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Depression. Diagnosis, Treatment and FAQ.
July 16, 2009 | Leave a Comment
DEPRESSION
• Report suicidal thoughts to a health professional
• Ask your doctor if fluoxetine (generic) is appropriate for you
• Discuss bupropion if sexual side effects from fluoxetine become a problem
• Consider cognitive behavioral therapy
• Try vigorous exercise 5 days a week
• Spend time outside in the sun or get a bright light
• Add fish oil to your dietary regimen
• Ask your doctor if St. John’s wort would be safe
• Inquire about Emsam when other treatments fail
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. Fora while there is little pleasure to be had in life. 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. 175
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. Let us repeat that. If any of the symptoms below apply
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 puyourself 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 chapter are meant to supplement whatever your health professional may offer you in the way of help.
The Good Old Days
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.
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. 176
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.”177 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.2? 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. ,179 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.”180
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.”181 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.182 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.”183 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. 1114, 181 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.186
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.”187
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. Some patients report therapeutic failures on this generic (see Generic Drug Quandary for details).
Since there is no way to predict whether someone will ben-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.
Nondrug Therapy: Back to the Future
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 $1.00 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. 193
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.”195,196
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).197,’9′
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 .200 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.
0 0 *
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.
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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.
Jul
14
CAN I STILL HAVE SEX AFTER PROSTATE TROUBLE?
July 14, 2009 | Leave a Comment
CAN I STILL
HAVE SEX AFTER
PROSTATE TROUBLE?
This probably will be the most read chapter in the book, and rightly so can i take flagyl and benadryl . The prostate is tightly bound up with a male’s manhood, and how he thinks of himself as a man viagra nottingham po box . That’s why even the mention, let alone the discussion, of the prostate and its troubles, make most men uneasy, nervous and embarrassed viagra from canada legitimate .
We’ll look at all problems with the prostate and how they may or may not affect a man’s libido, his attitude, his sexual performance and his sexual desires actos and advandia .
PROSTATITIS AND SEX
The first problem many men have with their prostate is prostatitis counsel on salmeterol . Symptoms of this involve lower back pain, pelvic discomfort, a burning in the penis when urinating, urinary frequency and sometimes a slight pain after ejaculation prozac dosages .
This form of noninfectious prostatitis may be caused by some infectious agent we know nothing about, or by some noninfectious form of inflammation what is arimidex . On the other hand, it also can be caused by a man’s sexual habits — too much sex or too little soma and teens .
During arousal, a man produces four times the prostatic fluid he usually does ampicillin for staphylococcus uti . If this fluid is not discharged by ejaculation, it remains in the prostate avelox treats for bacteria . If this happens often, the prostate can become seriously congested improvement after two days of zoloft .
To prevent this problem, a normal, healthy sex life is the best course of action gemfibrozil pill picture . If this is not possible, a massage of the prostate by a urologist will relieve the congested prostate and eliminate the pain carisoprodol somacid . If that’s not desired, masturbation is a quick solution suggested by many urologists steven lipshultz caffeine .
Too much sex, too quickly, say eight or ten ejaculations in a two day period, can overwork the prostate and again cause problems omeprazole swine . On the other hand, abstinence may cause a build up of prostatic fluids and lead to congestion so a massage is needed diltiazem recall lawyers .
Coitus interruptus, simply the removal of the penis before ejaculation, is a method of birth control once practiced by millions effects of mixing alcohol and seroquel . If done often enough, and if it stops the man’s climax, this too, can lead to an oversupply of fluid in the prostate and bring about congestion and its symptoms atorvastatin and side effect .
If coitus interruptus is used frequently by a couple, the man or woman should continue to excite the penis to a normal ejaculation to prevent buildup problems in the prostate atorvastatin calcium lipitor .
So for prostatitis, which can strike men of any age, sexual intercourse may be both the cause and the solution lithium magenize battries .
INFECTIOUS PROSTATITIS
This inflammation of the prostate is caused by some type of infection and can cause fever, chills, nausea and vomiting as well as an urgency to urinate, burning, pain and blood and pus in the urine caffeine get into the brain . It’s more serious than the non-infectious type can caffeine cause prostate cancer .
There may be serious congestion of the prostate and urologists sometimes use a prostate massage to relieve it insulan doses prednisone . Most urologists feel that sexual activity of any type that leads to ejaculation is the ideal way to empty the prostate and relieve the congestion caverta vs caverta .
BENIGN PROSTATIC HYPERPLASIA
With the enlargement of the prostate there will be some sexual changes, particularly if there is surgery involved ranitidine and side affects .
As you may remember, a man will have a normally enlarging prostate for ten to fifteen years, maybe more, before he notices it indications for lopressor . The enlargement itself does little to sexual performance with the exception of a seriously pinched urethra that could reduce the amount and force of an ejaculation clindamycin phophate .
When it comes to needed surgery for BPH, the question of sex becomes more important lamisil on market as generic .
First, there should be no sexual intercourse for six weeks after a normal TURP surgery a list of ingredients in aleve . This is to allow time for the “canal” dug through the enlarged prostate tissue to heal ultram generico .
On a standard TU RP operation to remove enlarged prostate tissue, about six percent of all men operated on will become impotent celexa verses lexapro tiredness . That means they will not be able to have a normal erection changing to abilify from zyprexa .
There are bundles of nerves on each side of the prostate, and some of these control the impulses and nerve responses that combine to produce an erection ricci prozac . If these nerve bundles are damaged in any way, impotence can follow enalapril for canines .
Remember, this six percent figure may not be totally accurate generic viagra 0d 0a . The figure is based on subjective information supplied by the patient generic vendor paroxetine . It wouldn’t be unusual for a man 68 or 70 or older to claim that he could have an erection before the operation, when in reality he had lost that ability due to natural aging or some other problem trileptal and alcohol . It is a factor to consider resonance premarin .
The other change in a man who has had a TURP operation is that the bladder neck may have been damaged or removed during the TURP pharmacogenomics of methotrexate 2008 . The bladder neck is like a “valve” that automatically closes when a man is ejaculating coumadin safety . It prevents the fluids from going upward into the bladder lexapro and menopausal symptoms . The urethra muscles then force the fluid out the end of the penis dangerous side effect from premarin .
After a TURP operation, the bladder neck may no longer be there or it may be enlarged to such an extent that the fluids of the ejaculation take the path of least resistance, and flow upward a half inch or so and empty into the bladder hydrocodone vs ultram er .
When this happens the man has exactly the same physical sensations that he had when the ejaculate emptied out the end of his penis exercise testosterone levels . The feeling, the motion, the thrill is the same, only the path the fluid takes is different is augmentin related to penicillin . This retrograde ejaculation is almost a one hundred percent probability in a TURP or open surgery for BPH countering the effects of caffeine . It’s simply a fact of life caffeine benzoate compat . However, with men who usually are in the operative stage, their age is often in the early to late sixties or later, and the lack of a penile ejaculation does not present much of a problem imitrex and side effects . This is especially true if the situation is carefully explained to the patient and his wife before the operation tamoxifen endometrial .
CANCER OF THE PROSTATE
Stage A and B cancer of the prostate will usually involve a radical prostatectomy, the complete removal of the prostate detrol 5mg . This almost always harms the nerve bundles on both sides of the prostate and results in a man being impotent caffeine safe level . However new techniques have now been developed to preserve these nerves anastrozole recurrence risk . Some urologists say that in so doing, they may leave some cancer cells behind after the operation diflucan dangerous side effects .
At this point the cancer is the main concern, the life of the patient, and not his sexual function cymbalta canine depression . The surgeon will try his best to get all of the cancerous growth topamax diet aid . The nerve bundles are not a high priority tramadol adn sex drive .
For the man who might be in his fifties, and is cured of a stage A cancer of the prostate, there are drugs and devices that can help him achieve an erection for satisfying intercourse evista cam bio .
The cancer patient who is treated with radiation, internal or external, can usually continue his sex life without any problems how to make natrual penicillin . His sexual ability would be the same before or after the radiation with the exception of the normal radiation caused fatigue problems overnight zocor . When used in certain areas, radiation can also cause impotence discount lipitor 80mg .
For the cancer patient with stage D cancer of the prostate, which is usually not operable, the man’s sex life would be in direct relation to where the cancer was situated and how it affected his ability to perform biaxin drug interactions . At this point the patient is much more interested in extending his life, and not worried about his sexual function topamax and leg pain .
SOME DRUGS CAN DEFEAT IMPOTENCE
There are drugs that can be used to help an impotent man manufacturer of accutane . One of them is called papaverine, and many urologists suggest its use clotrimazole diproponate . The drug is injected directly into the side of the penis no prescription clomiphene with overnight delivery . This drug causes a dilation of arteries in the penis thereby increasing the flow of blood to the penis and also causes less blood to leave the penis megan paul zyrtec commercial .
Blood is what causes an erection, and with the increased flow, many impotent men are able to achieve a firm erection and subsequent intercourse clopidogrel hemorrhage .
The patient is given the first injection in the office to teach him how to do it clarinex dosage . A skinny needle is used and there is no pain involved feeding zyrtec . The medication will cause a temporary burning sensation but it’s not severe med store furosemide .
Sometimes a patient has psychological problems involved with his impotence clomiphene and insomnia . Papaverine is especially good in these cases does circumcision make men need viagra . By injecting himself, the patient achieves and maintains an erection for up to an hour exelon employee discounts . This will naturally reduce the fear of failure which results so often in a poor performance anxiety female and male testosterone comparison facts .
Some urologists gradually reduce the dosage and frequency of the shots rimonabant study . For patients with purely psychological impotency problems this can result in a return to normal sexual function without any shots hydroxyzine pre-medication for hypersensitivity .
Another drug, Prostaglandins, is also being used for penile injections to help in impotency penicillin though the iv . It is also a vein-dilating medication and works much the same way that Papaverine does purchase viagra cialis levitra .
What about the over the counter aphrodisiacs that can be found in many health food stores? Most aren’t labeled as such, but the advertising or the labels suggesting a vigor for life, and an elixir especially for men, tell what they are selling nexium 2c heartburn .
The Food and Drug Administration has simply banned all aphrodisiacs from sale with the explanation that they do not do what they claim cheap online omeprazole . Most still sold don’t help, but don’t do that much harm either propecia offer . Here you have to remember the placebo effect remeron and elderly . If a sugar pill will help a man to get a workable erection, use it and don’t ask questions paxil and birthdefects .
One old folk remedy, however, is being talked about by some serious researchers and physicians zosyn rocephen augmentin . This is yohimbine effexor making you gain weight . It comes in a pill form and some doctors say it can help restore function and desire in some men ibuprofen and thc false positives . It is said to dilate blocked blood vessels and helps in the release of norepinephrine country of soma . Doctors say this compound is helpful in causing and maintaining erections gabapentin no prescription required . We expect to hear more about this yohimbine in the years ahead olmesartan uses .
PROSTHESES
For more than twenty years now, there have been available to urologists mechanical penile prostheses to implant in patients who are impotent nexium aleve drug interaction .
Today there are several types available and the man who can’t achieve a firm erection and can’t achieve penetration, may want to talk to his urologist about such a mechanical device is seroquel a ssri drug .
Before the talks get very far the urologist may suggest that the man and his wife go see a specialist in sexual counseling xenical weight loss story . Implanting a penile prostheses is a big decision for a couple to make, and before it happens, both partners must be sure this is the right thing to do amiodarone interosseous .
Sometimes a man will go ahead with such a project because he thinks that his wife wants him to mechanism of action of arcoxia . He may go through the operation and the certain amount of pain and recovery time required, only to find that his wife wasn’t all that eager for him to do it 2003 cymbalta .
It is best before any commitments are made for the couple to receive qualified counseling, and then to have a frank discussion with their doctor or urologist about the devices available, which would be best for this particular man, how they work, what can go wrong, how much the operation costs, and the end results of the procedures prazosin cats .
A single man of any age, should consider his situation carefully clonidine and burn . He may want to consider the effect such an operation might have on his friends, and anyone with whom he is considering having intimate relations taking a break from femara . He must ask himself if this is truly something that he wants to do which neurotransmitters are affected by lithium .
When the answer is a “yes” he needs to sit down with his urologist and look over the types of devices available caffeine comparison in energy drinks . there are two general types linezolid approved for myobacterium . Those implants which are rigid or semi-rigid and once in place remain the same unless they
are removed citalopram alcohol .
The second type includes those which can be inflated and deflated on demand, that are inflatable or that are hydraulic in nature cialis or vardenafil 20mg tablet .
The more recent developments include the inflatable types st john’s wort and lexapro together . Most of these consist of two hollow cylinders delivery of mebendazole at the ileum . One is implanted on each side of the penis in the area usually filled with blood during a normal erection minocin empire . These tubes are filled with fluid through the use of a rubber pump that is placed under the scrotum requip dosage .
This system uses a small pump, a cylinder, a reservoir and interconnecting tubes and every bit of it is concealed beneath the man’s skin and can’t be seen from the outside cymbalta and valtrex .
The abdominal muscles hide the small reservoir and fluid clonidine patches .
To activate this system the man squeezes the pump that forces fluid into the cylinders in the penis, Much the way blood does during a natural erection indocin liver . Some of these models do not require any fluid so have no reservoirs free caffeine free weight loss pills .
To return the penis to a flaccid position, the deflation valve is pushed and the fluid returns to the reservoir and the penis relaxes zocor maximum dosage .
This type of hidden device is more natural, and out of sight, and it permits the penis to return to a normal state when not inflated prescribing guide for sporanox . The inflated or hydraulic prosthesis is more complicated than some of the others and the most expensive to buy and to have surgically implanted aleve and liver disease .
The first available device was the Small-Carrion Penile Prosthesis developed by Dr nifedipine pronunciation . Michael Small and Dr cns penetration of ciprofloxacin . Herman Carrion of the University of Miami School of Medicine back in 1970 depakote pill identifier . It is simply a pair of tubes filled with spongy material health articles about avandamet . They are implanted surgically into the penis and gives a man a semirigid penis that can achieve vaginal
semirigi
One of the problems here is that it is the same all the time lithium distal tubule . A semirigid penis can be embarrassing at times, as well as being uncomfortable cheat antabuse .
A later development is made with flexible silicone rods that are hinged for better concealment coumadin track software . Such an implantation allows the penis to hang down normally codeine and ibuprofen . It offers a man intercourse but there may be some difficulty in vaginal penetration coffee and didronel . The permanent erection here is not quite so hard to live with and the man can wear tight clothing without any undue embarrassment benzoyl peroxide safe .
The rigid and semirigid implants are the most simple
to place, and since they have no working parts, can’t break
down or malfunction cheapest viagra anywhere . They are also the least costly but,
at the same time, are the most difficult to live with since
they leave the penis in a semirigid state 24-hours a day mixing paxil and alcoholi .
None of these prostheses have any bearing on or create
any effect on normal urination for the man using them tramadol urine levels .
A NEW IDEA
A new device is now on the market to help men achieve a workable erection fluoxetine mental fogginess . It’s called an Erect Aid Suction Device For Potency amoxycillin dose . The principal the device uses is that nature hates a vacuum ibuprofen liver . It’s always trying to fill up a partial vacuum lithium ion cordless vacuums .
The device uses a long hollow tube that will fit over a penis synthroid and adrenal fatigue . It is fixed to the body with a salve to create an air tight seal and then it is simply held in place with hand pressure what is diflucan .
Then a small pump is used to exhaust the air in the tube low testosterone after replacement therapy . This reduces the pressure inside the tube and blood from the body rushes into the penis to try to fill that vacuum effexor and excess iron . In doing, it fills the two cavities in the penis and creates an erection element lithium hazards . Next the tube is removed and a rubber device is quickly fitted around the base of the penis to retain the blood in place health issue paxil .
The erection will hold for thirty minutes, at which time the band must be removed to let the blood leave prilosec pharmacy online . Cost, about $300 penile burning sensation allergic to diflucan . This item is available at medical supply houses with a doctor’s prescription travolta depakote . There is no injection, no implantation, no mechanical device, no continuing prosthesis that gets in the way, no pain, and it’s simple and easy to use treating cats with amoxicillin . Urologists who suggest this system show their patient a video in the office, then let him take the video home to show to his wife wellbutrin 150 sr . Some offer a demonstration of the device in the office hash citalopram copyfarm .
Men who use it say it works wonderfully without any high operating cost, embarrasing hardware or surgical procedures lamictal elimination .
Jul
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PROSTATE CANCER WHAT’S THE DIAGNOSTIC SEQUENCE?
July 14, 2009 | Leave a Comment
A patient goes to a urologist for many reasons naprosyn naproxen 500mg . More and more family physicians are doing rectal digital examinations and when they find a lump or nodule on the prostate refer the patient to a specialist prescription drugs zyrtec .
The urologist will confirm the digital diagnosis and then begin other tests to confirm or deny the first decision information on cefdinir . He might do a biopsy of the prostate to test the tissue in the hard nodule drug interaction benadryl claritin . He almost certainly will do an ultrasound test and look at the findings on a sonogram or on a screen wellbutrin xl how long to work . There are also two blood tests he’ll do for further confirmation of a cancerous growth levonorgestrel hormone .
As we pointed out before, there is no connection between an enlarged prostate and cancer procardia pregnancy . Usually the cancer does not press in on the urethra so there are none of the usual BPH symptoms which might get a man to go see his doctor lithium deposits in u s .
There could be some symptoms a man might feel such as pain in the upper thighs, the pelvis or lower back, serious weight loss and shortness of breath post lasix washout t1 2 . Symptoms such as these might mean nothing unusual, or be a sign of some other physical problem or disease — or they could be from cancer getting imitrex in mexico .
If the pain is related to prostate cancer, it may be a sign that the disease has spread outside of the prostate, and often it is too late to save the patient maximum daily dosage of carvedilol . That’s why prostate cancer is often called a silent killer and the reason that preventive medicine must be practiced, the digital rectal exam, once a year avodart vrs flow mac .
Now, back to those tests to determine if the lump or nodule is cancer of the prostate rabbit snuffles trimethoprim sulfa . The drawing on the following page shows one way that cancer might grow in the prostate symptoms of amoxicillin allergic reactions . This is viewed from the two lobes of the prostate that can be digitally examined natural testosterone through nutrition .
A biopsy is the use of a needle inserted through the perineum or the rectum to remove a sample of tissue from the suspected nodule canine side effects prednisone . This can be done by feel by the urologist or with the help of ultrasound to locate the specific area pharmacy tech job paxil .
A biopsy can be done in the doctor’s office or as an outpatient at a hospital and requires a local anesthesia buy generic paxil . A relatively new way to take a biopsy is with what is called a “biopsy gun” viagra integration online . It isn’t a real gun amantadine 3 . It’s a biopsy needle that is used through the rectum and guided by ultrasound, but is “fired” in and out so quickly that the patient feels pressure and hears the sound the device makes, but he feels almost no pain muscle pains with vytorin . No anethesia is given natural alternatices for low testosterone .
One urologist says he shows the patient the device and the noise it will make heart disease prilosec . During the actual biopsy the patient jumps when he hears the sound, not because of pain flutamide are there natural alternatives . For most the use of the biopsy gun is quick, simple and painless anti-emetics and valsartan . A lot easier than going to the hospital for a biopsy the old way orlistat otc alli marketed information . And that means it’s less costly as well for the patient amantadine for pain . One patient said it was less painful for him than a shot in the arm, like a flu shot tetracycline antibiotics side effects .
The tissue core taken in the biopsy is evaluated to see if it is cancerous no ovulation clomid .
Another technique known as fine-needle aspiration cytology is often used these days doxycycline for kennel cough dosage . Here a urologist inserts an extremely fine needle through the rectum and removes cells from the prostate in three, four or five different locations drug reaction with lexapro and ultram . The technique results in minimum pain for the patient and no anesthesia is required is seroquel used for sleep .
If the tissue shows evidence of cancerous growth, the urologist usually will do more testing apo clindamycin . This is to find out the placement of the cancer and the extent of it calan forcat villas . One of these tests is the PSA test, the prostate specific antigen test lithium and diarehha . If the prostate is producing a higher level of antigen than usual, it is a good indication that cancer is present maximum dosage of fosamax .
The other test, the PAP, or the prostate acid phosphatase, may reveal if the cancer has spread to other parts of the body high testosterone side effects of . If the PAP is elevated, the urologist will follow up with chest X-rays and X-rays of the pelvic area as well as bone scans and perhaps a CAT scan if equipment is available tegretol once a day .
There is another way that many men learn that they have cancer of the prostate progesterone motrin 800 . This happens during a routine TURP operation where BPH has resulted in an operation amiden testosterone . The scrapings of tissue from the prostate are examined to see if they are benign or cancerous celebrex fatigue . If the pathologist reports there are some flakes that show cancer, the doctor then does more tests to determine the placement of the tumor, and the chance that he has already removed all of the cancerous tissue amantadine for flu .
When cancer is found in this instance, it is usually an early beginning of the disease, and one that was not found, or was not in the right place to be discovered, with the digital exam buy nizoral onlne .
Again here more tests would be done and the prostate examined again to determine what procedure might be needed penicillin course of treatment . This would be after the regular BPH surgery, since most evaluations of prostate tissue by a pathologist take two to three days in most areas on a routine basis fingers going numb elavil .
CAN CANCER OF THE PROSTATE BE CURED?
The quicker it can be diagnosed and treated, the better the chances are for cure non statin zetia .
Any cure depends on the treatment, so that’s the next thing your urologist will look at singulair price . What will work best for this type and size of cancer on this patient considering his general health, his wishes and his age?
Urologists classify cancers in four stages, A, B, C, and D can you take nexium long term .
STAGE A:
In stage A cancer it is silent, the patient doesn’t know he has it loratadine affects snort . It can’t be felt by digital rectal examination or even suspected for any reason united states zoloft bulimia . A PSA test here might show up the elevated antigen and lead to a suspicion flomax with cardura . This is one reason many people are suggesting that PSA tests be given to every man over forty years of age as a part of his annual physical prednisone acetate ophthalmic suspension .
The stage A of cancer is almost always found when a TURP or other operation is carried out for BPH nolvadex body building . The removed prostate tissue examined by a pathologist will show evidences of cancer testosterone dosage of 200ml .
STAGE B:
Stage B cancer is usually detected as a lump or hard or firm area on the prostate’s two outer lobes during a digital rectal examination lithium energizer c batteries . This might be after a man has reported BPH symptoms, or during a routine physical uses of pseudoephedrine .
STAGE C:
In stage C the cancer is usually found by digital rectal exam or after a BPH caused exam cipro ampicillin interaction . Here much and sometimes all of the prostate that can be felt is hard and firm indicating the cancer effexor worsened my anxiety . At this stage the cancer probably has spread from the prostate itself into the immediate vincinity fosamax weight loss .
STAGE D:
In stage D the cancer has spread from the prostate into any of the adjoining body areas such as the lymph nodes friedrich’s ataxia and prozac . By this time the cancer may also have spread into the lungs, or bones or any part of the body working while taking lithium .
Jul
1
Drugs for Anxiety Treatment
July 1, 2009 | Leave a Comment
Anxiety
Anxiety states may manifest themselves in a variety of ways from a general sense of uneasiness to acute panic attacks. The symptoms may also vary widely, from a minor physical disturbance such as dryness of the mouth and sweating of the hands and ‘butterflies in the stomach’ to breathlessness, hyperventilation and lightheadedness. Emotional stress often precipitates anxiety, and drug treatment is useful when the cause of the stress is ill-defined or cannot be removed. Such treatment should always be regarded as a short-term measure, as the prolonged use of anxiolytics involves the risks of dependence and the problems of eventual withdrawal. For such short-term treatment of severe anxiety, a benzodiazepine such as diazepam is often the drug of choice, but other drugs such as buspirone are also in use. Some of the potent antipsychotic agents are also given in small doses for the relief of anxiety. The beta-blockers are occasionally useful in controlling some of the symptoms of anxiety, when the possibility of stress can be anticipated, as in public speaking or performance.
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Approved name Brand name Daily dose range
alprazolam Xanax 750-1500.Lig
bromazepam Lexotan 3-18 mg
ch lord iazepoxide Librium 30-100 mg
clorazepate Tranxene 7.5-22.5 mg
diazepam Atensine, Valium 5-30 mg
lorazepam Ativan 2.5-10 mg
oxazepam 45-120 mg
Table 5 Benzodiazepine anxiolytics.