrums or didn’t want to do what he wanted to do. It was just an impossible situation. We got divorced in 2014.

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Piecing together the puzzle

Even though my symptoms made school challenging, I had always been high-functioning enough to figure out workarounds. I would have trouble understanding my teachers, but I’d be able to figure out things like reading or math more easily on my own. I didn’t have good grades, but I continued to pursue a PhD because I was so interested in science, and ultimately landed a job in research. When I first started working at Mayo Clinic in 2015, where I research myocarditis and sex differences in inflammation, I went to see a neurologist who specializes in migraines.

He recognized my symptoms right away as signs of a type of mitochondrial disease, an umbrella term for a group of genetic disorders that affect around 1 in every 5,000 people. One of the common symptoms of mitochondrial diseases is migraine, so my neurologist was familiar with both conditions. He referred me to a geneticist who finally was able to diagnose me with mitochondrial disease after 54 years using a test called a whole exome sequence. He also tested the genome of my mitochondria.

We all have mitochondria in our cells. If a cell is a car, mitochondria are the engine. Sugar provides energy—it’s the gas for the engine. If you have a mutation in your mitochondria, your body may not make or use energy correctly, which can lead to all different kinds of symptoms. For this reason, it can be very difficult to diagnose mitochondrial disease.

I really was having classic symptoms, but it never occurred to me or my doctors then that I had a genetic disease that no one knew about. Now, there are ways to detect what was wrong on a cellular level, but of course this didn't show up on a blood test or CT scan or tests that were available when I was younger.

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Becoming visible

It was incredibly overwhelming to finally get a diagnosis. For so long, I had been afraid to tell people my really weird symptoms because I was afraid they’d think I was crazy. Now I was able to start putting everything in context. Suddenly I had a frame of reference for all these things that had happened to me. Everything started making sense.

But it was traumatic at the same time. I had faced so much rejection and there was so much I had never been able to tell anyone. I always felt alone. That was the very worst thing about living with an invisible illness. But telling people in my life what was really going on made me feel rejected all over again. People responded in many different ways: Some didn’t want to hear about it; others would say unsupportive things like, “Well, you’re not dead,” or “You’re not in a wheelchair, so you’re fine—what’s the big deal?”

People close to me found it hard to hear about, wondering how this could all have been going on with my health and yet I had never told them. Other friends and colleagues were surprisingly compassionate and understanding. I’ve considered contacting my ex-husband now that I have a diagnosis, but I haven’t done that yet because it’s still so emotionally charged.

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Staying healthy with my invisible illness

There is no cure for mitochondrial disease, and treatment options are limited. For many patients, there’s nothing that helps. I appear to be low in a specific enzyme, CoQ10, that I can get in a special supplement for patients with mitochondrial disease. I also take antiviral medications—for so long I had chronic viral infections that I couldn’t get rid of, so that has helped a lot. I was in agonizing pain every day, but I didn’t realize how bad it really was until these treatments started to provide some relief. I’m going to research medications that seem to be helping my muscle spasms and stopping my seizures to see if they could have a benefit for other patients with mitochondrial disease.

As a teenager, I decided to rebel against my mom and eat my own way. But I got really, really sick and went back to eating sugar every few hours. Now I know I feel my best if I eat sugar and fat every few hours. I even set an alarm to wake up during the night to eat. When I was feeling my worst, I ate a lot of chocolate truffles and I was just gaining and gaining weight. With my medications, I have been able to diet for the first time in my life without having a metabolic crash.

There’s some preliminary evidence that getting complex carbs and plenty of fat can help people with mitochondrial disease. I’ve found starchy foods, like potatoes, work better for me than simple sugar, which the body burns too fast, so I keep 150-calorie snack bags of potato chips with me all the time.

Along with my snack supply, I carry a backpack with an emergency letter explaining step-by-step instructions for my medication. And my phone is full of alarms that I depend on to remember the times to eat and take my medicine.

When healthy mitochondria make energy in the body, they also give off heat—I finally understood why I’m always cold. I wear a winter jacket all the time, and I live in Florida. I keep my office very warm, and I have an electric blanket and a heating pad there. I travel with an electric blanket too.

I’m learning how to take more time off to rest and recover. Instead of working late, I go home and sleep. I didn’t do that before because it was my habit to just keep going because I was always behind.

I have to think about my health all the time every day to stay stabilized. I’ve been doing it my entire life, but now I know why. It is tiring, but when I don’t, I have terrible symptoms, so it’s worth it.

Today I have “white coat hypertension”—doctors literally make my blood pressure rise. Every time I visit a new doctor, my blood pressure goes through the roof, but I have great relationships with the doctors I see now. I think I also have what people are just starting to call “medical PTSD,” or post-traumatic stress disorder, after a traumatizing medical experience.

I worked all my life to appear “normal,” but now I can start to discover who I really am. Now that I can explain what’s going on, I can become a new person. I feel like I recognize myself in the mirror for the first time.

If you have a story to share about living with an invisible illness, email us at invisible@health.com

Scientists say it’s ‘not a myth’ that people on a vegan diet need extra vitamin B12.

Living with diabetes – especially if you need insulin to survive – is a never-ending job that can be life-threatening if done wrong. That constant daily stress can lead to “diabetes burnout”, a new study says.

Diabetics experiencing burnout are mentally and physically exhausted, feeling detached from their condition and apathetic about their need for self-care. Diabetes burnout can last hours or days, and sometimes weeks, months or even years, the researchers said.

Nothing left to give

“Diabetes is unique as a disease because the self-management requires constant activity, mental energy and physical energy,” explained Felicia Hill-Briggs, immediate past president for health care and education for the American Diabetes Association.

“You have to take medication, check your blood sugar, cook healthy, eat healthy, make sure you’re getting enough physical activity, and be sure to balance all those things,” said Hill-Briggs, who was not involved with the study.

She likened living with diabetes to running in a marathon: Even the best-trained and most elite athletes sometimes collapse at the end of a long race, with nothing left to give.

“You reach a point where you can’t do any more until you step back, and rest and rejuvenate,” Hill-Briggs said.

The new study, led by researcher Samereh Abdoli from the University of Tennessee, included interviews with 11 women and seven men (average age: 38) with type 1 diabetes. Seven people said they were currently experiencing diabetes burnout. All said they had gone through it during the past year.

Tired all the time

One 36-year-old woman said: “It’s exhausting, it is exhausting. It really is, to constantly take care of yourself and have to worry about everything you eat, everything you do, every move you make.”

A 22-year-old woman echoed that sentiment: “You’re tired all the time, I mean physically, you’re just feeling old, feeling worn out.”

Besides exhaustion, the study identified other themes:

• Detachment: Patients described feeling detached from their identity as a person with diabetes, from their self-care, and from their support systems. “I didn’t want to think about diabetes and I didn’t want to be a diabetic anymore,” said a 42-year-old man. A 51-year-old woman said: “I’ve had enough; I would rather deal with the result of the disease.”
• Other contributors: Researchers pointed to factors such as the constant burden of self-care and failure to achieve goals such as target blood sugar levels. “Having to test your blood sugar all day when you have other things going on? Not what you want to be worrying about. Waking up in the middle of the night? Low blood sugars at times that are inconvenient? Just that happening over and over again. I think you experience burnout,” explained a 31-year-old man.
• Strategies for recovery: Participants reported strategies to prevent or overcome diabetes burnout, including getting support from friends, family or health care providers, and trying to maintain a positive attitude. “I combat my burnout by reminding myself of what’s more important,” a 42-year-old woman said. “I’m getting to see my daughter grow up, I get to still work and do the practice that I love, I get to see new things and do things, and I have to remind myself of that, and that’s how I combat it. … Be thankful for what you got.”

Becky Lois is a child and adolescent psychologist at Hassenfeld Children’s Hospital at NYU Langone in New York City. She also wasn’t part of the research.

“Burnout is almost unavoidable,” Lois said. “You didn’t ask for diabetes. Sometimes it’s out of your control. And it’s really hard when it feels like everyone is telling you what to do.”

It’s great, she said, if people can recognize the distress that precedes burnout and work with their health care provider before burnout occurs. A simpler regimen might help. Maybe a loved one could remind you to check your blood sugar (or stop repeatedly reminding you). Having conversations with the people in your support system can really help, Lois said.

Ease up on the guilt

Hill-Briggs agreed it’s better to be proactive.

“Try to plan ahead of time how you might deal with burnout,” she said. “Do you want to go off your insulin pump for a week and do shots instead? Do you want to eat that food you never allow yourself? Or have a few days where your blood sugar won’t be as tightly managed?”

Hill-Briggs urged patients to ease up on the guilt trips. “Relax the sense of guilt,” she said. “Give yourself permission to lift your foot off the pedal for a little bit. It’s impossible to be perfect all the time.”

The study was published in the American Journal of Nursing.

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More than 4,500 hospital appointments are cancelled due to the industrial action on Wednesday.

A combination of uncertainty and surprise in chord progression gives you pleasure when you listen to music, a new study shows.

Researchers used a machine learning model to mathematically analyse 80 000 chords in 745 classic US Billboard pop songs. Other elements such as lyrics and melody were stripped out for the analysis.

Striking a good balance

When listeners were relatively certain about what chord to expect next, they found it pleasant when they were surprised by an unexpected chord, and when they were uncertain about the next chord, they found it pleasant when subsequent chords weren’t surprising.

“It is fascinating that humans can derive pleasure from a piece of music just by how sounds are ordered over time,” said study author Vincent Cheung, from the Max Planck Institute for Human Cognitive and Brain Sciences, in Germany.

“Songs that we find pleasant are likely those which strike a good balance between knowing what is going to happen next and surprising us with something we did not expect. Understanding how music activates our pleasure system in the brain could explain why listening to music might help us feel better when we are feeling blue,” Cheung said.

The study was published in the journal Current Biology.

Study co-author Stefan Koelsch, from the University of Bergen, in Norway, said, “Although composers know it intuitively, the process behind how expectancy in music elicits pleasure was still unknown. One important reason was because most studies in the past only looked at the effects of surprise on pleasure but not the uncertainty of the listeners’ predictions.”

The effect of uncertainty and surprise on one’s appreciation for other art forms, such as dance and film, could be subjects for future research, the researchers added in a journal news release.

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Young adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for nicotine addiction, new research shows.

For the study, a Duke University team used a nasal spray to determine how nicotine affected 136 non-smoking volunteers, aged 18 to 25.

ADHD sufferers choose nicotine

About half had been diagnosed with ADHD. The others had no diagnosed mental health conditions.

In the first three sessions, participants were given two different doses of nicotine spray as well as a placebo spray with no nicotine. In later sessions, the volunteers chose between a nicotine or placebo spray, but did they did not know which spray contained nicotine.

The participants first did this while relaxing and then while solving math problems.

“Regardless of demand conditions, the people with ADHD chose the spray with nicotine,” said study lead author Scott Kollins. He’s a professor in the department of psychiatry and behavioural sciences at Duke’s School of Medicine.

“Meanwhile, the people who did not have ADHD chose nicotine more often when they had to work on the cognitively challenging math problems,” he added.

The findings suggest “that the very first exposure to nicotine might be more pleasurable or reinforcing for individuals with ADHD, which in turn may lead to higher rates of dependence,” Kollins said. “This is important both for combustible cigarette smoking and the possibility of getting hooked on e-cigarettes.”

Potential risk for addiction

The study was published online recently in the journal Neuropsychopharmacology.

Nicotine affects brain physiology that’s involved in ADHD, the researchers noted.

When the investigators followed up with the participants six months after the study to find out if any had started using nicotine or tobacco, they found that none had.

Even so, the findings underscore the importance of talking to young people with ADHD about the effects of nicotine and their potential risk for addiction, the study authors said.

“It’s not enough for us to wait for kids and adolescents who have ADHD to have already experienced nicotine,” Kollins said. “We should talk to them about that sooner, before they have their first puff of a cigarette or vape with e-cigarettes.”

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Michael Dubrowsky left his savings to the Birmingham Royal Orthopaedic Hospital where he was treated.