More than half of U.S. kids pick strawberries as their favorite fruit. No wonder. The fruit is pretty to our eyes, sweet to our taste, and juicy in our mouths.

Wild strawberries grow on every continent except Africa and Australia/New Zealand. But you wouldn't want to eat some of them. Often, they are really small and tasteless. Some aren't even red.

So how did the strawberries you buy at the store or from roadside stands get to be SOOOOO delicious?

The great-great-great-great grandparents of today's strawberry come from two different continents—North America and South America. And they accidentally met and started producing a new type of strawberry on a third continent—Europe. This happened about 250 years ago, probably in a botanical garden in France.

In the 1500s, explorers brought one of the grandparents back to France from Virginia. This Virginia genotype got their attention because it had larger fruit and a deeper red color than the European strawberries of that time. And it produced more berries.

But it had to wait nearly 200 years for the other grandparent to arrive from South America.

In the early 1700s, a French spy spotted this strawberry genotype in Chile while he was making maps of Spanish forts. Plants of this genotype produced really big berries—larger than the spy had ever seen—so he brought a bunch of them back to France.

Trouble is, they didn't reproduce in France. Not until scientists called horticulturists (hor-ti-CUL-chur-ists) planted them next to the Virginia genotype. BINGO, they started producing baby plants. You see, all the plants from Chile were female and needed pollen from other strawberry plants to produce fertile seeds.

It wasn't long before a new strawberry was born. The horticulturists named it Fragaria x ananassa.

The baby berry was such a success that its great-great-great-great grandchildren are grown around the world today, mostly in the northern hemisphere. The United States is the leading producer and supplies about 20 percent of the world's strawberries. Next are Spain, Japan, Poland, Italy, the Korean Republic and China.

Every U.S. state grows strawberries that have been specially bred for that region of the country. California grows about three-fourths of U.S. strawberries. Florida is the next largest producer. All the different varieties grown in all the different countries can trace their ancestry back to the marriage of the Virginia and Chile strawberry in Europe 250 years ago.

Strawberries today are susceptible to a lot of diseases, and growers would like them to be more resistant. They would also like their plants to bear fruit earlier in the season and to make other improvements. The only way to do this is to change the plants' genes.

Six scientists from the federal government, universities and a commercial strawberry grower are holding strawberry tryouts around the country. Each of the scientists is growing 20 to 40 of the best of the Virginia and Chile genotypes, looking for traits they want the most.

"We will pick the most outstanding genotypes of those two parent species for breeding," says Stan C. Hokanson. He is a geneticist with the Agricultural Research Service (ARS).

In Dr. Hokanson's plots in Beltsville, Maryland, one genotype flowered nearly 2 weeks early. And two genotypes were disease free in the fall,"when all the cultivars were covered with leaf spot, scorch, and powdery mildew," says Hokanson. He is one of two ARS scientists working on the evaluation project.

Jim Hancock, professor of horticulture at Michigan State University in East Lansing, oversees the project. He says researchers had already selected promising genotypes during earlier evaluations.

"We tried to pick the best from these and select a representative sample. It's like doing the final cut."

A whole new strawberry with unique flavors and textures could result from these tryouts. But it will take at least 12 years— more likely 15 to 20 years—before strawberries with new, desirable traits go to market, says Tom Sjulin, with the large California grower, Driscoll Strawberry Associates, Inc.

Menopause is defined as the absence of menstrual periods for 12 months. It is the time in a woman's life when the function of the ovaries ceases.

The process of menopause does not occur overnight, but rather is a gradual process. This so-called perimenopausal transition period is a different experience for each woman.

The average age of menopause onset is 51 years old, but menopause may occur as early as the 30s or as late as the 60s Th–ere is no reliable lab test to predict when a woman will experience menopause.

The age at which a woman starts having menstrual periods is not related to the age of menopause onset.

Symptoms of menopause can include abnormal vaginal bleeding,hot flashes, vaginal and urinary symptoms, and mood changes.

Complications that women may develop after menopause include osteoporosis and heart disease.

Treatments for menopause are customized for each woman.

Treatments are directed toward alleviating uncomfortable or distressing symptoms.

What is menopause?

Menopause is defined as the state of an absence of menstrual periods for 12 months. The menopausal transition starts with varying menstrual cycle length and ends with the final menstrual period. Perimenopause is a term sometimes used and means "the time around menopause." It is often used to refer to the menopausal transitional period. It is not officially a medical term, but is sometimes used to explain certain aspects of the menopause transition in lay terms. "postmenopausal" is a term used to as an adjective to refer to the time after menopause has occurred. For example, doctors may speak of a condition that occurs in "postmenopausal women." This refers to women who have already reached menopause.

Menopause is the time in a woman's life when the function of the ovaries ceases. The ovary (female gonad), is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones such as estrogen. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a Fallopian tube to the uterus.

The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. Estrogens also protect the bone. Therefore, a woman can develop osteoporosis (thinning of bone) later in life when her ovaries do not produce adequate estrogen.

Perimenopause is different for each woman. Scientists are still trying to identify all the factors that initiate and influence this transition period.

At what age does a woman typically reach menopause?

The average age of menopause is 51 years old. But there is no way to predict when an individual woman will have menopause or begin having symptoms suggestive of menopause. The age at which a woman starts having menstrual periods is also not related to the age of menopause onset. Most women reach menopause between the ages of 45 and 55, but menopause may occur as earlier as the 30s or 40s or may not occur until a woman reaches her 60s. As a rough "rule of thumb," women tend to undergo menopause at an age similar to that of their mothers.

Perimenopause, often accompanied by irregularities in the menstrual cycle along with the typical symptoms of early menopause, can begin up to 10 years prior to the last menstrual period.

What conditions can affect the timing of menopause?

Certain medical and surgical conditions can influence the timing of menopause.

Surgical removal of the ovaries

The surgical removal of the ovaries (oophorectomy) in an ovulating woman will result in an immediate menopause, sometimes termed a surgical menopause or induced menopause. In this case, there is no perimenopause, and after surgery, a woman will generally experience the signs and symptoms of menopause. In cases of surgical menopause, women often report that the abrupt onset of menopausal symptoms results in particularly severe symptoms, but this is not always the case.

The ovaries are often removed together with the removal of the uterus (hysterectomy). If a hysterectomy is performed without removal of both ovaries in a woman who has not yet reached menopause, the remaining ovary or ovaries are still capable of normal hormone production. While a woman cannot menstruate after the uterus is removed by a hysterectomy, the ovaries themselves can continue to produce hormones up until the normal time when menopause would naturally occur. At this time a woman could experience the other symptoms of menopause such as hot flashes and mood swings. These symptoms would then not be associated with the cessation of menstruation. Another possibility is that premature ovarian failure will occur earlier than the expected time of menopause, as early as 1 to 2 years following the hysterectomy. If this happens, a woman may or may not experience symptoms of menopause.

Cancer chemotherapy and radiation therapy

Depending upon the type and location of the cancer and its treatment, these types of cancer therapy (chemotherapy and/or radiation therapy) can result in menopause if given to an ovulating woman. In this case, the symptoms of menopause may begin during the cancer treatment or may develop in the months following the treatment.

Premature ovarian failure

Premature ovarian failure is defined as the occurrence of menopause before the age of 40. This condition occurs in about 1% of all women. The cause of premature ovarian failure is not fully understood, but it may be related to autoimmune diseases or inherited (genetic) factors.

What are the symptoms of menopause?

It is important to remember that each woman's experience is highly individual. Some women may experience few or no symptoms of menopause, while others experience multiple physical and psychological symptoms. The extent and severity of symptoms varies significantly among women. It is also important to remember that symptoms may come and go over an extended time period for some women. This, too, is highly individual. These symptoms of menopause and perimenopause are discussed in detail below.

Irregular vaginal bleeding

Irregular vaginal bleeding may occur during menopause. Some women have minimal problems with abnormal bleeding during perimenopause whereas others have unpredictable, excessive bleeding. Menstrual periods (menses) may occur more frequently (meaning the cycle shortens in duration), or they may get farther and farther apart (meaning the cycle lengthens in duration) before stopping. There is no "normal" pattern of bleeding during the perimenopause, and patterns vary from woman to woman. It is common for women in perimenopause to have a period after going for several months without one. There is also no set length of time it takes for a woman to complete the menopausal transition. A woman can have irregular periods for years prior to undergoing menopause. It is important to remember that all women who develop irregular menses should be evaluated by her doctor to confirm that the irregular menses are due to perimenopause and not as a sign of another medical condition.

The menstrual abnormalities that begin in the perimenopause are also associated with a decrease in fertility, since ovulation has become irregular. However, women who are perimenopausal may still become pregnant until they have reached true menopause (the absence of periods for one year) and should still use contraception if they do not wish to become pregnant.

Hot flashes and night sweats

Hot flashes are common among women undergoing menopause. A hot flash is a feeling of warmth that spreads over the body and is often most pronounced in the head and chest. A hot flash is sometimes associated with flushing and is sometimes followed by perspiration. Hot flashes usually last from 30 seconds to several minutes. Although the exact cause of hot flashes is not fully understood, hot flashes are likely due to a combination of hormonal and biochemical fluctuations brought on by declining estrogen levels.

There is currently no method to predict when hot flashes will begin and how long they will last. Hot flashes occur in up to 40% of regularly menstruating women in their forties, so they may begin before the menstrual irregularities characteristic of menopause even begin. About 80% of women will be finished having hot flashes after five years. Sometimes (in about 10% of women), hot flashes can last as long as 10 years. There is no way to predict when hot flashes will cease, though they tend to decrease in frequency over time. They may also wax and wane in their severity. The average woman who has hot flashes will have them for about five years.

Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). This may lead to awakening and difficulty falling asleep again, resulting in unrefreshing sleep and daytime tiredness.

Vaginal symptoms

Vaginal symptoms occur as a result of the lining tissues of the vagina becoming thinner, drier, and less elastic as estrogen levels fall. Symptoms may include vaginal dryness, itching, or irritation and/or pain with sexual intercourse (dyspareunia). The vaginal changes also lead to an increased risk of vaginal infections.

Urinary symptoms

The lining of the urethra (the transport tube leading from the bladder to discharge urine outside the body) also undergoes changes similar to the tissues of the vagina, and becomes drier, thinner, and less elastic with declining estrogen levels. This can lead to an increased risk of urinary tract infection, feeling the need to urinate more frequently, or leakage of urine (urinary incontinence). The incontinence can result from a strong, sudden urge to urinate or may occur during straining when coughing, laughing, or lifting heavy objects.

Emotional and cognitive symptoms

Women in perimenopause often report a variety of thinking (cognitive) and/or emotional symptoms, including fatigue, memory problems, irritability, and rapid changes in mood. It is difficult to precisely determine exactly which behavioral symptoms are due directly to the hormonal changes of menopause. Research in this area has been difficult for many reasons.

Emotional and cognitive symptoms are so common that it is sometimes difficult in a given woman to know if they are due to menopause. The night sweats that may occur during perimenopause can also contribute to feelings of tiredness and fatigue, which can have an effect on mood and cognitive performance. Finally, many women may be experiencing other life changes during the time of perimenopause or after menopause, such as stressful life events, that may also cause emotional symptoms.

Other physical changes

Many women report some degree of weight gain along with menopause. The distribution of body fat may change, with body fat being deposited more in the waist and abdominal area than in the hips and thighs. Changes in skin texture, including wrinkles, may develop along with worsening of adult acne in those affected by this condition. Since the body continues to produce small levels of the male hormone testosterone, some women may experience some hair growth on the chin, upper lip, chest, or abdomen.

What are the complications and effects of menopause on chronic medical conditions?

Osteoporosis

Osteoporosis is the deterioration of the quantity and quality of bone that causes an increased risk of fracture. The density of the bone (bone mineral density) normally begins to decrease in women during the fourth decade of life. However, that normal decline in bone density is accelerated during the menopausal transition. As a consequence, both age and the hormonal changes due to the menopause transition act together to cause osteoporosis.

The process leading to osteoporosis can operate silently for decades. Women may not be aware of their osteoporosis until suffering a painful fracture. The symptoms are then related to the location and severity of the fractures.

Treatment of osteoporosis

The goal of osteoporosis treatment is the prevention of bone fractures by slowing bone loss and increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures for the condition. Therefore, the prevention of osteoporosis is as important as treatment.

Osteoporosis treatment and prevention measures are:

• Lifestyle changes including cessation of cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D.
• Calcium and vitamin D supplements may be recommended for women who do not consume sufficient quantities of these nutrients.
• Medications that stop bone loss and increase bone strength include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva),zoledronic acid (Reclast), raloxifene (Evista), and calcitonin (Calcimar). Teriparatide (Forteo) is a medication that increases bone formation.

Cardiovascular disease

Prior to menopause, women have a decreased risk of heart disease and stroke when compared with men. Around the time of menopause, however, a women's risk of cardiovascular disease increases. Heart disease is the leading cause of death in both men and women in the U.S.

Coronary heart disease rates in postmenopausal women are two to three times higher than in women of the same age who have not reached menopause. This increased risk for cardiovascular disease may be related to declining estrogen levels, but in light of other factors (see Treatment section below), postmenopausal women are not advised to take hormone therapy simply as a preventive measure to decrease their risk of heart attack or stroke.

Are hormone levels or other blood tests helpful in detecting menopause?

Because hormone levels may fluctuate greatly in an individual woman, even from one day to the next, hormone levels are not a reliable method for diagnosing menopause. Even if levels are low one day, they may be high the next day in the same woman. There is no single blood test that reliably predicts when a woman is going through the menopausal transition. Therefore, there is currently no proven role for blood testing regarding menopause except for tests to exclude medical causes of erratic menstrual periods other than menopause. The only way to diagnose menopause is to observe the lack of menstrual periods for 12 months in a woman in the expected age range.

What are the treatment options for menopause?

Menopause itself is a normal part of life and not a disease that requires treatment. However, treatment of associated symptoms is possible if these become substantial or severe.

Hormone therapy for Menopause Estrogen and progesterone therapy

Hormone therapy (HT) , also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens or a combination of estrogens and progesterone (progestin). Hormone therapy has been used to control the symptoms of menopause related to declining estrogen levels such as hot flashes and vaginal dryness, and HT is still the most effective way to treat these symptoms. But long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

Hormone therapy is available in oral (pill), transdermal form (for example, patch and spray such as Vivelle, Climara, Estraderm, Esclim, Alora). Transdermal hormone products are already in their active form without the need for "first pass" metabolism in the liver to be converted to an active form. Since transdermal hormone products such as Evamist) do not have effects on the liver, this route of administration has become the preferred form for most women. A number of preparations are available for oral and transdermal forms of HT, varying in the both type and amount of hormones in the products.

There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies that make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.

Like transdermal HT products, bioidentical hormone therapy products are administered transdermally. They are typically applied as cream or gels. Their advocates believe that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.

The decision about hormone therapy, is a very individual decision in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman's own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time. The WHI study findings do not support the use of HT for the prevention of chronic disease.

Oral contraceptive pills

Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause to treat irregular vaginal bleeding.

Prior to treatment, a doctor must exclude other causes of erratic vaginal bleeding. Women in the menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore, oral contraceptives are often given to women in the menopause transition to regulate menstrual periods, relieve hot flashes, as well as to provide contraception. The list of contraindications for oral contraceptives in women going through the menopause transition is the same as that for premenopausal women.

Local (vaginal) hormone and non-hormone treatments

There are also local (meaning applied directly to the vagina) hormonal treatments for the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal estrogen ring (Estring), vaginal estrogen cream, or vaginal estrogen tablets. Local and oral estrogen treatments are sometimes combined for this purpose.

Vaginal moisturizing agents such as creams or lotions (for example, K-Y Silk-E Vaginal Moisturizer or KY Liquibeads Vaginal Moisturizer) as well as the use of lubricants during intercourse are non-hormonal options for managing the discomfort of vaginal dryness.

Applying Betadine topically on the outer vaginal area, and soaking in a sitz bath or soaking in a bathtub of warm water may be helpful for relieving symptoms of burning and vaginal pain after intercourse.

If your nails are still weak and brittle then pay a visit to your doctor. This particular symptom may be caused by shortcomings of zinc, iron, calcium, protein, and by more serious diseases, such as lung disease thyroid problems or thyroid problems.

Almost twenty percent of the people on Earth suffer from brittle nails. The experts cannot tell exactly what the cause for our nails to weaken is, but they point out that the likely culprits may be the detergents and the removal of nail polish. Other factors are the dry, cold weather and the frequent hand washing.

Fortunately, the natural physical remedy for brittle nails is one of the most commonly met elements on the Earth: silicon. As essential microelement in our bodies, it encourages the creation of two important substances – connective tissue, i.e. collagen that gives our skin, nails and hair strength, health and flexibility, and the glycosaminoglycans that hydrate the tissues in our bodies.

You can add more silicon to your healthy diet bet on products from whole grains, leafy vegetables and soybeans. This diet will help not only for the health of your nails. A little more silicon also strengthens the bones and can reduce the following appearance of wrinkles by improving the elasticity of the skin.

Splitting nails are more commonly seen in women. The correct term for soft, thin, brittle and splitting nails is onychoschizia.

There are dry and brittle nails which means there is to little moisture or soft and brittle has to much moisture. The most common reason for this is often not having enough Iron in your body.

Signs of brittle nails include easy breaking of the nail, slow growing and peeling at the tip.

How to prevent brittle Nails

There are a few things that can be done to keep it to a minimum, try to avoid frequent wetting and drying of the fingernails, apply lotions with alpha-hydroxy acids. Wear rubber gloves when doing your household chores that involve getting your hands wet.

Household chemicals and polish removers can weaken your nails; try using the acetone free remover. If you like to wear polish use the one with nylon fibers to add a little extra strength to your nails. Always be very careful when filing, when noticing snags file them very gently to prevent more damage and make sure to always file in one direction. There are vitamins and minerals to help the prevention of brittle nails. Fingernails can create ridges along the bed if there is a insufficient amount of B-complex Vitamins, more precisely biotin, a lag of calcium will create dry and brittle nails.

Nutrition is a important part of healthy nails, you should eat plenty of calcium rich foods like dairy foods and dark green leafy vegetables, fish, beans and almonds

Try to refrain from biting your nails if you have a tendency to bite on your nails try to keep them short and put a colored nail polish on that will make you more conscious of you putting your nail in your mouth, the chipped polish does not look very nice and hopefully it will stop you from doing it. Treat yourself to a professional manicure once in a while your hands and nails will look great and encourage you to keep up on your nail care.

School phobia/School Avoidance/School Refusal are terms used to describe children who have a pattern of avoiding or refusing to attend school. Different from truancy, these behaviors occur in approximately 2% of school aged children. Historically called “school phobia”, many researches now prefer to use the terms “school avoidance” or “school refusal.” There is confusion regarding the terms because children who experience significant difficulty in attending school do so for different reasons and exhibit different behaviors. In general, children who refuse to attend or avoid school stay in close contact with their parents or caregivers, and are frequently (although not always) anxious and fearful. They may become very upset or ill when forced to go to school. Truants may be distinguished from this group by their antisocial or delinquent behaviors, their lack of anxiety about missing school, and the fact that they are not in contact with parents or caregivers when they are avoiding school.

Development

Part of the confusion regarding the term “school phobia” is that the behaviors are not usually considered to be a true phobia. Although some children fear school-related activities (bus ride, reading aloud in class, changing for physical education), some are anxious about home issues or about being separated from a caregiver. Children become anxious for many reasons. “Separation anxiety” typically occurs at about the age of 18 to 24 months. Toddlers will cry, cling and have temper tantrums when they are about to be separated from their caregiver (for daycare or a babysitter, for example). This is normal at this age, but some older children continue to have difficulty separating from caregivers.

Sometimes school-aged children who were previously able to separate from their caregivers will suddenly become anxious and fearful. A recent crisis in the community or the family (such as a death, divorce, financial problems, move, etc.) may cause a child to become fearful or anxious. Some children fear that something terrible will happen at home while they are at school. Children who are struggling in school with academic or social problems may also develop school refusal. Many children have social concerns and may have been teased or bullied at school or on the way to school. Some neighborhoods or schools are unsafe or chaotic.

Children who have missed a lot of school due to illness or surgery may experience difficulty returning to the classroom routines as well as academic and social demands. Still other children prefer to stay home because they can watch tv, have parental attention, and play rather than work in school. Children and youth who are transitioning (from elementary to middle school, or middle school to high school) may feel very stressed. All of these factors may lead to the development of school refusal/avoidance. Additionally, many children avoid or refuse school for a combination of reasons, further complicating treatment.

If untreated, chronic school refusal or avoidance may result in more than family distress. Academic deterioration, poor peer relationships, school or legal conflicts, work or college avoidance, panic attacks, agoraphobia and adult psychological or psychiatric disorders may result.

What can parents do?

Prevention

Toddlers and preschoolers can benefit from structured experiences with other adults. Parents can help young children to separate from caregivers in several ways. Reliable and safe babysitting or daycare are excellent examples. Many communities have opportunities for preschoolers such as story hour at the library, preschool religious training such as bible school, recreational activities, preschool, etc. When the child fusses at separation from the parent, the best strategy is to inform the child calmly that the parent will return and that the child is to stay. Then leave quickly. Children typically have more difficulty separating if their parents hover, linger, become upset, wait for the child to calm down or attempt to reason with the child. A firm, caring and quick separation is usually better for both parent and child. Preschool caregivers will typically report that the child’s distress quickly disappears. However, children whose parents prolong the separation or who have had unsuccessful preschool separation experiences may need more time or support to calm down. This may be because they have learned that their distress results in parental rescue from separation! Successful preschool experiences ease the transition to preschool or kindergarten.

When children refuse or avoid school

If complaints of illness are the excuse for not attending school, have the child checked by the family medical provider. If there is no medical reason to be absent, the child should be at school. The parent should attempt to discover if there is a specific problem causing the refusal. Sometimes the child feels relief just by expressing concerns about friends or school expectations. If the child is able to pinpoint a specific concern (such as worry about tests, teasing, etc.), then the parent should immediately talk to the child’s teacher about developing an appropriate plan to solve the problem. Some common sense strategies to try include having another family member bring the child to school, or if the child does stay home then rewards such as snacking, TV, toys, or parental attention should be eliminated. A school schedule may be duplicated at home.

However, if the child is extremely upset, if the child needs to be forced to attend school, if there is significant family stress, or if the refusal to attend school is becoming habitual, the family should not hesitate in asking for assistance from the school psychologist, school counselor, or other mental health professionals. Parents and the school need to work together to identify what is causing or maintaining this behavior and to develop a comprehensive plan of intervention. A key to success is rapid intervention; the longer the behavior occurs, the harder it is to treat.

Treatment depends upon the causes, which can be difficult to determine. Many children may have started to avoid school for one reason (e.g., fear of being disciplined by a teacher, feeling socially inadequate) but are now staying home for another reason (e.g., access to video games, lack of academic pressure, etc.). Several treatment plans may need to be tried. Helping the child to relax, develop better coping skills, improve social skills, using a contract, and helping the parents with parenting or family issues are all examples of possible treatments.

Depression is an illness that requires a good deal of self-care,” writes psychologist Deborah Serani, PsyD, in her excellent book Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing.

But this might seem easier said than done, because when you have depression, the idea of taking care of anything feels like adding another boulder to your already heavy load. Serani understands firsthand the pain and exhaustion of depression. In addition to helping clients manage their depression, Serani works to manage her own, and shares her experiences in Living with Depression.

If you’re feeling better, you might ditch certain self-care habits, too. Maybe you skip a few therapy sessions, miss your medication or shirk other treatment tools. According to Serani, as some people improve, they get relaxed about their treatment plan, and before they know it are blinded to the warning signs and suffer a relapse.

Because skimping on self-care is a slippery slope to relapse, Serani provides readers with effective tips in her book. As a whole, the best things you can do to stave off relapse are to stick to your treatment plan and create a healthy environment. I’ve summarized her valuable suggestions below.

1. Attend your therapy sessions. 

As you’re feeling better, you might be tempted to skip a session or two or five. Instead, attend all sessions, and discuss your reluctance with your therapist. If changes are warranted, Serani says, you and your therapist can make the necessary adjustments.

Either way, discussing your reluctance can bring about important insights. As Serani writes:

Personally, the times I skipped sessions with my therapist showed me that I was avoiding profound subjects — or that I was reacting defensively to something in my life. Talking instead of walking showed me how self-defeating patterns were operating and that I needed to address these tendencies.

2. Take your meds as prescribed. 

Missing a dose can interfere with your medication’s effectiveness, and your symptoms might return. Alcohol and drugs also can mess with your meds. Stopping medication altogether might trigger discontinuation syndrome. If you’d like to stop taking your medication, don’t do it on your own. Talk with your prescribing physician so you can get off your medication slowly and properly.

Serani is diligent about taking her antidepressant medication and talks with her pharmacist frequently to make sure that over-the-counter medicines don’t interfere. With the help of her doctor, Serani was able to stop taking her medication. But her depression eventually returned. 

She writes: …At first, it was upsetting to think that my neurobiology required ongoing repair and that I’d be one of the 20 percent of individuals who need medication for the rest of their lives. Over time, I came to view my depression as a chronic condition — one that required me to take medication much like a child with diabetes takes insulin, an adult with epilepsy takes antiseizure medication, or someone with poor eyesight wears glasses…

3. Get enough sleep. 

 Sleep has a big impact on mood disorders. As Serani explains, too little sleep exacerbates mania and too much sleep worsens depression. So it’s important to keep a consistent sleep and wake cycle along with maintaining healthy sleeping habits.

Sometimes adjusting your medication can help with sleep. Your doctor might prescribe a different dose or have you take your medication at a different time. For instance, when Serani started taking Prozac, one of the side effects was insomnia. Her doctor suggested taking the medication in the morning, and her sleeping problems dissipated.

For Serani, catnaps help with her fatigue. But she caps her naps at 30 minutes. She also doesn’t tackle potentially stressful tasks before bed, such as paying bills or making big decisions.

(If you’re struggling with insomnia, here’s an effective solution, which doesn’t have the side effects of sleep aids.)

4. Get moving. 

Depression’s debilitating and depleting effects make it difficult to get up and get moving. Serani can relate to these effects. She writes:

The lethargy of depression can make exercise seem like impossibility. I know, I grew roots and collected dust when I was anchored to my depression. I can still recall how getting out of bed was a feat in and of itself. I could barely fight gravity to sit up. My body was so heavy and everything hurt.

But moving helps decrease depression. Instead of feeling overwhelmed, start small with gentle movements like stretching, deep breathing, taking a shower or doing household chores. When you can, add more active activities such as walking, yoga or playing with your kids or whatever it is you enjoy.

It might help to get support, too. For instance, Serani scheduled walking dates with her neighbors. She also prefers to run errands and do household chores every day so she’s moving regularly.

5. Eat well. 

We know that nourishing our bodies with vitamins and minerals is key to our health. The same is true for depression. Poor nutrition can actually exacerbate exhaustion and impact cognition and mood.

Still, you might be too exhausted to shop for groceries or make meals. Serani suggests checking out online shopping options. Some local markets and stores will offer delivery services. Or you can ask your loved ones to cook a few meals for you. Another option is Meals-on-Wheels, which some religious and community organizations offer.

6. Know your triggers. 

In order to prevent relapse, it’s important to know what pushes your buttons and worsens your functioning. For instance, Serani is selective with the people she lets into her life, makes sure to keep a balanced calendar, doesn’t watch violent or abuse-laden films (the movie “Sophie’s Choice” sidelined her for weeks) and has a tough time tolerating loud or excessively stimulating environments.

Once you pinpoint your triggers, express them to others so your boundaries are honored.

7. Avoid people who are toxic. 

Toxic individuals are like emotional vampires, who “suck the life out of you,” according to Serani. They may be envious, judgmental and competitive. If you can’t stop seeing these people in general, limit your exposure and try having healthier individuals around when you’re hanging out with the toxic ones.

8. Stay connected with others. 

Social isolation, Serani writes, is your worst enemy. She schedules plans with friends, tries to go places she truly enjoys and has resources on hand when she’s somewhere potentially uncomfortable, such as books and crossword puzzles.

If you’re having a difficult time connecting with others, volunteer, join a support group or find like-minded people online on blogs and social media sites, she suggests. You also can ask loved ones to encourage you to socialize when you need it.

9. Create a healthy space. 

According to Serani, “… research says that creating a nurturing space can help you revitalize your mind, body and soul.” She suggests opening the shades and letting sunlight in. There’s also evidence that scent can minimize stress, improve sleep and boost immunity. Lemon and lavender have been shown to improve depression.

Serani says that you can use everything from essential oils to candles to soap to incense. She prefers lavender, lilac, vanilla and mango. If you’re sensitive to fragrance, she recommends diluting essential oils, buying flowers or even using dried fruit.

You also can listen to music, meditate, use guided imagery, practice yoga and even de-clutter parts of your home a little each time.

Serani’s last point involves empowering yourself and becoming resilient. She writes:

By learning about your biology and biography, following your treatment plan, and creating a healthy environment, you don’t allow anyone to minimize you or your depression. Instead of avoiding struggles, you learn from them. You trust your own instincts and abilities because they are uniquely yours. If you experience a setback, you summon learned skills and seek help from others to get back on-point. If a person’s ignorance on mental illness presents itself in the form of a joke or stigma, you clear the air with your knowledge of neurobiology and psychology.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Sed magna nibh, pharetra at ligula vitae, tristique tincidunt velit. Mauris commodo elementum quam vel sollicitudin. Integer sed quam mauris. Nulla iaculis blandit elit eu hendrerit. Donec hendrerit, est nec ornare ullamcorper, nunc mi dictum tortor, vitae ultrices nisi lacus nec nisi. Sed consequat interdum lacus eget iaculis. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Donec vel egestas ante. Nam fermentum mollis sapien, et mollis odio auctor ac. In quis nisl eget lacus vulputate dapibus id vitae purus. Quisque pharetra felis vitae risus rutrum, fringilla feugiat velit feugiat. Morbi luctus fringilla lacus, a iaculis elit cursus vel.

Proin porttitor, diam quis adipiscing tempus, leo leo volutpat ligula, eget vulputate velit turpis id eros. In at lobortis justo, ac imperdiet nibh. Suspendisse viverra diam quam, eu commodo diam venenatis eu. Sed neque augue, porta eu sollicitudin vel, blandit eget augue. Praesent eu rhoncus nunc, sed elementum justo. Vestibulum mollis lacus diam, vel aliquet arcu vehicula non. Curabitur bibendum pharetra elit, ac luctus risus pellentesque vel. Sed tincidunt consequat mauris in accumsan. Phasellus in vulputate tortor. Mauris feugiat neque vitae cursus iaculis. Phasellus vulputate interdum volutpat. Proin eu metus eu justo aliquam fermentum. Nam suscipit nibh felis, quis tempus nisi lobortis eu. Praesent egestas metus vitae egestas malesuada.