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Mosquitoes are not just a buzzing summertime nuisance; they can carry serious diseases like West Nile virus, malaria, and Zika. In recent months, the US has seen an unusual spike in the mosquito-borne illness dengue fever, also known as breakbone fever.

What is dengue, and where is it occurring in the US? How does it spread? And what steps can you take to protect against this and other mosquito-borne illnesses?

What is dengue and what are its symptoms?

Dengue is a viral disease caused by any of four closely-related viruses: dengue virus 1, 2, 3, and 4. Not everyone infected with dengue will become sick: only about one in four will experience symptoms that range from minimal discomfort to serious problems. A blood test is used to confirm the diagnosis.

When symptoms do occur, they tend to feel like the flu. The onset of feeling unwell usually begins within two to three days of being bitten by an infected mosquito but can take up to six to nine days, says Dr. Edward Ryan, director of global infectious diseases at Harvard-affiliated Massachusetts General Hospital.

Seek medical advice if you have recently traveled to an area with a risk of dengue and have a fever (101° F or higher) combined with any of these symptoms:

• aches and pains (often headache or pain behind the eye or in muscles, joints, or bones)
• nausea and vomiting
• a rash (faint red blotches).

About one in 20 people who gets sick will develop severe dengue, which requires emergency care. Those at an increased risk for severe dengue include infants a year or younger, pregnant women, adults ages 65 years or older, and those with previous dengue infections.

Symptoms of severe dengue require immediate medical care. They include:

• feeling very weak and lightheaded from low blood pressure
• bleeding from the nose or gums
• stomach swelling
• vomiting
• extreme fatigue.

How is dengue treated?

Dengue is cause by a virus, and no specific medications are available to combat it. Milder dengue symptoms typically last two to seven days, according to the Centers for Disease Control and Prevention (CDC). The symptoms are managed supportively: plenty of fluids, over-the-counter pain medications, and rest.

Severe dengue usually requires treatment in a hospital with intravenous (IV) fluids. Patients are monitored until their fever breaks and symptoms begin to wane. This usually happens in about three to five days. Recovery at home can last many more days before a person’s strength returns.

“While there are reports of people dying from severe dengue fever, deaths from dengue cases in the US are rare,” says Dr. Ryan.

How does dengue spread?

The viruses that cause dengue do not directly spread from person to person. Aedes species mosquitoes can become infected with the dengue virus when they bite a person who has the virus. Infected mosquitoes then spread the virus to other people.

US visitors to high-risk countries may unknowingly bring the virus home with them, giving dengue infection a chance to spread further. For example, an infected person will have dengue virus circulating in their bloodstream for up to one week after being bitten. Let’s say the person returns to the US sooner than seven days, where they get bitten by a mosquito. That mosquito in the US now carries the virus and could bite someone else, thereby spreading the infection.

Where is dengue occurring in the US?

Most dengue transmission in the United States happens in areas where this illness is already common, such as Puerto Rico, American Samoa, and the US Virgin Islands.

At this writing, the CDC has reported nearly 3,000 dengue cases in the United States and US territories. States with the highest reported instances include Florida, New York, Massachusetts, and California. (Puerto Rico, which declared a public health emergency in March, had reported almost 1,500 cases by late June 2024.) While US cases are higher than in previous years, they are still low compared to the global incidence of dengue, which hit a record 9.7 million cases in North, Central, and South America during the first six months of 2024.

It’s not clear what has caused the sudden rise in dengue cases. Dr. Ryan says it could be due to several factors, such as higher seasonal travel, more people living closer together in urban settings, and the fact that there are more mosquitoes are carrying dengue.

Is there a dengue vaccine?

Currently, there is no widely available dengue vaccine for US travelers. One FDA-approved vaccine, Dengvaxia, protects children ages 9 to 16 from all four types of dengue. It is used only for children who have had a previous infection and who live in areas where dengue is common. However, the vaccine will be discontinued in September 2025, with the final doses expiring in September 2026.

What steps can you take to prevent dengue?

The best way to prevent dengue when visiting high-risk areas and after returning home is to protect yourself from mosquito bites. Here are some tips from the CDC:

• Use EPA-registered insect repellents with one of the following active ingredients: DEET; picaridin (known as KBR 3023 and icaridin outside the United States); IR3535; oil of lemon eucalyptus (OLE) or 2-undecanone (plant-derived ingredients); or para-menthane-diol (PMD).
• Wear loose-fitting, long-sleeved shirts and pants.
• Wear clothing and gear treated with permethrin (an insecticide that kills or repels mosquitoes).
• Place screens on windows and doors.
• When traveling, stay in places with air conditioning and screens. Use a bed net if air-conditioned or screened rooms are unavailable or if sleeping outdoors.
• To prevent mosquitoes from laying eggs in or near water around your home, empty and scrub, turn over, cover, or throw out outdoor items that hold water. This includes tires, buckets, toys, kid pools, birdbaths, flower pot saucers, or trash containers.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Cancer treatment can involve difficult tradeoffs, and that's also true of the testosterone-blocking drugs used in treating prostate cancer. These drugs work in two different ways. Androgen deprivation therapies (ADT) shut down the body's production of testosterone, a hormone that fuels prostate cancer growth. A newer class of drugs called androgen-receptor signaling inhibitors (ARSIs) block testosterone by deflecting the hormone from its cell receptor.

ADT can slow or control prostate cancer, and mounting evidence shows that adding ARSIs also improves survival when the disease is in advanced stages. This treatment combination is called intensified ADT. Researchers are now testing intensified ADT for some men with early-stage prostate cancer as well.

However, all drugs that block testosterone have challenging side effects, including metabolic changes that can compromise cardiovascular health. In June, British researchers reported that cardiovascular risks worsen when ADT and ARSIs are given together. The authors concluded that men who get intensified ADT should be counseled about the risks, and monitored for signs of heart disease before and after the treatment begins.

Study goals and results

The findings were derived from a systematic review of 24 clinical trials that assessed ADT and ARSI treatment for prostate cancer. Published between 2012 and 2024, the trials enrolled a combined total of 22,166 men ages 63 to 77. Their diagnoses ranged across the prostate cancer spectrum, from nonmetastatic cancer with aggressive features to metastatic prostate cancer that no longer responded to ADT by itself.

The goal of the systematic review was to compare ADT and intensified ADT with respect to cardiac events, including hypertension, cardiac arrhythmias (abnormal heartbeats), blood clots, or — in the worst case — heart attack or stroke.

Results showed that adding an ARSI to ADT approximately doubles the risk of a cardiac event across all prostate cancer states. Risks for severe "grade 3" events that can require hospitalization ranged between 7.8% and 15.6%. Notably, giving two ARSIs — abiraterone acetate and enzalutamide — led to a roughly fourfold increase in cardiac risk. Mounting evidence shows that combining abiraterone acetate and enzalutamide worsens side effects without improving prostate cancer survival. The use of that combination is now broadly discouraged by expert groups around the world.

The authors emphasize that intensified therapy is riskier for men with pre-existing cardiac conditions than it is for healthier men. In an accompanying editorial, Dr. Katelyn Atkins, a radiation oncologist at Cedars-Sinai Medical Center in Los Angeles, noted that cardiovascular disease is the second leading cause of death among men with prostate cancer.

Candidates for traditional or intensified ADT, Dr. Atkins wrote, should be assessed for atherosclerosis, fatty plaques in coronary arteries that can accumulate asymptomatically. Fortunately, cardiac risk factors are treatable by lowering blood pressure, eating a heart-healthy diet, exercising, and in some cases using a cholesterol-lowering drug called a statin.

Experts comment

"More and more research shows that intensive therapy prolongs survival, and may in some men even evoke a cure," said Dr. David Crawford, head of urologic oncology at the University of Colorado Anschutz Medical Campus who was not involved in the study. "We have learned time and again from the treatment of many cancers that it is not one drug followed by another and another that results in the best outcomes. Rather, it is combining drugs more effectively to treat the cancer.

"Still, we need to tackle the challenges of prostate cancer treatment and focus on preventing cardiovascular events and other side effects of ADT. As clinicians and in clinical studies, we have seen that men who maintain their weight, exercise, expand muscle mass, and maintain normal lipids and blood pressure do much better than men who gain weight and have a lot of cardiovascular risk factors."

"This important study re-emphasizes the necessity to keep a patient’s cardiovascular history front and center when treatment choices are made, " said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor-in-chief of the Harvard Medical School Guide to Prostate Diseases.

"Intensification of treatment — that is, adding several drugs earlier and earlier in prostate cancer management — is to be both encouraged and cautioned. The caution is for physicians to consider and discuss pre-existing risk factors and how to modify them when deciding upon treatment programs. The ARSI class of drugs have greatly improved outcomes. The goal is to maximize the best outcomes while minimizing the side effects."

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Social media and stores are full of products that promise perfect skin. Increasingly, these products are being marketed not just to adults but to teens and tweens. Many are benign, but some can cause skin irritation — and can be costly. And even if these products are benign, does buying them support unhealthy notions about appearance and beauty?

It’s worth looking at this from a medical perspective. Spoiler alert: for the most part teens and tweens do not need specialized skin products, especially expensive ones. But let’s talk about when they may make sense.

When can a specialized skin product help tweens and teens?

So, when should your child buy specialized skin products?

• When their doctor recommends it. If your child has a skin condition that is being treated by a doctor, such as eczema or psoriasis, over-the-counter skin products may help. For example, with eczema we generally recommend fragrance-free cleansers and moisturizers. Always ask your doctor which brands to choose, and get their advice on how best to use them.
• If they have dry and/or sensitive skin. Again, fragrance-free cleansers are a good idea (look for ones recommended for people with eczema). So are fragrance-free, non-irritating moisturizers (look for creams and ointments rather than lotions, as they will be more effective for dry skin). If you have questions, or if the products you are buying aren’t helping, check in with your doctor.

What about skin products for acne?

It’s pretty rare to go through adolescence without a pimple. Many teens aren’t bothered by them, but if your child is bothered by their pimples or has a lot of them, it may be helpful to buy some acne products at your local pharmacy.

• Mild cleansers tend to be better than cleansers containing alcohol. You may want to check out cleansers intended for dry skin or eczema.
• Over-the-counter acne treatments usually contain benzoyl peroxide, salicylic acid, azelaic acid, or alpha-hydroxy acids. Adapalene can be helpful for more stubborn pimples.
• Steer away from astringents or exfoliants, which tend to irritate the skin.
• Talk to your doctor about what makes the most sense for your child — and definitely talk to them if over-the-counter products aren’t helpful. There are many acne treatments available by prescription.

Ask questions and help dispel myths

If your teen or tween doesn’t fall into one of these groups, chances are they don’t need anything but plain old soap and water and the occasional moisturizer if their skin gets dry.

If your child has normal, healthy skin yet is asking for or buying specialized skin products, ask them why. Do your best to dispel the inevitable marketing myths — like that the products will prevent problems they do not have. Let them know that should a problem arise, you will work with them — with the advice of their doctor — to find and buy the best products.

Use it as an opportunity, too, to talk about self-image and how it can be influenced by outside factors. This is an important conversation to have whether or not your child is pining for the latest cleanser they see on Instagram. Helping your child see their own beauty and strengths is a key part of parenting, especially for a generation raised on social media.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Ever wonder if every medical test or treatment you've taken was truly necessary? Or are you inclined to get every bit of health care you can? Maybe you feel good about getting the most out of your health insurance. Perhaps a neighborhood imaging center is advertising discounted screening tests, your employer offers health screens as a perk, or you're intrigued by ads touting supplements for a seemingly endless number of conditions.

But keep in mind: just because you could get a particular test or treatment or take a supplement doesn't mean you should. One study suggests that as much as 20% of all health care in the US is unneeded. In short: when it comes to health care, more is not always better.

Isn't it better to be proactive about your health?

We're all taught that knowledge is power. So it might seem reasonable to want to know as much as possible about how your body is working. And isn't it better to take action before there's a problem rather than waiting for one to develop? What's the harm of erring on the side of more rather than less?

The truth is that knowledge is not always power: if the information is irrelevant to your specific situation, redundant, or inaccurate, the knowledge gained through unnecessary health care can be unhelpful or even harmful. Unnecessary tests, treatments, and supplements come with risks, even when they seem harmless. And, of course, unnecessary care is not free — even if you're not paying a cent out of pocket, it drives up costs across health systems.

Screening tests, wellness strategies, and treatments to reconsider

Recommended screening tests, treatments, and supplements can be essential to good health. But when risks of harm outweigh benefits — or if proof of any benefit is lacking — think twice. Save your time, money, and effort for health care that is focused on the most important health threats and backed by evidence.

Cancer screening: When to stop?

Screening tests for some cancers are routinely recommended and can be lifesaving. But there's a reason they come with a recommended stop age. For instance, guidelines recommend that a person at average risk of colorectal cancer with previously normal colonoscopies stop having them once they turn 75. Similar limits apply to Pap smears (age 65) and mammograms (age 75). Studies suggest that beyond those ages, there is little benefit to continuing these screens.

Watch out for wellness marketing

Dietary supplements are a multibillion-dollar industry. And a whopping 70% or more of US adults take at least one, such as vitamin D, fish oil, or a multivitamin. People often consider them as insurance in case vital elements are missing from their diet, or they believe supplements can prevent dementia, heart disease, or another condition.

Yet little evidence supports a benefit of routine supplement use for everyone. While recent studies suggest a daily multivitamin might slow cognitive decline in older adults, there's no medical consensus that everyone should be taking a multivitamin. Fish oil (omega-3) supplements haven't proven to be as healthful as simply eating servings of fatty fish and other seafood low in toxic chemicals like mercury and PCBs. And the benefits of routinely taking vitamin D supplements remain unproven as well.

It's worth emphasizing that dietary supplements clearly provide significant benefit for some people, and may be recommended by your doctor accordingly. For example, if you have a vitamin or mineral deficiency or a condition like age-related macular degeneration, good evidence supports taking specific supplements.

Reconsider daily aspirin

Who should be taking low-dose aspirin regularly? Recommendations have changed in recent years, so this is worth revisiting with your health care team.

• Older recommendations favored daily low-dose aspirin to help prevent cardiovascular disease, including first instances of heart attack and stroke.
• New recommendations favor low-dose aspirin for people who've already experienced a heart attack, stroke, or other cardiovascular disease. Adults ages 40 to 59 who are at a high risk for these conditions and low risk for bleeding also may consider it.

Yet according to a recent study, nearly one-third of adults 60 and older without past cardiovascular disease take aspirin, despite evidence that it provides little benefit for those at average or low risk. Aspirin can cause stomach bleeding and raise risk for a certain type of stroke.

Weigh in on prostate cancer screening

Men hear about prostate cancer often. It's common, and the second leading cause of cancer deaths among men. But PSA blood tests and rectal exams to identify evidence of cancer in the prostate are no longer routinely recommended for men ages 55 to 69 by the United States Preventative Services Task Force.

The reason? Studies suggest that performing these tests does not reliably reduce suffering or prolong life. Nor do possible benefits offset downsides like false positives (test results that are abnormal despite the absence of cancer). That can lead to additional testing, some of which is invasive.

Current guidelines suggest making a shared decision with your doctor about whether to have PSA testing after reviewing the pros and cons. For men over age 70, no screening is recommended. Despite this, millions of men have PSA tests and rectal examinations routinely.

Not everyone needs heart tests

There are now more ways than ever to evaluate the health of your heart. But none are routinely recommended if you're at low risk and have no signs or symptoms of cardiovascular disease. That's right: in the absence of symptoms or a high risk of cardiovascular disease, it's generally safe to skip EKGs, stress tests, and other cardiac tests.

Yet many people have these tests as part of their routine care. Why is this a problem? Having these tests without a compelling reason comes with risks, especially false positive results that can lead to invasive testing and unneeded treatment.

Four more reasons to avoid unnecessary care

Besides the concerns mentioned already, there are other reasons to avoid unnecessary care, including:

• The discomfort or complications of testing. If you're needle-phobic, getting a blood test is a big deal. And while complications of noninvasive testing are rare (such as a skin infection from a blood test), they can occur.
• The anxiety associated with waiting to find out test results
• False reassurance that comes with false negatives (results that are normal or nearly so, suggesting no disease when disease is actually present)
• All treatments have side effects. Even minor reactions — like occasional nausea or constipation — seem unacceptable if there's no reason to expect benefit from treatment.

The bottom line

You may believe your doctor wants you to continue with your current schedule of tests and treatments, while they might think this is your preference! It's worth discussing if you haven't already, especially if you suspect you may be taking pills or getting tests you don't truly need.

If your doctor says you can safely skip certain tests, treatments, and supplements, it doesn't mean that he or she is neglecting your health or that you don't deserve great health care! It's likely that the balance of risks and benefits simply doesn't support doing these things.

Less unnecessary care could free up resources for those who need it most. And it could save you time, money, and unnecessary risks or side effects, thus improving your health. It's a good example of how less can truly be more.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Ready to address excessive drinking in your life? Many people find peer support helps them take steps toward recovery. Two well-known self-help organizations built around peer support are Alcoholics Anonymous (AA) and Self-Management and Recovery Training (SMART Recovery). While some people seeking recovery even attend both programs, others forego both options.

Why do people choose those different paths — and what do they like, dislike, and find helpful about their chosen option? To find out, researchers questioned 80 participants enrolled in a two-year study about recovery from alcohol use disorder (20 each in AA, SMART Recovery, both, or neither).

Dr. John F. Kelly, professor of psychiatry in addiction medicine at Harvard Medical School, led the study, which was published in the Journal of Substance Use and Addiction Treatment. Here he explains key findings and shares his perspective and advice for people seeking peer support to stop problematic drinking.

Camaraderie: A common theme for both groups

The most striking finding was that for people attending either group, camaraderie was by far the most important aspect.

“There’s something about the connection with other people with similar experiences that helps decrease the self-stigma and shame that people have around this issue,” says Dr. Kelly, who founded the Recovery Research Institute at Massachusetts General Hospital. “Seeing role models of people who found solutions and a way out, and championing these examples of successful recovery, is very powerful,” he adds.

What else do people appreciate about AA?

Founded in 1935, AA has been around far longer than SMART Recovery, which began in 1990. AA’s popularity makes it easy to find meetings, which was one benefit cited in the study. “Within a 45-minute drive of downtown Boston, there are 1,800 AA meetings a week, compared with just 30 SMART meetings,” says Dr. Kelly.

You can also find a wider variety of specialized AA meetings, including those catering to different age groups, women, or LGBTQ+ people, for example. Larger metropolitan areas may have meetings conducted in different languages, as well.

AA follows a 12-step program, defined as a set of spiritual principles that help people achieve sobriety. Yet hardly anyone in the study mentioned spirituality in their responses, says Dr. Kelly. In fact, other research suggests that about half the people attending AA don’t seem to have a strong sense of needing to believe in a formal deity or higher power. “Some people say that connection with other people is what makes it a spiritual experience,” he says.

What else draws people to SMART Recovery?

The study results confirm years of anecdotal reports about why people choose SMART Recovery over AA, says Dr. Kelly. “What attracts people to SMART Recovery is the organization’s focus on science and clinical evidence,” he says.

Their approach incorporates cognitive behavioral therapy (CBT) and motivational psychology into their support groups. The goal is to help participants to recognize and cope with the emotional and environmental triggers for their drinking. Still, in this study, people who chose SMART Recovery stayed with it for the social aspects, according to responses about what they like best about the program, says Dr. Kelly.

Compared to people who attended AA, study participants who chose SMART tended to have less severe problems with alcohol use. They had more education, higher rates of employment, and greater economic resources. They were also less likely to have had prior treatment or involvement with the criminal justice system. SMART may be a particularly good fit for people with that kind of profile.

People who attended both AA and SMART Recovery groups tended to be the most severely affected by their problems with alcohol, and were seeking anything and everything to get help. Those who attended neither program were less seriously affected.

What are other differences between AA and SMART Recovery?

While AA groups are led by members in recovery, SMART groups are led by trained facilitators who are not required to be in recovery themselves.

In the study, that lack of “lived experience” wasn’t perceived as a negative, although some people mentioned that they didn’t like some of the facilitators, Dr. Kelly says. However, a trained facilitator can gently stop and redirect members who engage in meandering, lengthy, and potentially irritating monologues (known as a “drunkalogue”) that may dominate group discussions. AA group leaders don’t intervene in that way and have no formal group facilitation training.

However, AA strongly encourages people who join the fellowship, as it is called, to have a sponsor. Sponsors are experienced members with at least one year of recovery who serve as mentors for new members and are available between meetings. SMART Recovery doesn’t have formal sponsors, but facilitators encourage people to swap phone numbers and reach out to each other between meetings.

Should you participate in a support group to stop drinking?

“When I’m counseling patients, I lay out the different options and let people decide which program seems like the best personal fit for them,” says Dr. Kelly.

Because AA has been around for much longer, he notes that there’s more evidence about what contributes most to success with this approach. Research shows the three factors that have the biggest positive effect on remission for alcohol misuse are:

• Having a sponsor. This is the single most important factor influencing recovery.
• Attending at least three meetings per week. Consistently showing up, especially during the first year, also appears to boost the odds of recovery.
• Speaking at meetings. Saying something aloud in the group meetings — even if it’s just a sentence or two — reinforces the likelihood of ongoing recovery. It also makes it easier to connect with other members in the “meeting after the meeting.”

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Parents often wonder: What can we do to keep our children healthy? Are there ways to boost the immune system and ward off illnesses?

The answer is yes — but there are no magic wands or magic supplements. The best way to keep the immune system healthy is, basically, to take necessary steps to keep healthy. As boring as that sounds, it’s tried and true.

Here’s what you can do to help keep your children healthy this school year.

Give them a healthy diet

By healthy I mean a diet with lots of fruits and vegetables (five servings a day are recommended, and they should take up half of every meal plate), whole grains, and lean protein. A healthy diet also has dairy or another source of calcium, and healthy fats like vegetable oils.

The foods to avoid are processed foods, foods with added sugar, and foods with unhealthy fats, like the saturated fats found in animal products. That doesn’t mean your child can’t ever eat cookies or ice cream. But if you want to your child to be healthy, they shouldn’t eat those foods every day. (The Academy of Nutrition and Dietetics has suggestions for healthier baked goods and other ways to make your family’s diet healthier).

There are many supplements that claim to boost your immune system. While the jury is still out as to whether most of them make a real difference, none of them take the place of a healthy diet. If you have a child who refuses vegetables or otherwise has a limited diet, a multivitamin with iron may make sense; talk to your doctor about whether vitamins or supplements are a good idea for your child.

Make sure they get enough sleep

We all need sleep to refresh and recharge our bodies, and that includes children. The amount of sleep a child needs varies by age (from 12 to 16 hours a day for infants to eight to 10 hours for teens), and also from child to child (some just need more than others). You can encourage healthy sleep by limiting screens — for teens, devices really should be shut off an hour or two before bedtime, and preferably not be in the bedroom at night — and keeping to a regular schedule.

Get them active

Exercise keeps us healthy and less likely to get sick. Children should really be active for an hour a day. “Active” doesn’t have to mean playing a sport or going to the gym; it could be playing at the playground or going for a walk. More is not necessarily better; if you have a child who is a serious athlete, exercising several hours a day, make sure that the exercise isn’t eating into sleep or causing burnout, both of which could cause problems with the immune system.

Manage stress

Stress makes us less healthy and more prone to infection. Make sure that kids have downtime to play, and access to activities and people that make them happy. Spend time together as a family, and create opportunities for your children to talk about anything that might be worrying them. If you have concerns about your child’s moods or emotional health, talk to your doctor.

Make sure they are up to date on important vaccines

Immunizations protect us from all sorts of illnesses. Check with your doctor to see if your child is up to date on immunizations. The flu shot is recommended yearly for all people 6 months of age or older.

Don’t forget the simple precautions

Everyone in the family can take simple precautions to help stay healthy. Wash your hands. Cover your coughs and sneezes with your elbow. Stay away from sick people to the extent that you can. Masks can help, too, especially in crowded indoor spaces.

If your child has a health problem that could make it harder to fight off an infection, talk to your doctor about any extra or different precautions you should take.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

If you’re struggling with depression, the most important question about taking an antidepressant is whether it will work. But another question on your mind may be whether it will fuel weight gain.

A new study provides some context by suggesting how much weight, on average, people taking one of eight commonly used antidepressants might expect to gain. This insight is valuable, since people with depression often stop taking antidepressants because they don’t like the effect on their weight, a Harvard expert says.

“It’s important to acknowledge that weight gain is a key reason that some people decide to stop antidepressants, even if they’re otherwise working well,” says Dr. Roy Perlis, associate chief of psychiatric research at Massachusetts General Hospital. “It’s also a reason people may be reluctant to start them in the first place, even if they’re quite depressed or anxious.”

What did the study look at?

Published July 2024 in Annals of Internal Medicine, the new study drew on data from more than 183,000 people between ages 20 and 80. Their average age was 48, and 65% were women. Most were overweight or obese at the study’s start.

The researchers analyzed participants’ electronic health records and body mass index. They gauged weight gain or loss at regular intervals — six, 12, and 24 months — after people began taking an antidepressant for the first time.

The study compared the weight-related effects of sertraline (Zoloft) to seven other antidepressant medications:

• escitalopram (Lexapro)
• paroxetine (Paxil)
• duloxetine (Cymbalta)
• citalopram (Celexa)
• fluoxetine (Prozac)
• venlafaxine (Effexor)
• bupropion (Wellbutrin).

What did the research find?

The antidepressants led to the following average weight gain:

• sertraline: Nearly 0.5 pounds at six months; 3.2 pounds at 24 months
• escitalopram: 1.4 pounds at six months; 3.6 pounds at 24 months
• paroxetine: 1.4 pounds at six months; 2.9 pounds at 24 months
• duloxetine: 1.2 pounds at six months; 1.7 pounds at 24 months.

Citalopram, fluoxetine, and venlafaxine didn’t confer lower or higher odds of weight gain than Zoloft, the study found. And only bupropion was associated with a small amount of weight loss — 0.25-pounds — at six months. But that trend reversed at 24 months, when bupropion led to an average weight gain of 1.2 pounds.

What does the study tell us?

“Weight gain is common among antidepressant users, even if the amounts gained on average are modest,” says Dr. Perlis, who was not involved in this new study. It underscores similar findings from other studies of antidepressants, including research he published with colleagues a decade ago.

“While differences in weight gain for specific antidepressants tend to be small, there are certainly some — like bupropion — that tend to cause less weight gain,” he notes.

It’s crucial to keep in mind that the study points out average weight gain. Many people taking antidepressants won’t gain any weight and others could gain more. “Still, having average values to work with — and seeing that these averages line up well with prior studies — at least lets us give people a sense of what they might expect,” he says.

“One caution is that some people lose weight as a result of depression, which can impact appetite,” he adds, “so some of what we’re seeing may be people regaining weight they’d lost as their depression or anxiety improves.”

What additional limitations did the study have?

Other limitations may have shaped the findings. The study was observational, meaning it cannot prove that antidepressants cause weight changes, only that they were linked with them. It wasn’t a randomized, controlled trial — considered the gold standard in research — and the participants taking antidepressants weren’t compared to a control group not taking the medications.

Additionally, only about one in three participants was still taking their initially prescribed medication six months after the study started. That makes it difficult to link any later weight changes with a specific medication.

“As with any study that’s not randomized, we don’t know if the differences between medicines could reflect other differences in who gets prescribed these medicines,” Dr. Perlis says. “But, for circumstances where a randomized trial is unrealistic, health records can be a helpful way of trying to study side effects and at least generate a partial answer to these important questions.”

What else should you consider?

Another thing to consider, if you’re taking an antidepressant, is what types of side effects you’re willing to tolerate in pursuit of its mood-smoothing benefits.

“The best way to manage side effects is to anticipate them — to have an open conversation with your doctor about the potential risks and how we’ll manage them if they occur,” Dr. Perlis says.

What can you discuss with your doctor?

If weight gain is a particular concern for you, you may also wish to consider nondrug treatments for depression. They include:

• Cognitive behavioral therapy (CBT), a type of psychotherapy that teaches people to become aware of their thought patterns and adjust them during stressful moments to reframe their thinking.
• Repetitive transcranial magnetic stimulation (rTMS), a brain stimulation therapy that is noninvasive. It uses an electromagnetic coil placed on the scalp to deliver magnetic pulses that stimulate nerve cells to brain regions involved in depression.

“We know that certain kinds of talk therapies, especially cognitive behavioral therapy, can be very effective for treating depression and anxiety disorders,” Dr. Perlis says. “Whether people choose talk therapy or antidepressant medications can depend on their preference. It’s important to have multiple options.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Dementia usually develops in people ages 65 years and older. So-called young-onset dementia, occurring in those younger than age 65, is uncommon. Now, a new study published in December 2023 in JAMA Neurology has identified 15 factors linked to a higher risk of young-onset dementia.

Let’s see what they found, and — most importantly — what you can do to reduce your own risks.

Are early dementia and young-onset dementia the same?

No. Experts think of early dementia as the first stage in dementia. Mild cognitive impairment and mild dementia are forms of early dementia. So, someone age 50, 65, or 88 could have early dementia.

Young-onset dementia refers to the age at which dementia is diagnosed. A person has young-onset dementia if symptoms and diagnosis occur before age 65.

What has previous research shown?

A previous study of men in Sweden identified some risk factors for young-onset dementia, including high blood pressure, stroke, depression, alcohol use disorder, vitamin D deficiency, drug use disorder, and overall cognitive function.

What to know about the new study

In the new study, a research team in the Netherlands and the United Kingdom looked at data from the UK Biobank. The biobank follows about half a million individuals in the United Kingdom who were 37 to 73 years old when they first joined the project between 2006 and 2010. Most participants identified as white (89%), and the remaining 11% were described only as “other.” Slightly more than half of the participants (54%) were women.

The researchers excluded anyone age 65 or older and people who already had dementia at the start of the study, leaving 356,052 participants for the analyses. Over roughly a decade, 485 participants developed young-onset dementia. The researchers compared participants who did and did not develop young-onset dementia to identify possible risk factors.

What did the researchers learn about risks for young-onset dementia?

In reviewing the results, I think it is helpful to group the risk factors into several categories, and then to examine each of them. These risks may act on the brain directly or indirectly.

Eight factors that we know or strongly suspect cause dementia:

• Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.
• Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.
• Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.
• Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.
• Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.
• Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.
• Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.
• Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

Cognitive reserve can be described as our capacity to think, improvise, and problem-solve even as our brains change with age. These two risk factors make it more likely that dementia symptoms will show up at a younger age.

• Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.
• Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

No, and here’s why not: Sometimes research turns up apparent risk factors that might be due to reverse causation. It’s possible, for example, that symptoms of impending dementia appear to be risk factors because they become noticeable before obvious dementia is diagnosed.

• Lower handgrip strength is a sign of frailty, which is often associated with dementia.
• No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the “healthy drinker effect” in dementia).
• Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

Lastly, there are risk factors that could be either a contributing cause or a result of the impending dementia.

• High C-reactive protein is a sign of inflammation.
• Orthostatic hypotension is an abnormal drop in blood pressure when a person stands up after lying down or sitting. While this condition can lead to brain damage and dementia, it can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.

What can you do to prevent young-onset dementia?

Taking these five steps can reduce your risk for developing dementia before age 65:

• Don’t drink alcohol in excess.
• Seek opportunities to socialize with others regularly.
• Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.
• Make sure you are hearing well and use hearing aids if you are not.
• Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, MD