Depression Definition Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps.

Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended time. See also depression in the elderly and adolescent depression. Alternative Names Blues; Discouragement; Gloom; Mood changes; Sadness; Melancholy Considerations Depression is generally ran ed in terms of severity !! mild, moderate, or severe. "he degree of your depression, which your doctor can determine, influences how you are treated. Symptoms of depression include#

"rouble sleeping or excessive sleeping $ dramatic change in appetite, often with weight gain or loss %atigue and lac of energy %eelings of worthlessness, self!hate, and inappropriate guilt &xtreme difficulty concentrating $gitation, restlessness, and irritability 'nactivity and withdrawal from usual activities %eelings of hopelessness and helplessness (ecurring thoughts of death or suicide )ow self esteem is common with depression. So are sudden bursts of anger and lac of pleasure from activities that normally ma e you happy, including sex. Depressed children may not have the classic symptoms of adult depression. *atch especially for changes in school performance, sleep, and behavior. 'f you wonder whether your child might be depressed, it+s worth bringing to a doctor+s attention. "he main types of depression include#

Ma,or depression !! five or more symptoms listed above must be present for at least - wee s, but ma,or depression tends to continue for at least . months. /Depression is classified as minor depression if less than five depressive symptoms are present for at least - wee s.0 Dysthymia !! a chronic, generally milder form of depression but lasts longer !! usually as long as two years. $typical depression !! depression accompanied by unusual symptoms, such as hallucinations /for example, hearing voices that are not really there0 or delusions /irrational thoughts0.

1ther common forms of depression include#

2ostpartum depression !! many women feel somewhat down after having a baby, but true postpartum depression is rare. 2remenstrual dysphoric disorder /2MDD0 !! depressive symptoms occur one wee prior to menstruation and disappear after you menstruate. Seasonal affective disorder /S$D0 !! occurs during the fall!winter season and disappears during the spring!summer season. )i ely to be due to lac of sunlight. Depression may also occur with mania / nown as manic!depression or bipolar disorder0. 'n this condition, moods cycle between mania and depression. Depression is more common in women than men and is especially common during the teen years. Men seem to see help for feelings of depression less often than women. "herefore, women may only have more documented cases of depression. Causes Depression often runs in families. "his may be from heredity, learned behavior, or both. &ven with a genetic predisposition, it is usually a stressful or unhappy life event that triggers the onset of a depressive episode. Depression may be brought on by#

Disappointment at home, wor , or school /in teens, this may be brea ing up with a boyfriend or girlfriend, failing a class, or parents divorcing0 Death of a friend or relative 2rolonged pain or having a ma,or illness Medical conditions such as hypothyroidism /underactive thyroid0, cancer, or hepatitis Drugs such as sedatives and high blood pressure medications $lcohol or drug abuse 3hronic stress 3hildhood events li e abuse or neglect Social isolation /common in the elderly0 4utritional deficiencies /such as folate and omega!5 fatty acids0 Sleeping problems Home Care 'f you are depressed for - wee s or longer, you should contact your doctor, who can offer treatment options. (egardless of whether you have mild or ma,or depression, the following self!care steps can help#

Get enough sleep. %ollow a healthy, nutritious diet. &xercise regularly. $void alcohol, mari,uana, and other recreational drugs. Get involved in activities that ma e you happy, even if you don+t feel li e it. Spend time with family and friends.

"ry tal ing to clergy or spiritual advisors who may help give meaning to painful experiences. 3onsider prayer, meditation, tai chi, or biofeedbac as ways to relax or draw on your inner strengths. $dd omega!5 fatty acids to your diet, which you can get from cold!water fish li e tuna, salmon, or mac erel. "a e folate /vitamin B60 in the form of a multivitamin /788 to 988 micrograms0. 'f your depression occurs in the fall or winter months, try light therapy using a special lamp that mimics the sun. Many people try a popular over!the!counter herb called St. :ohn+s *ort. Some studies do suggest that this herbal remedy may be helpful for mild depression, but not moderate or severe. Be aware that St. :ohn+s *ort has potential drug interactions and should 41" be ta en with prescription antidepressants, birth control pills, protease inhibitors for ;'<, theophylline, warfarin, digoxin, reserpine, cyclosporine, or loperamide. "al to your doctor if you are thin ing about trying this herb for mild depression. 'f you have moderate to severe depression, the most effective treatment plan will li ely be a combination of counseling and medication. When to Contact a Medical Professional 3all 6==, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others. 3all your doctor right away if#

>ou hear voices that are not there. >ou have fre?uent crying spells with little or no provocation. >ou have had feelings of depression that disrupt wor , school, or family life for longer than - wee s. >ou have 5 or more depressive symptoms. >ou thin that one of your current medications may be ma ing you feel depressed. D1 41" change or stop any medications without consulting your doctor. >ou believe that you should cut bac on drin ing, a family member or friend has as ed you to cut bac , you feel guilty about the amount of alcohol you drin , or you drin alcohol first thing in the morning. $ complete history, a psychiatric interview and a physical examination will be performed to try to classify your depression as mild, moderate, or severe and to see if there is an underlying, treatable cause /such as alcohol abuse or an underactive thyroid0. ;ospitali@ation is usually recommended if suicide seems possible. &xpect some exploration of the issues and events associated with your feelings of depression. >our doctor will as you about#

>our depressive moods and other associated symptoms /sleep, appetite, concentration, energy0.

2ossible stressors in your life, and support systems in place. *hether thoughts about ending your life have ever crossed your mind. Drug and alcohol use, and about the medications you are currently ta ing, if any. "reatment will vary according to the cause and severity of your depressive symptoms, as well as your personal preference. "he most effective therapy for moderate or severe depression is a combination of antidepressant medication and psychotherapy. %or mild depression, counseling and self!care measures without medication may be enough. 'f you are ta ing medications for other purposes that could cause depression as a side effect, these may need to be changed. D1 41" change or stop any of your medications without consulting your doctor. %or people who are so severely depressed as to be unable to function, or who are suicidal and cannot be safely cared for in the community, psychiatric hospitali@ation may be necessary. Prevention ;ealthy lifestyle habits can help prevent depression, or lessen the chances of it happening again. "hese habits include eating properly, sleeping ade?uately, exercising regularly, learning to relax, and not drin ing alcohol or using drugs. 3ounseling may help you through times of grief, stress, or low mood. %amily therapy may be particularly important for teens who feel blue. %or elderly or others who feel socially isolated or lonely, try volunteering or getting involved in group activities. Moore D, :efferson :. Ma,or Depressive Disorder. 'n# Handbook of Medical Psychiatry. -nd ed. Mosby, 'nc., -887; =57!=7=. Screening for Depression Recommendations and Rationale. AS 2reventive Services "as %orce, Guidelines from Guide to 3linical 2reventive Services# 5rd ed. (oc ville, Md. AS Department of ;ealth and ;uman Services, 2ublic ;ealth Service, $gency for ;ealth 3are 2olicy and (esearch; May =, -88-. *orld ;ealth 1rgani@ation. The World Health Report 2 ! " Mental Health# $e% &nderstanding' $e% Hope. Geneva *orld ;ealth 1rgani@ation, -88=. Guide to 3linical 2reventive Services# Screening for Depression, (ecommendations and (ationale. (oc ville, Md. AS 2reventive Services "as %orce, Dept of ;ealth and ;uman Services, 2ublic ;ealth Service, $gency for ;ealth 3are 2olicy and (esearch. (nn )ntern Med. -88-; =5./=80# B.8CB.7. Practice *uideline for the Treatment of Patients With Ma+or Depressi,e Disorder, -nd &d. $rlington, <$# $merican 2sychiatric $ssociation; -888.

A Special Message For Anyone Who Has Panic Attacks What !f ! "old #ou #our Ne$t Panic Attack Would %nly &ast A Fe' Seconds and "hat #ou 'ould Never Have "o ($perience Another Again )egardless %f What #ou Have *een &ed "o *elieve Acute An$iety And Panic Attacks Can *e Cured !n (asy+"o+Follo' Steps Without Any Medication ,sing A )evolutionary Ne' "echni-ue )eno'ned An$iety ($pert Joe Barry Has "aught "housands %f People "o *e Panic Free. +Here !s Ho'... From /oe *arry March 01 2334 Dear %riend ;ave you experienced the terrifying sensations of a panic attac D Do you suffer from anxiety or its associated symptoms. 'f so, you are not alone. More and more people right across the world, are reporting to suffer from anxiety and panic attac s. This is a very unfortunate but totally unnecessary experience. (re any of these symptoms familiar to you during an an-iety episode.

Di//y spells leading to panic Tightness in throat and chest" shortness of breath Racing heart %ith tingle sensations 0bsessi,e %orries and un%anted thoughts 0,er%helming fear that something a%ful is about to occur

"hese and other similar uncomfortable sensations are all too common but the truth is you do not have to ever suffer from another panic attack or an$iety attack again +!5ll e$plain 'hy. Most of the people ' deal with have been struggling with anxiety disorders for many years and have usually exhausted themselves loo ing for a solution in every boo , course, or treatment program out there. By the time they get to me, they are very s eptical and have little faith in ever getting rid of their condition. "his does not have to be the case with you. Soon !5ll *e Sho'ing #ou "he Most Po'erful "echni-ue For (liminating An$iety And Panic Attacks "he techni?ue ' teach has been developed by me :oe Barry, a former sufferer of all too fre?uent panic attac s. ' developed a completely natural approach to eliminating =88E of anxiety and panic attac s within minutes. "his may seem very hard to believe for someone who may have had this condition for some time but believe me the ne' information is no' availa6le to 6e free from an$iety. ! 'ill reveal the 'hole techni-ue to you.

>ou will be ama@ed at how such a simple techni?ue nown as the 0ne Mo,e1 techni2ue could be so powerful in restoring you bac to your former care free self. ' am not only tal ing about eliminating panic attac s but also getting your general anxiety level right bac down to @ero without the use of any medication or prescriptive relaxation techni?ues. #our an$iety 'ill vanish. #our Confidence Will Soar And "he )esults &ast A &ifetime. Best of all...

't does not rely on outdated anxiety techni?ues such as Fdeep breathingF or Fpositive affirmationsF.

't ta es seconds to implement wherever you are, !at home, at wor or out sociali@ing with friends. "his techni?ue is not 4)2 or hypnosis. 't is an advanced cognitive techni?ue born from traditional psychology practices. >ou will no longer have to spend anymore money on expensive doctor or therapist visits. >ou will not be as ed to follow a time consuming 58 step program that will bring only minor improvements. $fter reading this information you will be able to immediately have confidence to tac le any of the big stresses you may have been putting off e.g. driving1 air travel1 intervie's etc. 7etting #ou *ack "o #our Former Self !s What !s !mportant ..."hat5s %ur 7oal "ogether >ou let me put the techni?ue to wor for you and with pure ,oy you will see calm being restored to your life. ' developed and refined this techni?ue over the past =8 years and chances are you will not have come across anything li e it before. &veryone of the testimonials found here is legitimate and written by people ,ust li e you. 'f you will let me ' will tell you something extremely important about anxiety and panic attac s. "his is crucial if you are to seriously begin on the road to full recovery

1G, here goes..

"his !s "he 8ey "o *eing Panic Attack Free... #ou Must &earn "o *reak "he Fear %f Having Another Panic Attack %r #ou Will Never ($perience Complete Freedom From An$iety !"he anticipation of a panic attac starts the wave cycle of anxiety in motion. !"he foundation of a future panic attac is laid hours before you actually experience one. !"he slightest trigger will then launch the full blown panic attac into full motion. !2anic manifests itself in approximately -8 minute formations. "his !s Where #our Pro6lem &ies "here is one ey factor that ma es the difference between those who fully eliminate panic attac s from their lives and those who do not. "he ey ingredient is not medication, lifestyle changes, or relaxation exercises. 't is when the individual no longer fears the thought of having a panic attack. "his may seem li e a simplified and obvious observation but give it careful consideration. "he one thing that has you searching for a solution to anxiety and panic attac s this very moment is the fear of having another one. "he first time a person experiences a panic attac it can feel li e their world is falling down around them. 4owhere feels safe as the anxiety becomes li e a stal er lur ing in the bac ground. *hen this happens people begin to either avoid situations that ma e them anxious or they medicate themselves to the point where they are numb to the fear. ' am sure you will agree neither of the above is a satisfactory solution. *hat my program Panic Away does, and in particular the One Move technique, is give people the a6ility to immediately stop fearing another panic attack. 't is very simple yet ama@ingly effective. ;ere is how it wor s# $fter a person experiences a panic attac for the first time, the experience can be so impacting that it leaves a strong imprint on the persons psyche. "his mental imprint generates a cycle or loop of an$iety /see diagram0 whereby the person develops an unhealthy fear of having another panic attac . 2eople can spend anywhere from months to years caught in this repetitive cycle of anxiety. Panic (%ay teaches a techni?ue that now allows that person to 6reak the cycle of an$iety and return to normal everyday living. "he really uni?ue element of the techni?ue, is that there is no need for you to regress into your past and find out why you had your initial panic attac in order to get results. $ll that is needed is your willingness to brea out of the anxiety cycle. Are you ready to try this right no' 9

'n the end you must

*reak "his Cycle %f Fear With A "ool "hat Will Allo' #ou "o Never Fear Another Panic Attack "hat Has *een "he Solution For "he "housands %f People ! have "aught So Far

There is more...

!)earn to avoid ma ing the one mista e almost everyone ma es during a panic attac episode. !>ou may have heard the reassuring fact that panic attac s are not life threatening but did you now exactly why this isD Being fully educated on the latest research /-88.0 will help you understand the true nature of panic attac s. !*hat you eat and how you exercise today will effect the power and intensity of your next panic attac . 'n addition Panic (%ay outlines the foods, the correct e$ercises along with some massage pressure points that will completely eliminate all bac ground anxiety. %rom the feedbac ' get, ' have learnt that other courses and treatments out there are not showing people how to do this. (ather than fully empowering you, they teach coping mechanisms and strategies on how to get over a panic attac once it happens. "hat is not good enough. /ust coping 'ith this condition is not good enough. 2eople need a program that teaches them how to free themselves from ever having a another panic attac again. "hat ' am sure is the only ind of result you are interested in. ' 3oe 4arry McDonagh, have been teaching this new revolutionary approach to dealing with anxiety and panic attac s for over five years now and the results are astounding people. "o give you a little bac ground, ' was in my second year of debilitating panic attac s when ! discovered this po'erful techni-ue that stopped panic attacks in their tracks ' had been studying the cognitive behavior approach for dealing with panic attac s from some of the top psychologists when ' discovered this techni?ue."he real brea through came when ' made some startling observations about how a panic attack fuels and generates itself. ' developed the techni?ue on the principle that if you extinguish the fuel that powers the panic attac , you eliminate its reoccurrence. ' began teaching small groups of people my discovery and started getting immediate results. "his surprised me as ' was initially unsure if ' could replicate the same results. 2eople were reporting instant panic elimination and further research confirmed that the techni?ue ' taught was not only instantly effective but also a permanent solution to all forms of panic and anxiety disorders. ' have since taught the %ne Move: techni-ue to thousands of people in over 58 different countries.

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;ave >ou "hought $bout ;ow $nxiety ;olds >ou Bac D Imagine if you will...

2laning holidays or travel without fear of anxiety. 4ever fearing to leave your home or to be alone. ;aving the belief to trust your body is not in any danger whatsoever. to Ma ing appointments or sociali@ing with people and never dreading you might have leave unexpectedly half way through. Going about your business daily without any lingering anxiety or anxious thoughts in your mind. Giving a speech or presentation without any concern of having a panic attac . *atching your close relationships improving as the barrier of fear is removed. %eeling confident to fly ,drive or travel by any means you choose without concern. Stopping nocturnal panic and anxiety that can eep you up at night. it Doing the one thing you love that panic attac s may be stopping you from doing, be hill!wal ing to scuba diving. %eeling really free again. !not caught in feelings or thoughts of disconnected reality. Being free from unsettling thoughts that can encircle your mind.

Fact; A Panic Attack Will Not Harm #ou ' now when you are in the middle of a panic attac it feels li e this terrifying experience is so intense, it might ,ust ill youH >ou feel an array of unusual bodily sensation from di@@iness, rapid heart beat to tingles /paresthesias0 right through your body. >ou fear you may have a heart attac or that the anxiety will push you over the edge mentally. ! 'ant to reassure you that even though the sensations can 6e terrifying1 they 'ill not cause you harm. "here is very good medical studies to bac this up. 'n fact panic attac s are not too dissimilar from a good aerobic exercise wor out. "he fear is powered by an overreaction to bodily sensations.

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So What Can ! "each #ou9... What Makes My "echni-ue So Special 9 Firstly1 My techni?ue is completely uni?ue and proving daily to be an absolute success when it comes to treating anxiety and panic attac s. ' have extensive experience wor ing through my own anxiety and then that of countless others through private coaching. *hile going through my own anxiety episode ! studied the 6est psychologists 'orking in the field. ' learnt a huge amount from them but not enough to get me panic free. $lmost by accident ' stumbled on a techni?ue that brought it all together and got me immediately anxiety free . 1ver the years wor ing with people ' developed the techni?ue, honed it down, and made it more understandable so that everyone, regardless of their situation, could apply it. "his is years of e$perience ! 'ant to share 'ith you. Secondly1 ' am a perfectionist. 'f you wor with me ' am dedicated to your well being. ;aving suffered from panic attac s ' would never promote something unless it was getting truly remar able results. ! am not interested in half hearted results1 ' want you to cross the finish line ,ust li e ' did and move beyond the anxiety issue that is holding you bac . ' truly believe you will get full recovery using my program. 2lease do not mista e this for 'nternet hype or an exaggerated sales pitch. "hirdly1 ' love results. 'n the end this is all about the results.! (esults (esults (esults. ' will use the exact same procedure ' used to get results for all the people ' have helped to date. (eal results are what drives me to get this information out there to the wider public who suffer from anxiety and panic attac s. 'Fll teach you the most critical information you need to now in a concise manner. >ou will not be as ed to digest pages of unnecessary filler or fluff. &very page is relevant to you and part of a structured process.

Ho' Did ! 7et Someone 'ith <3 years of Panic Attacks Completely An$iety Free9 ...' used the exact same techni?ue ' am going to share with you. ' will help you ?uic ly brea down negative patterns that might be stopping you from feeling well again. ' get countless letters, emails, phone calls from people telling me how much of a difference this program has made to their lives. Here is a recent e-ample# Please Don5t &et #our Mind Fool #ou !nto "hinking #our An$iety !s ,ni-ue and Not Cura6le "hat is simply not true and ' have the experience to bac that claim up. "here are no lost causes !no matter ho' long you have 6een suffering from an$iety. >ou must not simply go on coping with this condition. >ou must embrace the opportunity now to change all of that today. 't is so very important to remove these self imposed limitations and get rid of the anxiety that is holding your life bac . 1nly you can ma e the move towards this freedom.

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#ou Must Make "he Move "o'ards an An$iety Free &ife +!t Will Not Find #ou "hings start to happen instantly when you begin my program. Due to the way the course is structured, an internal cognitive shift happens whereby you slowly no longer fear having a panic attac . "hat is a ma,or brea through point and is the pivot of the techni?ue. >our general anxiety drops away and you are restored to your more confident former self. I Have Been Researching This For Over 10 Years -Now You an Benefi! - Here Is How... During my anxiety period ' studied the research papers from the academics and ' read every boo ' could get my hands on. >ou might be familiar with some of these popular authors on the sub,ect of anxiety# 5dmund 3. 4ourne' " Robert Handly' " Pauline $eff' " 6ucinda 4assett "here was however still something missing from all ' read.... ' tried all the exercises ' did the relaxation and breathing techni?ues but nothing was shifting this deep fear of my next dreaded panic attac . 't was very frustrating for ?uite some time. "hen while experimenting with a combination of new cognitive ideas it dawned on me how to extinguish the very fuel the panic attac is driven by. "his changed everything1 ! could no' put myself in all the situations ! feared 'ithout having to 'orry a6out having a panic attack. 3utting the fuel of the panic attac s had some great noc on bonuses, the obsessive worries and unwanted thoughts disappeared as well. 't was li e a dense fog lifted. 1nce ' had moved clear of this fog of anxiety it became clear what mista es ' was ma ing and how a simple change in thin ing was all that was needed to advance my recovery. ' want to share this vital understanding with you right now in order for you to get the exact same powerful results. My program is downloaded to any computer within minutes. What top medical professionals think a6out my techni-ue Allo' me to 6e 6riefly 6oastful... 'n a mar etplace crowed with products and courses telling you they have the solution to your anxiety problem it is very hard to find something new that is truly uni?ue and effective. Nothing ! have come across is getting results like the Panic Away pro ra!. *hat ' have found is that there is a lot of rewriting of old cogniti,e beha,ior therapies and mixtures of relaxationIvisuali@ation techni?ues to help manage the anxiety. DonFt get me wrong these can be very effective at reducing general anxiety levels but they do not go to the very heart of the matter. "he people ! 'ork 'ith have usually tried all those familiar techni-ues and are no' looking for something more effective ! Something that will really accelerate their recovery.Something that will stop them having to ever have another worry about anxiety again.

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>ou see, ' needed to develop a program that tac led the anxiety on two fronts# =0 "he elimination of all 2anic $ttac s. -0 and reduce the persons general anxiety that causes the unwanted thoughts and everyday anxiety. "a ing this approach has led to countless success stories such as# No More... fear of leaving the house in case of a panic attac . 4o more fear of getting stuc somewhere you canFt excuse yourself from. 4o more ma ing excuses why you cannot ma e it to a social engagement. 4o more putting off holiday plans or business travel. 4o more fear of business meetings or situations where you are as ed to spea . 4o more fear of getting stuc in traffic. 4o more living in a very trapped existence.

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Generic name/s0# Al6uterol Brand name/s0# Airet1 Proventil1 Proventil HFA1 =entolin What is the most important information ! should kno' a6out al6uterol inhalation9 't is very important that you use your albuterol inhaler or nebuli@er properly, so that the medicine gets into your lungs. >our doctor may want you to use a spacer with your inhaler. "al to your doctor about proper inhaler and nebuli@er use. See medical attention if you notice that you re?uire more than your usual or more than the maximum amount of any asthma medication in a -7!hour period. $n increased need for medication could be an early sign of a serious asthma attac . What is al6uterol inhalation9 $lbuterol is a bronchodilator. 't wor s by relaxing muscles in the airways to improve breathing. $lbuterol inhalation is used to treat conditions such as asthma, bronchitis, and emphysema. $lbuterol inhalation may also be used for conditions other than those listed in this medication guide. Who should not use al6uterol inhalation9 Before using this medication, tell your doctor if you have

heart disease or high blood pressure, epilepsy or another sei@ure disorder, diabetes, an overactive thyroid /hyperthyroidism0, or any type of liver or idney disease.

What happens if ! miss a dose9 Ase the missed dose as soon as you remember. ;owever, if it is almost time for your next regularly scheduled dose, s ip the missed dose and use the next one as directed. Do not use a double dose of this medication. What should ! avoid 'hile using al6uterol inhalation9 $void situations that may trigger an asthma attac such as exercising in cold, dry air; smo ing; breathing in dust; and exposure to allergens such as pet fur. What are the possi6le side effects of al6uterol inhalation9 Stop using albuterol inhalation and see emergency medical attention if you experience any of the following serious side effects# an allergic reaction /difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives0; or chest pain or irregular heartbeats.

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1ther, less serious side effects may be more li ely to occur. 3ontinue to use albuterol inhalation and tal to your doctor if you experience

headache, di@@iness, lightheadedness, or insomnia; tremor or nervousness; sweating; nausea, vomiting, or diarrhea; or dry mouth.

Side effects other than those listed here may also occur. "al to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs 'ill affect al6uterol inhalation9 Before using albuterol inhalation, tell your doctor if you are ta ing any of the following medicines#

a beta!bloc er such as atenolol /"enormin0, metoprolol /)opressor, "oprol J)0, propranolol /'nderal0, and others; a tricyclic antidepressant such as amitriptyline /&lavil0, doxepin /Sine?uan0, imipramine /"ofranil0, nortriptyline /2amelor0, and others; a monoamine oxidase inhibitor /M$1'0 such as isocarboxa@id /Marplan0, phenel@ine /4ardil0, or tranylcypromine /2arnate0; another inhaled bronchodilator; or caffeine, diet pills, or decongestants.

>ou may not be able to use albuterol inhalation, or you may re?uire a dosage ad,ustment or special monitoring during treatment. Drugs other than those listed here may also interact with albuterol inhalation or affect your condition. "al to your doctor and pharmacist before ta ing any prescription or over!the! counter medicines. Where can ! get more information9 >our pharmacist has additional information about albuterol inhalation written for health professionals that you may read. What does my medication look like9 $lbuterol inhalation is available with a prescription under the brand names <entolin and 2roventil. 1ther brand or generic formulations may also be available. $s your pharmacist any ?uestions you have about this medication, especially if it is new to you.

<entolin =B g!!light!blue inhaler with a dar !blue mouthpiece cover 2roventil =B g!!yellow inhaler with an orange mouthpiece cover

)emem6er1 keep this and all other medicines out of the reach of children1 never share your medicines 'ith others1 and use this medication only for the indication prescri6ed.

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Generic name/s0# Alpra>olam Brand name/s0# Niravam1 ?ana$1 ?ana$ ?) What is the most important information ! should kno' a6out alpra>olam9 Ase caution when driving, operating machinery, or performing other ha@ardous activities. $lpra@olam will cause drowsiness and may cause di@@iness. 'f you experience drowsiness or di@@iness, avoid these activities. $void alcohol while ta ing alpra@olam. $lcohol may increase drowsiness and di@@iness caused by alpra@olam. Do not crush, chew, or brea the extended!release form alpra@olam /Janax J(0. Swallow them whole. "hese tablets are specially formulated to release the medication slowly in the body. $lpra@olam is habit forming. >ou can become physically and psychologically dependent on the medication. Do not ta e more than the prescribed amount of medication or ta e it for longer than is directed by your doctor. *ithdrawal effects may occur if alpra@olam is stopped suddenly after several wee s of continuous use. Sei@ures may be a side effect of sudden discontinuation of the medication. >our doctor may recommend a gradual reduction in dose. What is alpra>olam9 $lpra@olam is in a class of drugs called ben@odia@epines. $lpra@olam affects chemicals in the brain that may become unbalanced and cause anxiety. $lpra@olam is used to relieve anxiety, nervousness, and tension associated with anxiety disorders. $lpra@olam is also used to treat panic disorders. $lpra@olam may also be used for purposes other than those listed in this medication guide. What should ! discuss 'ith my healthcare provider 6efore taking alpra>olam9 Do not ta e alpra@olam if you have narrow!angle glaucoma. $lpra@olam may worsen this condition. Before ta ing this medication, tell your doctor if you

have idney disease; have liver disease; have a history of alcohol or drug abuse; have asthma, bronchitis, emphysema, or another respiratory disease; are depressed or have suicidal thoughts; or have mania, bipolar disorder, or another psychiatric condition /other than anxiety or panic disorder0.

>ou may not be able to ta e alpra@olam, or you may re?uire a dosage ad,ustment or special monitoring during treatment if you have any of the conditions listed above. $lpra@olam is in the %D$ pregnancy category D. "his means that alpra@olam is nown to be harmful to an unborn baby. Do not ta e this medication without first tal ing to your doctor if you are pregnant or could become pregnant during treatment. 't is not nown whether

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alpra@olam passes into breast mil . Do not ta e alpra@olam without first tal ing to your doctor if you are breast!feeding a baby. 'f you are over .K years of age, you may be more li ely to experience side effects from alpra@olam. >our doctor may prescribe a lower dose of the medication. What happens if ! miss a dose9 "a e the missed dose as soon as you remember. ;owever, if it is almost time for the next dose, s ip the dose you missed and ta e only the next regularly scheduled dose. Do not ta e a double dose of this medication. $ double dose could be dangerous. What should ! avoid 'hile taking alpra>olam9 Ase caution when driving, operating machinery, or performing other ha@ardous activities. $lpra@olam will cause drowsiness and may cause di@@iness. 'f you experience drowsiness or di@@iness, avoid these activities. $void alcohol while ta ing alpra@olam. $lcohol may increase drowsiness and di@@iness caused by alpra@olam. $lpra@olam may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives /used to treat insomnia0, pain relievers, anxiety medicines, sei@ure medicines, and muscle relaxants. "ell your doctor about all medicines that you are ta ing, and do not ta e any other medicine without first tal ing to your doctor. What are the possi6le side effects of alpra>olam9 'f you experience any of the following serious side effects, stop ta ing alpra@olam and see emergency medical attention or contact your doctor immediately# an allergic reaction /difficulty breathing; closing of the throat; swelling of the lips, face, or tongue; or hives0; sores in the mouth or throat; yellowing of the s in or eyes; a rash; hallucinations or severe confusion; or changes in vision. 1ther, less serious side effects may be more li ely to occur. 3ontinue to ta e alpra@olam and tal to your doctor if you experience

drowsiness, di@@iness, or clumsiness; depression; nausea, vomiting, diarrhea, or constipation; difficulty urinating; vivid dreams; headache; dry mouth; decreased sex drive; or changes in behavior.

Side effects other than those listed here may also occur. "al to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs 'ill affect alpra>olam9

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Do not ta e etocona@ole /4i@oral0 or itracona@ole /Sporanox0 during treatment with alpra@olam without first tal ing to your doctor. $lpra@olam may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives /used to treat insomnia0, pain relievers, anxiety medicines, sei@ure medicines, and muscle relaxants. "ell your doctor about all medicines that you are ta ing, and do not ta e any medicine without first tal ing to your doctor. $ntacids may decrease the effects of alpra@olam. Separate doses of an antacid and alpra@olam by several hours whenever possible. Drugs other than those listed here may also interact with alpra@olam. "al to your doctor and pharmacist before ta ing any prescription or over!the!counter medicines, including herbal products. Where can ! get more information9 >our pharmacist has additional information about alpra@olam written for health professionals that you may read. What does my medication look like9 $lpra@olam is available with a prescription under the brand names Janax and 4iravam. 1ther brand or generic formulations may also be available. $s your pharmacist any ?uestions you have about this medication, especially if it is new to you. )emem6er1 keep this and all other medicines out of the reach of children1 never share your medicines 'ith others1 and use this medication only for the indication prescri6ed.

Generic name/s0# @olpidem Brand name/s0# Am6ien1 Am6ien C) What is the most important information ! should kno' a6out >olpidem9 Ase caution when driving, operating machinery, or performing other ha@ardous activities. Lolpidem will cause drowsiness and may cause di@@iness. 'f you experience drowsiness or di@@iness, avoid these activities. Lolpidem should be ta en ,ust before bedtime. >ou may experience some carryover effects the next day. Do not drin alcohol while ta ing @olpidem. $lcohol will increase drowsiness and may increase di@@iness while you are ta ing @olpidem, which could be dangerous. Do not stop ta ing @olpidem suddenly if you have been ta ing it for more than = or - wee s. "his may cause withdrawal symptoms and ma e you uncomfortable. "al to your doctor if you need to stop treatment with @olpidem. Do not crush, chew, or brea the controlled!release @olpidem tablets. Swallow the controlled! release tablets whole. What is >olpidem9 Lolpidem is in a class of drugs called sedativeIhypnotics or sleep medications. Lolpidem affects chemicals in your brain that may become unbalanced and cause insomnia.

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Lolpidem induces sleep and causes relaxation. 't is used to treat sleep disorders such as trouble falling asleep, wa ing up many times during the night, or wa ing up too early in the morning. Lolpidem is for short!term use only!!usually B to =8 days. )onger!term use must be monitored closely by a doctor. Lolpidem may also be used for purposes other than those listed in this medication guide. What should ! discuss 'ith my healthcare provider 6efore taking >olpidem9 Before ta ing this medication, tell your doctor if you

have idney disease; have liver disease; have asthma, bronchitis, emphysema, or another respiratory disease; or are depressed or have suicidal thoughts.

>ou may not be able to ta e @olpidem, or you may re?uire a lower dose or special monitoring during treatment if you have any of the conditions listed above. Lolpidem is in the %D$ pregnancy category B. "his means that it is unli ely to harm an unborn baby. Do not ta e @olpidem without first tal ing to your doctor if you are pregnant or could become pregnant during treatment. Lolpidem passes into breast mil and may affect a nursing baby. Do not ta e this medication without first tal ing to your doctor if you are breast!feeding a baby. 'f you are over .8 years of age, you may be more li ely to experience side effects from @olpidem. >ou may re?uire a lower dose of this medication. Lolpidem is not approved by the %D$ for use by children younger than =9 years of age. What happens if ! miss a dose9 Since @olpidem is usually ta en only if you need it to help you sleep, missing a dose will not cause any problems. "a e the missed dose only if you can be sure that you will get B or 9 full hours of sleep after the dose. 'f you do not sleep for B or 9 full hours, you may experience carryover effects from @olpidem after you wa e up. What should ! avoid 'hile taking >olpidem9 Ase caution when driving, operating machinery, or performing other ha@ardous activities. Lolpidem will cause drowsiness and may cause di@@iness. 'f you experience drowsiness or di@@iness, avoid these activities. Lolpidem should be ta en ,ust before bedtime. >ou may experience some carryover effects the next day. Do not drin alcohol while ta ing @olpidem. $lcohol will increase drowsiness and may increase di@@iness while you are ta ing @olpidem, which could be dangerous. $void other sedatives, sleeping pills, and tran?uili@ers, including over!the!counter preparations. "hey should not be used while you are ta ing @olpidem unless your doctor directs otherwise. What are the possi6le side effects of >olpidem9 'f you experience any of the following serious side effects, stop ta ing @olpidem and see emergency medical attention# an allergic reaction /difficulty breathing; closing of your throat; swelling of your lips, face, or tongue; hives0; or hallucinations, abnormal behavior, or severe confusion.

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1ther, less serious side effects may be more li ely to occur. 3ontinue to ta e @olpidem and tal to your doctor if you experience

headache, drowsiness, di@@iness, or clumsiness; nausea, vomiting, diarrhea, or constipation; depression; muscle aches or pains; vivid or abnormal dreams; or amnesia /memory loss0 after a dose.

$ problem that may occur when sleep medicines are stopped is nown as Mrebound insomnia.M "his means that a person may have more trouble sleeping the first few nights after the medicine is stopped than before starting the medicine. 'f you should experience rebound insomnia, do not get discouraged. "his problem usually goes away on its own after = or - nights Lolpidem is habit forming. Stopping this medication suddenly can cause withdrawal effects if you have ta en it continuously for several wee s. "al to your doctor about the safe use of this medication. Side effects other than those listed here may also occur. "al to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs 'ill affect >olpidem9 Lolpidem may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, other sedatives /used to treat insomnia0, pain relievers, anxiety medicines, and muscle relaxants. "ell your doctor about all medicines that you are ta ing, and do not ta e any medicine unless your doctor approves. Drugs other than those listed here may also interact with @olpidem. "al to your doctor and pharmacist before ta ing any prescription or over!the!counter medicines, including herbal products. Where can ! get more information9 >our pharmacist has additional information about @olpidem written for health professionals that you may read. What does my medication look like9 Lolpidem is available with a prescription under the brand name $mbien. 1ther brand or generic formulations of this medication may also be available. $s your pharmacist any ?uestions you have about this medication, especially if it is new to you.

$mbien K mg!!pin , capsule!shaped, film!coated tablets $mbien =8 mg!!white, capsule!shaped, film!coated tablets $mbien 3( ..-K mg!!pin round controlled release tablets

)emem6er1 keep this and all other medicines out of the reach of children1 never share your medicines 'ith others1 and use this medication only for the indication prescri6ed.

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Generic name/s0# (scitalopram Brand name/s0# &e$apro What is the most important information ! should kno' a6out escitalopram9 >ou may have an increased ris of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under =9 years old. "al with your doctor about this ris . *hile you are ta ing escitalopram you will need to be monitored for worsening symptoms of depression andIor suicidal thoughts during the first wee s of treatment, or whenever your dose is changed. 'n 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. >our doctor will need to chec you at regular visits for at least the first =- wee s of treatment. 3ontact 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 attac s, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania /mental andIor physical hyperactivity0, thoughts of suicide or hurting yourself. Do not ta e escitalopram together with a monoamine oxidase inhibitor /M$1'0 such as isocarboxa@id /Marplan0, phenel@ine /4ardil0, selegiline /&ldepryl, &msam0, or tranylcypromine /2arnate0. >ou must wait at least =7 days after stopping an M$1' before you can ta e escitalopram. What is escitalopram9 &scitalopram is an antidepressant in a group of drugs called selective serotonin reupta e inhibitors /SS('s0. &scitalopram affects chemicals in the brain that may become unbalanced and cause depression or anxiety. &scitalopram is used to treat anxiety and ma,or depressive disorder. &scitalopram may also be used for purposes other than those listed in this medication guide. What should ! discuss 'ith my healthcare provider 6efore taking escitalopram9 >ou may have an increased ris of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under =9 years old. "al with your doctor about this ris . *hile you are ta ing escitalopram you will need to be monitored for worsening symptoms of depression andIor suicidal thoughts during the first wee s of treatment, or whenever your dose is changed. 'n 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. >our doctor will need to chec you at regular visits for at least the first =- wee s of treatment. Do not use escitalopram if you are using an M$1 inhibitor such as isocarboxa@id /Marplan0, tranylcypromine /2arnate0, phenel@ine /4ardil0, or selegiline /&ldepryl, &msam0. Serious and sometimes fatal reactions can occur when these medicines are ta en with

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escitalopram. >ou must wait at least =7 days after stopping an M$1 inhibitor before you can ta e escitalopram. Before ta ing escitalopram, tell your doctor if you have#

liver or idney disease; sei@ures or epilepsy; bipolar disorder /manic depression0; or a history of drug abuse or suicidal thoughts.

'f you have any of these conditions, you may not be able to use escitalopram, or you may need a dosage ad,ustment or special tests during treatment. %D$ pregnancy category 3. "his medication may be harmful to an unborn baby. "ell your doctor if you are pregnant or plan to become pregnant during treatment. &scitalopram can pass into breast mil and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast!feeding a baby. Ho' should ! take escitalopram9 "a e this medication exactly as it was prescribed for you. Do not ta e the medication in larger amounts, or ta e it for longer than recommended by your doctor. >our doctor may occasionally change your dose to ma e sure you get the best results from the medication. "a e each dose with a full glass of water. "ry to ta e the medicine at the same time each day. "o be sure you get the correct dose of li?uid escitalopram, measure the li?uid with a mar ed measuring spoon or medicine cup, not with a regular table spoon. 'f you do not have a dose!measuring device, as your pharmacist for one. 't may ta e 7 wee s or more for you to start feeling better. Do not stop using escitalopram without first tal ing to your doctor. >ou may have unpleasant side effects if you stop ta ing this medication suddenly. Store escitalopram at room temperature away from moisture and heat. What happens if ! miss a dose9 "a e the missed dose as soon as you remember. ;owever, if it is almost time for the next regularly scheduled dose, s ip the missed dose and ta e the next one as directed. Do not ta e extra medicine to ma e up the missed dose. What should ! avoid 'hile taking escitalopram9 Do not ta e escitalopram together with citalopram /3elexa0, isocarboxa@id /Marplan0, phenel@ine /4ardil0, selegiline /&ldepryl, &msam0, or tranylcypromine /2arnate0. $void drin ing alcohol, which can increase some of the side effects of escitalopram. $void using other medicines that ma e you sleepy /such as cold medicine, other pain medication, muscle relaxants0. "hey can add to sleepiness caused by escitalopram. &scitalopram can cause side effects that may impair your thin ing or reactions. Be careful if you drive or do anything that re?uires you to be awa e and alert. What are the possi6le side effects of escitalopram9 Get emergency medical help if you have any of these signs of an allergic reaction# s in rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. 3ontact your

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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 attac s, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania /mental andIor physical hyperactivity0, thoughts of suicide or hurting yourself. 3all your doctor at once if you have any of these serious side effects#

sei@ure /convulsions0; tremors, shivering, muscle stiffness or twitching; problems with balance or coordination; or agitation, confusion, sweating, fast heartbeat.

1ther less serious side effects are more li ely to occur, such as#

feeling nervous, restless, or unable to sit still; headache, trouble concentrating; drowsiness, di@@iness; sleep problems /insomnia0; nausea, diarrhea, heartburn; weight changes; decreased sex drive, impotence, or difficulty having an orgasm; or dry mouth, ringing in your ears.

Side effects other than those listed here may also occur. "al to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs 'ill affect escitalopram9 "al to your doctor before ta ing any medicine for pain, arthritis, fever, or swelling. "his includes aspirin, ibuprofen /$dvil, Motrin0, naproxen /$leve, 4aprosyn0, diclofenac /<oltaren0, indomethacin, piroxicam /%eldene0, nabumetone /(elafen0, etodolac /)odine0, and others. "a ing any of these drugs with escitalopram may cause you to bruise or bleed easily. Before ta ing escitalopram, tell your doctor if you are using any of the following medicines#

carbama@epine /"egretol0; cimetidine /"agamet0; lithium /)ithobid, &s alith0; a blood thinner such as warfarin /3oumadin0; any other antidepressants such as amitriptyline /&lavil0, citalopram /3elexa0, fluoxetine /2ro@ac, Sarafem0, fluvoxamine /)uvox0, imipramine /"ofranil0, nortriptyline /2amelor0, paroxetine /2axil0, or sertraline /Loloft0; or almotriptan /$xert0, frovatriptan /%rova0, sumatriptan /'mitrex0, naratriptan /$merge0, ri@atriptan /Maxalt0, or @olmitriptan /Lomig0.

'f you are using any of these drugs, you may not be able to use escitalopram, or you may need dosage ad,ustments or special tests during treatment. "here may be other drugs not listed that can affect escitalopram. "ell your doctor about all the prescription and over!the!counter medications you use. "his includes vitamins,

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minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Where can ! get more information9 >our pharmacist has additional information about escitalopram written for health professionals that you may read. What does my medication look like9 &scitalopram is available with a prescription under the brand name )exapro. 1ther brand or generic formulations may also be available. $s your pharmacist any ?uestions you have about this medication, especially if it is new to you.

)exapro K mg!!white, round, tablets )exapro =8 mg!white, round, scored tablets )exapro -8 mg!white, round, scored tablets )exapro K mgIK m)!peppermint!flavored oral solution

)emem6er1 keep this and all other medicines out of the reach of children1 never share your medicines 'ith others1 and use this medication only for the indication prescri6ed. What is S()%A,(&9 S&(1NA&) is a prescription medicine for the treatment of both depressive episodes in bipolar disorder and manic episodes in bipolar ' disorder. $lthough the exact way that S&(1NA&) wor s is not nown, it is thought to wor by regulating the balance of chemicals in the brain. (emember, only you and your doctor can decide if S&(1NA&) is right for you. What kinds of symptom results have 6een reported 'ith S()%A,(&9 'n clinical studies, S&(1NA&) effectively treated both depressive symptoms and manic symptoms associated with bipolar disorder. "epressive sy!pto!s 'n clinical studies, patients treated for depression showed these types of improvements#

&ess sadness &ess pessimism More normal sleep &ess edgy and tense

"hese people also showed improvement in the way they managed these other depressive symptoms#

(educed appetite 3oncentration difficulties

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%ears 'nability to perform everyday tas s

Manic sy!pto!s 'n clinical studies, patients treated for mania showed these types of improvements#

Fe'er racing thoughts *etter Budgment More normal sleep &ess irrita6ility

"hese people also showed improvement in the way they managed these other manic symptoms#

&levated mood Distractibility $gitation Disheveled appearance ;ypersexuality $ggressive behavior "al ing too fast

Ho' soon can ! e$pect results from S()%A,(&9 &veryone will respond differently; however, symptom improvements have been seen as early as the first wee for some patients. ;owever, it may ta e you several wee s before you start to feel better. "ry to be patient and follow your doctorFs directions. 't is important to ta e S&(1NA&) exactly as your doctor has prescribed. What are the most common side effects 'ith S()%A,(&9 'n clinical studies, the most commonly observed side effects were dry mouth, drowsiness, sedation, di@@iness, wea ness, constipation, abdominal pain, sudden drop in blood pressure when standing, sore throat, weight gain, abnormal liver tests, upset stomach, and lethargy. What important safety information should ! kno' a6out S()%A,(&9

$ntidepressants have been shown to increase the ris of suicidal thoughts and actions in children and teens. $ll patients should be watched closely by family members and caregivers and any worsening or unusual changes in behavior should be reported to their physician immediately "he following have been reported with S&(1NA&) and medicines li e it. "ell your doctor if you experience any of the following o <ery high fever; rigid muscles; sha ing; confusion; sweating; changes in pulse, heart rate, or blood pressure; or muscle pain and wea ness as these may be a sign of a rare, but potentially fatal, side effect nown as neuroleptic malignant syndrome

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o o

Ancontrollable movements of the face, tongue, or other parts of the body, nown as tardive dys inesia &xcessive thirst or hunger, increased urination or wea ness, as these may be signs of diabetes

What else should ! kno' a6out taking S()%A,(&9

>ou may feel light!headed or di@@y, especially when you stand up from a lying position, when you start ta ing S&(1NA&), or when your dosage changes $n eye exam for cataracts is recommended at the beginning of treatment and every . months "ell your doctor if you have a history of or are at ris for sei@ures >ou may feel drowsy, especially when you first start ta ing S&(1NA&). Do not drive or operate machinery if you feel drowsy >ou should avoid becoming pregnant while on S&(1NA&) >ou should not breast!feed while on S&(1NA&) >ou should notify your health care provider if you are ta ing or plan to ta e any prescription or over!the!counter drugs >ou should avoid consuming alcoholic beverages Be sure to drin plenty of water to avoid becoming dehydrated or overheated >ou may have dry mouth. 't may help to suc on sugar!free hard candy or chew sugar!free gum and use a room vapori@er to add moisture to the air "a e S&(1NA&) as prescribed by your doctor. >ou should contact your doctor if you feel the need to stop treatment

Will ! gain 'eight 'ith S()%A,(&9

>ou may gain weight with S&(1NA&). 'n clinical studies, the average weight gain was approximately 7 pounds over a period of up to 97 days. Be sure to get regular exercise and eat a wellObalanced diet. !n addition to medicine1 'hat can ! do to manage my 6ipolar disorder9 "he ma er of S&(1NA&) believes there is more to treatment than ,ust ta ing medicineO and therefore offers resources that can help you understand your condition better, trac your improvement, stic with your prescribed medicine schedule, and more.

!mportant Safety !nformation "his is not a complete summary of safety information. Serious side effects can occur with any psychotropic medication. 2lease discuss the full Prescribing Information with your health care provider.

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S&(1NA&) is indicated for the treatment of depressive episodes in bipolar disorder and acute manic episodes in bipolar ' disorder. (lderly patients 'ith dementia+related psychosis Chaving lost touch 'ith reality due to confusion and memory lossD treated 'ith this type of medicine are at an increased risk of death compared to place6o Csugar pillD. S()%A,(& is not approved for treating these patients. Antidepressants have increased the risk of suicidal thoughts and actions in children and teenagers. All patients starting treatment should 6e 'atched closely for 'orsening of depression1 suicidal thoughts or actions1 unusual changes in 6ehavior1 agitation1 and irrita6ility. Families and caregivers should 'atch patients daily and report these symptoms immediately to their physician. S()%A,(& is not approved for patients under the age of EF. $ rare, but potentially fatal side effect reported with S&(1NA&) and medicines li e it, is neuroleptic malignant syndrome /4MS0. "ell your doctor if you have very high fever; rigid muscles; sha ing; confusion; sweating; changes in pulse, heart rate, or blood pressure; or muscle pain and wea ness because treatment should be stopped if you have 4MS. $nother serious side effect reported with S&(1NA&) and medicines li e it is tardive dys inesia /"D0# uncontrollable movements of the face, tongue, or other parts of the body. "D may become permanent, and the ris of "D is believed to increase as the amount of and length of time on these medications increase. *hile "D can develop in patients ta ing low doses for short periods, this is much less common. "here is no nown treatment for "D, but it may go away partially or completely if treatment is stopped. ;igh blood sugar and diabetes have been reported with S&(1NA&) and medicines li e it. 'f you have diabetes or ris factors such as obesity or a family history of diabetes, as your doctor about chec ing your blood sugar before starting S&(1NA&) and throughout treatment. 'f you develop symptoms of high blood sugar or diabetes, such as excessive thirst or hunger, increased urination or wea ness, contact your doctor. 3omplications from diabetes can be serious and even life threatening. $n eye exam for cataracts is recommended at the beginning of treatment and every . months. "ell your doctor if you have a history of or are at ris for sei@ures. Since drowsiness has been reported with S&(1NA&), you should not participate in activities such as driving or operating machinery until you now that you can do so safely. $void drin ing alcohol while ta ing S&(1NA&) because it increases the effects of alcohol. $void becoming overheated or dehydrated while ta ing S&(1NA&). "he most common side effects are dry mouth, drowsiness, sedation, di@@iness, wea ness, constipation, abdominal pain, sudden drop in blood pressure when standing, sore throat, weight gain, abnormal liver tests, upset stomach, and lethargy.

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"'o different conditions &ven though ma,or depressive disorder /what many of us call MdepressionM0 and bipolar disorder have some symptomsOthe depressive onesOin common, they are t%o different conditions7and they re2uire different treatments. 'n general, depression involves overwhelming feelings of sadness, worthlessness, and hopelessness. Bipolar disorder involves periods of depressive episodes and manic episodes. Manic episodes are periods of elated mood, which can include racing thoughts, extreme irritability or rec less behavior. Some people with bipolar disorder may experience mixed episodesOperiods of time when symptoms of both depression and mania may be presentOalthough S&(1NA&) is not indicated for the treatment of mixed episodes. Depression and bipolar disorder can each interfere with your daily life, ma ing it more difficult to accomplish and en,oy the things you normally do. But if the condition is diagnosed correctly, you can receive appropriate treatment!and embrace the activities and relationships that matter most to you. Misperceptions a6out 6ipolar disorder Bipolar disorder causes depressive episodes and manic episodes at different times during the illness. $ common misperception is that bipolar mood changes are usually ?uic and drastic. 'n reality, mood shifts are often ?uite gradual. $n episodeOwhether depressive or manicOcan last for days, wee s, months, or even years. Moreover, people with bipolar disorder are not always depressed or manic; they can go for long stretches of time in a Mnormal,M balanced mood. "he typical person with bipolar disorder has an average of four episodes during the first =8 years of the illness.= Depressive episodes vs manic episodes Bipolar disorder affects people differently. >ou may experience some of the symptoms listed here#

Depressive (pisodes2 Sadness &xcessive crying )oss of pleasure Sleeping too much or too little )ow energy (estlessness

Manic (pisodes2 (acing thoughts; tal ing too much &xtreme irritability 'nappropriate sense of euphoria /excitement0 (ec less behavior )ittle sleep needed

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Difficulty concentrating 'rritability )oss of appetite or overeating %eelings of worthlessness and hopelessness 1ngoing physical problems that are not caused by physical illness or in,ury /eg, headaches, digestive problems, pain0 "houghts of death or suicide

&xcessive energy 1ut of control spending Difficulty concentrating $bnormally increased activity, including sexual activity 2oor ,udgment $ggressive behavior

)isk factors for 6ipolar disorder More than three percent of AS adults have bipolar disorder.5 "he illness affects men and women e?ually7 and is found in all races and ethnic groups. 2eople with a family history of either bipolar disorder or depression are at increased ris for bipolar disorder.K 't is very important to tell your doctor about any family members with a history of mental illness. A treatment for 6ipolar disorder 'f you do receive a diagnosis of bipolar disorder, you and your doctor may explore various medication options. S&(1NA&) is one treatment you may wish to consider. )earn more about S&(1NA&)

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Generic name/s0# Sertraline Brand name/s0# @oloft What is the most important information ! should kno' a6out sertraline9 >ou may have an increased ris of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under =9 years old. "al with your doctor about this ris . *hile you are ta ing sertraline you will need to be monitored for worsening symptoms of depression andIor suicidal thoughts during the first wee s of treatment, or whenever your dose is changed. 'n 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. >our doctor will need to chec you at regular visits for at least the first =- wee s of treatment. 3ontact 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 attac s, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania /mental andIor physical hyperactivity0, thoughts of suicide or hurting yourself. Do not ta e sertraline together with pimo@ide /1rap0, or a monoamine oxidase inhibitor /M$1'0 such as isocarboxa@id /Marplan0, phenel@ine /4ardil0, selegiline /&ldepryl, &msam0, or tranylcypromine /2arnate0. >ou must wait at least =7 days after stopping an M$1' before you can ta e sertraline. What is sertraline9 Sertraline is an antidepressant in a group of drugs called selective serotonin reupta e inhibitors /SS('s0. Sertraline affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive!compulsive symptoms. Sertraline is used to treat depression, obsessive!compulsive disorder, panic disorder, anxiety disorders, post!traumatic stress disorder /2"SD0, and premenstrual dysphoric disorder /2MDD0. Sertraline may also be used for purposes other than those listed in this medication guide. What should ! discuss 'ith my healthcare provider 6efore taking sertraline9 >ou may have an increased ris of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under =9 years old. "al with your doctor about this ris . *hile you are ta ing sertraline you will need to be monitored for worsening symptoms of depression andIor suicidal thoughts during the first wee s of treatment, or whenever your dose is changed. 'n addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your

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mood or symptoms. >our doctor will need to chec you at regular visits for at least the first =- wee s of treatment. Do not use sertraline if you are using pimo@ide /1rap0, or an M$1 inhibitor such as isocarboxa@id /Marplan0, tranylcypromine /2arnate0, phenel@ine /4ardil0, or selegiline /&ldepryl, &msam0. Serious and sometimes fatal reactions can occur when these medicines are ta en with sertraline. >ou must wait at least =7 days after stopping an M$1 inhibitor before you can ta e sertraline. Before ta ing sertraline, tell your doctor if you have#

liver or idney disease; sei@ures or epilepsy; bipolar disorder /manic depression0; or a history of drug abuse or suicidal thoughts.

'f you have any of these conditions, you may not be able to use sertraline, or you may need a dosage ad,ustment or special tests during treatment. %D$ pregnancy category 3. "his medication may be harmful to an unborn baby. "ell your doctor if you are pregnant or plan to become pregnant during treatment. 't is not nown whether sertraline passes into breast mil or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast!feeding a baby. Ho' should ! take sertraline9 "a e this medication exactly as it was prescribed for you. Do not ta e the medication in larger amounts, or ta e it for longer than recommended by your doctor. >our doctor may occasionally change your dose to ma e sure you get the best results from the medication. "a e each tablet with water. "ry to ta e the medicine at the same time each day. "he oral li?uid form of this medicine must be diluted before you ta e it. "o be sure you get the correct dose, measure the li?uid with medicine dropper provided, not with a regular table spoon. Mix the dose with 7 ounces /one!half cup0 of water, ginger ale, lemonIlime soda, lemonade, or orange ,uice. Do not use any other li?uids to dilute the medicine. Stir this mixture and drin all of it right away. "o ma e sure you get the entire dose, add a little more water to the same glass, swirl gently and drin right away. "ry to ta e sertraline at the same time each day. Sertraline may be ta en with or without food. 't may ta e 7 wee s or more for you to start feeling better. Do not stop using sertraline without first tal ing to your doctor. >ou may have unpleasant side effects if you stop ta ing this medication suddenly. Store sertraline at room temperature away from moisture and heat. What happens if ! miss a dose9 "a e the missed dose as soon as you remember. ;owever, if it is almost time for the next regularly scheduled dose, s ip the missed dose and ta e the next one as directed. Do not ta e extra medicine to ma e up the missed dose.

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What should ! avoid 'hile taking sertraline9 Do not ta e sertraline together with pimo@ide /1rap0, isocarboxa@id /Marplan0, phenel@ine /4ardil0, selegiline /&ldepryl, &msam0, or tranylcypromine /2arnate0. $void drin ing alcohol, which can increase some of the side effects of sertraline. Do not ta e the li?uid form of sertraline if you are ta ing disulfiram /$ntabuse0. )i?uid sertraline may contain alcohol and you could have a severe reaction to the disulfiram.

$void using other medicines that ma e you sleepy /such as cold medicine, other pain medication, muscle relaxants0. "hey can add to sleepiness caused by sertraline. Sertraline can cause side effects that may impair your thin ing or reactions. Be careful if you drive or do anything that re?uires you to be awa e and alert. What are the possi6le side effects of sertraline9 Get emergency medical help if you have any of these signs of an allergic reaction# s in rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. 3ontact 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 attac s, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania /mental andIor physical hyperactivity0, thoughts of suicide or hurting yourself. 3all your doctor at once if you have any of these serious side effects#

sei@ure /convulsions0; tremors, shivering, muscle stiffness or twitching; problems with balance or coordination; or agitation, confusion, sweating, fast heartbeat.

1ther less serious side effects are more li ely to occur, such as#

feeling nervous, restless, or unable to sit still; drowsiness, di@@iness, wea ness; sleep problems /insomnia0; nausea, diarrhea, dry mouth, or changes in appetite or weight; or decreased sex drive, impotence, or difficulty having an orgasm.

Side effects other than those listed here may also occur. "al to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs 'ill affect sertraline9 "al to your doctor before ta ing any medicine for pain, arthritis, fever, or swelling. "his includes aspirin, ibuprofen /$dvil, Motrin0, naproxen /$leve, 4aprosyn0, diclofenac /<oltaren0, indomethacin, piroxicam /%eldene0, nabumetone /(elafen0, etodolac /)odine0, and others. "a ing any of these drugs with sertraline may cause you to bruise or bleed easily. Before ta ing sertraline, tell your doctor if you are using any of the following medicines#

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tramadol /Altram, Altram &(, Altracet0; digitoxin /3rystodigin0; phenytoin /Dilantin0; valproate /Depacon, Depa ene0; lithium /)ithobid, &s alith0; a blood thinner such as warfarin /3oumadin0; any other antidepressants such as amitriptyline /&lavil0, citalopram /3elexa0, escitalopram /)exapro0, fluoxetine /2ro@ac, Sarafem0, fluvoxamine /)uvox0, imipramine /"ofranil0, nortriptyline /2amelor0, or paroxetine /2axil0; almotriptan /$xert0, frovatriptan /%rova0, sumatriptan /'mitrex0, naratriptan /$merge0, ri@atriptan /Maxalt0, or @olmitriptan /Lomig0; or heart rhythm medication such as flecainide /"ambocor0, propafenone /(hythmol0, and others.

'f you are using any of these drugs, you may not be able to use sertraline, or you may need dosage ad,ustments or special tests during treatment. "here may be other drugs not listed that can affect sertraline. "ell your doctor about all the prescription and over!the!counter medications you use. "his includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Where can ! get more information9 >our pharmacist has additional information about sertraline written for health professionals that you may read. What does my medication look like9 Sertraline is available with a prescription under the brand name Loloft. 1ther brand or generic formulations may also be available. $s your pharmacist any ?uestions you have about this medication, especially if it is new to you.

Loloft -K mg!capsule!shaped, green, film!coated, scored tablets Loloft K8 mg!!capsule!shaped, light!blue, film!coated, scored tablets Loloft =88 mg!!capsule!shaped, light!yellow, film!coated, scored tablets Loloft 1ral 3oncentrate -8 mgIm)!clear, colorless solution with a menthol scent

)emem6er1 keep this and all other medicines out of the reach of children1 never share your medicines 'ith others1 and use this medication only for the indication prescri6ed.

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