Do you have a Healthy Millionaire Mind? Dr. Thomas J. Stanley extensively interviewed and surveyed 733 Millionaires asking what factors were most vital to their success.
Top 10 factors they attribute to their success:
1. Being honest with all people
2. Being well-disciplined
3. Getting along with people
4. Having a supportive spouse
5. Working harder than most people
6. Loving my career/business
7. Having strong leadership qualities
8. Having a very competitive spirit/personality
9. Being very well-organized
10. Having an ability to sell my ideas/products
Integrity, someone who doesn’t cheat is high on the list, as well as having extraordinary energy and being physically fit. Integrity and physical fitness are within your control. Anyone can cheat. Anyone can be lazy and not exercise. Wise people make better choices, and reap the long-term rewards from it.
Here are remaining factors Millionaires attribute to their success:
The Food and Drug Administration on Tuesday approved esketamine, the first major depression treatment to hit the U.S. market in decades and a new option for patients who haven’t responded to existing therapies.
Esketamine—delivered as a nasal spray—was tested in combination with oral antidepressants in patients with treatment-resistant depression. The drug is related to ketamine, a common anesthetic sometimes misused recreationally.
Many experts hail esketamine as a critical option for patients in dire need of new treatment.
Janssen, the subsidiary of Johnson & Johnson developed the drug, called Spravato.
Zoe Biehl spoke with an experienced psychiatrist (who wished to remain anonymous) to dive deeper and learn more about how exactly prescribing ketamine for depression works.
Some psychiatrists have been prescribing ketamine off-label for depression. What does off-label mean exactly?
Off-label refers to using an FDA-approved medication for a purpose other than the indication that it is FDA approved for.
Off-label use of medications is common.
It is entirely legal to prescribe for symptoms other than the FDA-approved indication, as long as the drug is FDA approved for distribution in the US.
In order to for a drug to be approved by the FDA, it has to be proven both safe and effective for its proposed indication.
All drugs have potential for adverse effects, so for a medication to be considered safe it has to have a low incidence of severe adverse effects compared to the benefits derived from treating the indicated condition.
A medication may be effective for conditions other than the FDA approved indication. It’s just that it has not undergone the extensive and expensive process of FDA approval.
As long as the medication is proven safe, physicians can legally prescribe a medication for off-label use. An approved drug has a well known safety profile, so it is generally safe to consider a medication for other conditions.
What are some examples of other medications that are prescribed off-label?
Some antidepressants that have passed FDA approval for treatment of depression have been used for neuropathic pain or chronic pain syndromes for over 30 years, but most of them are not FDA approved for pain.
Another example is trazodone—an older medication that has FDA approval for treatment of depression, but it is also very sedating to the point of making it difficult to reach the full dose for the anti-depressant effect. So, because of its sedating side effects, it has become commonly used for insomnia at lower doses. One can assume it is safe enough at lower doses to use for simple insomnia because it has been studied in higher doses in depression.
So how do doctors give the ketamine to patients once they prescribe it to them off-label?
Ketamine is given via IV in a supervised setting, using 1/10 the anesthetic dose, which is 0.5 mg / kg body weight. The effect tends to be delayed to the next day, at which time some sort of reset and release of habitual thoughts and emotions occurs, leaving an opportunity to engage in therapy to help solidify the results.
The antidepressant effect of ketamine tends to wear off within a few days.
Dextromethorphan (DXM) in the usual over-the-counter doses for cough is given twice a day to help maintain the antidepressant effect of ketamine. DXM affects similar receptors and neural pathways as ketamine at a much more mild and attenuated level. Some practitioners have been prescribing DXM in the hopes that it might augment and maintain the effects of the ketamine treatment.
A doctor in San Diego is giving oral ketamine at the same dose of 0.5 mg / kg body weight for situational depression in hospice patients with good results. He has the pharmacy compound the IV ketamine into a syrup that is administered every night for the remainder of their life (which is only a few weeks for the population that he has been treating). It is a small number of patients, but so far he has found it to be generally well tolerated and effective.
Ketamine only comes in IV formulation—there is no commercially available oral formulation. So you have to use a compounding pharmacy, where personalized medications in specific doses are created to fit the unique needs of a patient.
Ketamine for depression is experimental. There is not enough evidence of safety and efficacy to justify wide-spread off-label use at this point. For outpatients, the treatment protocols involve oral or IV administration in a supervised office setting. It is not dispensed as a prescription to be taken at home.
What are some concerns/risks in prescribing ketamine off-label for depression?
The important issue with ketamine is the fact that the use of it for depression is still highly experimental. It would not be as serious a concern if it were a simple medication like ibuprofen being used for treatment of cough—which can work when the cough is related to inflammation in the trachea.
Ibuprofen is a fairly safe medication. Ketamine is not. It can be used at anesthetic doses to induce a dissociative state in which pain is not felt. Any medication that is used for anesthesia can be lethal if overused. And ketamine has a street value as it is used as a party drug. This can result in people seeking treatment for reasons other than depression, or for people who are looking to access drugs simply to get high.
Ketamine has been studied by the FDA for one-time single use as an anesthetic. There is no data of the safety of repeated doses over time.
Use of ketamine for depression is being closely monitored and studied. The protocols stress the importance of screening out people with a history of substance abuse. There is concern that such patients might be more prone to respond to low-dose ketamine by developing addictive responses to the use of the medication.
The use of ketamine for depression is also limited to just a few treatments a week for a limited number of weeks. The problem is that the antidepressant effect wears off, so the idea is to use these days when the mood is improved to work on psychological issues and shift one’s perspective and break cycles of habitual negative thoughts.
How does that work exactly? What does the ketamine do?
The use of ketamine for depression is analogous to the use of plant medicine in shamanism.
Ayahuasca, for example, limited to a single session (or a limited series of 2-4), each time focusing on a specific desired goal of the ceremony—purging, cleansing, insight, teaching, and/or healing of a specific illness or concern. The idea is to use the insights gained from the expanded awareness and consciousness and incorporate the ideas and insights into daily life.
The goal of repeated ceremonial use of ayahuasca is to be able to access and retain the insights and expanded level of consciousness without the need for the plant. By remembering the state of expanded insight and re-entering that level of awareness consciously, you can incorporate the effects of the plant into your daily life.
So, likewise with ketamine, the idea is to enter a state of release of depression, feel what it feels like to have the burden of depression lifted, and learn to maintain that state of mind by conscious intent and practice.
Some researchers have noted that ketamine seems to break the ruts of chronic negative thoughts and negative emotional states that self-perpetuate when depressed, and by breaking the patterns for a few hours or days, you have an opportunity to move forward without continuing the patterns of negative thoughts and feelings. It’s like a reboot of a computer. A momentary shutting down, setting the dials back to zero, and then starting again. Like turning your computer off and on again to resolve a persistent and baffling problem on your computer.
A British physician from England who has been researching ketamine has suggested that ketamine is somehow addressing the “ruts” in our thoughts and emotions.
When certain negative thoughts and feelings are repeated over and over, you tend to fall back into the same ruts over and over. He feels ketamine clears out the ruts, like repaving a street, providing a smooth surface to respond and move forward in a different direction instead of following the same old paths.
Ketamine is a drug that was approved by the FDA in the 1970’s to be used by doctors and veterinarians as an anesthetic.
It’s also a fairly popular recreational drug that provides out-of-body experiences.
However, even though ketamine has been legal for around 50 years, it was only in the last few years that psychiatrists began to realize this drug is actually quite effective at treating depression. According to one clinical study, around 70-85% of patients with severe depression reported that their ketamine treatment was effective.
“There has been a long-standing need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition,” said Dr. Tiffany Farchione, acting director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research, in a press release about the decision.
“This is potentially a game changer for millions of people,” said Dr. Dennis Charney, dean of the Icahn School of Medicine at Mount Sinai in New York. “It offers a lot of hope.”
Esketamine works through a mechanism different from those of drugs like Prozac, Charney said. And that is probably why studies show it can often help people with major depressive disorder who haven’t been helped by other drugs.
“Many of them are suicidal,” Charney said. “So it’s essentially a deadly disease when you haven’t responded to available treatments and you’ve been suffering for years if not decades.”
Charney was part of the team that first showed two decades ago that ketamine could treat depression. He also is named as co-inventor on patents filed by the Icahn School of Medicine relating to the treatment for treatment-resistant depression, suicidal ideation and other disorders.
Esketamine, developed by Johnson & Johnson, will be administered as a nasal spray and be used in conjunction with an oral antidepressant. It will be marketed under the brand name Spravato. The FDA has approved it for patients who have failed to respond adequately to at least two other drugs.
That means about 5 million of the 16 million people in the U.S. with major depression might benefit from esketamine, said Courtney Billington, president of Janssen Neuroscience, a unit of Johnson & Johnson.
But esketamine presents some challenges because of its similarities to ketamine. In high doses, both drugs can cause sedation and out-of-body experiences. And ketamine, often called Special K in its illicit form, has become a popular party drug.
So Johnson & Johnson is taking steps to make sure esketamine will be used only as intended, Billington said.
“Spravato will not be dispensed directly to a patient to take at home,” he said. “It will only be available in approved and certified treatment centers.”
Patients will inhale the drug under supervision at these centers once or twice a week. And they will receive a dose that is unlikely to produce side effects such as hallucinations.
“The amount of active ingredient that’s in this product, it’s at a very, very low dose,” Billington said.
Even so, the FDA, according to its press release, is requiring a warning label that says patients “are at risk for sedation and difficulty with attention, judgment and thinking (dissociation), abuse and misuse, and suicidal thoughts and behaviors after administration of the drug,”
Esketamine’s approval comes as more and more doctors have begun administering a generic version of ketamine for depression. Generic ketamine is approved as an anesthetic, not as an antidepressant. Even so, doctors can legally prescribe it for off-label medical uses.
And as a growing number of studies have shown ketamine’s effectiveness against depression, ketamine clinics have sprung up around the United States. These clinics often administer the drug in an intravenous infusion that can cost more than $500 per treatment.
Many doctors who have become comfortable offering ketamine for depression probably won’t switch to esketamine, said Dr. Demitri Papolos, director of research for the Juvenile Bipolar Research Foundation and a clinical associate professor at Albert Einstein College of Medicine.
For the past 10 years, Papolos has been prescribing an intranasal form of ketamine for children and adolescents who have a disorder that includes symptoms of depression.
“I’m very pleased that finally the FDA has approved a form of ketamine for treatment-resistant mood disorders,” Papolos said. He said the approval legitimizes the approach he and other doctors have been taking.
But he hopes that doctors who are currently using ketamine continue to do so. “It’ll be a lot less expensive and a lot easier for their patients [than esketamine],” he said.
Esketamine “may not be as effective as a generic that any psychiatrist or physician can prescribe without restrictions,” Papolos said.
Johnson & Johnson said the wholesale cost of each treatment with ketamine will range from $590 to $885, depending on the dose. That means twice-weekly treatments during the first month will cost centers that offer the drug at least $4,720 to $6,785. Subsequent weekly treatments will cost about half as much.
The drugmaker says those figures don’t include administration and observation costs.
Gretchen Rubin’s new book is out today to show you how decluttering and organizing can make more room for happiness and lead to inner calm.
Gretchen is the author of several books, including the blockbuster New York Times bestsellers, The Four Tendencies, Better Than Before, The Happiness Project, and Happier at Home. She has an enormous readership, both in print and online, and her books have sold 3.5 million copies worldwide, in more than thirty languages.
On her popular weekly podcast Happier with Gretchen Rubin, she discusses good habits and happiness with her sister Elizabeth Craft; they’ve been called the “Click and Clack of podcasters.” She’s a member of Oprah’s SuperSoul 100.
We interviewed Gretchen about her new book Outer Order, Inner Calm. Welcome.
Question: HOW CAN DECLUTTERING BRING ABOUT INNER CALM?
When people get rid of all that stuff that they don’t need, don’t use or don’t love, what people actually experience is they feel like they have more.
Question: I’M A MINIMALIST AND AGREE. WHAT IF SOMEONE CAN’T PART WITH THINGS DUE TO SENTIMENTAL REASONS? WHAT ADVICE CAN YOU GIVE THEM?
It’s not always easy. In the choice, there is decision fatigue, it’s hard. It’s emotionally draining. It’s intellectually draining, but once all of that stuff has been wiped away, given away, recycled, donated, that’s when you can really see, well, where to do I put things?
People can ask themselves 3 questions:
How do I organize things so I can find them easily?
How do I organize things so they make sense to me?
How do I organize things so they look appealing?
Your impulse might be to buy more containers, filing cabinets, or fancy hangers to organize what you currently have, but Rubin said you have to start by asking these three questions: Do I need it? Do I use it? Do I love it?
By the time you get rid of the things cluttering your life, you won’t need that filing cabinet “because you only have three documents left.
If it’s clothing, ask yourself if you ran into your ex would you be happy to be seen wearing it? If not, get rid of it.
Question: MAKES SENSE. WITHOUT GIVING THE ENTIRE BOOK AWAY SHARE YOUR #1 TIP FOR DECLUTTERING TO GAIN OUTER ORDER, INNER CALM.
One great habit is the one-minute rule. Anything you can do in less than a minute, do without delay.
For example, if you can hang up your coat instead of throwing it on the chair.
If you can rip open a letter and see that you can put it in the recycling.
It’s a little habit that’s easy to work into even a very busy life.
GREAT TIP. HERE’S MORE TIPS ON HOW TO HELP A FRIEND DECLUTTER: