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By E. Dargoth. Gustavus Adolphus College, Saint Peter, Minnesota.

That is why I am less likely to use Prozac as my first choice for a SSRI in some children 75mg triamterene amex. There are a number of other side effects of SSRIs including weight gain and headaches buy discount triamterene 75mg. If you have decreased sexual desire on a SSRI, there are several options. You might switch to another class of medications such as Wellbutrin or Serzone. If despite the sexual side effects, you wanted to stay on the SSRI, you could lower the dose, or you could add Ritalin, or Wellbutrin. Sweating is one of the side effects listed for Effexor in Healthy Place psychiatric medications list. Watkins: The sweating is usually more annoying than serious. If it were accompanied by confusion, excessive salivation or other bad side effects, then call the doctor. Watkins: Some women with PMS, take a higher dose of an SSRI the five or six days before their menstrual period. Before you do this, you and your doctor should chart your moods daily for about three months. See if there is a correlation between your monthly cycle and your moods. Moody Blue: What do you think about the drug Topamax being used for patients with mixed states? Johns Wort in a few patients who did not do well on several other antidepressants. I have also used Fish Oil (Omega 3 Fatty Acids) for mood swings. However, I prefer to try the more established medications first. Since we have very little data on mixing these herbal compounds with traditional medications, I prefer the person to be off other antidepressants before we try the alternative treatments for depression or bipolar disorder. Is it possible my son can get depression, and are there ways I can help prevent serious depression? Watkins: You should be sure that your son gets a lot of affection from family. Encourage him to develop a mind-set that he can solve problems and that life is not a helpless situation. If he does get depression, you may be in a good position to see it and get him help early. I recommend that children with a family history of depression or bipolar disorder get education about drug abuse and responsible sexual behavior. They are at increased risk for these problems, and a lot can be done for prevention. David: How important a role does nutrition play in maintaining mood stability? Watkins: My patients sometimes say that I act like their mother: Eat your breakfast, eat a balanced diet and exercise regularly. I believe that there was a recent study out of Duke that suggested that regular exercise helped depression. I have sometimes thought that the extreme Ketogenic diets make some people more irritable. You can click on this link, sign up for the mail list at the top of the page so you can keep up with events like this. Johns Wort being dangerous in combination with certain foods, much the way the MAOIs are.

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Eventually 75 mg triamterene, we will have long-term prospective data on children exposed in utero to anticonvulsants triamterene 75 mg otc. These data will come from the North American AED Registry. Until then, however, the findings of these studies are consistent enough to indicate that in utero exposure to anticonvulsants may have neurotoxic effects; this appears to be the case particularly with sodium valproate monotherapy and polytherapy. The potential for neurobehavioral sequelae is an issue that has not been adequately factored into the risk-benefit decision for treating women with epilepsy or bipolar disorder during pregnancy. For women with epilepsy, the situation is more difficult, since seizures during pregnancy are associated with particularly bad perinatal outcomes. But for bipolar disorder, we have a spectrum of treatment options. Often women and their physicians choose to discontinue a psychotropic drug in the first trimester, and they assume that therapy can safely be reintroduced during the second trimester. Still, the data on potential behavioral toxicity, particularly with sodium valproate, should make one pause before reinstituting treatment with sodium valproate during the second and third trimester - Mand the data should raise the question of whether this is an appropriate medicine to be using at any point during pregnancy in women with bipolar illness. The goal is to keep women emotionally well during pregnancy and to avoid relapse during pregnancy. Prenatal exposure to a drug is sometimes necessary to sustain well-being of patients. Nevertheless, recent data have indicated that the risk of polycystic ovarian syndrome is increased in women treated with sodium valproate. When this finding is considered with the teratogenicity data for sodium valproate and its possible longer term neurobehavioral sequelae, one has to reconsider the wisdom of using this medication in reproductive-age women, particularly since some of the treatment alternatives for bipolar illness are either less teratogenic or appear to be nonteratogenic. Reproductive-age women who want to become pregnant or who are already pregnant should consult their physicians about alternative treatment strategies that can be continued throughout pregnancy. Such alternatives are lithium or lamotrigine (Lamictal), both of which may be used with or without one of the older typical antipsychotics, which do not appear to be teratogenic. Our goal is to avoid exposure to a drug with known teratogenicity with respect to organs, and quite probably, with respect to behavior. Lee Cohen is a psychiatrist and director of the perinatal psychiatry program at Massachusetts General Hospital, Boston. He is a consultant for and has received research support from manufacturers of several SSRIs. He is also a consultant to Astra Zeneca, Lilly and Jannsen - manufacturers of atypical antipsychotics. Early data shows that lamotrigine (Lamictal) may be safe for treating bipolar women who are pregnant. As the use of anticonvulsants to treat bipolar illness has grown over the past decade, so has the number of women successfully treated with these medications who have questions about whether they should discontinue these drugs before they attempt to conceive, or what to do if they are already pregnant. The anticonvulsants that have been most widely used for bipolar illness are sodium valproate and carbamazepine, and more recently, gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), and tiagabine (Gabitril). Until recently, there have been few reproductive safety data available on the newer anticonvulsants. Many women and their physicians are caught in a particularly vexing bind because two of the mainstays of bipolar therapy, lithium and sodium valproate (Depakote), are known teratogens, though the teratogenicity of these two compounds is particularly different. The risk associated with first-trimester exposure ranges from a relatively modest 0. The latter is based on recent findings from the Antiepileptic Drug Registry at Massachusetts General Hospital (Am. But the data that are accumulating on lamotrigine, approved in June for maintenance treatment of bipolar disorder, provide some welcome news for reproductive-aged women with bipolar disorder. An interim report on cases collected by the lamotrigine pregnancy registry maintained by the manufacturer, GlaxoSmithKline, since September 1992 indicates that the drug does not appear to be teratogenic. The report does note, however, that the sample size is not large enough to make definitive conclusions.

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Ann: Is it often that someone with an eating disorder has a co-conspirator effective triamterene 75 mg, and should the co-conspirator be kept away from the recoveree? Crawford: It is not uncommon for persons with eating disorders to get together and defensively support the illness in each other buy discount triamterene 75mg line. This is a real problem, but usually, deep inside, the patients know what is going on. I do think that family members need to meet their own needs and not let the eating disorder ruin their life too. This is one of those "fine line" issues where one needs to strike a balance between "appropriately concerned," but not "consumed". Jenshouse: Would it help someone to get treatment if you offered to go with them or is that not a good idea? Crawford: Patients are often brought in by supportive friends who are quite helpful. Frequently friends and family will attend our support groups with the patient. I am frightened to let my secret out, but I really think I need some help. If I do decide to tell him, can you suggest a "gentle" way to break the news? Keensia: How can I tell someone that I have an eating disorder? Crawford: Our view is that being secretive about an eating disorder is a sign of avoidance and denial. If your boyfriend genuinely cares for you, he should accept you as you are, but also should support you toward a healthier life. Crawford: I would fear that viewing the problem as a "phase" might be a way to minimize the seriousness of it. However, many adolescents with eating disorders do recover in adulthood. Many adolescents are very concerned about body image and weight, but do not have a full syndrome. If these symptoms are interfering with everyday life, then help is needed. Bob M: Here are a few audience comments relating to what we are talking about:LDV: When my husband comes home from work and and asks the food? LMermaid: My wife has anorexia and admits this but will never, ever admit that she is depressed and this has contributed towards her not taking meds which are linked with Serotonin reuptake. Should I be convincing her she is depressed or supporting her stand? She does seem depressed to me from time-to-time, due to her eating disorder and complications stemming from it. Crawford: The medications can frequently be helpful for anorexic patients regardless of whether depression is present. And to everyone in the audience, thank you for your participation and your questions. I want to again urge you need help recovering from you eating disorder, please take it seriously. Sacker joined us to discuss the medical risks of eating disorders (anorexia and bulimia), which range from hair loss, kidney failure, electrolyte imbalance, esophageal rupture, loss of menstrual period, to heart failure. He also commented on the problems that the audience shared, including how eating disorders affect fertility and pregnant women and problems with diet pills. What if you abused ipecac syrup, or abuse diuretics, or have been abusing laxatives? To find out what these behaviors can result in, read the transcript below. Our topic tonight is "The Medical and Psychological Risks of Eating Disorders.

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Symlin is given at mealtimes and is indicated for:Type 1 diabetes buy triamterene 75 mg on line, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy triamterene 75 mg overnight delivery. Type 2 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin. Symlin is contraindicated in patients with any of the following:a known hypersensitivity to Symlin or any of its components, including metacresol;a confirmed diagnosis of gastroparesis;hypoglycemia unawareness. Symlin therapy should only be considered in patients with insulin-using type 2 or type 1 diabetes who fulfill the following criteria:have failed to achieve adequate glycemic control despite individualized insulin management;are receiving ongoing care under the guidance of a healthcare professional skilled in the use of insulin and supported by the services of diabetes educator(s). Patients meeting any of the following criteria should NOT be considered for Symlin therapy:poor compliance with current insulin regimen;poor compliance with prescribed self-blood glucose monitoring;recurrent severe hypoglycemia requiring assistance during the past 6 months;presence of hypoglycemia unawareness;confirmed diagnosis of gastroparesis;require the use of drugs that stimulate gastrointestinal motility;Symlin alone does not cause hypoglycemia. However, Symlin is indicated to be co-administered with insulin therapy and in this setting Symlin increases the risk of insulin-induced severe hypoglycemia, particularly in patients with type 1 diabetes. Severe hypoglycemia associated with Symlin occurs within the first 3 hours following a Symlin injection. If severe hypoglycemia occurs while operating a motor vehicle, heavy machinery, or while engaging in other high-risk activities, serious injuries may occur. Therefore, when introducing Symlin therapy, appropriate precautions need to be taken to avoid increasing the risk for insulin-induced severe hypoglycemia. These precautions include frequent pre- and post-meal glucose monitoring combined with an initial 50% reduction in pre-meal doses of short-acting insulin (see DOSAGE AND ADMINISTRATION ). Symptoms of hypoglycemia may include hunger, headache, sweating, tremor, irritability, or difficulty concentrating. Rapid reductions in blood glucose concentrations may induce such symptoms regardless of glucose values. More severe symptoms of hypoglycemia include loss of consciousness, coma, or seizure. Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions, such as long duration of diabetes; diabetic nerve disease; use of medications such as beta-blockers, clonidine, guanethidine, or reserpine; or intensified diabetes control. The addition of any antihyperglycemic agent such as Symlin to an existing regimen of one or more antihyperglycemic agents (e. The following are examples of substances that may increase the blood glucose-lowering effect and susceptibility to hypoglycemia: oral anti-diabetic products, ACE inhibitors, diisopyramide, fibrates, fluoxetine, MAO inhibitors, pentoxifylline, propoxyphene, salicylates, and sulfonamide antibiotics. Clinical studies employing a controlled hypoglycemic challenge have demonstrated that Symlin does not alter the counter-regulatory hormonal response to insulin-induced hypoglycemia. Likewise, in Symlin-treated patients, the perception of hypoglycemic symptoms was not altered with plasma glucose concentrations as low as 45 mg/dL. Symlin should be prescribed with caution to persons with visual or dexterity impairment. Healthcare providers should inform patients of the potential risks and advantages of Symlin therapy. Healthcare providers should also inform patients about self-management practices including glucose monitoring, proper injection technique, timing of dosing, and proper storage of Symlin. In addition, reinforce the importance of adherence to meal planning, physical activity, recognition and management of hypoglycemia and hyperglycemia, and assessment of diabetes complications. Refer patients to the Symlin Medication Guide and Patient Instructions for Use for additional information. Instruct patients on handling of special situations such as intercurrent conditions (illness or stress), an inadequate or omitted insulin dose, inadvertent administration of increased insulin or Symlin dose, inadequate food intake or missed meals. Symlin and insulin should always be administered as separate injections and never be mixed. Women with diabetes should be advised to inform their healthcare professional if they are pregnant or contemplating pregnancy. The dosing requirements for Symlin are not altered in patients with moderate or severe renal impairment (ClCr >20 to ?-T50 mL/min). No studies have been done in dialysis patients (see CLINICAL PHARMACOLOGY ; Special Populations). Studies have not been performed in patients with hepatic impairment.

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