
Why a common asthma drug will now carry extra safety warnings about depression
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Australia’s Therapeutic Goods Administration (TGA) recently issued a safety alert requiring extra warnings to be included with the asthma and hay fever drug montelukast.
The warnings are for users and their families to look for signs of serious behaviour and mood-related changes, such as suicidal thoughts and depression. The new warnings need to be printed at the start of information leaflets given to both patients and health-care providers (sometimes called a “boxed” warning).
So why did the TGA issue this warning? And is there cause for concern if you or a family member uses montelukast? Here’s what you need to know.
First, what is montelukast?
Montelukast is a prescription drug also known by its brand names which include Asthakast, Lukafast, Montelair and Singulair. It’s used to manage the symptoms of mild-to-moderate asthma and seasonal hay fever in children and adults.
Asthma occurs when the airways tighten and produce extra mucus, which makes it difficult to get air into the lungs. Likewise, the runny nose characteristic of hay fever occurs due to the overproduction of mucus.
Leukotrienes are an important family of chemicals found throughout the airways and involved in both mucus production and airway constriction. Montelukast is a cysteinyl leukotriene receptor antagonist, meaning it blocks the site in the airways where the leukotrienes work.
Montelukast can’t be used to treat acute asthma (an asthma attack), as it takes time for the tablet to be broken down in the stomach and for it to be absorbed into the body. Rather, it’s taken daily to help prevent asthma symptoms or seasonal hay fever.
It can be used alongside asthma puffers that contain corticosteriods and drugs like salbutamol (Ventolin) in the event of acute attacks.
What is the link to depression and suicide?
The possibility that this drug may cause behavioural changes is not new information. Manufacturers knew this as early as 2007 and issued warnings for possible side-effects including depression, suicidality and anxiousness.
The United Kingdom’s Medicines and Healthcare products Regulatory Agency has required a warning since 2008 but mandated a more detailed warning in 2019. The United States’ Food and Drug Administration has required boxed warnings for the drug since 2020.

Montelukast is known to potentially induce a number of behaviour and mood changes, including agitation, anxiety, depression, irritability, obsessive-compulsive symptoms, and suicidal thoughts and actions.
Initially a 2009 study that analysed data from 157 clinical trials involving more than 20,000 patients concluded there were no completed suicides due to taking the drug, and only a rare risk of suicide thoughts or attempts.
The most recent study, published in November 2024, examined data from more than 100,000 children aged 3–17 with asthma or hay fever who either took montelukast or used only inhaled corticosteroids.
It found montelukast use was associated with a 32% higher incidence of behavioural changes. The behaviour change with the strongest association was sleep disturbance, but montelukast use was also linked to increases in anxiety and mood disorders.
In the past ten years, around 200 incidences of behavioural side-effects have been reported to the TGA in connection with montelukast. This includes 57 cases of depression, 60 cases of suicidal thoughts and 17 suicide attempts or incidents of intentional self-injury. There were seven cases where patients taking the drug did complete a suicide.
This is of course tragic. But these numbers need to be seen in the context of the number of people taking the drug. Over the same time period, more than 200,000 scripts for montelukast have been filled under the Pharmaceutical Benefits Scheme.
Overall, we don’t know conclusively that montelukast causes depression and suicide, just that it seems to increase the risk for some people.

And if it does change behaviour, we don’t fully understand how this happens. One hypothesis is that the drug and its breakdown products (or metabolites) affect brain chemistry.
Specifically, it might interfere with how the brain detoxifies the antioxidant glutathione or alter the regulation of other brain chemicals, such as neurotransmitters.
Why is the TGA making this change now?
The new risk warning requirement comes from a meeting of the Australian Advisory Committee on Medicines where they were asked to provide advice on ways to minimise the risk for the drug given current international recommendations.
Even though the 2024 review didn’t highlight any new risks, to align with international recommendations, and help address consumer concerns, the advisory committee recommended a boxed warning be added to drug information sheets.
If you have asthma and take montelukast (or your child does), you should not just stop taking the drug, because this could put you at risk of an attack that could be life threatening. If you’re concerned, speak to your doctor who can discuss the risks and benefits of the medication for you, and, if appropriate, prescribe a different medication.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Nial Wheate, Professor of Pharmaceutical Chemistry, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Does “A Little Dirt” Help Or Harm, vs Allergies?
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We’re not talking about exposure to the allergen in question, by the way.
But first let’s mention that yes, that can help (albeit should be done under very controlled conditions only with appropriate medical professionals, in the case of things that can cause anaphylactic shock and death).
If you’re interested in that, see: Peanut Allergy Diagnoses Have Been Halved: What Did They Do?
But no, we really are talking about “a little dirt” where the dirt in question is not, itself, allergenic.
Natural inoculation
Researchers (Dr. Ruslan Medzhitov et al.) have found that early-life exposure to diverse microbes and proteins builds broad immune memory that shifts responses away from allergy-driving IgE antibodies, and towards protective IgG antibodies, reducing later allergic reactions (to anything).
About that “anything”…
Yes, it gives cross-reactive immune memory: exposure to many microbes and antigens created immune memory that protected against new, previously unseen allergens.
No, that doesn’t mean it’ll definitely prevent all and any allergies, it simply means it reduces the risk of all and any allergies.
How it works: cross-reactive adaptive immunity suppressed type II immune responses and reduced IgE-mediated mast cell activation.
Or, translating that from sciencese:
Why it works: immune systems trained by real-world environments respond to harmless real-world allergens in a balanced way, instead of overreacting.
You can read the paper in full, here: Environmentally driven immune imprinting protects against allergy
You may be wondering about general hygiene, and isn’t handwashing, use of sanitizer, etc, important to protect against disease? And yes, yes it is.
See also: The Truth About Handwashing
However, in the words of Dr. Medzhitov,
❝But the tradeoff is that our immune system is in this untrained, unprepared state, and otherwise harmless exposures trigger a pathological allergic response❞
So, does this “natural inoculation” mean we should skip vaccines?
No.
This is about encountering harmless microbes in order to train the immune system to respond in a balanced fashion to something that is neither wanted nor a serious threat.
With this kind of well-trained reaction, the body is more likely to be able to one day encounter a peanut and not immediately kill itself in response.
However, that’s about things that are not in and of themselves a serious threat (except insofar as the body might have overreacted to them)
There is an important difference between a peanut and a deadly virus that has evolved to take over the cells of your body until you die:
- In the case of a peanut, the ideal bodily response is “don’t worry about it”
- In the case of a deadly virus or bacterium, the ideal bodily response is “destroy it by any means necessary”
For more on that, see: Why Some People Get Sick More (And How To Not Be One Of Them)
Want to learn more?
For much more detail than we can go into here, check out this excellent book that we reviewed a while back:
It’s worth noting that with regard to the first-named author there, the bio begins:
❝Kari Nadeau, MD, PhD, is the director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University and is one of the world’s leading experts on food allergy❞
We mention this, because there’s a lot of quack medicine out there [in general, but especially] when it comes to things such as food allergies. So let’s be clear up front that Dr. Nadeau is actually a world-class professional at the top of her field 😎
Take care!
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Easily Digestible Vegetarian Protein Sources
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝What could be easily digestible plant sources of protein for a vegetarian. My son is a gym holic and always looking for ways to get his protein from lentils other than eggs. He says to reach his protein requirement for the day, the amount of lentils he has to eat is sometimes heavy on the gut. Would really appreciate if you throw some light on this ❞
Unless one has IBS or similar (or is otherwise unaccustomed to consuming healthy amounts of fiber), lentils shouldn’t be at all problematic for the digestion.
However, the digestive process can still be eased by (speaking specifically for lentils here) blending them (in the water they were cooked in). This thick tasty liquid can then be used as the base of a soup, for example.
Soy is an excellent source of complete protein too. Your son probably knows this because it’s in a lot of body-building supplements as soy protein isolate, but can also be enjoyed as textured soy protein (as in many plant-based meats), or even just soy beans (edamame). Tofu (also made from soy) is very versatile, and again can be blended to form the basis of a creamy sauce.
Mycoproteins (as found in “Quorn” brand products and other meat substitutes) also perform comparably to meat from animals:
Meatless Muscle Growth: Building Muscle Size and Strength on a Mycoprotein-Rich Vegan Diet
See also, for interest:
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Our ‘food environments’ affect what we eat. Here’s how you can change yours to support healthier eating
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In January, many people are setting new year’s resolutions around healthy eating. Achieving these is often challenging – it can be difficult to change our eating habits. But healthy diets can enhance physical and mental health, so improving what we eat is a worthwhile goal.
One reason it’s difficult to change our eating habits relates to our “food environments”. This term describes:
The collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status.
Our current food environments are designed in ways that often make it easier to choose unhealthy foods than healthy ones. But it’s possible to change certain aspects of our personal food environments, making eating healthier a little easier.
Unhealthy food environments
It’s not difficult to find fast-food restaurants in Australian cities. Meanwhile, there are junk foods at supermarket checkouts, service stations and sporting venues. Takeaway and packaged foods and drinks routinely come in large portion sizes and are often considered tastier than healthy options.
Our food environments also provide us with various prompts to eat unhealthy foods via the media and advertising, alongside health and nutrition claims and appealing marketing images on food packaging.
At the supermarket, unhealthy foods are often promoted through prominent displays and price discounts.
We’re also exposed to various situations in our everyday lives that can make healthy eating challenging. For example, social occasions or work functions might see large amounts of unhealthy food on offer.
Not everyone is affected in the same way
People differ in the degree to which their food consumption is influenced by their food environments.
This can be due to biological factors (for example, genetics and hormones), psychological characteristics (such as decision making processes or personality traits) and prior experiences with food (for example, learned associations between foods and particular situations or emotions).
People who are more susceptible will likely eat more and eat more unhealthy foods than those who are more immune to the effects of food environments and situations.
Those who are more susceptible may pay greater attention to food cues such as advertisements and cooking smells, and feel a stronger desire to eat when exposed to these cues. Meanwhile, they may pay less attention to internal cues signalling hunger and fullness. These differences are due to a combination of biological and psychological characteristics.
These people might also be more likely to experience physiological reactions to food cues including changes in heart rate and increased salivation.
It’s common to eat junk food in front of the TV.
PR Image Factory/ShutterstockOther situational cues can also prompt eating for some people, depending on what they’ve learned about eating. Some of us tend to eat when we’re tired or in a bad mood, having learned over time eating provides comfort in these situations.
Other people will tend to eat in situations such as in the car during the commute home from work (possibly passing multiple fast-food outlets along the way), or at certain times of day such as after dinner, or when others around them are eating, having learned associations between these situations and eating.
Being in front of a TV or other screen can also prompt people to eat, eat unhealthy foods, or eat more than intended.
Making changes
While it’s not possible to change wider food environments or individual characteristics that affect susceptibility to food cues, you can try to tune into how and when you’re affected by food cues. Then you can restructure some aspects of your personal food environments, which can help if you’re working towards healthier eating goals.
Although both meals and snacks are important for overall diet quality, snacks are often unplanned, which means food environments and situations may have a greater impact on what we snack on.
Foods consumed as snacks are often sugary drinks, confectionery, chips and cakes. However, snacks can also be healthy (for example, fruits, nuts and seeds).
Try removing unhealthy foods, particularly packaged snacks, from the house, or not buying them in the first place. This means temptations are removed, which can be especially helpful for those who may be more susceptible to their food environment.
Planning social events around non-food activities can help reduce social influences on eating. For example, why not catch up with friends for a walk instead of lunch at a fast-food restaurant.
Creating certain rules and habits can reduce cues for eating. For example, not eating at your desk, in the car, or in front of the TV will, over time, lessen the effects of these situations as cues for eating.
You could also try keeping a food diary to identify what moods and emotions trigger eating. Once you’ve identified these triggers, develop a plan to help break these habits. Strategies may include doing another activity you enjoy such as going for a short walk or listening to music – anything that can help manage the mood or emotion where you would have typically reached for the fridge.
Write (and stick to) a grocery list and avoid shopping for food when hungry. Plan and prepare meals and snacks ahead of time so eating decisions are made in advance of situations where you might feel especially hungry or tired or be influenced by your food environment.
Georgie Russell, Senior Lecturer, Institute for Physical Activity and Nutrition (IPAN), Deakin University and Rebecca Leech, NHMRC Emerging Leadership Fellow, School of Exercise and Nutrition Sciences, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Apricot vs Papaya – Which is Healthier?
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Our Verdict
When comparing apricots to papaya, we picked the apricots.
Why?
In terms of macros, apricots have nearly 3x the protein, as well as slightly more fiber and carbs, winning in this round, although honestly there’s not a huge difference as the protein numbers are small and the other macros are very close.
In the category of vitamins, apricots have more of vitamins A, B1, B2, B3, B5, B6, B7, E, and K, while papaya has more of vitamins B9, C, and choline, making a compelling 9:3 win for apricots.
Looking at minerals next, apricots have more copper, iron, manganese, phosphorus, potassium, and zinc, while papaya has more calcium magnesium, and selenium; another win for apricots.
In other considerations, apricots have more polyphenols, especially flavonols and phenolic acids, as well as some cancer-fighting properties that papaya can’t boast.
Adding up the sections makes for a clear overall win for apricots, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like:
Top 8 Fruits That Prevent & Kill Cancer
Enjoy!
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Should We Skip Shampoo?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝What’s the science on “no poo”? Is it really better for hair? There are so many mixed reports out there.❞
First, for any unfamiliar: this is not about constipation; rather, it is about skipping shampoo, and either:
- Using an alternative cleaning agent, such as vinegar and/or sodium bicarbonate
- Using nothing at all, just conditioner when wet and brushing when dry
Let’s examine why the trend became a thing: the thinking went “shampoo does not exist in nature, and most of our body is more or less self-cleaning; shampoos remove oils from hair, and the body has to produce more sebum to compensate, resulting in a rapid cycle of dry and greasy hair”.
Now let’s fact-check each of those:
- shampoo does not exist in nature: true (except in the sense that everything that exists can be argued to exist in nature, since nature encompasses everything—but the point is that shampoo is a purely artificial human invention)
- most of our body is more or less self-cleaning: true, but our hair is not, for the same reason our nails are not: they’re not really a living part of the overall organism that is our body, so much as a keratinous protrusion of neatly stacked and hardened dead cells from our body. Dead things are not self-cleaning.
- shampoos remove oils from hair: true; that is what they were invented for and they do it well
- the body has to produce more sebum to compensate, resulting in a rapid cycle of dry and greasy hair: false; or at least, there is no evidence for this.
Our hair’s natural oils are great at protecting it, and also great at getting dirt stuck in it. For the former reason we want the oil there; for the latter reason, we don’t.
So the trick becomes: how to remove the oil (and thus the dirt stuck in it) and then put clean oil back (but not too much, because we don’t want it greasy, just, shiny and not dry)?
The popular answer is: shampoo to clean the hair, conditioner to put an appropriate amount of oil* back.
*these days, mostly not actually oil, but rather silicon-based substitutes, that do the same job of protecting hair and keeping it shiny and not brittle, without attracting so much dirt. Remember also that silicon is inert and very body safe; its molecules are simply too large to be absorbed, which is why it gets used in hair products, some skin products, and lube.
See also: Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier?
If you go “no poo”, then what will happen is either you dry your hair out much worse by using vinegar or (even worse) bicarbonate of soda, or you just have oil (and any dirt stuck in it) in your hair for the life of the hair. As in, each individual strand of hair has a lifespan, and when it falls out, the dirt will go with it. But until that day, it’s staying with you, oil and dirt and all.
If you use a conditioner after using those “more natural” harsh cleaners* that aren’t shampoo, then you’ll undo a lot of the damage done, and you’ll probably be fine.
*in fact, if you’re going to skip shampoo, then instead of vinegar or bicarbonate of soda, dish soap from your kitchen may actually do less damage, because at least it’s pH-balanced. However, please don’t use that either.
If you’re going to err one way or the other with regard to pH though, erring on the side of slightly acidic is much better than slightly alkaline.
More on pH: Journal of Trichology | The Shampoo pH can Affect the Hair: Myth or Reality?
If you use nothing, then brushing a lot will mitigate some of the accumulation of dirt, but honestly, it’s never going to be clean until you clean it.
Our recommendation
When your hair seems dirty, and not before, wash it with a simple shampoo (most have far too many unnecessary ingredients; it just needs a simple detergent, and the rest is basically for marketing; to make it foam completely unnecessarily but people like foam, to make it thicker so it feels more substantial, to make it smell nice, to make it a color that gives us confidence it has ingredients in it, etc).
Then, after rinsing, enjoy a nice conditioner. Again there are usually a lot of unnecessary ingredients, but an argument can be made this time for some being more relevant as unlike with the shampoo, many ingredients are going to remain on your hair after rinsing.
Between washes, if you have long hair, consider putting some hair-friendly oil (such as argan oil or coconut oil) on the tips daily, to avoid split ends.
And if you have tight curly hair, then this advice goes double for you, because it takes a lot longer for natural oils to get from your scalp to the ends of your hair. For those of us with straight hair, it pretty much zips straight on down there within a day or two; not so if you have beautiful 4C curls to take care of!
For more on taking care of hair gently, check out:
Gentler Hair Care Options, According To Science
Take care!
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Total Recovery – by Dr. Gary Kaplan
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First, know: Dr. Kaplan is an osteopath, and as such, will be mostly approaching things from that angle. That said, he is also board certified in other things too, including family medicine, so he’s by no means a “one-trick pony”, nor are there “when your only tool is a hammer, everything starts to look like a nail” problems to be found here. Instead, the scope of the book is quite broad.
Dr. Kaplan talks us through the diagnostic process that a doctor goes through when presented with a patient, what questions need to be asked and answered—and by this we mean the deeper technical questions, e.g. “what do these symptoms have in common”, and “what mechanism was at work when the pain become chronic”, not the very basic questions asked in the initial debriefing with the patient.
He also asks such questions (and questions like these get chapters devoted to them) as “what if physical traumas build up”, and “what if physical and emotional pain influence each other”, and then examines how to interrupt the vicious cycles that lead to deterioration of one’s condition.
The style of the book is very pop-science and often narrative in its presentation, giving lots of anecdotes to illustrate the principles. It’s a “sit down and read it cover-to-cover” book—or a chapter a day, whatever your preferred pace; the point is, it’s not a “dip directly to the part that answers your immediate question” book; it’s not a textbook or manual.
Bottom line: a lot of this work is about prompting the reader to ask the right questions to get to where we need to be, but there are many illustrative possible conclusions and practical advices to be found and given too, making this a useful read if you and/or a loved one suffers from chronic pain.
Click here to check out Total Recovery, and solve your own mysteries!
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