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Do Antidepressants Work as Promised?

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Note: This is an editorial

Antidepressants – what’s going on?

One out of ten Americans are currently on antidepressants.  That’s just the beginning.  More than 25% of college students at some schools are on them.

Everyone is being given them for all sorts of reasons.  Are they really that effective or safe?  Maybe.  That said, there is a horrible secret.

We don’t know how antidepressants work.  We don’t know if they are safe for long term use.  And finally, we don’t know how well they work, and for what reasons they should be prescribed.

There’s too much money at risk for the big drug companies to bother to answer these questions.

After all, antidepressants are ideal money-makers, $80 billion annually.  They have to be taken daily for months if not years, and it can be impossible to tell if they’re working.  And they have serious side effects, like possibly doubling your risk of committing suicide.

Flawed studies

Everything we know about antidepressants comes from medical studies.  But the studies are really screwed up.

First, who runs the studies?  The drug companies.  What do they have at stake?

Good results mean that they make hundreds of millions of dollars.  Bad results mean they’ve wasted years of research and development.  What do you think happens?

Positive results in the studies are inflated on average 32%.  One analysis of 74 trials covering 12,500 patients showed that 36 studies gave negative results – and a shocking 11 of those were reported as being positive!  And if the negative studies can’t be spun positive, then we simply don’t hear about them.

Studies on antidepressant safety and efficacy are 94% positive – but if negative studies were published, they’d only be 51% positive.  The difference between what we hear and what is actually going is especially big for new drugs like Remeron.

The less time spent testing the drug means the less chance of picking up annoying side effects and saves operating costs.  Because of that, most studies don’t track long term use, and some studies last only a month.

That’s right.  Despite antidepressants being taken for months if not years, most research into them only goes on for a month or two, ignoring long term risks.

Extremely limited research

Millions of people take antidepressants.  By contrast, the studies which confirm their efficacy and safety study at most a thousand patients.

The initial studies for Prozac that approved its use had only a few hundred patients complete the study.

Some quick math.  30 million people have taken Prozac.  Now imagine there’s a serious side effect that occurs in 1/10,000 of the people who use it, and was missed in the initial studies.  That’s 3,000 people.

Antidepressants aren’t benign drugs, far from it.  They can cause thoughts of suicide in up to 4% of children, anger and violence in adults, alongside more mundane issues like nausea, restlessness and sexual dysfunction.

The Serotonin Hypothesis – a myth?

We don’t know how the medications work.  The Serotonin Hypothesis – that reduced levels of serotonin in the brain cause depression – is inaccurate and lacks scientific basis.

Lowering the level of serotonin in the brain doesn’t cause depression.  Increasing its levels directly doesn’t do much, either.  And if low levels of serotonin were to blame for depression, antidepressants wouldn’t take several weeks to work – they would work within days because that’s how fast they raise levels.

To cap it off, antidepressants that don’t target serotonin – like Wellbutrin – work at about the same rate as those that do.  Clearly the serotonin hypothesis is a vast over simplification that’s convenient for the drug companies.

Use in bipolar?

Antidepressants are very heavily used in patients with bipolar disorder.  Unfortunately, the data seems to be at best only moderately in support of such use, and there are no antidepressants approved for use in Bipolar (July 2008).

The STEP-BD, Systemic Treatment Enhancement Program for Bipolar Disorder, a study run by the National Institute of Mental Health, seems to show that antidepressants are only as effective as placebo for bipolar depression.

And while antidepressants aren’t much better than placebo for bipolar patients, they may exacerbate mood cycling.

Use for depression

A similar major study of antidepressant efficacy for regular depression, STAR*D, showed similarly lackluster results.

STAR*D’s data is open to interpretation, but at the least indicates that antidepressants are not as effective as thought.  About only 50% of patients experienced improvement initially, and over a year span efficacy was only about 25%.

For the vast majority of uses, antidepressants may work only as well as placebo, or a sugar pill.  Placebos, after all, show about the same 25% efficacy.  Due to the psychological nature of depression, the placebo effect absolutely must be monitored for.

Conclusion

Antidepressants do help some people, and do save lives.  A black-box warning in 2003 which sharply reduced their use may be linked to a significant increase in teen suicides.

But they are also huge money makers with highly inflated efficacy rates, and should not be as heavily prescribed as they are.  In many populations, they are no more effective than placebo, but unlike placebo have significant side effects.

Their use in Bipolar patients should be carefully examined.

You might like:

10 Ideas for Treatment Resistant Depression

Agomelatine: A New Treatment for Depression

50 Ways to Make Friends

Sources:

Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression
Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?
Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature
The Shocking Truth – Boston Magazine

Depression Help – No Drugs

Natural Depression Relief

HCF Happy, Calm & Focused - The Brain Supplement America Loves

Red Wine and Proper Diet

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What impact does food have on our health, both mental and physical?

A pretty big one.

One out of four Americans suffers from some sort of mental disorder, significantly more than in China and other countries, part of which may be because of diet.

And French people have a 40% less risk of heart infarction compared to the rest of Europe, though this contention – called the “French paradox” – is highly argued.

Eskimos consume very high fat diets yet tend to have lower risk of heart disease.  The answer may lie in their consumption of certain fish with important fatty acids.

Depression, a common malady, has been linked in part to dietary decisions.  Increasing folic acid, magnesium and Vitamin B12 may help treat depression.

A good diet at its basics has a combination of fruits, vegetables, whole grains and fish.  Studies tend to show that adding one serving of fruits and vegetables daily significantly reduces risk of heart disease and possibly stroke.

Red Wine

Consumption of two or fewer servings of wine daily has been shown to reduce risk of heart disease.*

Red wine is very high in natural substances called polyphenols, containing more than 200 of them.  They are powerful anti-oxidants, which means they help prevent degeneration and aging of your cells.

Importantly, red wine has resveratol, a substance that has been shown to increase the lifespans of various animals, but not mice.  Resveratol is a plant antibiotic that seems to fight the formation of cancer at every step of the process, including inhibiting ribonucleotide reductase and other carcinogenic processes.

Resveratol may also fight brain disease and help keep your blood healthy.  Research has not caught up with all the exciting claims made about resveratol, however.

Red wine – in moderation – may also help lower cholesterol and help your innate immune system.  Some research shows that regular consumption of small amounts of red wine can help both women and men with sexual response and enjoyment, though those studies have been with small samples and need verification.

*Note: the American Heart Association does not recommend drinking, and consumption of three or more drinks daily is associated with heart disease and stroke.

You might like:

The Health Benefits of Simple Foods
50 Ways to Make Friends

Sources:
Resveratrol and its analogs: Defense against cancer, coronary disease and neurodegenerative maladies or just a fad?
A systemic review of the roles of n-3 fatty acids in health and disease

Restasis for Dry Eye (Opthalmic Cyclosporine)

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Does your eye get irritated or feel dry?

Most older people have at least some experience with dry eye, a condition that can require treatment and disrupt quality of life.

Dry eye is caused by inadequate tear production or inflammation in your eyes.

If you don’t know what Restasis is, you probably want to skip to the Cylcosporine part. This is a friendship post (in response to a friends question).

What is Restasis?

Restasis is an eye drop treatment that primarily consists of Cyclosporine.  See later for a discussion of how Cyclosporine works.  Restasis’s effectiveness has been shown in multiple studies for treatment of various eye conditions like keratoconjunctivitis.

Its use for irritation from contact lenses has not been extensively studied, and it seems that typical eye drops may work just as well.  Before using Restasis make sure it is 1) approved for your indication and that it is 2) more effective than less powerful treatments, and that you don’t have any conditions that mean you shouldn’t take it.

Restasis tends to work.  Some studies show 15% significant improvement, while other studies show 72.1% of patients with dry eye getting better to some degree.  In general, it seems that most Restasis users experience improvement.  Patience is key, because it takes several months to achieve a therapeutic effect.

Side effects of Restasis are mostly mild and consist of eye burning or blurring.  This is in contrast to corticosteriods, another treatment, which do have serious side effects, as well as most systemic drugs which effect the whole body.

Because Restasis is applied to the eye, and tends not to penetrate into the body, it seems to be safe.  That said, there are indications like infection and herpes which you need to tell your doctor because it may not be an appropriate medication then.

Use patterns of Restasis are not entirely clear.  Most users are over 50 and women, and it’s typically one of the first treatments sought.  While the manufacturer recommends using 2 vials daily, most users end up using from .25 a vial to 1.25 vials daily, but if this provides adequate treatment has not been medically evaluated.

Important issues

Whether cyclosporine is carcinogenic is a hottly debated topic in medicine.  What about Restasis?

A cursory look at the 58 articles found in pubmed for the search “Opthalmic Cyclosporine Cancer” shows that none talk about the potential of Restasis to cause cancer.

Several, however, talk about the use of cyclosporine to treat retinoblastomas, a serious type of eye cancer.

It’s important to note that blindness and other serious events have been reported in association with bone marrow transplants and Restasis use.

What is Cyclosporine?

Cyclosporine is a substance produced by the fungus Tolypocladium Inflatum, and is a powerful medication used to prevent organ rejection after transplant.  If you’re giving someone else’s kidney or heart, for instance, it can help stop your body from launching an attack on the new and foreign body part.

Because of how it works, Cyclosporine can also help with dry eye.

Cyclosporine does at least two important things.  It changes how T cells interact with IL-2, reducing its effectiviness.  IL-2, or interleukin-2, is a messenger protein that tells your T-cells to replicate.  Because T-cells play a key role in immune reactions, suppressing their growth can reduce the inflammation in your eye.

Cyclosporine may also help keep your eye healthy and strong.  The way it does this is by preventing essential lining cells from committing apoptosis – or cellular suicide.  Cells tend to commit apoptosis if their local environment becomes a war zone, so to speak, with a continual immune reaction causing too much stress.  Keeping epithelial cells alive also helps prevent further degeneration.

Sources:

Topical Ophthalmic Cyclosporine: Pharmacology and Clinical Uses

Can Restasis Help Dry-Eye Contact Lens Wearers?

Topical ciclosporin in the treatment of ocular surface disorders

Medical Uses of Hypnosis

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Hypnosis, Greek for “sleep,” is a fascinating phenomena.

While hypnotized, people can be given suggestions that effect their subconscious more directly than normal.  They can recover lost memories, or be given suggestions that help them deal with problems like smoking or overeating.

If you tell someone who’s hypnotized that their skin is itching, they may develop a real rash.

Hypnosis has very real physical effects and plays an important role in various medical interventions.  If you doubt the power of the mind over our bodies, remember that someone can develop a big stomach, nausea and all the symptoms of pregnancy – just by believing that they’re pregnant!

A government task force in health said recently that there is “strong evidence” that hypnosis is an effective treatment for chronic pain.  It can help with other conditions too.

Hypnosis and Smoking

Wouldn’t it be amazing if a few sessions and suddenly you couldn’t stand the thought of smoking anymore?

Unfortunately, the data isn’t so optimistic.  Smokers who underwent one session focused on developing mental strategies to create negative associations did show somewhat increased rates of cessation and reduction.  But limited clinical information is an important limiting factor.

That said, hypnosis tends to show a 25% cessation rate in studies, considerably better than placebo.

Hypnosis and Irritable Bowl Syndrome (IBS)

Hypnosis may help with IBS where traditional treatments fail.  One study of 30 patients resistant to traditional treatments had some undergo pyschotherapy and others partake in hypnosis sessions.  The hypnosis group ended up having significant reduction in symptoms that lasted for more than 18 months.

The mechanisms of how hypnosis helps IBS are not clear, but probably has to do with how stress and psychosocial factors effect acid release in the digestive system.  Hypnotizing people and asking them to visualize eating a meal signals acid production as if they really had eaten.

Hypnosis and Pain

Aging is associated with increased pain.  Up to 80% of older residents in a nursing home, for instance, report problems with pain.  Additionally, even younger people suffer from pain associated with injuries or cancer.

Hypnosis is exceptionally useful in pain treatment, helping roughly 75% of those who use it.  It is more effective than biofeedback, cognitive behavioral therapy and possibly even morphine!

Research has shown that hypnosis can help with pain from burns, cancer and fibromyalgia, including other conditions.

Remember:

Hypnosis, unlike standard medical treatments, is not tightly regulated.  While it is a valid and important tool in treatment, beware hyperbole and claims that are unrealistic.  If you consider hypnosis, make sure your therapist is reputable.

References:
Hypnosis for pain management in the older adult
Hypnotherapy for treatment of irritable bowel syndrome

7 Worst Mistakes Blogs Make

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Having a blog has taught me a lot – it’s taught me ways to screw up blogging!

Most blogs make at least one of these seven mistakes.

Is your blog making one of them?

1) No value provided

Why should I read your blog?  There are hundreds out there doing exactly what you do – no?

You need to have a unique value proposition, or you have to do what it is you do better or different from everyone else.  This isn’t easy, but it becomes a hell of a lot easier when you focus on your reader, and on providing him or her with stuff that is relevant and interesting.

Make lists of things that are useful!  Write from new angels, be controversial!  Think, what can I write that I myself would want to read, hold onto, save and/or share?  Now start producing that material.

The trick is you don’t have to be amazing every post.  What you need to do is provide a combination of OK material with jaw-dropping, damn that’s good, useful articles.  If you can’t write every few weeks an article that is damn useful, you’re not trying hard enough or you’ve backed yourself into a bad niche.

If you want to learn a lesson in what works on the web, visit the front page of a major site like Digg for a few days.

2) Poor design

If you want your blog to succeed, you need to have a good design.  Your stuff must be easy to read.  It must also be presented in a way that is interesting and useful to the most important people – the folks reading your stuff.

Avoid annoying animations, pictures, whatever.  You want to connect to your niche while staying readable and professional.  If you’re writing for stay at home moms, pink and cupcakes might be OK; but animations of dancing babies NOT.

Don’t let your advertising ruin the design of your site.

3) On someone else’s server

Buy your own domain!  It’s surprisingly easy, makes you professional, and gives you control over your blog.

4) Lack of connection

Make your posts interlace.  When you write a topic, expand from it, and have other posts link to each other.  This is essential to maximize the amount of life you get from a casual reader.  If someone comes, sees that you have other relevant posts, they’re going to keep on reading and maybe become a more permanent guest.

5) Lack of easy conversion

You need to make it as easy as possible for people to save or share or whatever your website.  That means making it really easy to become a follower or share it on social websites.

6) Poorly Written

Yes, the vast majority of bloggers don’t have degrees in English.  But that doesn’t justify the terrible writing that is present on most websites.

Write to your audience.  Make it interesting, snazzy and keep readers coming back for more.

7) Forget the reader

This is the most debilitating and serious mistake.  You absolutely can not forget who your audience, what they find interesting, what they want.  It is only by making them happy that you can succeed.

Make it your mission to satisfy what your readers want.  They’ll repay the favor.

Related:

50 Ways to Make Friends
10 Questions to Improve your Life

Did you agree with this post?

Or have you noticed any mistakes of your own?  Tell us!

Treating Pain After Total Knee Replacement Surgery

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Have you had a Total Knee Replacement surgery (TKR) and are experiencing pain?  Unfortunately, you’re not alone.

At least one out of eight patients report pain a year after surgery, and some studies say this its almost one out of five.

The pain tends to develop.  Patients report limited pain for the first three months, while strong pain medication is used.  For some, however, reducing the pain medication doesn’t coincide with a decrease in pain, which may even increase.

Local treatments

Analgesics, or painkillers, are often used for TKR associated pain.  Many prefer not to take oral medications that are systemic in nature and so choose local treatments.

Localized patches that dispense pain medication are an option.  Capsaicin and other creams are also commonly used.

Massaging the painful area may help prevent desensitization.

Alternative therapies for pain

Meditation and other alternative treatments like hypnosis have shown some – but limited – help with pain management.

“Antidepressants” for pain

Your doctor may consider prescribing a medication commonly known as an anti-depressant.  While they certainly serve that function, they also have pain reducing effects in doses lower than those used for depression.

Tricylcic antidepressants tend to be more effective than SSRIs like Prozac, but they also tend to have more side effects.

Diagnosing

Figuring out what is causing the pain takes proper diagnosis.  Unfortunately, that means more imaging and testing.

Some questions to help figure out what’s going on:

1) Is the pain sharp or chronic?
2) Does it occur during a specific activity?
3) Did the pain exist before surgery?

Sharp pain, for instance, tends to indicate a mechanical issue, while chronic pain may indicate infection or other issues.  Signs of infection include chills and fever, and should be treated immediately.

Neuroma

One of many possible complications is the presence of a neuroma, or an overgrowth of nervous tissue.  Treatment consists of selective denervation and has a high success rate of around 86%.  Side effects are common, too, unfortunately, but tend to subside over 3-6 weeks.

Fast and Safe Pain Relief

Sources:

The management of patients with painful total knee replacement

Evaluation of patients with a painful total knee replacement

Anxiety Associated With Psoriasis

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Do you have psoriasis?  In addition to the physical problems, you’re probably experiencing a great deal of anxiety and emotional pain.  What can you do?

Psychosomatic problems

It might be a good idea to think about getting psychological therapy if you suffer from the following:

1) History of psychological factors causing psoriasis

2) Depression and/or Anxiety

3) Increased itching

4) Feelings of isolation, stigmatization or thoughts of suicide

Increased sensations of itching have been shown to have a psychological link, and if you’re feeling down it’s important to get help.

If your kid is suffering from psoriasis, strongly consider psychological intervention as in pediatric populations psoriasis has an even higher link to stress and life tensions.

Therapy can help you deal with your condition.  It can also possibly help reduce the severity and occurrences of psoriasis.

40-80% of psoriasis has a link to or is caused by psychological factors. And having psoriasis makes life a lot harder.  Sufferers often feel discriminated against and unattractive.  As such, ordinary activities like socializing and sexual relations evoke a great deal of anxiety.

Therapy can prevent this anxiety from exacerbating the psoriasis and causing more pain in a vicious cycle.

Moderately heavy consumption of alcohol can prevent clearance of psoriasis.

Antidepressants and Psoriasis

A trial of bupropion (Wellbutrin) in 11 patients found significant reduction of plaques.  Oddly enough, only one person actually felt like his mood improved.

That said, three psoriasis patients who were prescribed bupropion to help quit smoking suffered extreme reactions and were hospitalized.

Lithium and fluoxetine may exacerbate psoriasis.

Sources:

Psychological influences in psoriasis
Psychiatric morbidity in psoriasis: a review

Naturally eliminate anxiety and depression

Back of Knee Pain Causes

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Do you have serious pain in the back of your knee?

Read on to learn what might be the reason – and what you can do.

What causes back of the knee pain?

You need to first figure out what isn’t the problem.

Hip injuries, for instance, can cause knee pain because of shared nerve paths.  Many conditions like Sinding-Larsen’s Disease and neuromas cause knee pain.

You also need to understand the problem.

Did the pain start after a particular event? Is the pain sharp and consistent?  Or does it occur during a particular activity?

The most common causes of knee pain are

1) arthritis

2) acute damage from trauma

3) chronic damage

Damage to your anterior or posterior cruciate ligament is a common cause of knee pain in athletes.  Misalignment of bones and/or muscle can cause long term damage and pain.

More than six local tissues can be sources of pain, including damage to the skin, bone, nerve and muscle.

How is knee pain treated?

There’s not much you can do for your knee pain – if it’s really serious – without getting a proper diagnosis from a doctor.  A doctor will give you exercises to strengthen specific muscles that’ll reduce pain.

During this rehab, physical activity that could make the pain worse should be avoided or reduced.

Braces and shoes with special balances are also potential treatments.

Glucosamine, a supplement, has shown some – but very limited – improvement in trials.

Surgery should be a last resort.  Less invasive procedures like arthroscopy should be first considered, and only after failed attempts should knee replacement be considered.

Fast and Safe Pain Relief

Related:

Treating Pain After Total Knee Replacement

Sources:

Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment

Diagnosis and Treatment of Patients with Patellofemoral Pain

Do you have serious pain in the back of your knee (right below the kneecap)? You probably want to know what causes it.

What causes the pain?

Hip injuries can cause knee pain because of shared nerve paths. Many conditions like Sinding-Larsen’s Disease and neuromas can cause knee pain. To properly diagnose your knee pain requires an experienced clinician.

It could be arthritis, especially if you’re 40 or older and have a history of physical activity. Did the pain start after a particular event? If so, it might be acute damage like a tear of a tissue that’s causing the pain.

Is the pain sharp and consistent? Or does it occur during a particular activity?

Damage to your anterior or posterior cruciate ligament is a common cause of knee pain in athletes.

More than six local tissues can be sources of pain, including damage to the skin, bone, nerve and muscle.

How is this pain treated?

The standard of care currently is first proper diagnosis. Then the relevant muscles are strengthened through exercises. Physical activity that could make the pain worse should be avoided or reduced while rehabilitating the knee.

Surgery should be a last resort.

Is it Bipolar or ADHD?

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Bipolar is a mood disorder characterized by extremes of mood that alternate from highs to lows, and at least 1 percent of people have it or symptoms of it.

ADHD is significantly more common, yet clinicians often mistake it for Bipolar, especially in hospilization cases.  The reason for all this confusion is because the two disorders share a great deal of symptoms.

Diagnostically, the criteria for ADHD and bipolar overlap at 12 out of 18 points.  Doctors often use mental checklists to diagnosis, especially when they’re pressed for time.  Proper diagnosis of mental conditions requires extensive testing and evaluation.

Most importantly, hyperactivity, impulsiveness and reduced attention span are symptoms of both and may in the end not actually indicate either.

Worse, bipolar and ADHD can come together.  The rates aren’t clear, but anywhere from 5-40% of adults with ADHD may suffer from a bipolar disorder.

Distinguishing between the two hinges on noticing 1)  mood elevations 2) abnormal thinking 3) extremeness.

The details:

Bipolar is episodic, ADHD chronic

Bipolar episodes tend to come in more defined periods.

That said, people with ADHD can exhibit vast variability which can be confused for bipolar.  When someone with ADHD is engaged and excited with something, their ability to work without pause, irritability at being interrupted and hyperfocus can be mistaken for bipolar.

Making it more complicated, bipolar can cycle rapidly which can mimic the behavioral pattern described above.

Bipolar has significant increases in mood with reduced need for sleep

Extremes of mood are more associated with bipolar than ADHD.  When in a manic state, need for sleep is reduced and people with bipolar may stay up all night working on various projects that seem amazingly interesting and important.

Note:  insomnia alone isn’t enough to indicate bipolar.  We all have difficulty sleeping occasionally.  It’s when consistent lack of sleep doesn’t cause sleepiness that bipolar is indicated.

Bipolar can have psychosis

Someone during a manic period can have delusions of grandeur or become paranoid.  They may think they are a celebrity, extremely important or on the verge of a major discovery.  Or they might decide that people are spying on them, plotting against them, or talking about them.

ADHD does not tend to have extreme deviations in the logical process.  But someone with ADHD may have creative or seemingly strange thoughts that are still grounded in reality.

Night terrors

In kids, night terrors are associated with having bipolar, but not with ADHD.

You might like:

Do Antidepressants Work As Promised?

What is Therapy?

Remember:

Psychiatric diagnoses are not set in stone.  Make sure your doctor knows the important details.  Medications can have powerful effects both for good and bad, and you want to be sure you’re taking the right ones.

10 Questions to Improve Your Life

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Questions are more powerful than statements.  They leave something unresolved, which creates room for the mind to fill in.

A question can turn your world upside down.

1) How can I make exercising fun?

2) What can I do that my grandkids will be proud of?

3) Who will calm you on a Monday night at 1am when your heart is broken?

4) Who am I holding a grudge against?  Why?

5) What does my gut feeling say?

6) What makes me happy?

7)  How can I help my community?

8) How can I make new friends?

9) How can I spend less time doing things I hate?

10) What’s an interesting new magazine that I can subscribe to?