If you’re feeling down most of the time and find yourself withdrawing from social activities, you may be facing mental health issues. It may be hard to reach out for help, but you may need emotional support to get better.

People in debt are three times more likely to have a mental health problem than those not in debt, according to new research led by the University of Southamptom. With levels of debt increasing in the recent years, in light of the economic recession and fiscal instability. Researchers from theUniversity of Southampton, along with a researcher from Kingston University, carried out a review on all previous research, which looked at the relationship between health problems and unsecured debt.

The results, published online in Clinical Psychology Review, showed that those in debt were more than three times more likely to have a mental health problem as those who were not in debt. 

Less than nine percent of participants with no mental health problems were in debt, compared to more than a quarter of participants being in debt and with a mental health problem.

The team found that those in debt were also more likely to suffer from depression, drug dependence and psychosis and the results also suggest that those who die by suicide are more likely to be in debt.

Dr Thomas Richardson, Clinical Psychologist from the University of Southampton who led the research, comments: “This research shows a strong relationship between debt and mental health; however it is hard to say which causes which at this stage. It might be that debt leads to worse mental health due to the stress it causes. It may also be that those with mental health problems are more prone to debt because of other factors, such as erratic employment. Equally it might be that the relationship works both ways. For example people who are depressed may struggle to cope financially and get into debt, which then sends them deeper into depression.

“Debt advisors should consider asking about mental health when speaking to members of the public. Similarly mental health professionals should ensure they ask about whether their patients are in debt. Further research is now needed to show exactly how debt leads to poor mental health, so that interventions can be designed to try and prevent those in financial trouble developing mental health problems and vice versa.”

People with severe or chronic illness have much higher odds of needing psychiatric care.

TUESDAY, July 24, 2012 (HealthDay News) — People with physical health problemsranging from back pain to cancer are three times more likely to seek mental health care than those without such woes, a new study finds.

“The interplay between our physical and mental health has long been suspected,” lead author Jangho Yoon, a health policy economist who specializes in mental health policy issues at Ohio State University in Columbus, said in a university news release.

“When I have back pain, I feel stressed. And if it impacts my ability to work or to do my usual activities, then I can feel upset or even a bit depressed,” he said. “But no large-scale studies existed that showed the statistical proof of this correlation.”

The findings may also highlight the need for better coordinated care between those who provide care for physical and mental health issues, Yoon’s team said.

The study looked at data from more than 6,000 adults who took part in the 2004 and 2005 U.S. Medical Expenditure Panel Surveys. None of the participants had previously reported a physical or mental health condition.

Even after omitting people with catastrophic physical conditions such as cancer, stroke and heart attack, the researchers still found that people with physical health issues were three times more likely to seek mental health care.

They also found that people who perceived their physical ailments to be severe were more likely to seek mental health care.

The study was published online recently in the journal Health Services Research.

Yoon believes that a simple screening survey may help doctors assess patients and direct them to mental health treatment if they require it.

That type of initiative would be “a win-win,” Yoon said. “There is a chance of cost savings in our medical system if we identify potential mental health problems early, before they become more severe.”

“More importantly, coordinated care and early intervention leads to better health outcomes, and better care for the patient,” he added.

Inspector general wants more regulation for flawed centers.

WASHINGTON — WEDNESDAY, Aug. 22, 2012 (MedPage Today) — Most community mental health centers employ at least one questionable billing practice, a government report has found.

More than half of community mental health centers (52 percent) were found to have employed at least one of nine predetermined questionable billing practices, the Department of Health and Human Services Office of Inspector General (OIG) found in a report released Tuesday. About a third of the 195 centers (35 percent) it reviewed exceeded thresholds for unusually high billing in at least two of the nine areas.

The OIG report focused on the centers’ practices in billing for partial hospitalization programs. Medicare Part B reimburses community mental health centers for providing such programs, which are intense, structured outpatient mental health treatment programs.

To combat possible billing fraud, the OIG recommended that the Centers for Medicare and Medicaid Services (CMS) increase monitoring of the mental health centers’ billing and fraud prevention, take appropriate action against questionable billing, finalize proposed conditions of participation, and enforce the requirement that certifying doctors be listed on partial hospitalization program services claims.

Enforcing the requirement that physicians be listed on the claims “provides additional information for CMS to use to verify whether the [partial hospitalization program] services billed were medically reasonable and necessary,” the report stated.

CMS has already agreed with all of the OIG’s recommendations, the report said.

In 2010, 206 centers received $218.6 million for providing partial hospitalization services to 25,000 Medicare beneficiaries. In 2011, four community mental health center owners and managers were convicted of fraudulently billing Medicare for roughly $200 million for medically unnecessary partial hospitalization services from 2002 to 2010.

To find out more about the problem, the investigative wing of of HHS developed nine questionable billing characteristics, then reviewed 2009 and 2010 Medicare claims to spot community mental health centers with one of the characteristics to help identify areas of possible waste.

Questionable characteristics included:

• Beneficiaries who received only group psychotherapy during participation
• Beneficiaries who were not evaluated by physicians during participation
• Beneficiaries with no mental health diagnoses 1 year before participation
• Beneficiaries with cognitive disorders such as Alzheimer’s disease
• Beneficiaries who were readmitted to inpatient treatment

The OIG found that in 2010, eight of 11 metropolitan areas with at least three mental health centers had a higher percentage of questionable billing than the national average; areas with the highest percentages of centers employing questionable practices included Houston, Miami, and Baton Rouge, La.

In addition, 90 percent of centers with questionable billing were located in states that don’t require mental health centers to be licensed or certified.

CMS expects to publish a final rule for conditions of participation for community mental health centers in spring 2013.

Source: OIG: Mental Health Centers Need Scrutiny

Depression and other mental health problems are common in men, but men often don’t receive proper diagnosis and treatment.

Mental health in men is a serious issue. An estimated six million men in the United States suffer from depression, according to the National Institute of Mental Health. Phobias, such as social phobias and panic attacks, are the second most common mental health condition in men older than 25. Although schizophrenia, a lifelong mental illness, strikes men and women in about equal numbers, it comes on earlier in men — symptoms appear in the late teens to early 20s in men compared to the mid-20s to early 30s in women. Most alarming, four times as many men as women die from the most serious consequence of mental health problems: suicide.

Fortunately, help is available for men with depression and other mental health conditions.

Men and Mental Health: Gender Differences

Studies have found that depression is twice as common in women as in men, but many experts believe depression in men may be under-reported.

“It’s well known that women are more likely to recognize that something is wrong and go to the doctor,” says Stephan Quentzel, MD, a family physician, psychiatrist, and assistant professor of medicine at Albert Einstein College of Medicine in New York City.

Because women are more likely to go to the doctor with mental health complaints, they’re diagnosed more often. Additionally, depression looks different in men. While a depressed woman may feel sad, cry easily, and lack energy, depression in a man is more likely to exhibit itself as aggression, anger, and irritability. He may get into fights, abuse his wife and children, or compulsively seek thrills in high-risk behavior. Often, a depressed man will cope by taking drugs or drinking too much. This can mask depression, making it less likely that a man will receive treatment for the underlying mental health condition. “For a variety of reasons, many men aren’t getting proper diagnosis and treatment for their depression, which can be life-saving,” says Dr. Quentzel.

Men and Mental Health: The Stigma of Depression in Men

Cultural expectations can make it hard for men to admit to mental health problems and seek help. Because a man may feel pressure to maintain a tough-guy image, he may suffer in silence or try to fight through his depression, using strategies like violence or drinking.

“There’s a stigma attached to depression in men,” says Quentzel. “Men can see being depressed as a sign of weakness.” The alarming suicide rate in men may be a reflection of the stigma of depression. Rather than seeking treatment, a man may choose suicide as the best way out of his pain and distress. While women actually make more suicide attempts than men, males are more often successful in their suicide attempts, partly because they’re more likely to use guns (women often take pills). Many experts believe that proper diagnosis and treatment of mental health problems in men could greatly reduce the suicide rate.

Men and Mental Health: The Benefits of Treatment

Many mental health conditions are highly treatable. Medications for phobias and schizophrenia are effective for most patients, though it may take some trial and error to find the right one; and depression can be treated in a variety of ways.

“At least 80 percent of adults with depression improve when they receive treatment with antidepressant medication, psychotherapy (talk therapy), or a combination of both,” says Quentzel. Electroconvulsive therapy (ECT) may be a treatment option for severe depression. Men should start by making an appointment with their primary care doctor, who may then refer them to a psychologist, psychiatrist, or other psycho therapist for appropriate diagnosis and treatment. With proper treatment, most men begin to feel better within six months.

Seeking help for mental health issues can lead to a happier and healthier life. Keep in mind that depression and other mental illnesses are real diseases that affect men as well as women. Getting treatment for a mental condition is not a sign of weakness. It may be the best thing a man can do for himself and his loved ones.

Findings reflect need for improved psychological services, researcher says.

TUESDAY, Sept. 27 (HealthDay News) — The number of Americans who say they suffer from mental health disabilities has jumped significantly over the past decade, a new study shows.

Researchers from the Johns Hopkins Bloomberg School of Public Health found the prevalence of self-reported mental health disability rose from 2 percent between 1997 and 1999 to 2.7 percent between 2007 and 2009. The increase amounts to nearly 2 million disabled adults, the study noted.

“These findings highlight the need for improved access to mental health services in our communities and for better integration of these services with primary care delivery,” said Dr. Ramin Mojtabai, an associate professor at the Bloomberg School of Public Health, in a university news release. “While the trend in self-reported mental health disability is clear, the causes of this trend are not well understood.”

In conducting the study, researchers examined information collected in the U.S. National Health Interview Survey involving 312,364 adults ranging in age from 18 to 64.

The increase in adults reporting mental health disabilities was mainly among people with significant psychological distress who did not seek out mental health services in the past year and in people who also reported disabilities related to other chronic conditions, the study noted.

Financial hardship may be to blame for lack of treatment. The number of people who did not receive mental health care due to financial reasons increased from 2 percent between 1997 and 1999 to 3.2 percent 10 years later, the researchers said.

The study was reported online Sept. 22 ahead of print publication in the American Journal of Public Health.

Fewer adults reported disability related to other chronic conditions than 10 years earlier, while roughly the same number experienced significant psychological distressat the start and end of the decade.

Insurance coverage for mental health treatment is more widely available now. Here’s what you should know.

Each year more than 5 million American adults experience a major depressive episode and do not seek treatment, according to a recent NerdWallet study. For some, the stigma associated with mental illness keeps them from seeking help, but others may be avoiding treatment simply because they are unsure of whether they can afford it or whether their health insurance covers it. While insurance coverage for mental health treatment is more widely available and comprehensive thanks to recent changes, some say it still doesn’t go far enough.

If you purchased your health insurance through state exchanges set up by theAffordable Care Act, mental health care is covered. It is one of the 10 benefits that must be covered on all plans under the law. If you have insurance through your employer, there’s a pretty good chance you’re covered too. A Society for Human Resource Management survey of 2014 employee benefits found that 87 percent of employer health plans cover mental health treatment. But exactly what mental health services are covered under these plans varies and depends on what medical services are covered.

RELATED: 6 Cheap Ways to Get Mental Health Care

Mental Health Parity Law

Historically, mental health coverage had been treated as a less important health concern than medical coverage by the insurance industry. That has changed over the years, culminating with the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in 2008. Also referred to as the mental health parity law, the act essentially mandates mental health and substance abuse coverage to be comparable to physical health coverage.

“New efforts are underway to expand coverage to the millions of Americans who have lacked access to affordable treatment for mental and substance use disorders,” said Labor Secretary Thomas E. Perez , upon passage of the final parity rules. “These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices, and increase health plan transparency. Ultimately, they’ll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it.”

The parity law says that insurance policies covering mental health care must treat that care as they do other medical coverage. If you generally pay a $40 copay for doctor’s appointments and treatments, for instance, an appointment with your psychologist can’t carry a higher price tag.

Before the final rules of the parity law took effect, patients in need of mental health treatment would often have to seek pre-approval for coverage, and even then they would be limited to a certain number of visits per year. That is no longer the case. Though health insurance companies can always review whether covered treatments are necessary, they can no longer put arbitrary caps on mental health visits that they wouldn’t put on medical appointments.

Depending on the specifics of your policy, and whether similar medical treatments are covered, your mental health coverage can include: emergency room visits, hospital stays, individual and group therapy appointments, psychiatrist visits and coverage for mental health prescriptions.

Plans Still Not Required to Have Mental Health Coverage

“The parity law, on paper, certainly appears to be an improvement in health care policies”, says Lisa Blackstock, a patient advocate from Soul Sherpa. “The key is whether or not your policy covers [mental] health care.”

The law does increase the quality of care for those who have mental health coverage, but it does not mandate mental health coverage on all policies. Instead it requires health insurance plans that do cover mental health treatment to cover it on par with medical treatment. The American Psychological Association points out there are some programs exempt from the parity law. Some state government employee plans can opt out of parity requirements. Likewise, Medicare is not subject to the law.

Even if mental health coverage is available, some providers may not accept your insurance. Blackstock told NerdWallet that mental health providers are often reluctant to accept these policies because reimbursement rates are so low.

If you are unclear about your coverage, consult your description of plan benefits or contact your insurance carrier directly.

Deductibles, Copays Still Apply

The parity law, along with requirements under the ACA, may mean mental health care is more accessible than ever. But that doesn’t mean there aren’t costs. Just like your medical care, mental health care is subject to copays, coinsurance, deductibles and other out-of-pocket costs. It is likewise still subject to coverage denials from insurance companies.

You can prepare for these costs by becoming familiar with your plan’s coverage specifics before you seek mental health treatment. If you receive with an unexpected denial or higher-than-anticipated bills after treatment, you may find help through a medical bill advocate.

Blackstock says patients with mental health questions shouldn’t be afraid to get help.

“My advice to all persons regarding emotional well-being and mental health is to maintain a strong support group, be open when stress gets to be too much, and don’t be hesitant to appoint an agent for you in your advance health care directive who you can trust to help navigate your care when the going gets tough,” Blackstock says.  “If you incur a big bill for mental health treatment that isn’t covered by insurance, find a patient advocate with a proven track record in bill negotiation … Someone needs to pick it apart and aggressively advocate on your behalf, not unlike an attorney or Realtor doing their job in their respective fields.”

[5/2/2007] The U.S. Food and Drug Administration (FDA) today proposed that makers of all antidepressant medications update the existing black box warning on their products’ labeling to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment (generally the first one to two months).

• FDA News (issued 5/2/2007)
• Medication Guide for Antidepressant Drugs (PDF – 27KB)
• Revisions to Product Labeling (PDF – 28KB)
• Questions and Answers (5/2007)

List of Antidepressant Drugs with Medication Guides

Anafranil (clomipramine)
Asendin (amoxapine)
Aventyl (nortriptyline)
Celexa (citalopram hydrobromide)
Cymbalta (duloxetine)
Desyrel (trazodone HCl)
Elavil (amitriptyline)
Effexor (venlafaxine HCl)
Emsam (selegiline)
Etrafon (perphenazine/amitriptyline)
fluvoxamine maleate
Lexapro (escitalopram oxalate)
Limbitrol (chlordiazepoxide/amitriptyline)
Ludiomil (maprotiline)
Marplan (isocarboxazid)
Nardil (phenelzine sulfate)
nefazodone HCl
Norpramin (desipramine HCl)
Pamelor (nortriptyline)
Parnate (tranylcypromine sulfate)
Paxil (paroxetine HCl)
Pexeva (paroxetine mesylate)
Prozac (fluoxetine HCl)
Remeron (mirtazapine)
Sarafem (fluoxetine HCl)
Seroquel (quetiapine)
Sinequan (doxepin)
Surmontil (trimipramine)
Symbyax (olanzapine/fluoxetine)
Tofranil (imipramine)
Tofranil-PM (imipramine pamoate)
Triavil (perphenazine/amitriptyline)
Vivactil (protriptyline)
Wellbutrin (bupropion HCl)
Zoloft (sertraline HCl)
Zyban (bupropion HCl)
For more information on some of these drugs, please see the Index to Drug-Specific Information.

Historical Information on Antidepressant Use in Children, Adolescents, and Adults