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Лечение аллергии-Allergy treatment

IS PROZAC AN EFFECTIVE TREATMENT FOR PANIC ATTACKS AND AGORAPHOBIA?

Yes, it is. Prozac has a powerful effect on the frightening bursts of anxiety and rising waves of panic that characterize panic disorder, the symptoms of which include shortness of breath, dizziness, rapid heartbeat, sweaty palms, trembling, choking, chest pain, and fear of going crazy, passing out, or dying. In one study, nineteen out of twenty-five patients who were treated with Prozac for panic disorder and, in some cases, agoraphobia, showed moderate to remarkable improvement in their symptoms. Treatment was most effective when it started at the low level of 5 mg a day.

It is likely that Prozac and other medications, by alleviating panic attacks, can also cause a decrease in the symptoms of agoraphobia, the debilitating fear of open spaces, including going into crowded streets and department stores that often results in patients becoming completely housebound, sometimes for years on end.

Behavioral therapy, typically including exercises aimed at desensitizing the patient to frightening stimuli, also plays an important role in the treatment of both panic disorder and agoraphobia. Patients with panic disorder, agoraphobia, or social phobia, should use a combination of an antidepressant and behavioral therapy.

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WHAT DO PATIENTS AND PSYCHIATRISTS MEAN BY A NORMAL MOOD?

The expression «normal mood» is basically an artificial construct. In reality, most people experience mild and transient moodswings. Anyone can feel more down than usual or more up than usual for a few hours or several days; those mild mood fluctuations are part of what we mean by normal. But when the person is always revved up or always down in the dumps, when these up or down feelings become so strong that they go beyond the usual baseline range, psychiatrists begin to consider the mood pathological even if the patient does not

Patients are likely to define the word normal in individual ways that entirely depend on their personal fusion. For people with a life-rime history of minimal depression, normal is for them slightly depressed. To psychiatrists seeing these patients and comparing them with hundreds of other people in the general population, these patients are clearly more depressed than the cultural norm and would be diagnosed as such. These people might be considered hypothymic; their mood is at the bottom of normal or slightly below.

Similarly, hyperthymics who have been energetic, driving, and productive all their lives usually see this as their normal mood. However, experts in mood disorders know that these people are more energetic and active than are most people in the population. These people lead lives at the top of normal or slightly beyond—although they describe themselves as «normal.»

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HOW COMMON ARE SUICIDAL THOUGHTS OR FEELINGS AMONG PEOPLE WHO ARE DEPRESSED?

Because 15% of patients with bipolar manic depression ultimately commit suicide and the rates for unipolar depression seem to be similar, it would appear that suicidal thoughts are very common.

Between 40% and 60% of patients undergoing an acute episode of major depressive disorder have suicidal thoughts, and an even higher percentage may have a history of suicidal thoughts or wishes. Many other psychiatrists and psychophannacologists would go even further, believing mat as many as 90% of patients who appear in the psychiatrist’s office for the treatment of acute or chronic depression have at some time at least expressed the thought that «I sometimes wish I were dead,» or «My family would be better off without me,» or «I wish I could go to bed and never wake up,» or «I just wish I’d get hit by a car.»

In 1991, a total of 30,810 people killed themselves, making suicide the eighth leading cause of death in the United States. Provisional data indicate that fewer people killed themselves in 1992, dropping suicide a notch on the ladder of death. As of this writing, suicide appears to be the ninth leading cause of death, right behind a new entry in the top eight HIV infection.

But regardless of the precise figures, the likelihood is strong that far more people than reported actually died by their own hands. Because there is still a stigma against suicide, not all self-inflicted deaths are so labeled, and many forms of suicide, such as single-car accidents and death through drug abuse, are neither acknowledged nor identified as such.

Moreover, the number of people who attempt suicide without success is thought to be fully eight to ten times larger than the number of those who succeed.

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DOES PROZAC AFFECT THYROID FUNCTION?

Depressed patients are first required to have a complete physical exam, an EKG, and a blood chemistry profile that measures, among other substances, the level of thyroid hormone. Because an amount below the normal range is sufficient in itself in some cases to cause depression, patients with underactive thyroids may need first and foremost to take thyroid medication. If the depression has not begun to disappear on thyroid hormone alone after seven to ten days, a trial of an antidepressant is initiated. However, if patients are already in a major depression superimposed on hypothyroidism, they may need an antidepressant as well as the thyroid hormone.

Fortunately, studies have shown no important interactions between Prozac and thyroid hormone. The two medications can be taken simultaneously. Thyroid hormone is usually given as levothyroxin. Cytomel or T3 (triiodothyronine) is given to boost the action of tricyclic antidepressants and used as a step-up treatment with Prozac if the antidepressant is not doing the job on its own.

To date, no clear-cut warning has been given regarding any important adverse effects of Prozac on the thyroid. Very infrequent cases of hypothyroidism have been reported with patients on Prozac. Even more rarely, goiter and hyperthyroidism have been reported, although they probably are not related to the Prozac treatment.

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PROZAC: WHAT TIME TO TAKE IT AND OVERDOSE.

Prozac is usually taken in the morning after breakfast, which seems to produce fewer side effects, particularly nausea and insomnia. But some patients have been able to tolerate it with other meals or at other times of the day, including bedtime, without adverse side effects. Many patients take Prozac at a time when it is most convenient for them or simply easy to remember, whether in the morning, after dinner, or at bedtime.

Can you overdose on Prozac? Not easily. During preclinical trials with Prozac up to 1993, no deaths occurred in patients receiving Prozac in normal doses. Two deaths were reported during comparative clinical trials, but in both cases other drugs were involved, so the role of Prozac is not clear. Another thirty-two patients recovered after overdose without any lasting harm, including one who reportedly took 3000 mg of Prozac, which is over thirty-seven times the recommended maximum dose of 80 mg.

In contrast, it is easy to overdose with other antidepressants such as the TCAs and MAOIs due to the toxic effects of high doses on the heart. With Prozac, even in large amounts, the risk of serious cardiovascular or neurologic harm is very small. Prozac should be considered one of the safest of all the antidepressant drugs.

If I will take a capsule by mistake, will it hurt me? No. A single dose of Prozac should not hurt a healthy person. The possible side effects and risks of using Prozac in small doses in conjunction with tricyclic and tetracyclic antidepressants appear to be minimal. However, the use of Prozac with MAOI antidepressants such as Nardil, Parnate or Marplan is considered dangerous. Prozac taken by mistake with an MAOI could conceivably cause a toxic reaction with elevated blood pressure, nausea, vomiting, or shock. Immediate transport to an emergency ward is indicated if such symptoms follow. A patient switching from an MAOI to Prozac must wait at least two weeks. A patient switching from Prozac to an MAOI must wait at least five weeks. Failure to observe these precautions can result in severe toxic reactions and even death.

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