Jun
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Effexor Interactions with other Drugs
June 29, 2011 | Leave a Comment
Effexor Interactions with other Drugs.
Your doctor or pharmacist may already be aware of any possible interactions of Effexor. Do not start, stop or change the dosage of any medicine only after consulting your doctor. In conjunction with such drugs as: MAO inhibitors (eg, furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine), weight-loss drugs (eg, phentermine, sibutramine), tryptophan, taken with Effexor only 2 weeks before treatment and at least 7 days after the last dose of effexor. If you are currently using any of these medications, tell your doctor or pharmacist before starting Effexor, because this can lead to very serious (even fatal) interactions Effexor. Some medications that can affect the heart rhythm (QTc prolongation in the EKG) include amiodarone, dofetilid, pimozide, quinidine, sotalol, procainamide, thioridazine, and erythromycin, among others, may also be combined with this medication adverse effects. Effexor can increase the risk of such influence. QTc prolongation can rarely cause serious (rarely fatal) irregular heartbeat. Consult your doctor or pharmacist for more details informiatsii and instructions on how you can reduce the risk of such influence. Tell your doctor about all medications you are taking, especially: drugs affecting liver enzymes that remove the Effexor out of your body (eg, cimetidine, azole antifungals such as ketoconazole, itraconazole), medicines (eg, antipsychotics such as clozapine / haloperidol, HIV medications such as indinavir, tricyclic antidepressants-TCAs such as desipramine), “water pills” (diuretics such as furosemide), drugs that can cause bleeding / bruising (eg, aspirin, antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, “blood thinners” such as heparin / warfarin). Aspirin may increase the risk of bleeding when using this drug. If your doctor has you take poropisal low-dose aspirin for heart attack or stroke and for prevention (usually at dosages of 81-325 milligrams per day), you should continue taking it unless your doctor instructs you to. Discuss the risks and benefits with your doctor. Also tell your doctor if you are taking any other drugs that increase serotonin, such as lithium, meperidine, propoxyphene, buspirone, dextromethorphan, SSRIs, other SNRIs, St. John’s wort, drugs used to treat migraines such as ” triptans “and dihydroergotamine, drugs such as MDMA /” ecstasy, “amphetamine. Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (eg, diphenhydramine), anti-drugs (eg, carbamazepine), medicine for sleep or anxiety (eg, diazepam, alprazolam, zolpidem), muscle relaxants, narcotic pain relievers from (eg, codeine), psychiatric medicines (eg, chlorpromazine, risperidone, amitriptyline, trazodone). Look at the instructions of all your medicines to see whether they contain ingredients that cause drowsiness. Ask your pharmacist about using those products in safe mode. Cimetidine is a drug, nonprescription drug, which is commonly used to treat indigestion. This may cause undesirable interactions when taking Effexor, ask your pharmacist about other products to treat stomach acid. Buy Effexor on line without rx but do consult your doctor prior to making an internet pharmacy order.
Note:
Effexor is not used with other analogs of this drug. Psychiatric / medical checkups and lab tests (eg, blood pressure, cholesterol levels, control of growth in children) should be performed periodically to monitor your progress or check for side effects. Ask your doctor for more information.
Jun
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Abilify used for the treatment of acute episodes of schizophrenia (including as maintenance funds). Buy Abilify only after consulting with your doctor.
Abilify also used to treat acute manic episodes of bipolar disorder type I, including patients who have recently given mixed or manic episode (maintenance).
Contra Abilify
Abilify is contraindicated in patients under 18 years of age and patients with hypersensitivity to any component of the drug.
Side effects Abilify
Abilify can cause the certain side effects (check with your doctor)
International name:
Aripiprazole
Group Affiliation:
Antipsychotic (neuroleptic)
Description of the active substance (INN):
Aripiprazole
Description of the product brand name:
Abilify
Dosage form:
Tablets
Pharmacological Effects:
Neuroleptic. Presumably the therapeutic effect of aripiprazole in schizophrenia is caused by a combination of partial agonist activity on D2 dopamine and serotonin receptors 5NT1a and antagonistic activity against 5NT2 serotonin receptor. Aripiprazole has a high affinity in vitro to the D2 and D3 dopamine receptors, and 5NT1a 5NT2a serotonin receptors and moderate affinity for dopamine D4, 5NT2s 5NT7 and serotonin, alpha 1-adrenoreceptors and H1 histamine receptors. Aripiprazole is also characterized by a moderate affinity for serotonin reuptake sites and the lack of affinity for muscarinic receptors. Aripiprazole in animal experiments showed antagonism against dopaminergic hyperactivity and dopaminergic agonism against gipoaktivnosti. Interaction not only with dopamine and serotonin receptors explains some of the clinical effects of aripiprazole.
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Indications:
An acute attack of schizophrenia, as well as for maintenance therapy. Acute manic episodes of bipolar disorder type I and for maintenance therapy in patients with bipolar disorder type I, has recently suffered a manic or mixed episode.
Contraindications:
Hypersensitivity, the age of 18 years, during lactation.
Dosage and administration:
Inside, regardless of the meal, a once a day. Schizophrenia: initial dose 10-15 mg / day maintenance dose - 15 mg / day in clinical trials, the effectiveness of the drug in doses ranging from 10 to 30 mg / day. Manic episodes in bipolar disorder: initial dose 15-30 mg / day. If necessary, dose adjustment is carried out at intervals of not less than 24 h. In clinical studies demonstrated efficacy at doses of 15-30 mg / day with a manic episode at the reception for 3-12 weeks. Safety of doses above 30 mg / day in clinical trials has not been evaluated. Dose adjustment in patients older than 65 years, as well as in chronic renal failure and hepatic failure (class A, B and C on the classification of Child-Pyuga) is not required.
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Antidepressants. Depression Treatment Drugs.
May 26, 2011 | Leave a Comment
The name itself speaks of such drugs - they are designed to treat depression. Such medications are always recommended as a first step in therapy for depression, from heavy to moderate, in combination with conversational therapy. An example is the cognitive-behavioral therapy.
Antidepressants are widely used in treating various mental disorders such as:
- Strong phobias such as agoraphobia and social,
- Panic disorder,
- Anxiety disorder
- Post Traumatic Stress Disorder,
- Anxiety disorder
- Bulimia.
In some cases, certain antidepressants such as tricyclics, were not developed initially as painkillers, but there is evidence of their effectiveness in treating chronic pain of a nervous nature. Chronic nerve pain that is often referred to as neuropathic, arise in the body as a result of damage to the normal state of the nerve and quite often, such pain can not be removed with the help of painkillers such as “Paracetamol”.
Very often, an antidepressant used to treat different cases of non neuropathic nature. And many experts in the medical field, consider them to be less effective for such purposes. Pain, are not associated with neurological disorders, with the help of antidepressants may be localized, especially for chronic pain in the neck and back, as well as fibromyalgia.
Depression. Unipolar depression, or as it is called clinical depression, can occur in almost any age, but most often it affects people in a range from 25 to 44 years, although sometimes observed in children aged 5-6 years. The total number of patients exposed to depression for about 20% of women and 10% of men. In the depressed person loses the capacity for work, lose interest in school, he may have much worse health. And the worst thing is that depression leads to commit suicide.
The difference between short periods of illness, clinical depression leads to constant changes in mood, which has a negative impact on self-esteem of man, his relationships with people, as well as the climate in the family. Depressive episodes occasionally occur and occur over many days and months, and in some cases even a few years. In a state of clinical depression will determine the following mental and physical factors:
- A sense of complete irrelevance, helplessness, hopelessness and despondency.
- Inability to concentrate and make decisions.
- Violation of the functions of sleep.
- Depressed mood (sadness, unexplained sadness).
- Loss of sexual interest.
- Loss of interest in everything that enjoyed previously. Loss of enjoyment of life.
- Loss of appetite, weight loss, or conversely, its set.
- Fatigue.
When conducting clinical diagnosis of depression, such symptoms are repeated consistently, at least for two weeks. But here we must remember that these symptoms may be the consequence of such widespread diseases as diabetes, hypertension, heart disease, etc. This suggests that depression may be a secondary symptom of another disease. The final diagnosis will be able to supply only a doctor after a long observation and careful examination.
So what is the cause of depression? Specific cause can not be called to this day. But conducted scientific studies have shown that depression is mated to an imbalance of certain chemicals, which are called neurotransmitters - namely, norepinephrine, serotonin and dopamine. Such neurotransmitters are widespread in many parts of the human brain and are designed to perform their specific neural functions.
The clinical study showed that patients with clinical depression do not have enough norepinephrine or serotonin in the limbic system of the brain. Also there is a large imbalance between these two neurotransmitters in the brain. Existing antidepressants are designed to increase the content of these neurotransmitters. In addition, some of them affect the level of dopamine in the brain regions. After receiving such drugs emotions and mood in patients should stabilize, and the person returns to a normal life. Like all medicines, antidepressants have side effects such as changes in blood pressure as well as they can interfere with some physiological functions of a person, such as sleep or appetite.
We must remember that:
- Everyone can easily find an antidepressant that will come to him personally.
- Six out of ten people will feel much better after the first use of selected antidepressant. Others to find the appropriate medication, will have to try different antidepressants.
- Existing antidepressants have both advantages and disadvantages, and as long as you do not start taking some of them, you can not know whether it helps you in combating depression.
Antidepressants are classified according to types of neurotransmitters, for which they work, as well as on the basis of these effects.
There are some types of antidepressants:
- Selective serotonin reuptake inhibitors (SSRIs)
These antidepressants have been widely used since the mid 1980’s, and most often prescribed for depression. This group of antidepressants makes it possible to block the return of serotonin back into the cell, which sends a nerve impulse. Such exposure increases the concentration of serotonin in the synaptic gap between nerve cells, thus greatly enhances the stimulation of postsynaptic cells, which takes the pulse.
The group of SSRIs includes the following products:
- Sertraline (Zoloft)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
In its effect, all these SSRIs are equally effective and tolerated almost equally. But, nevertheless, the response of individual patients to different chemical compounds individual. In this regard, some patients may experience some side effects after taking specific SSRIs. Among the side effects of antidepressants in this group are - insomnia, anxiety, dizziness, nausea and vomiting.
- Tricyclic antidepressants
Tricyclic antidepressants began to be applied in the late 1950’s - early 1960’s. As with SSRIs, tricyclic antidepressants block the reuptake of the neurotransmitter norepinephrine in the presynaptic nerve cells, and thus increases its free concentration.
The group of tricyclic antidepressants include:
- Amitriptyline (Elavil)
- Imipramine (Tofranil)
- Maprotiline (Lyudiomil)
- Nortriptyline (Pamelor)
- Desipramine (Norpramin)
- Clomipramine (Anafranil)
First and foremost, tricyclic antidepressants affect blood pressure and heart rate, as norepinephrine is involved in the activities of the autonomic nervous system that controls such functions. At the use of drugs in this group there are the following side effects - tachycardia, postural hypotension, dry mouth and urinary retention. Drugs in this group are used rarely because of their toxicity and danger of overdose. But for some patients who can not tolerate SSRIs or other antidipressants, tricyclic antidepressants are the way out. In order to avoid various side-effects during the treatment course required careful medical supervision.
- Selective serotonin reuptake inhibitors and norepinephrine
Production of drugs in this group began in mid-1990’s. The action of these drugs are based on blocking the reuptake of norepinephrine and serotonin. This group of drugs include:
- Duloxetine (Cymbalta)
- Venlafaxin (Effexor)
- Buprpion (Wellbutrin “,” Zyban “), which also blocks the reuptake of dopamine and norepinephrine
Side effekts the same as that of the SSRI, but expressed somewhat weaker, and the same drugs as duloxetine and buprion in terms of weight gain and sexual dysfunction in general have minimal impact.
- Monoamine oxidase inhibitors (MAOIs)
An enzyme called monoamine oxidase, leads to a reduction of norepinephrine and serotonin in the synaptic gap between neurons and presynaptic nerve cell.
This group includes the following products:
- Isocarboxazid (Marplan)
- Selegiline (Eldepril)
- Moclobemide (Manerix)
- Phenelzine (Nardil)
- Tranylcypromine (Parnat)
By adjusting the content of norepinephrine, these drugs cause several side effects that affect the cardiovascular system. Patients who take these antidepressants should limit consumption of products, which include tyramine. This is because the tyramine interaction with MAOIs, causing hypertension. Tyramine is a part of products such as sauerkraut, sausage, beef and chicken livers, soy sauce, dried meat and fish, cheese, yogurt, sour cream, figs and raisins. It is also necessary to refrain from drinking any alcoholic beverages.
- Noradrenergic and specific serotonergic antidepressant (HACC)
Antidepressants, which are produced at the present time, very well tolerated by patients, to help cope with anxiety and depression, and most importantly, they have significantly fewer side effects than previous generations of antidepressants.
Some of these drugs began to publish in mid-1980’s, and some have begun to produce more recently. Preparations of HACC reduce the rate of absorption of noradrenaline presynaptic nerve cell, and in turn increases its concentration in the free form. In addition, they provide the ability to block certain serotonin receptors, which significantly improves the “useful” serotonin neurotransmission.
The group of HACC include:
- Nefazodone (Serzon)
- Trazodone (Dezirel)
- Mianserin (Lerivon)
- Mirtazilin (Remeron)
Side effects of these drugs include dry mouth, drowsiness, increased appetite and weight gain. But these effects are mild result.
It should be good to remember that all currently existing antidepressants are equally good for treating depression. Starting a course of treatment must take into account the following factors - age, heredity, individual tolerance of drugs, the response to no more use drugs. Before applying the new antidepressants it is mandatory to consult a physician.
Publications by topic:
· Antidepressants
· Treatment with antidepressants
· Description antidepressants
Antidepressants belong to a large group of drugs, the main feature of which is the removal of the doldrums. Antidepressants include monoamine oxidase inhibitors: hydrazine (iprazid, Nialamide) and negidrazinovye derivatives (indopan, etc.), 4 - and 3-ring compounds (Mianserin, imipramine, amitriptyline, azafen, pirazidol), secondary amines (desipramine).
Isolated as a group of antidepressants II generation (nomifenzil, trazadon, etc.) and preparations of lithium.
Possible side effects: drowsiness, dry mouth, “a veil before the eyes, constipation, difficulty urinating, fainting, sweating, tremors, rashes, palpitations, headache.
Caution: When combined with certain medications and foods MAO inhibitors have the opposite effect, which can lead to a significant rise in blood pressure.
When antidepressant therapy in both groups and alcohol intake should be limited. Ask your doctor whether it is possible for antidepressants drive or other mechanisms.
More
Haibolee studied and security are the tricyclic compounds. The mechanism of action of tricyclic antidepressants is associated with the blockade of the reuptake of norepinephrine presynaptic nerve endings, resulting in the content of norepinephrine in the synaptic clefts increases.
In places the accumulation of noradrenaline (different brain structures, as well as heart and lungs, spleen and other organs) increases the activity of adrenergic nerve impulse transmission, excitation occurs the central and peripheral a-and b-adrenergic receptors.
A similar effect of 3-cyclic antidepressants be observed in the dopamine and serotonin. Drugs in this group blocking the central and peripheral M-cholinergic receptors, providing atropinopodobnoe action.
MAO inhibitors block monoamine oxidase Nialamide causing oxidative deamination and inactivation of monoamines (noradrenaline, dopamine, serotonin), with the accumulation of these amines in brain structures.
Some antidepressants combine the action of MAO inhibitors and 4 - and 3-cyclic compounds. Common property of all antidepressants is timolepticheskoe action: effects on affective with improved mood and overall mental state.
Do without the selection of drugs that reduce the severity of depression, almost never fails.
Lack of interest in what happens in the outside world, apathy, indifference, low mood, difficulty concentrating, amounting to a complete inability to concentrate, sometimes unwillingness to live with enormous difficulty overcome a teenager. Intolerance of depression is a major cause of relapse, even for those folks who genuinely want to give up drugs. A matter of choice of antidepressants - the question is absolutely doctor.
In most patients, even after treatment by the methods described above paid, retained or that symptoms of depression.
Below the names of three drugs, which seem to us best to treat depression caused by the abolition of drugs: Auroriks, Coaxil, Zoloft.
These drugs are designed on modern principles of the so-called metabolic therapy. They are not the “chemistry” in the domestic sense. Their effect on the metabolism due to the fact that they facilitate the body natural synthesis of some compounds (eg serotonin), lack of which in the nervous system leads to depression.
List the three drugs is located in the descending order of their effectiveness.
Aurorix and coaxil, inter alia, help the patient improve metabolism in the nerve cell. In their systematic reception improves memory, easier to focus, gradually leaving the feeling of constant fatigue.
We must remember that no anti-depressants, even the most modern and do not act immediately. The effect of the above drugs does not develop earlier than 7-10 days of reception. Are not anti-depressants and “substitutes” of drugs. No special feelings for the first person to receive not feel. They are designed to gradually and imperceptibly the normalization of the mental state of the patient.
In principle, due to the fact that these antidepressants are not addictive and have virtually no side effects (except in cases of individual intolerance), you can start using them without consulting your doctor. But it is necessary to take into account two factors:
First, the best anti-depressant may be a doctor.
Secondly, the very state of depression - it is an occasion to persuade the patient to see a doctor. Teen bad … In the depression, he is aware of this. If you can give anti-depressants, he gets better, and a visit to the doctor begins to be postponed indefinitely. When a person feels well, to persuade him to systematically treated much more difficult.
Abolition of heroin addict will take more easily than usual. In his mind is not put off your words and warnings and the fact that with the help of pills, which gave the mother, it is easy to “jump out of the system.” As a result of an attempt to help in self-control drug addict with depression may result in relapse and even greater difficulties with the adoption of a teenager a final decision to quit drugs.
Melipraminum (imipramine, antideprin, imipramine) refers to the strong antidepressants with concomitant stimulant.
Pharmacokinetics.
The drug is well absorbed when taken orally, reaches maximum concentration in the blood 1-2 hours after intramuscular injection, 30-60 minutes. Hakaplivaetsya in the liver, kidneys and brain. Well penetrates the blood-brain barrier. Relationship with protein 76-95%. Actively metabolized in the liver, excreted in the urine. The half-life 9-20h. Testimony. Melipraminum used in depressive states of various etiologies: asthenic-depressive states of endogenous depression in patients with manic-depressive psychosis, reactive depression, depression with psychopathy, neuroses, as well as enuresis.
May
14
Depression: Nondrug Therapy
May 14, 2011 | Leave a Comment
Nondrug Therapy
At the beginning of this chapter we suggested some old-fashioned approaches to treating depression that might be worth reconsidering. We were referring to seemingly archaic practices such as counseling, exercise, and fish oil. Surprisingly, there is some scientific support for these quaint concepts.
Talking Therapy
In our rush-rush world, people rarely take time to talk anymore. The idea that someone could actually sit down for an hour or so and discuss the issues that are causing distress seems outdated. Insurance companies and “mangled care organizations” may not be thrilled at the prospect of paying a psychologist or psychiatrist $100 to $200 a week to do counseling for several months. The bean counters seem to prefer paying for prescription drugs indefinitely. What is so bizarre about this ass-backwards approach is that psychotherapy can enhance the effectiveness of medications and can be stopped once it has been successful. That seems cost-effective to us.
For those in the know, cognitive behavioral therapy, interpersonal therapy, and problem-solving therapy are surprisingly effective for mild to moderate depression. 188 Cognitive behavioral therapy (CBT) got traction in the 1970s. In a nutshell, this therapy works on the premise that depression arises from dysfunctional thoughts and beliefs. We are all influenced by our early learning experiences. When those thought processes
Cognitive Behavioral Therapy
The results of well-conducted research suggest that cognitive behavioral therapy (CBT) is as effective as antidepressants in treating depression. The benefits are long lasting and we don’t know of any serious side effects to talking therapy.
Downside: Such treatment can be expensive and it requires an experienced psychotherapist. Identifying someone who has the requisite expertise may not be that easy.
Cost: Approximately $100 to $200 per session. This is highly variable depending upon the practitioner’s skill level and are dysfunctional, they can be triggered by situations later in life and produce depression and other psychiatric symptoms. The trick here is to have skilled therapists help patients identify and challenge negative automatic thoughts so that behavior can be changed.”‘
One study found that “cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression but this degree of effectiveness may depend on a high level of therapist experience or expertise.”" Another study found that “cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.”"‘
Exercise
As effective as talking therapy may be for depression, exercise may also be beneficial. Investigators have known for decades that aerobic exercise can improve mood and outlook. Recent research backs this up. A review confirms that exercise can benefit mental health, helpiy to alleviate depression as well as improve physical health.’ According to Canadian reviewers, there is “irrefutable evidence” that physical activity can be effective against depression.
One study was dubbed DOSE, for Depression Outcomes Study of Exercise. Men and women between 20 and 45 years of age with mild to moderate depression were asked to exercise for various amounts of time ranging up to 30 minutes of moderate-intensity movement almost every day of the week. That allowed the investigators to compare the “dose response” from exercise. They found that low-intensity exercise was no better than pla- cebo, but high-intensity exercise was an effective treatment
Light
To give your exercise a jump start, go outside and get a little sun on your face. There is growing evidence that light therapy can be beneficial against depression. One eminent psychiatrist reviewed the literature, expecting to find that the research was awful and the therapy didn’t work. Instead, after reviewing the data objectively, he came to the conclusion that phototherapy was “comparable to what has been described in the clinical literature for conventional medications to treat depression. The findings are as strong or as striking.”
Bright light therapy is helpful not only for seasonal af-fective disorder (SAD), which frequently occurs during the winter, but also for depression that occurs at any time of the year. There is evidence that light can enhance the effects of exercise as well as the antidepressant action of medications like citalopram (Celexa).
Fish Oil
Grandma might have been right that cod liver oil is good for your mind as well as your body. She may not have had the benefit of randomized, placebo-controlled trials, but we do. Most of them show that fish oil can be helpful against depression. 199 We’re hoping that there will be more studies in the future to determine the best dose of DHA and EPA, the main fatty acids in fish oil. We’re not thrilled with cod liver oil, per se. These days you can obtain pharmaceutical-grade fish oil that does not have the excessive levels of vitamin A you often find in cod liver oil. Too much vitamin A is bad for your bones.
St. John’s Wort
The medical community has had a very hard time grappling with research suggesting that an herb might be as good as an antidepressant like fluoxetine (Prozac) for relieving depression. Nevertheless, there have been dozens of clinical trials demonstrating that St. John’s wort can be effective in treating mild to moderate depression. In some studies, St. John’s wort works as well as prescription antidepressants, and it usually has fewer -troublesome side effects.
St. John’s wort has long been prescribed in Europe for treating depression and other mood disorders. Although there are studies showing that the extract is not better than placebo, there are several showing that it works at least as well as prescription antidepressants. Most trials indicate that St. John’s wort appears to be safe and well tolerated, perhaps better tolerated than a pharmaceutical antidepressant. The way St. John’s wort acts to relieve depression is not known. Scientists don’t even know which of its many constituents might be responsible for the activity. This makes it hard to select an extract appropriately. Only standardized extracts, preferably ones that have been tested and found effective, should be used. Three standardized products that have been tested in Germany are available here. The brand names are Kira, Movana, and Perika.
St. John’s Wort (Hypericum perfornow)
Some people may find that St. John’s wort is an effective antidepressant. As long as it is taken under medical supervision and caution is exercised regarding drug interactions, we think it is worth consideration.
Side effects: Side effects are uncommon and usually mild. Unlike many prescription antidepressants, St. John’s wort does not cause sexual dysfunction. Digestive upset has been reported. Allergic reactions are possible.
Downside: St. John’s wort can cause photosensitization, making the skin and the eyes vulnerable to damage from sunlight. St. John’s wort interacts dangerously with a wide range of prescription medications. Ask your pharmacist or your doctor to check on this possibility if you contemplate taking St. John’s wort together with any other medicine.
Cost: Approximately $15 to $20 a month for Kira brand.
The Selegiline (Emsam) Patch
The latest and most interesting chapter in antidepressant therapy involves a prescription skin patch containing the drug selegiline (Emsam). ‘Ibis transdermal medication works in a completely different manner from most current antidepressants. It is called a monoamine oxidase inhibitor (MAGI). Such drugs were among the first antidepressants ever developed. But they lost their luster because of a potentially deadly. interaction with many foods, beverages, and drugs. The “cheese effect,” as it came to be known, could cause extremely high blood pressure when a person taking a medication like Marplan or Parnate ate an aged cheese such as cheddar. This could result in a stroke.
Q. What can you tell me about selegiline? The vet prescribed it for my elderly dog. She had been very agitated, pacing for hours at a time (sometimes 12 or 15 hours straight!). She would pace until she dropped from exhaustion, sleep for half a day, then get up and start pacing again. She was also drooling excessively, dig-ging compulsively, deliberately knocking things over, and urinating in the house whenever I left. My vet said these are all symptoms of senile dementia in dogs. I think it was precipitated by the death of my other dog. They had been together for more than 12 years and she just couldn’t handle being alone. Several days after she started on selegiline all those behaviors stopped completely. It was amazing. She started acting like herself again. After seeing how much it helped my dog, I would definitely take it myself. Do they ever prescribe it for people with memory problems?
A. Our veterinary consultant, Andrea Frost, DVM, says that selegiline can be helpful for dogs with the canine equivalent of senile dementia. When an old dog gets lost in his own house or becomes incontinent because he can’t remember to ask to go out, quality of life for the owner, if not for the dog, has really declined. Not every dog has as dramatic a response as yours, but selegiline can help buy some old dogs a little more quality time with their human families. Selegiline is used in human medicine to treat people with Parkinson’s disease and depression. It has been studied against Alzheimer’s disease with mixed results.
The good news is that this new-generation MAGI is far less likely to cause such problems. In the lowest-dose skin patch, there is no food prohibition. When people take higher doses (9 or 12 milligrams), however, they do have to be careful about foods containing tyramine (beef liver, blue cheese, bologna, Brie, broad beans, Camembert, cheddar, Chianti, chicken liver, draft beer, miso soup, Parmesan cheese, pepperoni, salami, sauerkraut, and yeast extract) because their blood pressure could rise dangerously high.
Emsam should not be combined with other antidepressants or St. John’s wort. It is crucial to check with your pharmacist and your physician before combining any other medication when you are using Emsam.
In double-blind trials, scientists determined that Emsam is significantly more effective than placebo. The most common side effects include irritation where the patch is applied to the skin, rash, indigestion, headache, insomnia, diarrhea, dry mouth, and dizziness when standing up suddenly. Sexual side effects appear to be uncommon. Anyone who experiences thoughts of suicide while using this patch should contact the prescribing physician immediately.
Conclusions
If there is one lesson you should learn from this book it is that everyone responds differently to various treatments. That is as true for relieving depression as for lowering cholesterol or controlling diabetes. Some people find that Prozac is an absolute miracle, lifting them from the despair of lifelong depression. Others find it makes them irritable, jittery, and incredibly uncomfortable. There is no good way to predict how any individual will react, so the best advice we can give is to stay vigilant.
If you start to feel better on an antidepressant, that’s great. If you experience no improvement or get worse, contact your health-care professional immediately and seek alternatives. In some cases, combining several approaches such as vigorous exercise, fish oil, and light therapy may be as effective as prescription medicine.
• Depression can take the wind out of your sails. Do not expect that you will be able to pull yourself together on your own. Seek help from friends, family, and qualified professionals.
• Antidepressants can be very helpful for some people. There is no clear evidence that one is superior to another. Trial and error may be the only way to tell which one will produce the best results for you.
• Suicidal thoughts are now recognized as a potential complication of virtually all antidepressant therapy. Family and friends should be especially vigilant during the first few weeks of treatment and whenever your dosage is changed.
May
9
Signs and Symptoms of Depression. Antidepressants (Depression Medication) List. Generic Antidepressants Online
May 9, 2011 | Leave a Comment
What are the general symptoms of depression? What are depression signs? What are the most popular antidepressants? Where can I buy antidepressants online? Before buying antidepressants online from an internet pharmacy you should first of all learn the typical signs and symtoms of depression. After consulting tour doctor you can purchase antidepressants online and even save money buying a generic version of brand drugs, which are exactly the same drugs.
Almost everyone knows what it’s like to feel sad. Losing a pet, a friend, or a loved one is devastating. Being fired or getting a divorce can send you into a tailspin. An accident or a serious disease affects not only the physical body but also the psyche. It can be as if darkness has settled into your bones and sucked the joy right out of the marrow.
Most of us eventually recover from the boulders that are dropped on us. But some people never manage to dig themselves out of a hole. According to the National Institute of Mental Health, major depression affects about 15 million people each year. One in five of us will experience some form of depression sometime during our lifetime.
When the fog descends, people may forget what it’s like to feel happy. Sleep becomes next to impossible or all you want to do. Food loses its appeal and its flavor. Those with major depression often have a low energy level; they find it hard to mobilize themselves to finish projects or visit friends or family. They feel gloomy and down in the dumps for weeks or even months. They doubt their abilities and feel pessimistic much of the time. Just remembering simple things becomes an overwhelming challenge. They may experience thoughts of suicide—a hallmark of major depression. Such a mood disorder requires professional help immediately.
SIGNS OF DEPRESSION
• Feeling sad, gloomy, or “empty” for more than a few weeks
• Feeling hopeless
• Feeling helpless or worthless
• Insomnia, early-morning wakening, or persistently sleeping too much
• Feeling worn-down, fatigued, or like you’re moving in slow motion
• Loss of appetite: eating because it’s necessary rather than because the food tastes good and satisfies hunger
• Loss of interest in sex
• Restlessness or agitation, pacing the floor
• Difficulty with concentration and with remembering simple things; indecisiveness
• Physical complaints such as headache or pain that don’t get better when treated
• Thoughts of death or suicide to you or someone you care about, seek highly qualified assistance right now!
Digging out from a depression should never pull be a do-it-yourself project. You cannot put yourself up by the bootstraps or tough it out on your own.
Chronic depression increases the risk for heart disease, stroke, diabetes, and other serious conditions and must not be ignored. The suggestions we will widiscuss in this article are meant to supplement whatever your health professional may offer you in the way of help.
As remarkable as this may sound, some people actually coped surprisingly well with depression 50 to 100 years ago. They intuitively knew that there were some strategies that worked. For one thing, they looked around for someone to talk to. It might have been a pastor, a friend, a neighbor, or a relative. If they could afford it, they went to a psychologist or psychiatrist for counseling. Just talking things out sometimes seemed to help.
People also exercised. It might have been a physically exhausting task like chopping wood, hoeing a field or hiking through the woods. In those days, people spent more time outdoors working hard and walking from here to there. Nowadays we go from the air-conditioned comfort of our house or apartment to the air-conditioned comfort of a car, bus, or train to the air-conditioned comfort of an office or mall. We rarely spend time outside in the sun, and the only “workout” we get is at the gym or health club.
Oh yes, there was one more thing. In the good old days, especially during the winter, mothers made their kids swallow a spoonful of cod liver oil. It was never clear exactly what cod liver oil was good for, but mothers seemed to know that fish oil had beneficial properties. It was just “good for you,” no matter how bad it tasted.
Well, it turns out that virtually all of those quaint old strategies have now been proven helpful against depression. As you will learn shortly, research has shown that fish oil, exercise, light exposure, and cognitive behavioral therapy are surprisingly effective in dealing with depression.
Today medical treatment of depression by best antidepressants is usually prescribed by doctors all over the world. Below there is a list most popular and effective antidepressants available on the market today. In brackets there are given the active ingredients and each medicine is provided with the dosage information.
You can buy these common antidepressants online without a prescription from on line generic pharmacy. No rx needed to purchase antidepressants online, but it is wise to study antidepressants information before making your generic antidepressants order.
Abilify (Aripiprazole) 10, 15, 20 mg
Asendin (Amoxapine) 50, 100 mg
Bupron SR (Bupropion) 150 mg
Celexa (Citalopram) 40, 10, 20 mg
Cymbalta (Duloxetine) 20, 30, 40 mg
Desyrel (Trazodone) 25, 50, 100 mg
Effexor (Venlafaxine) 37,5, 75 mg
Effexor Xr (Venlafaxine) 150, 75 mg
Elavil (Amitriptyline) 10, 25, 50 mg
Endep (Amitriptyline) 10, 25, 50, 75 mg
Eskalith (Lithium carbonate) 300 mg
Fludac (Fluoxetine) 20 mg
Fluoxetine (Fluctin) 20 mg
Geodon (Ziprasidone) 40, 80, 20 mg
Lexapro (Escitalopram) 10, 20, 5 mg
Luvox (Fluvoxamine) 100, 50 mg
Nortriptyline (Nortriptyline Hydrochloride) 25 mg
Pamelor (Nortriptyline) 25 mg
Paxil (Paroxetine) 10, 20, 30, 40 mg
Paxil Cr (Paroxetine) 12,5, 25, 37,5 mg
Prozac (Fluoxetine) 10, 20, 40, 60 mg
Remeron (Mirtazapine) 15, 30 mg
Risnia (Risperidone) 2 mg
Risperdal (Risperidone) 1, 2, 3, 4 mg
Seroquel (Quetiapine) 25, 50, 100, 200, 300 mg
Sinequan (Doxepin) 10, 25, 75 mg
Tofranil (Imipramine) 25, 50, 75 mg
Venlor (Venlafaxine) 75 mg
Wellbutrin (Bupropion) 150 mg
Wellbutrin SR (Bupropion) 150 mg
Zoloft (Sertraline) 25, 50, 100 mg
Zyprexa (Olanzapine) 2,5, 5, 7,5, 10, 15, 20 mg
Jul
16
Depression. Diagnosis, Treatment and FAQ.
July 16, 2009 | Leave a Comment
Drug Therapy
Fifty years ago “talking therapy” was considered essential in the treatment of depression. Psychologists and psychiatrists saw lots of patients who suffered from mild to moderate depression. But during the 1970s biological psychiatry took off. The medical profession embraced the theory that depression was primarily caused by an imbalance of chemicals in the brain. Many health professionals adopted the belief that a depressed person only needed antidepressant medication to normalize brain biochemistry. All you had to do was “feed your head” the right chemicals and the depression would disappear.
During those heady days many patients were given tricyclic antidepressants to soothe their troubled psyches. Medications like amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Janimine, Tofranil), and nortriptyline (Aventyl, Pamelor) were prescribed in huge numbers. Never mind that such drugs caused drowsiness, fatigue, constipation, dry mouth, dental problems, weight gain, blurred vision, urinary difficulties, dizziness, disturbed concentration, impaired memory, mental confusion, sexual dysfunction, and impotence.
Although these medications did help many people get out of the depths of despair, the side effects were sometimes as depressing as the depression itself. Imagine what it would be like to put on 30 or 40 pounds, feel mentally cloudy and constipated most of the time, and have no sex life. But insurance companies liked these medications. It seemed far more cost-effective to have an internist or a family practice doctor prescribe an antidepressant than to approve a lengthy series of counseling sessions with a psychologist or psychiatrist.
Then along came Prozac (fluoxetine). In 1987 when it was introduced, this antidepressant hardly made a splash. First-year sales were just barely respectable, but more than doubled in the second year. By the third year, Americans spent more on Prozac than on all other antidepressants combined. Everyone seemed to fall in love with Prozac—physicians, pharmacists, patients, and, most of all, the big payers (insurance companies and HMOs).
Prozac—a selective serotonin reuptake inhibitor, or SSRI—was so successful because it got great PR, and because it seemed to have fewer side effects than traditional tricyclic antidepressants. At least it was less likely to cause sedation, dizziness, constipation, or dry mouth. It also was more effective—or at least that was the impression among physicians and patients. There were never any data to support that belief, but that didn’t stop the media blitz. Prozac even made the cover of Newsweek and Time magazines. Once people decided it was the new wonder drug, other pharmaceutical manufacturers were desperate to get in the game. The race was on.
It wasn’t long before the wannabes started showing up, trying to claim a piece of the Prozac pie. Today the competitors include bupropion (Wellbutrin), citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor). Almost 190 million prescriptions are written for these antidepressants each year, with sales exceeding $12 billion.
Such coeds are being prescribed enthusiastically for a wide range of other health problems, too. The pharmaceutical industry has promoted some of these antidepressants for conditions such as obsessive-compulsive disorder, panic attacks, hot flashes, premenstrual distress, nervousness, and shyness (”social anxiety disorder”).
Almost from the beginning, though, these drugs have been controversial. In the original clinical trial for Prozac, 15 percent of patients in the study dropped out because they felt worse instead of better—a statistic that was not widely publicized. Anxiety, insomnia, restlessness, nausea, and tremors caused distress for some people. There also was a high incidence of sexual dysfunction with the SSRIs. But the real controversy has always swirled around whether Prozac and similar compounds could trigger thoughts of suicide or homicide in some people.
Antidepressants and Suicide
In 1988, we received a letter from a grieving physician. His daughter had been prescribed Prozac for an eating disorder; a month later she took her er life by hanging herself. This oph- thalmologist was convinced that Prozac had contributed to her tragic death. At the time, we discounted this story—which we now regret—and told him that depressed people sometimes take desperate action and may try to harm themselves when they start treatment. Later, he responded that his daughter had never been depressed, nor had she been acting like a person who planned to take her life.
In 1990 an article appeared in the American Journal of Psychiatry describing a half-dozen patients who developed “intense violent suicidal preoccupation after 2 to 7 weeks of fluoxetine treatment.” This report stirred up quite a lot of concern, but many psychiatrists downplayed the connection. When we asked the drug company and the FDA about this report, we were told that depressed people sometimes commit suicide and that the drug was not to blame.
Over the last 18 years we have heard of many other instances in which people became preoccupied with harming themselves or others after starting on an antidepressant. A man taking Zoloft awoke in the middle of the night with a strong urge to kill himself. A woman reported wild thoughts on Prozac about ramming her car into other cars and getting a gun to kill an irritating co-worker. Another woman told us that she experienced an overwhelming urge to open her car door and jump-out of the vehicle while it was going at 50 miles an hour down the highway.
My son Mike was prescribed Paxil for depression while he was a graduate teaching assistant at New Mexico State University. Around day 13 he slipped into a mood that I had never seen before. He never came out of it. Four days later he shot himself in the temple with a rifle. He had taken Paxil for 17 days.
I hold the FDA and GlaxoSmithKline (maker of Paxil) responsible for my son’s suicide. No one should ever have to look at a son or daughter’s tombstone!
Whenever we discussed our concerns with psychiatrists, drug companies, or FDA officials, we were told that such events were purely coincidental. Our federal watchdog insisted that the medicines could not have been responsible for such tragic outcomes. But when British drug regulators began warning physicians that SSRI-type medications might trigger suicidal thoughts, agitation, and self-injury in young patients, the whole ball of yarn began to come unraveled.
Eventually, an FDA staffer, Andrew Mosholder, MD, MPH, was given the task of analyzing 22 studies. His conclusion: “Short-term pediatric trials of antidepressant drugs demonstrate an increased rate of suicidal events with active drug compared to placebo.” He also said that there is not adequate information to tell if antidepressants other than Prozac are effective for children.
FDA JULY 1, 2005, PUBLIC HEALTH ADVISORY
• Adults being treated with antidepressant medicines, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.
• Close observation of adults may be especially important when antidepressant medications are started for the first time or when doses for the specific drugs prescribed have been changed.
• Adults whose symptoms worsen while being treated with antidepressants, including an increase in suicidal thinking or behavior, should be evaluated by their health-care professional.
The idea that drugs designed to fight depression and prevent suicide could potentially make things worse for some kids seemed to shock FDA officials to the core. Initially, Dr. Mosholder was muzzled. Eventually, though, the data convinced even the FDA hardliners. Belatedly, the agency issued warnings about suicidal thinking and antidepressants. These cautions came far too late to prevent many terrible tragedies over nearly 2 decades. As difficult as it has been for psychiatrists and FDA officials to contemplate, people taking SSRI-type antidepressants are sometimes preoccupied with thoughts of suicide or homicide. Harvard psychiatrist Joseph Glenmullen,’ MD, has criticized the makers of SSRI-type antidepressants for delaying adequate warnings.”‘ The maker of Effexor XR added “homicidal ideation” to its label years after the drug was introduced. The company considers this a very rare adverse event and does not believe the drug can be causally linked to actual homicides. But there have been a number of high-profile violent events associated with antidepressants. Causal or not, this controversy continues to simmer. The entire SSRI-suicide story strikes us as mishandled. Just as with the Vioxx (rofecoxib) scandal, it has seemed to us that FDA officials have been more intent on protecting the pharmaceutical companies’ profits than the public health. To add even more confusion to this already sordid affair, the reputation these drugs have enjoyed as being highly effective against depression is now suspect. Remember that placebo-controlled trials are the gold standard that everyone is supposed to adhere to. Drug companies are required to show that their expensive antidepressants are significantly superior to a placebo. But an “analysis of 96 antidepressant trials between 1979 and 1996 showed that in 52 percent of them, the effect of the antidepressant could not be distinguished from that of placebo. In other words, “more than half of all recent clinical trials of commonly used antidepressants failed to show statistical superiority for the drug over placebo.”
That, dear reader, is almost beyond belief. It suggests that either placebos—sugar pills—are amazingly effective in relieving depression or that current antidepressants are not all that impressive.
Another overview of many clinical trials concludes that the latter is the case. It goes even further and suggests that “recent meta-analyses show selective serotonin reuptake inhibitors have no clinically meaningful advantage over placebo…. Antidepressants have not been convincingly shown to affect the long-term outcome of depression or suicide rates.” Of course, this kind of analysis relies on the statistical manipulation and combining of many smaller studies. As compelling as the conclusions may be, they do not substitute for really big, well-conducted trials.
The largest and most definitive study of depression and antidepressant medications was a $35 million project, funded by the National Institutes of Health, called the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial. This was no drug company whitewash. This was your tax money at work. What made this research so valuable was that the investigators looked at actual recovery from depression (”remission”), not just some symptom improvement. Recovery is, after all, what depressed patients really care about. The antidepressants used in the STAR*D trial were bupropion SR (Wellbutrin SR), citalopram (Celexa), sertraline (Zoloft), and venlafaxine XR (Effexor XR). When the long-awaited results were published in the New England Journal of Medicine (March 2006), they were surprisingly disappointing. About one-fourth of the patients achieved real remission, regardless of the type of antidepressant that was taken. What makes this so discouraging is that these patients got optimal treatment. They received intense evaluation and a level of care not usually available to the average patient. If the depressed folks in this study had been treated in a more typical manner, “the remission rate probably would have been significantly lower—perhaps even in the single digits.”That’s abysmal. If there is any good news that came out of the STAR*D research, it is that when a different antidepressant medication was substituted after initial treatment failure, about one in three patients finally did achieve remission. What this means is that antidepressants actually do what they are supposed to do (cure depression) about half the time. Depending upon your perspective, that means the glass is either half full or half empty.
We are happy to learn that 50 percent of the patients in this trial got better. But even under these ideal conditions, half did not, regardless of the type of medicine used. That means that an awful lot of people are suffering drug side effects without benefit. And since there were no placebo controls in STAR*D, we have no idea how many folks might have improved if they had received sugar pills instead of drugs. So how can you determine which antidepressant is best for you? In truth, it is extremely difficult for physicians and patients to make clear decisions about safety and effectiveness when it comes to these medications. Despite all the hype from the drug companies, it is hard to prove that one type of antidepressant is better than another one.
Newer drugs like Cymbalta affect both serotonin and another neurotransmitter called norepinephrine (hence their name serotonin/norepinephrine reuptake inhibitors, or SNRIs). This dual action is supposed to make such drugs more effective. It has certainly driven up the cost. A single Cymbalta pill can cost between $3 and $4. A Wall Street Journal review reported that when Cymbalta was compared head-tohead with venlafaxine (Effexor), an older drug in this class, “Cymbalta wasn’t significantly different from Effexor in treating depression.”
The bottom line is that there are no “best choices” when it comes to these kinds of antidepressants. All these drugs are roughly similar in effectiveness, and all have the potential to cause serious adverse reactions for some people. Anyone who experiences anxiety, agitation, irritability, and especially thoughts of violence toward himself or others should contact a health professional immediately!
Watch Out for Withdrawal!
There is one other complication associated with these antidepressants that is rarely discussed. Sudden discontinuation of drugs like Effexor, Paxil, Serzone, and Zoloft may cause unexpected symptoms. We have heard from many patients that they experienced dizziness, nausea, insomnia, headaches, nervousness, sweating, shakiness (like a bad hangover), weakness, visual disturbances, and an inability to concentrate. One reader called the problem “Paxil Head,” like having your head stuck in a blender.
I take Zoloft, and have tried to stop taking it several times. Each time I stop I experience a-very strange thing. Doctors, nurses, and pharmacists dismiss me like I’m a nut case, but I swear this is true. I get electrical shocklike sensations in my head and become extremely dizzy. I absolutely know this is associated with not taking Zoloft. Not 2 hours after I resume taking it again the symptoms, which are overwhelming, disappear completely. I would like to get off of this drug but have no idea how to do so, especially when I cannot function without it and no one recognizes I’m having any trouble. They just think I’m crazy.
What is so sad about this particular problem is that no one really knows how common withdrawal symptoms are. There are, as far as we can tell, few good guidelines for helping people overcome this complication. So we do not know how long people will experience dizziness, shocklike sensations, or nausea after they stop a drug like Zoloft. Drug companies are not particularly interested in developing protocols for discontinuing SSRI/SNRI-type medications, since they would then need to admit they have a problem on their hands. That means that patients and physicians are on their own. Gradual tapering over several weeks may be necessary. We have heard from some doctors that they switch patients over to fluoxetine and then taper it very slowly. That’s because Prozac lingers in the body and may be less likely to trigger withdrawal symptoms.
Fluoxetine (Prozac)
Fluoxetine is a stand-in for all SSRI-type drugs. Although there are subtle variations between medications in this class, there are more similarities than differences.
Side effects: Headache, nausea, dizziness, diarrhea, nervousness, anxiety, and insomnia are relatively common and may affect up to one-fourth of the patients who take SSRI-type medications. Some people may experience drowsiness or dizziness. Delayed ejaculation, inability to achieve orgasm, and decreased sexual desire are common complications of this entire class of drugs. Less frequent problems may include decreased appetite, indigestion, sweating, mania, dry mouth, heart palpitations, tremor, chills, constipation, blurred vision, memory problems, confusion, rash, and joint pains. Blood sugar control or thyroid function may be altered. Seizures, while uncommon, have been reported in roughly 0.1 to 0.2 percent of patients, an incidence comparable to that seen with older antidepressants. Any thoughts of suicide or violence must be reported to a physician immediately).
Downside: SSRI-type medications like Prozac can interact with many other drugs. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant.
Cost: Approximately $130 to $140 for a month’s supply of Prozac. Generic fluoxetine costs $16 to $20 for the same amount.
Despite all the controversy, we still think Prozac is worthy of consideration, especially since it is less likely to precipitate withdrawal symptoms when discontinued. And we are not convinced that other SSRI/SNRIs are more effective. Many people benefit dramatically from this or another SSRI or SNRI. Prozac is now available generically as fluoxetine, so the cost factor is less problematic. We’re not convinced, though, that all generic fluoxetine is created equal.
Bupropion (Wellbutrin)
This antidepressant is less likely to interfere with sexuality and may even be helpful for people who have experienced diminished libido. It is also available generically, so there is a cost savings. People tend to feel energized rather than sluggish when taking bupropion.
Side effects: Common complaints include insomnia, dry mouth, anxiety or agitation, headache, nausea, and dizziness. Less common adverse reactions that we are aware of include mania, seizures, irregular heart rhythms, skin rash, hallucinations, paranoia, high blood pressure, and migraine.
Downside: Bupropion can interact with many other medications. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant. Any thoughts of suicide or violence must be reported to a physician immediately!
Cost: Approximately $130 to $150 for a month’s supply of brand-name Wellbutrin SR; generic bupropion SR runs roughly $60 to $70 for a similar amount.
efit more from one antidepressant than another, this is mostly a process of trial and error. It may take 4 to 6 weeks to begin to see improvement, so it is important to give each medication a fair trial. If no success is achieved after a few drugs in the same class are tried, then it may be time to move on to another category.
Bupropion (Wellbutrin) may offer certain advantages over other SSRI-type drugs. For one thing, it is far less likely to interfere with sexuality. Some have even reported that it restores libido.
Some people do benefit from old-fashioned tricyclic-type antidepressants such as desipramine, imipramine, and nortriptyline. For people who become agitated or anxious on an SSRI/SNRI or find that bupropion keeps them wide awake, tricyclics may offer an acceptable alternative.
There is also a completely different kind of antidepressant that comes as a skin patch (Emsam). We will discuss it at the end of this chapter.
Jul
15
The Prostate in Sexual Activity.
July 15, 2009 | Leave a Comment
The Prostate in Sexual Activity
The prostate is part of the male reproductive system and supplies part of the seminal fluid. It is not essential for the man’s sexuality, though, nor even for his ability to reproduce. When a man’s prostate is removed, male sexuality is not normally affected ripped fuel. His sex drive is intact, and his ability to
achieve and maintain an erection is unchanged.
SEMINAL FLUID
In fact most of the fluid you ejaculate isn’t sperm at all. Most of the fluid consists mainly of secretions from a number of glands. The largest of these glands is the prostate.
The various secretions from these glands probably serve the purpose of providing the sperm with a greater motility after they have been ejaculated, which stimulates their activity and enables them to move towards the egg. It is thought by some people that the prostate also has a lot to do with the feeling that an orgasm gives you. When a man
has an orgasm, sperm fluid from the seminal vesicles and the secretions from the prostate all mix together as semen at the top of the urethra, just below the bladder. A man gets an intensely pleasurable sensation when the semen floods down the urethra into the penis . He also gets a pleasurable feeling when the semen squirts out of the penis and into the tight region of a woman’s vagina. The prostate gland can be felt, as a man’s orgasm proceeds, to contract i-liythmically, which some people believe to be very much an integral part of the pleasure he experiences on orgasm.
What prostate fluid contains:
• Water.
• Salts.
• Minerals.
• Proteins.
• Antibodies.
• Enzymes.
• Citric acid.
• Fats buy domain fioricet tramadol .
• Prostaglandins, which are hormone-like chemicals.
PROSTATIC DISEASE
Prostatic disease can have an effect not only on the urinary system, but also on the reproductive system. The male reproductive and urinary systems are, of course, closely linked, if only because they share the same exit route - the penis - or, to be more exact, the urethra which runs through the centre of the penis. The prostate gland is the site at which the male sex hormone testosterone, which is made by the testicles, is broken down. It is here that it then forms another hormone called dihydrotestosterone (DHT). The conversion is controlled by an enzyme called 5-alphareductase. In a study conducted by Imperato-McGinley (Science, 1974), the males in an obscure tribe in the Dominican Republic are deficient in 5-alpha-reductase and are often mistaken for girls until they reach puberty. Until then, they have a very small penis and scrotum, which suddenly enlarge at puberty, along with the development of a deep voice. These males only ever develop a very small prostate gland, they never go bald, and they do not suffer from acne check.
It is this genetic deficiency in 5-alpha-reductase that has enabled researchers to comprehend the role played by dihydrotestosterone in the enlargement of the prostate gland.
Testosterone
As well as prostate enlargement, the male hormone testosterone also has several other effects on the male body.
These include the following:
• The growth of the penis.
• The growth of testes.
• The production of sperm.
• A deeper voice.
• The growth of facial and body hair.
• The male sex drive.
• Bone growth hair loss.
• Strength.
• Acne.
• Baldness.
A MAN’S GREATEST FEARS
One of man’s greatest fears on seeing a urologist and considering the prospect of a prostatectomy is what effect this will have on his sexuality. The idea of having any sexual organ tampered with by a surgeon is very frightening for most men, who worry that it may have a deleterious effect on their sex lives. Many men are so frightened that their prostate problems will affect their sex lives, particularly if they have to have an operation, that they put off going to the doctor gastroparesis caused by prozac . And even when they do eventually go to the doctor, they may be too embarrassed to discuss sexual matters. Sex is something that all too many men find difficult -if not impossible - to talk about with their doctor. But this is foolish. It is only by talking the matter over with their doctor that they will find their fears were groundless and that they can therefore be reassured.
The doctor’s role.
To make matters worse, some doctors and urologists are sometimes insensitive on this subject. It is quite wrong of them to assume that their patients are too old to be interested in sex. Sex can play an important role in the lives of many men until well into old age, and they should treat their fears as real and serious. A man who is due to have a prostatectomy should not just fret about this in secret, he should talk to his doctors about it - his GP, his consultant, his surgeon. Most importantly, the doctor should respect his fears, and him for coming to air them with him. It’s not easy for any man to do this, and if he succeeds in overcoming his reluctance to do so, the doctor should recognise what that has cost him. If the doctor reacts badly, it might have catastrophic effects: it might just send him scuttling back to his burrow, his pride injured, and he might never be able to take the risk again. Only when both doctor and patient can talk about this calmly, sensibly, realistically, will the patient be reassured that it will have no effect on his sexuality - neither on his libido, nor his ability to obtain or maintain an erection, nor on his performance.
Retrograde ejaculation
What it may well do, however, is cause him to be infertile after the operation. Even a man who has no intention of becoming a father again may find the idea of losing his potential to be a father very distressing. A man may find this emasculating, as if it were questioning his manhood. He’s only lost his ability to procreate, not his sexuality, but this can have a devastating effect on him. This is reminiscent of a woman who regrets the loss of her womb after a hysterectomy, even though she is beyond childbearing, and feels she has lost her femininity. A doctor should have the sensitivity to talk to his patient about this. Only with patience and understanding can he help
him come to terms with his feelings of fear and loss. Retrograde ejaculation will not make a man impotent, nor - in most cases - will it prevent him from having orgasms. It will, however, make the sensation of orgasm a different one - and, in all honesty, probably not as good. Some women, too, are disappointed by the new feeling of a ‘dry’ climax in their male partner. These changes in a man’s sexuality should be addressed beforehand. He should be told what to expect. A sensitive doctor will also help a couple come to terms with their new-found sexuality.
Impotence
It is possible, though by no means certain - nor even common -that prostatectomy may cause impotence Some men are frightened that it might have this effect, probably because they have heard tales of the old perineal prostate operation (which is hardly ever done nowadays) or the radical prostatectomy in which the entire prostate, including the capsule in which it is enclosed, is removed (sometimes performed for prostate cancer). In both these operations, the nerves supplying the penis were sometimes cut, which led to a man’s impotentence. The problem of impotence is therefore unlikely but it may arise. If a man is very frightened that the operation may lead to impotence, he may actually experience a kind of psychological impotence afterwards. This underlines how important it is for a man to be reassured before the operation. If a psychological problem does occur, a counsellor or sex therapist should be able to deal with it.
An excuse to avoid sex
In spite of all the evidence that prostate surgery has no effect at all on a man’s sexuality (other than retrograde ejaculation), it does occasionally seem to happen. An obvious explanation for this is that some men may use surgery as an excuse to avoid sex, which they had stopped enjoying ages ago anyway. Occasionally, if a man is not in very good health, a prostate operation - which is, after all, a major operation requiring a long convalescence period - may be enough to push his sexuality over the edge.
Generally, though, most men do not have any problems with their sex lives after the operation. In fact, a man may actually find that his sex life has greatly improved since he had his prostatectomy, if only because he now has full control of his bladder.
Jul
1
Prescription Drugs for Depression Treatment Available Online without Prescription
July 1, 2009 | Leave a Comment
Generic Antidepressants Online without a prescription: Paxil, Effexor, Abilify, Celexa, Cymbalta, Lexapro, Wellbutrin, Zoloft, Seroquel, Risperdal, Prozac and others.
There are numerous effective drugs for depression treatment (antidepressants) available on the market today. You can buy antidepressantst online from internet pharmacy without a prescription. The most popular and widely prescribed antidepressants today are Paxil, Effexor, Abilify, Celexa, Cymbalta, Lexapro, Wellbutrin, Zoloft, Seroquel, Risperdal, Prozac and others. However, being a serious drug any antidepressant must be carefully selected by you and your doctor and already in the course of your treatment which is usually a rather long time you can easyly go online and buy almost any antidepressants or generic antidepressants which are same drugs from on line pharmacy.
Depression is a natural reaction to disappointment and grief, but it is normally brief and self-limiting. Excessive or prolonged depression is an illness, sometimes without apparent cause, and it appears to be linked with an imbalance in the brain of certain amine substances, including serotonin, that act as neuroregulators. Antidepressants drug therapy can assist in restoring a normal balance, but prolonged treatment is usually necessary to evoke a full response. The drugs in most frequent use are the tricyclic antidepressants, so-called from their chemical structure, together with the monoamine oxidase inhibitors (MAOIs). All the tricyclic antidepressants have the same general pattern of activity, but some, such as amitriptyline, are more sedative than others. Some related compounds have a similar antidepressant action, but blood counts are essential with mianserin and convulsions have been reported after maprotiline therapy.The monoamine oxidase inhibitors are phenelzine, isocarboxazid and tranylcypromine. They are now used less often, as they are potent drugs that react with many other therapeutic agents, as well as certain food such as cheese, broad beans, pickled herring, and meat/yeast extracts. A new MAGI is moclobernide, which has a more selective and reversible action on the A-form of MAO. Particular care is necessary with tranylcypromine. Fluvoxamine, fluoxetine, paroxetine and sertraline are newer drugs that have a more selective antidepressant action mediated by inhibiting the re-uptake of serotonin. They are referred to collectively as SSRIs (selective serotonin re-uptake inhibitors).
Below there is a list of antidepressants (Paxil, Effexor, Abilify, Celexa, Cymbalta, Lexapro, Wellbutrin, Zoloft, Seroquel, Risperdal, Prozac) available to buy online without a prescription from online pharmacy. The generic versions of these antidepressants are for sale. Generic antidepressants are 100% the same drugs as brands having the same chemical formula and highest quality, but you can order them at a very cheap price online with fast delivery from the comfort of your home. All the dosages are available. See the list for generic antidepressants active ingredients, dosages and other brief data.
Paxil (Paroxetine) 10, 20, 30, 40 mg. One of the most popular antidepressants with an active ingredient Paroxetine is manufactured in the dosages of Paxil 40 mg, 30mg, Paxil Paroxetine 20 mg and 10 mg. Generic Paxil is available to buy online without rx or any prescription. Paxil is a very effectice drug in depression fighting. You can buy Paxil online without prescription at a dramatically cheap price without overpaying fo costly US prescription pills. Generic Paxil online is a top quality fully approved drug. No prescription Paroxetine (generic Paxil) can be ordered 24/7 in internet. Consult your doctor for Paxil information and treatment plan before you purchase Paxil on line.
Abilify (Aripiprazole) 10, 15, 20 mg. The active ingredient of Abilify is Ariprazole. Buy generic Abilify Ariprazole online without prescription and save both time and money on visiting a doctor and getting a prescription. Abilify online price is up to 80% cheaper than its price offline. Abilify is manufactured in capsules Ariprazole 10mg, 15mg and 20mg. Choose the dosage and quantity of pills necessary for your depression treatment make an order and your Abilify pills will be delivered to you in a couple of business days.
Celexa
Lexapro
Wellbutrin
Zoloft
Seroquel
Risperdal
Prozac
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