There’s an old parable large__12801641634about how to catch a monkey.

The story goes that if you want to catch a monkey, you put a hole in a coconut, and inside the hole you put some nuts or fruit. You tie the coconut to a tree and wait.

A hungry monkey will put his hand down the hole and grab the fruit or nuts in his fist. When he attempts to take his fist out of the hole, he finds that his fist is too big.

The legend states that the monkey becomes trapped, not because of the coconut, but because of his unwillingness to let go.

The metaphorical coconut trap is something that everyone deals with.

Do you hold on to times people have hurt you in the past? Are your feelings still hurt from painful words that were said to you? Or do you continue to agonize over times when you have messed up? Is letting go of your own mistakes difficult?

There are two people in a row boat, each one with an oar. One person feels hurt or angry, and they stop a rowing, while their partner keeps at it.

The boat moves in a circle, going nowhere.

The anger, frustration, and pain people experience keeps them from working together to move forward.

These tightly kept feelings don’t do any good. They don’t change the past, and when acted upon they do not change anyone else.

They merely keep you stuck.

Another trap that keeps people from feeling free is regret over what they did or didn’t do in life.

It’s like a cage, where they feel like they’re interacting with the world, but they’re being held back. It may feel safe to hide under anger or resentment. But the reality is that this cage keeps a person from participating in and enjoying life.

Most people don’t even realize what it is that’s keeping them from moving forward.

They may blame their unhappiness on their bad luck or how other people treated them. Or perhaps they may understand their own role in the situation. They understand by holding on to their anger and hurt is like poison. They know they’re trapped by it, but they feel powerless. They hold on to their hurt and pain as if it’s the most important thing in the world.

For some people, holding on to their anger or pain becomes the center of their lives. It becomes the scapegoat for everything wrong, for all the missed opportunities in their life.

Most people greatly underestimate the amount of control they have over themselves. When children are young, they have a very difficult time managing their feelings. However, as people mature, they gain the ability to recognize their feelings and decide what to do with them.

If you are holding on to a deep sense of anger, what can you do to find reconciliation?

The first step is to realize that what you’re holding on to is not helpful and is something you want to change. Then you can begin to figure out how you can get to a place of peace.

Do you need to talk your feelings out with a friend or therapist? Do you need to write a letter or have a conversation? Is it enough to decide in your mind that you don’t want to hang on to the negativity, or do you need to do something physical?

Once you are able to let go of these emotions, once you let go of the fruit or open up the cage door, you will have a sense of freedom that you never imagined.

Things Not to Do If You, a Friend or a Loved One Has Bipolar DisorderBy Marcia Purse, About.com GuideUpdated April 02, 2012Reviewed by a board-certified health professional. See About.com’s Medical Review Board.Ads:
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AdsLoved One with Bipolar?http://www.coping-with-bipolar.comLearn how to cope and deal with your loved one’s bipolar disorder.3 Herbs that Beat Anxietyhttp://www.a2xanxiety.comDoctors Reveal 1 Weird Compound to Calm Anxiety that May Surprise You1. Patients: Don’t Hide Symptoms from Your DoctorDid you know that it takes an average of nine to 10 years for people to be properly diagnosed with bipolar disorder? There are two big reasons for this. One is that doctors miss the diagnosis all too frequently, even when hypomanic symptoms are brought to their attention. The other is failure of patients to report symptoms.More often than not, it is depression symptoms that send people to see a psychiatrist or other therapist. You may have viewed past hypomanic symptoms as just “not depressed,” “feeling like a normal person” or “feeling good.”If you respond to antidepressant therapy, you may think, “Wow, it’s working” and not recognize that you’ve gone into a hypomanic state (the severity of mania makes it much more likely to be recognized). But if you don’t relate your behaviors to your doctor when you’re “feeling good,” he or she may not realize you’ve gone too far in the opposite direction from depression until the symptoms escalate into serious problems.2. Patients: Don’t Let Your Doctor Skip Physical TestsThere are physical illnesses whose symptoms can overlap with those of bipolar disorder and complicate its diagnosis. They include lupus, epilepsy and Lyme disease, among others.
See: Diagnosing Bipolar: Ruling Out Physical Conditions
3. Patients: Don’t Stop Taking Your Medications on Your OwnUnless you’re having a severe side effect, you should never discontinue medications without your doctor’s supervision. Abruptly stopping some medications can cause serious side effects, too. For example, the reaction many people experience when they discontinue certain antidepressants is so unpleasant it even has a name: SSRI discontinuation syndrome. If you want to stop taking one or more of your medications, talk to your doctor first!
See: 5 Bad Reasons to Stop Taking Your Meds
4. Patients: Don’t Keep Toxic People in Your LifeYou know who they are – the people who hurt your feelings constantly, the ones who drain your energy, the ones who attack you again and again. Depending on the relationship, it can be relatively easy to very difficult to actually remove a toxic person from your life. But it’s essential that you do something about it.
See: Toxic People – Who They Are and How to Avoid Them
5. Patients: Stop Damaging Your BodyThere are some dangers inherent in bipolar disorder that make it more likely you’ll do harmful things to yourself or be intimidated into letting medical personnel give you inadequate or even improper treatment. It’s up to youto take action about these issues. Understand why they happen and what you need to do, with insights from others to help you.
See: Don’t Give Up On Your Health – Part 1
6. Patients: Don’t Meddle with Your MedicationsSuppose you’ve been prescribed 150 milligrams of medication X, 30 milligrams of medication Y and 50 to 75 milligrams of medication Z per day. That means your doctor has given you permission to take from two to three 25-milligram tablets of drug Z in a day depending on your judgment. But you don’t think that’s enough, so you start taking 100 milligrams of drug Z or 60 milligrams of drug Y. Almost immediately you start having side effects, have a mood change or another problem occurs. Think that’s far-fetched? Think again.
See: Disastrous Medication Changes
7. Parents: Don’t Refuse to Think About Giving Your Bipolar Child MedicationsIt’s understandable that a parent may be uneasy about giving a bipolar child the types of strong medications that are needed to guide that child toward stability. Certainly there are risks involved with these drugs, as there are with all prescription drugs. But remember that your child is suffering, and there are few other options to help him or her.
See: Important Reasons to Use Medications for Bipolar Children
8. Parents: Don’t Miss Out on Opportunities to Help Your Child at SchoolChildren with bipolar disorder often need special assistance at school. They can have trouble focusing, have anger issues and be easily tormented by other children. Also, it’s quite common for a bipolar child to have co-morbid attention deficit hyperactivity disorder (ADHD) and to take medications at school. You need to know your child’s rights and implement the available programs.
See: School Tools: Individualized Education Program (IEP)
And: School and Medications
9. Loved Ones and Friends: Don’t Challenge the Diagnosis or Dismiss the TreatmentI can’t tell you how often people with bipolar disorder tell me that their friends or family members refuse to accept their diagnosis or refuse to learn anything about bipolar illness. Common responses include: “Oh, you’re just trying to get attention;” “Snap out of it, get a job and quit whining;” “If you only (prayed more, tried harder, ate more vegetables, etc.) you’d be fine; or simply, “I don’t believe it,” ending the conversation.Bipolar disorder is a serious illness that can disrupt every phase of life and even cause death. It can be disabling. Don’t refuse to listen and learn.
See: Don’t Challenge My Diagnosis
And: Don’t Tell Me How to Get Over Bipolar Disorder
10. Family Members: Don’t Destroy Yourself for a Loved One’s Bipolar DisorderThis is an exceedingly difficult issue. When do your needs outweigh the needs of your bipolar spouse, parent or grown child? Only you can decide, but if the time comes when you need to make the decision, do whatever is necessary to take the best care of yourself. Insights from others may help you if you’re in this position, and we offer several.

Low Vitamin D Common, May Affect Depression1 image Vitamin D has been the target of a wide variety of studies lately looking at everything from how it affects your blood pressure to the length of your life.

For several years, vitamin D levels have been linked to depression, but most of these studies were done in older adults who were often in poor health. A new study out this week has looked to fill that gap by examining whether vitamin D levels play a role in depression for younger women as well.

How is vitamin D related to depression?

Vitamin D was first linked to depression in a variety of population studies that looked at the blood of older women and compared it to their risk of a variety of diseases. Among the things that jumped out was vitamin D, which seemed in some studies to be associated with the risk of being depressed. But the data hasn’t been conclusive. Studies that have examined all of the available data have found relationships in both directions, with some showing no effect of vitamin D levels on depression.

In spite of that, there are some thoughts on how vitamin D might relate to mood. Vitamin D has receptors in areas of the brain involved in emotion and also helps produce some of the chemicals in the brain responsible for mood. It’s also involved with activation of the immune system, which could in some cases trigger a stress response and affect a person’s emotions.

Why was it important to do this study in young women?

More studies needed to be done to conclusively say whether or not vitamin D was related to mood disorders. But on top of that, it was unclear if the studies that existed related to the entire population or just those tested directly in the research. If vitamin D affected mood early in life, it might be possible to intervene when someone’s vitamin D levels were first dropping to avoid a more serious case of depression later in life. If there was no effect, health care providers could focus on vitamin D levels in older groups without worrying about younger women. This study helped both add to the literature on depression and vitamin D while also expanding the ages tested.

How did the researchers test this association and what did they find?

The researchers recruited 185 young, healthy college women and surveyed them weekly to assess any symptoms of depression they might have. They also drew blood at the beginning of the study and then at the end of the study five weeks later. They recruited students from all times of the year so they could be sure that season wasn’t playing a role and also asked about a variety of factors that could relate to vitamin D levels, like the amount of exercise they get or the amount of time they spent outside.

The researchers found that lower levels of vitamin D predicted higher levels of depressive symptoms during the five weeks of the study. While the relationship was just an association, the researchers point out that the opposite wasn’t true, namely that more depressive symptoms didn’t predict lower vitamin D levels.

Additionally, the researchers found that the women were surprisingly low in vitamin D. About six in 10 women of color were below healthy levels of vitamin D and about a third of all other women were low.

How does this affect me?

The study provides support for the idea that vitamin D and mood are related in some way and that low levels may be linked to depression. Even if you’re a young, healthy woman, you may still have low vitamin D levels, which can impact your health in other important ways. The test is easy to get and supplementation is simple and straightforward if your levels happen to be below where they should be.

Lithium is not as widely used for relapse prevention in bipolar disorder as perhaps it should be. However, the main reason is simple. It is perceived to be an unsafe drug and, in practice, this requires us to monitor its serum levels and the renal and endocrine function of patients who take it long term. At both an emotional and a practical level, the harm lithium may do weighs heavy in the minds of physicians and perhaps also their patients.

The study by Kessing et al¹ in this issue of JAMA Psychiatry examines the relationship between a bipolar diagnosis, drug exposure, and the risk of renal disease, probably the main focus for safety concerns. By linking the national databases in Denmark, it represents a comprehensive test of how an entire population fares in a socialized medical care system with a strong historical tradition of using lithium. Renal disease is variously described but ultimately defined by declining glomerular function. End-stage renal failure is a hard, potentially fatal outcome and is unlikely to be affected by any marked bias in detection: in Denmark it was ascertained from the national transplantation and dialysis register. Possible or definite renal disease short of renal failure is much more common and may or may not have functional consequences. Stage 3 of chronic renal disease, from which point patients may develop symptoms, is defined by a glomerular filtration rate less than 60 mL/min/1.73 m². Its detection will obviously be increased by frequent monitoring and, while a necessary prelude to end-stage renal failure, it is rarely sufficient: rates of end-stage renal failure are low (about 1 case in every 530 persons or 6861 person-years’ observation in the Danish registers)

Bipolar disorder and alcoholism often occur together. Up to half the people who have bipolar disorder also struggle with alcoholism.

Although the association between bipolar disorder and alcoholism isn’t clearly understood, these factors likely play a role:

• Inherited traits. Genetic differences appear to affect brain chemistry linked to bipolar disorder. These same traits may also affect the way the brain responds to alcohol and other drugs, increasing the risk of alcoholism and addiction to other drugs.
• Depression and anxiety. Some people drink to ease depression, anxiety and other symptoms of bipolar disorder. Drinking may seem to help, but in the long run it makes symptoms worse. This can lead to more drinking — a vicious cycle that’s difficult to overcome.
• Mania. This upswing from depression is usually characterized by an intensely elated (euphoric) mood and hyperactivity. It commonly causes bad judgment and lowered inhibitions, which can lead to increased alcohol use or drug abuse.

Bipolar disorder and alcoholism or other types of substance abuse can be a dangerous combination. Each can worsen the symptoms and severity of the other. Having both conditions increases the risk of mood swings, depression, violence and suicide.

Someone who has both bipolar disorder and alcoholism or another addiction is said to have a dual diagnosis. Treatment may require the expertise of mental health care providers who specialize in the treatment of dual disorders.

If you’ve lost control over your drinking or you abuse drugs, get help before your problems become worse and harder to treat. Seeing a mental health expert right away is especially important if you also have signs and symptoms of bipolar disorder or another mental health condition.

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Bipolar Disorder Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

• Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
• Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
• Inherited traits. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

RISK FACTORS

According to DSM-IV diagnostic criteria, bipolar disorder (bipolar affective disorder, manic-depressive disorder) is characterized by marked mood swings between mania (mood elevation) and depression. The essential feature of bipolar I disorder (BDI) is a clinical course that is defined by the occurrence of 1 or more manic or mixed episodes; the essential feature of bipolar II disorder (BDII) is a clinical course that is defined by the occurrence of 1 or more major depressive episodes accompanied by at least 1 hypomanic episode. As such, bipolar disorder can cause significant personal distress and social dysfunction.

Bipolar disorder has been subdivided in several ways, but classically there are 2 clinical categories of the disorder. BDI is characterized by the occurrence of 1 or more manic or mixed episodes (mixed episode means that symptoms of mania and depression are present at the same time). Often individuals with BDI have also had 1 or more major depressive episodes. Episodes of substance-induced mood disorder (caused by the direct effects of a medication, other somatic treatments for depression, drug abuse, or toxin exposure) or of mood disorder caused by a general medical condition are not considered when making a diagnosis of bipolar disorder. By contrast, BDII is diagnosed when depression is interspersed with less severe episodes of elevated mood that do not lead to dysfunction or disability (hypomania).

Although individuals with BDI can return to a fully functional level between episodes, some continue to display mood lability and interpersonal or occupational difficulties. Manic symptoms are the hallmark of the illness and can represent a real medical emergency. However, bipolar depression is often much more clinically significant.¹

Depression was the third leading cause of burden among all diseases in 2002, and it is expected to rise in the next 20 years.² Evidence suggests that depressive episodes and symptoms are equal to or more disabling than corresponding levels of manic or hypomanic symptoms and that only subsyndromal depressive symptoms (and not subsyndromal manic or hypomanic symptoms) are associated with significant impairment in patients with bipolar disorder.³ This scenario highlights the need for effectively treating bipolar depression.

Although antidepressant drugs remain the mainstay of treatment for unipolar major depression in both primary and secondary care settings,⁴ the evidence to support antidepressant treatment for bipolar depression is limited and increasingly controversial—especially now that evidence is available for alternative medications, including quetiapine and lamotrigine.⁵

Apart from the limited evidence, a key problem with antidepressants is the potential for increasing the risk of iatrogenic episodes of elevated mood. This is the reason many reviews and guidelines for bipolar depression have recommended the use of a mood stabilizer (usually lithium or valproate) rather than an antidepressant as the first-line treatment for bipolar depression.^6,7 Antidepressants are advised only as second-line treatment and always with a concurrent mood stabilizer to prevent switching to mania. However, in real-world clinical practice, antidepressants are still frequently prescribed for bipolar disorder.⁸ Thus, 3 important clinical questions arise: (1) What is the effectiveness (if any) of antidepressants in bipolar depression? (2) What is the risk of manic switching? (3) How effective are antidepressants in preventing relapse of bipolar depression?

Efficacy of antidepressants and risk of manic switching
In 2004, the efficacy and safety of antidepressants for the short-term treatment of bipolar depression were studied and the results were analyzed.9 The main aims of the study were to shed light on the effectiveness of antidepressants using a methodologically sound approach, to quantify the increased risk of a manic switch, and to see whether there were antidepressants that were more effective or less likely to produce a switch. Using various electronic databases, the authors performed a systematic review and meta-analysis of randomized controlled trials.

Twelve studies were included and 1088 participants were analyzed. Participants were adults aged up to 70 years of whom approximately 60% to 70% were women; patients with a diagnosis of serious physical illness or substance abuse were excluded. The review found that antidepressants significantly increased treatment response at 4 to 10 weeks. Comparing 1 or more antidepressants with placebo, patients taking an antidepressant (paroxetine, imipramine, fluoxetine, tranylcypromine, or selegiline) were more likely to respond (risk ratio [RR], 1.9; 95% confidence interval [CI], 1.5 to 2.3). The number needed to treat (NNT) with antidepressants was 5 (95% CI, 4 to 7). (The NNT is a measure of treatment effectiveness and the average number of people who need to be treated with a specific intervention [for a given period] to achieve 1 additional beneficial outcome.)

There were fewer data available for analysis of remission, but the results were consistent. Patients treated with an antidepressant (paroxetine, imipramine, or fluoxetine) were more likely to achieve remission than those who were not taking an antidepressant (RR, 1.41; 95% CI, 1.11 to 1.80). NNT was 9 (95% CI, 5 to 33). In the studies comparing antidepressants with placebo, about 75% of patients received a concurrent mood stabilizer or an atypical antipsychotic (this point should be taken into account in order to draw clinically meaningful conclusions).

The review data did not suggest that switching to mania is a common early complication of treatment with antidepressants. In the review by Gijsman and colleagues,9 there was no evidence of an increased risk for switching to a manic episode in the included trials. The event rate for antidepressants was 3.8% and for placebo it was 4.7%. This difference was not statistically significant. Gijsman and colleagues9 also looked at whether some antidepressants are less likely to produce a manic switch. They found 3 trials that allowed comparison between 2 important classes of antidepressants, tri-cyclic antidepressants (TCAs), and SSRIs. Findings from this study show that switching occurred in 8% of patients taking TCAs versus 0% of those taking SSRIs (although the difference is not statistically significant), and suggest that TCAs may be more likely to induce mania than SSRIs.9 The main limitation of these analyses is that there were few manic events overall, limiting the power to detect a clinically important difference between compounds.

Recently, Sachs and colleagues10 reported the results of a large (N = 366) randomized trial comparing mood stabilizers alone (valproate, lithium, carbamazepine) with combination therapy with an antidepressant (paroxetine or bupropion) plus a mood stabilizer in patients with bipolar depression. At 26 weeks, there was no significant difference in the proportion of patients who achieved a durable recovery (27.3% vs 23.5% respectively), nor was there any difference in the pro-portion of patients who experienced a manic episode (10.7% vs 10.1%).

Other studies have examined the relative risk of switching into hypomania or mania associated with second-generation antidepressants in patients with bipolar depression.11-13 Results conflicted somewhat with the findings reported by Gijsman and colleagues.9 Examining the comparative risks of switching into hypomania/ mania during acute and continuation trials of adjunctive antidepressant treatment for bipolar depression, one study found that adjunctive treatment with antidepressants for bipolar depression was associated with substantial risks of threshold switches to full-duration hypomania or mania even during short-term treatment.13

This 10-week trial examined the relative acute effects of 3 second-generation antidepressants (bupropion, sertraline, and venlafaxine) as add-on treatments to mood stabilizers. In this study, 174 outpatients with BDI or BDII (stratified for rapid cycling) and in the depressed phase were randomly treated with a flexible therapeutic dose of an antidepressant. All 3 antidepressants were associated with a similar range of acute response (49% to 53%) and remission (34% to 41%); how-ever, a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline was found: standardized rating scale scores showed that switching occurred in 10% of patients taking bupropion, 9% taking sertraline, and 29% taking venlafaxine.

Interestingly, this trial also found a strong interaction between the rapid-cycling status of patients and the relative risk of switching for all 3 medication groups. In participants without rapid cycling disorder, the risk of switching was identical for all 3 medication groups. It could be that the dual actions of venlafaxine on serotonin and noradrenaline reuptake, which may account for its greater efficacy in patients with unipolar depression,14,15 may have contributed to the higher rate of switching with this agent than with the other 2 agents. These findings may also be consistent with the higher switch rates for the TCAs, which represent combined serotonin and noradrenaline reuptake inhibitors.

The results from the study by Post and colleagues11 were confirmed in a long-term continuation treatment follow-up phase lasting up to 1 year.13 Hence, more caution appears indicated for patients with bipolar depression for use of venlafaxine than use of bupropion or sertraline as adjunctive treatment to a mood stabilizer, especially if there is a history of rapid cycling. It should be noted that all of these antidepressants are FDA-approved for the treatment of major depression but are not FDA-approved for use in bipolar depression.
Effect of antidepressants in preventing relapse

The other compelling clinical issue in bipolar depression is the risk of recurrence and prevention of relapse. Bipolar disorder is known to be a recurrent disorder, and more than 90% of patients with bipolar disorder experience recurrences.16

However, available data are scarce on the clinical features associated with the risk of recurrence. Interesting findings resulted from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a national longitudinal public health initiative funded by NIMH.17 One of the main aims of the trial was to look for the features associated with risk of recurrence.18 The study prospectively enrolled patients with bipolar disorder who were receiving treatment according to contemporary practice guidelines and observed them for up to 24 months.

Of the 1469 participants who were symptomatic at study entry, 858 subsequently achieved recovery (58.4%). During the 24-month follow-up period, 48.5% of patients experienced recurrences, and depressive episodes developed in more than 34.7%, compared with manic/hypomanic/mixed episodes in 13.8%. Furthermore, in this study, residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence.

Unfortunately, we found just one systematic review investigating the effectiveness of long-term use of antidepressants, which did not provide sufficient evidence to assess the ability of antidepressants to prevent relapse of bipolar disorder.19 The review found 7 randomized controlled trials that enrolled 363 people with BDI or BDII. Data were found only for imipramine, desipramine, bupropion, and fluoxetine (antidepressants) and lithium (a mood stabilizer).

The review provided a narrative overview of the studies, because the variety of comparisons did not allow researchers to perform a meta-analysis or to quantify reliable conclusions. The available evidence suggested that there was no clear benefit for routinely adding long-term antidepressants to ongoing treatment with lithium. Moreover, the same review found that antidepressants may be less effective in preventing relapse when they are prescribed without a mood stabilizer (in this case, lithium).19

Clinical implications

There is some evidence20 that antidepressants are effective in the short-term treatment of bipolar depression, but a large recent trial reported no benefit10 and caution should be paid to the risk of manic switching. Alternative agents, such as quetiapine or lamotrigine, should be considered. When using an antidepressant, it may be prudent to use an SSRI or bupropion rather than a TCA or venlafaxine as first-line treatment. However, the patient history (ie, response to antidepressant treatment without adverse effects, including treatment-emerging manic switch) should be the best guide for choosing the individual treatment strategy.

Looking at the randomized evidence, there is no support for the addition of long-term antidepressants to ongoing treatment with a mood stabilizer for maintenance treatment in persons with bipolar depression. Early discontinuation following resolution of the acute episode should be con-sidered. Recurrence is frequent and associated with the presence of residual mood symptoms at initial recovery. Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce the risk of recurrence. Given the limited evidence, there is a compelling need for further studies with longer follow-up and careful definition of the risk/ benefit profile in terms of efficacy and tolerability.

Recent evidence found conflicting results about possible correlates between suicidality and antidepressant exposure.21,22 This aspect is of crucial importance when using antidepressants not only for bipolar disorder but also for unipolar disorder,23 and it indicates important directions for further research. New pharmacological strategies with agents different from antidepressants are under investigation (quetiapine, lamotrigine, olanzapine, olanzapine plus fluoxetine) and need to be carefully evaluated to improve our therapeutic skills for treating bipolar depression.

SOURCE WWW.BIPOLARANDSUPPORT.COM JAN/ADMIN

ABILIFY:

Generic name
Aripiprazole

Antipsychotic second generation

Indications
Schizophrenia, Bipolar Disorder

Dosage forms
2mg, 5 mg, 10mg, 15mg, 20mg, 30 mg

Maximum daily dose
Adults 30 mg
Children 30 mg 10-17 yrs old

Half life

75 Hours

Side effects

Nausea, drowsiness, muscle stiffness, restlessness, shakiness, constipation, cold symptoms, upper respiratory infection, muscle weakness, rash, dizziness, fainting, seizures, sexual problems, elevated blood sugar, abnormal muscle movements, weight gain,

There may be more side effects than listed here!!!!

NOTE:

Always contact your doctor about any unusual side effects you may experience!!!!

ADDERALL

GENERIC NAME:
Dextroamphetamine, Amphetamine.

Brand Name: Adderall

CLASS:
Psychostimulant

Indications:
Attention deficit Disorder, Narcolepsy

Dosage forms:
5 mg, 7.5 mg, 10 mg, 12.5 mg, 20 mg, 30 mg

Maximum daily Dosage

ADULTS 60 mg
CHILDREN 40 mg

HALF LIFE

10-12 hours

Side effects:

Loss of appetite, trouble sleeping, nervousness, abdominal pain, weight loss, rpaid heart beat, nausea, rash, head ache, rash, drowsiness, blurred vision, worse psychotic symptoms, motor tic, seizure, abnormal heart beat, hair loss, increase eye pressure

This is not a complete list check with your doctor for other symptoms you may experience…

ALPRAZOLAM

Brand name
Xanax

Class
Benzodiazepine

Indications

General anxiety disorder, panic disorder

Dosage forms

0.25 mg, 0.5 mg, 1 mg, 2 mg

Maximum daily dosage
Adults 4 mg
Children Non-FDA approved

Half life 12-15 hours

Side effects

dizziness, drowsiness, nausea, headache, sexual problems, weakness, confusion, liver problems

This is not a complete list check with your doctor and report any unusual side effects

MORE TO COME

ajn/admin @ http://www.bipolarandsupport.com