Anti-Depressant Drugs

Depression in Elderly Men

January 19th, 2009

Men must cope with several kinds of stress as they age. If they have been the primary wage earners for their families and have identified heavily with their jobs, they may feel stress upon retirement­loss of an important role, loss of self esteem­that can lead to depression. Similarly, the loss of friends and family and the onset of other health problems can trigger depression.

Depression is not a normal part of aging. Depression is an illness that can be effectively treated, thereby decreasing unnecessary suffering, improving the chances for recovery from other illnesses, and prolonging productive life. However, health care professionals may miss depressive symptoms in older patients. Older adults may be reluctant to discuss feelings of sadness or grief, or loss of interest in pleasurable activities. They may complain primarily of physical symptoms. It may be difficult to discern a co occurring depressive disorder in patients who present with other illnesses, such as heart disease, stroke, or cancer, which may cause depressive symptoms or may be treated with medications that have side effects that cause depression. If a depressive illness is diagnosed, treatment with appropriate medication and/or brief psychotherapy can help older adults manage both diseases, thus enhancing survival and quality of life.

“As you get sick, as you become drawn in more and more by depression, you lose that perspective. Events become more irritating, you get more frustrated about getting things done. You feel angrier, you feel sadder. Everything’s magnified in an abnormal way.”

-Paul Gottlieb, Publisher

Identifying and treating depression in older adults is critical. There is a common misperception that suicide rates are highest among the young, but it is older white males who suffer the highest rate. Over 70 percent of older suicide victims visit their primary care physician within the month of their death; many have a depressive illness that goes undetected during these visits. This fact has led to research efforts to determine how to best improve physicians’ abilities to detect and treat depression in older adults.

Approximately 80 percent of older adults with depression improve when they receive treatment with antidepressant medication, psychotherapy, or a combination of both. In addition, research has shown that a combination of psychotherapy and antidepressant medication is highly effective for reducing recurrences of depression among older adults. Psychotherapy alone has been shown to prolong periods of good health free from depression, and is particularly useful for older patients who cannot or will not take medication. Improved recognition and treatment of depression in later life will make those years more enjoyable and fulfilling for the depressed elderly person, and his family and caregivers.

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What causes depression in women?

January 7th, 2009

Scientists are examining many potential causes for and contributing factors to women’s increased risk for depression. It is likely that genetic, biological, chemical, hormonal, environmental, psychological, and social factors all intersect to contribute to depression.

Genetics

If a woman has a family history of depression, she may be more at risk of developing the illness. However, this is not a hard and fast rule. Depression can occur in women without family histories of depression, and women from families with a history of depression may not develop depression themselves. Genetics research indicates that the risk for developing depression likely involves the combination of multiple genes with environmental or other factors.

Chemicals and hormones

Brain chemistry appears to be a significant factor in depressive disorders. Modern brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people suffering from depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior don’t appear to be functioning normally. In addition, important neurotransmitters-chemicals that brain cells use to communicate-appear to be out of balance. But these images do not reveal WHY the depression has occurred.

Scientists are also studying the influence of female hormones, which change throughout life. Researchers have shown that hormones directly affect the brain chemistry that controls emotions and mood. Specific times during a woman’s life are of particular interest, including puberty; the times before menstrual periods; before, during, and just after pregnancy (postpartum); and just prior to and during menopause (perimenopause).

Premenstrual dysphoric disorder

Some women may be susceptible to a severe form of premenstrual syndrome called premenstrual dysphoric disorder (PMDD). Women affected by PMDD typically experience depression, anxiety, irritability and mood swings the week before menstruation, in such a way that interferes with their normal functioning. Women with debilitating PMDD do not necessarily have unusual hormone changes, but they do have different responses to these changes. They may also have a history of other mood disorders and differences in brain chemistry that cause them to be more sensitive to menstruation-related hormone changes. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

Postpartum depression

Women are particularly vulnerable to depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. Many new mothers experience a brief episode of mild mood changes known as the “baby blues,” but some will suffer from postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. One study found that postpartum women are at an increased risk for several mental disorders, including depression, for several months after childbirth.

Some studies suggest that women who experience postpartum depression often have had prior depressive episodes. Some experience it during their pregnancies, but it often goes undetected. Research suggests that visits to the doctor may be good opportunities for screening for depression both during pregnancy and in the postpartum period.

Menopause

Hormonal changes increase during the transition between premenopause to menopause. While some women may transition into menopause without any problems with mood, others experience an increased risk for depression. This seems to occur even among women without a history of depression. However, depression becomes less common for women during the post-menopause period.

Stress

Stressful life events such as trauma, loss of a loved one, a difficult relationship or any stressful situation-whether welcome or unwelcome-often occur before a depressive episode. Additional work and home responsibilities, caring for children and aging parents, abuse, and poverty also may trigger a depressive episode. Evidence suggests that women respond differently than men to these events, making them more prone to depression. In fact, research indicates that women respond in such a way that prolongs their feelings of stress more so than men, increasing the risk for depression. However, it is unclear why some women faced with enormous challenges develop depression, and some with similar challenges do not.

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Men and Depression

December 30th, 2008

Researchers estimate that at least six million men in the United States suffer from a depressive disorder every year. Research and clinical evidence reveal that while both women and men can develop the standard symptoms of depression, they often experience depression differently and may have different ways of coping with the symptoms. Men may be more willing to acknowledge fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances rather than feelings of sadness, worthlessness, and excessive guilt. Some researchers question whether the standard definition of depression and the diagnostic tests based upon it adequately capture the condition as it occurs in men.

“I’d drink and I’d just get numb. I’d get numb to try to numb my head. I mean, we’re talking many, many beers to get to that state where you could shut your head off, but then you wake up the next day and it’s still there. Because you have to deal with it, it doesn’t just go away. It isn’t a two hour movie and then at the end it goes ‘The End’ and you press off. I mean it’s a twenty four hour a day movie and you’re thinking there is no end. It’s horrible.”

-Patrick McCathern, First Sergeant, U.S. Air Force, Retired

Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a “symptom” of underlying depression in men or a co occurring condition that more commonly develops in men. Nevertheless, substance use can mask depression, making it harder to recognize depression as a separate illness that needs treatment.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, angry, irritable, and, sometimes, violently abusive. Some men deal with depression by throwing themselves compulsively into their work, attempting to hide their depression from themselves, family, and friends. Other men may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm’s way.

“When I was feeling depressed I was very reckless with my life. I didn’t care about how I drove. I didn’t care about walking across the street carefully. I didn’t care about dangerous parts of the city. I wouldn’t be affected by any kinds of warnings on travel or places to go. I didn’t care. I didn’t care whether I lived or died and so I was going to do whatever I wanted whenever I wanted. And when you take those kinds of chances, you have a greater likelihood of dying.”

-Bill Maruyama, Lawyer

More than four times as many men as women die by suicide in the United States, even though women make more suicide attempts during their lives. In addition to the fact that men attempt suicide using methods that are generally more lethal than those used by women, there may be other factors that protect women against suicide death. In light of research indicating that suicide is often associated with depression, the alarming suicide rate among men may reflect the fact that men are less likely to seek treatment for depression. Many men with depression do not obtain adequate diagnosis and treatment that may be life saving.

More research is needed to understand all aspects of depression in men, including how men respond to stress and feelings associated with depression, how to make men more comfortable acknowledging these feelings and getting the help they need, and how to train physicians to better recognize and treat depression in men. Family members, friends, and employee assistance professionals in the workplace also can play important roles in recognizing depressive symptoms in men and helping them get treatment.

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Co-Occurrence of Depression with Other Illnesses

December 21st, 2008

Depression can coexist with other illnesses. In such cases, it is important that the depression and each co-occurring illness be appropriately diagnosed and treated.

Research has shown that anxiety disorders­which include post traumatic stress disorder (PTSD), obsessive compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder­commonly accompany depression. Depression is especially prevalent among people with PTSD, a debilitating condition that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural disasters, accidents, terrorism, and military combat. PTSD symptoms include: re experiencing the traumatic event in the form of flashback episodes, memories, or nightmares; emotional numbness; sleep disturbances; irritability; outbursts of anger; intense guilt; and avoidance of any reminders or thoughts of the ordeal. In one NIMH supported study, more than 40 percent of people with PTSD also had depression when evaluated at one month and four months following the traumatic event.

Substance use disorders (abuse or dependence) also frequently co occur with depressive disorders. Research has revealed that people with alcoholism are almost twice as likely as those without alcoholism to also suffer from major depression. In addition, more than half of people with bipolar disorder type I (with severe mania) have a co occurring substance use disorder.

Depression has been found to occur at a higher rate among people who have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson’s. Symptoms of depression are sometimes mistaken for inevitable accompaniments to these other illnesses. However, research has shown that the co occurring depression can and should be treated, and that in many cases treating the depression can also improve the outcome of the other illness.

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Symptoms of Depression and Mania

December 12th, 2008

Not everyone who is depressed or manic experiences every symptom. Some people experience only a few; some people suffer many. The severity of symptoms varies among individuals and also over time.

Depression

• Persistent sad, anxious, or “empty” mood.
• Feelings of hopelessness or pessimism.
• Feelings of guilt, worthlessness, or helplessness.
• Loss of interest or pleasure in hobbies and activities that were once enjoyable, including sex.
• Decreased energy, fatigue; feeling “slowed down.”
• Difficulty concentrating, remembering, or making decisions.
• Trouble sleeping, early morning awakening, or oversleeping.
• Changes in appetite and/or weight.
• Thoughts of death or suicide, or suicide attempts.
• Restlessness or irritability.
• Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.

“You don’t have any interest in thinking about the future, because you don’t feel that there is going to be any future.”

-Shawn Colten, National Diving Champion

“I wouldn’t feel rested at all. I’d always feel tired. I could get from an hour’s sleep to eight hours sleep, and I would always feel tired.”

-Rene Ruballo, Police Officer

Mania

• Abnormal or excessive elation.
• Unusual irritability.
• Decreased need for sleep.
• Grandiose notions.
• Increased talking.
• Racing thoughts.
• Increased sexual desire.
• Markedly increased energy.
• Poor judgment.
• Inappropriate social behavior.

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Paroxetine

December 3rd, 2008

Paroxetine is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Paroxetine affects chemicals in the brain that may become unbalanced.

Paroxetine is used to treat depression, obsessive-compulsive disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).

Paroxetine may also be used for purposes other than those listed in this medication guide.

The most important information You should know about paroxetine.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are a child or young adult. Talk with your doctor about this risk. While you are taking paroxetine you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse: mood changes, anxiety, panic attacks, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania (mental and/or physical hyperactivity), thoughts of suicide or hurting yourself.

Paroxetine may cause heart defects or serious, life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking paroxetine, do not stop taking the medication without first talking to your doctor.

Do not take paroxetine together with pimozide (Orap), thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

Discuss with your healthcare provider.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are a child or young adult. Talk with your doctor about this risk. While you are taking paroxetine you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks.

Do not use paroxetine if you are using pimozide (Orap), thioridazine (Mellaril), or an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam).

Serious and sometimes fatal reactions can occur when these medicines are taken with paroxetine. You must wait at least 14 days after stopping an MAO inhibitor before you can take paroxetine. After you stop taking paroxetine, you must wait at least 14 days before you start taking an MAOI.

Before taking paroxetine, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;
• seizures or epilepsy;
• bipolar disorder (manic depression), or a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use paroxetine, or you may need a dosage adjustment or special tests.

FDA pregnancy category D. Paroxetine may cause heart defects or serious, life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking paroxetine, do not stop taking the medication without first talking to your doctor.

Paroxetine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should You take paroxetine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

Do not crush, chew, or break a controlled-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Shake the liquid form of paroxetine well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take up to 4 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment.

You may have withdrawal symptoms (such as agitation, dizziness, numbness or tingling, ringing in your ears, confusion, or behavior changes) after you stop taking paroxetine. Do not stop taking this medication suddenly without first talking to your doctor.

Store paroxetine at room temperature away from moisture and heat.

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Luvox (Fluvoxamine)

November 9th, 2008

What is fluvoxamine?

Fluvoxamine is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors. Fluvoxamine affects chemicals in the brain that may become unbalanced and cause obsessive-compulsive symptoms.

Fluvoxamine is used to treat obsessive-compulsive disorders involving recurring thoughts or actions.

What is the most important information I should know about fluvoxamine?

Do not take fluvoxamine together with thioridazine (Mellaril), terfenadine (Seldane), astemizole (Hismanal), cisapride (Propulsid), pimozide (Orap), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take fluvoxamine. After you stop taking fluvoxamine, you must wait at least 14 days before you can start taking an MAOI.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Fluvoxamine is FDA-approved for children with obsessive-compulsive disorder (OCD). It is not approved for treating depression in children. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking fluvoxamine, do not stop taking the medication without first talking to your doctor.

What should I discuss with my healthcare provider before taking fluvoxamine?

Do not use fluvoxamine if you are using any of the following drugs:

• thioridazine (Mellaril);
• terfenadine (Seldane);
• astemizole (Hismanal);
• cisapride (Propulsid); or
• pimozide (Orap); or
• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam).
• Serious and sometimes fatal reactions can occur when these medicines are taken with fluvoxamine. You must wait at least 14 days after stopping an MAO inhibitor before you can take fluvoxamine. After you stop taking fluvoxamine, you must wait at least 14 days before you can start taking an MAOI.Before taking fluvoxamine, tell your doctor if you have:
• liver disease;
• seizures or epilepsy;
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts.

You may not be able to take fluvoxamine, or you may need a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking fluvoxamine, do not stop taking the medication without first talking to your doctor.

Fluvoxamine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give fluvoxamine to anyone younger than 18 years old without the advice of a doctor. Fluvoxamine is FDA-approved for children with obsessive-compulsive disorder (OCD). It is not approved for treating depression in children.

How should I take fluvoxamine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Take each dose with water.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

It may take 4 weeks or more for you to start feeling better. Do not stop using fluvoxamine without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

Store fluvoxamine at room temperature away from moisture and heat.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a fluvoxamine overdose may include nausea, vomiting, blurred vision, rapid heartbeat, lack of coordination, trouble breathing, drowsiness, fainting, and coma.

What should I avoid while taking fluvoxamine?

Do not take fluvoxamine together with thioridazine (Mellaril), terfenadine (Seldane), astemizole (Hismanal), cisapride (Propulsid), pimozide (Orap), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

Avoid drinking alcohol, which can increase some of the side effects of fluvoxamine.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by fluvoxamine.

Fluvoxamine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of fluvoxamine?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• tremors, shivering, muscle stiffness or twitching;
• seizure (convulsions);
• problems with balance or coordination;
• unusual thoughts or behavior; or
• agitation, confusion, sweating, fast heartbeat.

Other less serious side effects are more likely to occur, such as:

• feeling nervous, restless, or unable to sit still;
• sleep problems (insomnia);
• drowsiness, weakness;
• urinating more than usual;
• loss of appetite, weight gain or loss;
• nausea, vomiting, diarrhea, gas, constipation, or upset stomach;
• decreased sex drive, impotence, or difficulty having an orgasm; or
• dry mouth, unpleasant taste in your mouth.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

You may have some side effects after you stop using fluvoxamine, including headache, nausea, vomiting, sleepiness or insomnia, nervousness, or agitation.

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Abilify (Aripiprazole)

October 28th, 2008

What is aripiprazole?

Aripiprazole is an antipsychotic medication. It works by changing the actions of chemicals in the brain.

Aripiprazole is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression).

What is the most important information I should know about aripiprazole?

Aripiprazole is not for use in psychotic conditions that are related to dementia. Aripiprazole has caused fatal heart attack and stroke in older adults with dementia-related conditions.

Stop using aripiprazole and call your doctor at once if you have the following symptoms: fever with stiff muscles and rapid heart rate; uncontrolled muscle movements; symptoms that come on suddenly such as numbness or weakness, severe headache, and problems with vision, speech, or balance.

Aripiprazole can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol, which can increase some of the side effects of aripiprazole.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by aripiprazole.

Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise. It is easier to become dangerously overheated and dehydrated while you are taking aripiprazole.

What should I discuss with my healthcare provider before taking aripiprazole?

Aripiprazole is not for use in psychotic conditions that are related to dementia. Aripiprazole has caused fatal heart attack and stroke in older adults with dementia-related conditions.

Before taking aripiprazole, tell your doctor if you have:

• liver disease;
• kidney disease;
• heart disease, high blood pressure, heart rhythm problems;
• a history of heart attack or stroke;
• a history of breast cancer;
• seizures or epilepsy;
• a personal or family history of diabetes; or
• trouble swallowing.

If you have any of these conditions, you may not be able to use aripiprazole, or you may need a dosage adjustment or special tests during treatment.

The liquid form (oral solution) of this medication may contain up to 15 grams of sugar per dose. Before taking aripiprazole oral solution, tell your doctor if you have diabetes.

The orally disintegrating tablet form of this medication may contain over 3 milligrams of phenylalanine per tablet. Before taking Abilify Discmelt, tell your doctor if you have phenylketonuria.

Aripiprazole may cause you to have high blood sugar (hyperglycemia). Talk to your doctor if you have any signs of hyperglycemia such as increased thirst or urination, excessive hunger, or weakness. If you are diabetic, check your blood sugar levels on a regular basis while you are taking aripiprazole.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Aripiprazole can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take aripiprazole?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Do not take aripiprazole for longer than 6 weeks unless your doctor has told you to.

Take each dose with a full glass of water.

Aripiprazole can be taken with or without food.

Aripiprazole is usually taken once a day. Follow your doctor ’s instructions.

Measure the liquid form of aripiprazole with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

To take aripiprazole orally disintegrating tablets (Abilify Discmelt):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.
• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
• Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

It is important to take aripiprazole regularly to get the most benefit.

To be sure this medication is helping your condition, your doctor will need to check your progress on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store aripiprazole tablets at room temperature away from moisture and heat.

Aripiprazole oral solution should be stored in the refrigerator and can be used for up to 6 months after opening.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of an aripiprazole overdose may include drowsiness, vomiting, agitation, aggression, confusion, tremors, fast or slow heart rate, seizure (convulsions), trouble breathing, feeling light-headed, or fainting.

What should I avoid while taking aripiprazole?

Aripiprazole can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Dizziness may be more likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.

Avoid drinking alcohol, which can increase some of the side effects of aripiprazole.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by aripiprazole.

Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise. It is easier to become dangerously overheated and dehydrated while you are taking aripiprazole.

What are the possible side effects of aripiprazole?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using aripiprazole and call your doctor at once if you have any of these serious side effects:

• fever, stiff muscles, confusion, sweating, fast or uneven heartbeats;
• jerky muscle movements you cannot control;
• sudden numbness or weakness, especially on one side of the body;
• sudden headache, confusion, problems with vision, speech, or balance;
• increased thirst, frequent urination, excessive hunger, or weakness;
• feeling light-headed, fainting; or
• urinating less than usual or not at all.

Continue taking aripiprazole and talk to your doctor if you have any of these less serious side effects:

• dizziness, drowsiness, or weakness;
• constipation;
• nausea, vomiting, upset stomach;
• headache, anxiety;
• sleep problems (insomnia); or
• weight gain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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Citalopram

October 16th, 2008

What is citalopram?

Citalopram is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Citalopram affects chemicals in the brain that may become unbalanced and cause depression.

Citalopram is used to treat depression.

What is the most important information I should know about citalopram?

Do not take citalopram together with a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take citalopram. After you stop taking citalopram, you must wait at least 14 days before you start taking an MAOI.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Some antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking citalopram, do not stop taking the medication without first talking to your doctor.

What should I discuss with my healthcare provider before taking citalopram?

Do not use citalopram if you are using an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines are taken with citalopram. You must wait at least 14 days after stopping an MAO inhibitor before you can take citalopram. After you stop taking citalopram, you must wait at least 14 days before you start taking an MAOI.

Before taking citalopram, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;
• seizures or epilepsy;
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use citalopram, or you may need a dosage adjustment or special tests during treatment.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking citalopram, do not stop taking the medication without first talking to your doctor.

Citalopram can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give citalopram to anyone younger than 18 years old without the advice of a doctor.

How should I take citalopram?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

To be sure you get the correct dose of liquid citalopram, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take 4 weeks or longer before you start feeling better. Do not stop using citalopram without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

Store citalopram at room temperature away from moisture and heat.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a citalopram overdose may include nausea, vomiting, tremor, sweating, rapid heartbeat, confusion, dizziness, seizures, and coma.

What should I avoid while taking citalopram?

Do not take citalopram together with escitalopram (Lexapro), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

Avoid drinking alcohol, which can increase some of the side effects of citalopram.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by citalopram.

Citalopram can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of citalopram?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• seizure (convulsions);
• tremors, shivering, muscle stiffness or twitching;
• problems with balance or coordination; or
• agitation, confusion, sweating, fast heartbeat.

Other less serious side effects are more likely to occur, such as:

• feeling nervous, restless, or unable to sit still;
• drowsiness, dizziness, trouble concentrating;
• sleep problems (insomnia);
• nausea, gas, upset stomach, loss of appetite;
• weight changes;
• urinating more than usual;
• decreased sex drive, impotence, or difficulty having an orgasm; or
• dry or watery mouth, yawning, or ringing in your ears.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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Chlordiazepoxide

October 5th, 2008

What is chlordiazepoxide?

Chlordiazepoxide is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens).

Chlordiazepoxide affects chemicals in the brain that may become unbalanced and cause anxiety.

Chlordiazepoxide is used to treat anxiety disorders or alcohol withdrawal.

Chlordiazepoxide may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking chlordiazepoxide?

Do not use this medication if you are allergic to chlordiazepoxide or to other benzodiazepines, such as alprazolam (Xanax), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).

Before taking chlordiazepoxide, tell your doctor if you are allergic to any drugs, or if you have:

• glaucoma;
• asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
• porphyria;
• kidney or liver disease;
• a history of depression or suicidal thoughts or behavior; or
• a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use chlordiazepoxide, or you may need a dosage adjustment or special tests during treatment.

Chlordiazepoxide can cause birth defects in an unborn baby. Do not use chlordiazepoxide without your doctor’s consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Chlordiazepoxide may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

The sedative effects of chlordiazepoxide may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking chlordiazepoxide.

How should I take chlordiazepoxide?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Chlordiazepoxide should be used for only a short time. Do not take this medication for longer than 4 months without your doctor’s advice.

Chlordiazepoxide may be habit-forming and should be used only by the person it was prescribed for. Chlordiazepoxide should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Contact your doctor if this medicine seems to stop working as well in treating your symptoms.

Do not stop using chlordiazepoxide suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Your symptoms may return when you stop using chlordiazepoxide after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using chlordiazepoxide. Withdrawal symptoms may include tremor, sweating, trouble sleeping, muscle cramps, stomach pain, vomiting, diarrhea, irritability, memory problems, confusion, unusual thoughts or behavior, and seizure (convulsions).

To be sure this medication is not causing harmful effects, your blood and liver function may need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

Store chlordiazepoxide at room temperature away from moisture, heat, and light.

Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of chlordiazepoxide can be fatal.

Symptoms of a chlordiazepoxide overdose may include extreme drowsiness, confusion, excitation, muscle weakness, loss of balance or coordination, feeling light-headed, fainting, or coma.

What should I avoid while taking chlordiazepoxide?

Do not drink alcohol while taking chlordiazepoxide. This medication can increase the effects of alcohol.

Chlordiazepoxide can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can increase some of the side effects of chlordiazepoxide.

What are the possible side effects of chlordiazepoxide?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• confusion;
• depressed mood, thoughts of suicide or hurting yourself;
• restless muscle movements in your eyes, tongue, jaw, or neck;
• hyperactivity, agitation, hostility;
• hallucinations; or
• jaundice (yellowing of the skin or eyes).

Less serious side effects are more likely to occur, such as:

• drowsiness, tiredness;
• swelling;
• skin rash;
• nausea, vomiting, constipation; or
• irregular menstrual periods.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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