By H. Pranck. Western Kentucky University.
Few of us have a recovery where the illness is completely gone buy generic viagra super active 100mg online erectile dysfunction doctors in sri lanka. Because of this order viagra super active 50 mg with visa erectile dysfunction treatment uk, we have to find something that works for us or the illness will take over purchase viagra super active 50mg on line erectile dysfunction gene therapy. Natalie: What are the 4 steps to taking charge of bipolar disorder? What many people might be surprised to know is that only about 20% of people respond quickly and effectively to bipolar medications discount viagra super active 100 mg without prescription erectile dysfunction in 40s. The rest of us have to try a variety of medication combinations in order to eventually find something that works. Unfortunately this can take years and the side-effects are often terrible. The good thing about these changes is that they are often free. For example, drug and alcohol abuse are the number one reason for poor treatment outcome. And yet, simply stopping the behavior is difficult for many people. Caffeine is another trouble maker, especially for people with anxiety. Stopping caffeine can make a big difference and many people do this successfully. This step had a huge impact on my life as it is, where I finally realized that my odd, confusing and often very scary behavior is totally normal for bipolar disorder. This section is not simply going to a doctor or therapist, which are naturally helpful and important. Step four teaches people how to ask for help from the right person and then helps family members and friends. Natalie: The step that deals with medications and supplements -- in your online autobiography, you state that you stopped taking medications because you were unhappy with the side-effects. And you promised your doctor at the time that if your condition got really bad you would restart them. Knowing that each person is different, I want to know specifically for YOU, was that a good thing? I was given 23 medications within my first four years of treatment of bipolar disorder with little result. I also gained over 50 pounds and was physically miserable. This was simply not acceptable and I would not let doctors do this again. I believe that effective medication treatment should be done very carefully and individually. Simply throwing a medication at someone to see if it fits, is a disservice to those of us with the illness and for many people, especially those with rapid-cycling, because it makes the illness much worse. Having said this, I very much believe in medications. Considering that antidepressants should not be used alone in the treatment of bipolar disorder unless under strict observation by a doctor or in conjunction with a mood stabilizer, I had immediate rapid-cycling between depression and mania almost daily towards the end. Last year, due to some personal and work triggers, I once again was too ill to manage on my own and I started Lamictal. It has worked well for me and helps about 25% of the time. Sometimes I have real breakthrough and I know what it is like to have a quiet brain, but it is rare. That is why I wrote Take Charge of Bipolar Disorder. Natalie: Lifestyle changes, behavioral changes, asking for assistance from others all seem helpful. But I want to know how difficult is it to effectively manage the illness and create lasting stability without taking antipsychotic medications and mood stabilizers for bipolar disorder? When Abilify came on the market I was so excited and yet I still had trouble. Mood stabilizers are essential but not all of us respond well to them. I say- try everything you can until you find something that works- but just do it slowly and with a good doctor Natalie: The last step: "Asking for help from family members, friends, your doctors. And what suggestions do you have for dealing with that issue? Julie Fast: First of all, it is very rare for someone to say, "I need help. The reality is that the person without the illness will often only get clues that a person needs help. It is hard to ask for help in the middle of a mood swing. I teach people to have something in place before they get sick so that others know what to do without the person with bipolar disorder having to talk so much about what they need. When I am sick now, my family and friends know that I will be either depressed, psychotic or anxious and they know what to do. It took years for this to finally work- but it works! Julie Fast: How could you know what do to unless someone teaches you? A book like Take Charge definitely teaches you many of the skills you need, but the real teacher is the person with the illness. Ask them what they need and what helps during specific mood swings. There is no way a family member or friend can just know this by osmosis. There seems to be this big separation between those of us with the illness and those who want to help. It takes time to get people to work together, but they can. Over the past four years, I have received and read over 30,000 emails from people who have bipolar disorder or who love someone who does. And out of all of those letters, and I am not kidding, not one of them said something new about this illness. I have had letters from Saudi Arabia, Thailand, Australia, Finland, etc. This shows me that this is not an individual illness with an individual cure. This means that a set management plan that is specific in what needs to be done, will work for everyone. Oh, I would say that the people with a management plan that they use every single day, are the ones who are successful- they take the meds they can take and always keep trying to find new ones that work more successfully, they watch their sleep, they accept that partying or working at a stressful job will probably make them ill, they surround themselves with supportive people and teach those people how to help them, they keep going no matter how sick they are or how much they want to die and they know the first signs of mania so they can get help before it goes too far. And most of all, they know and believe that this is a serious and often life threatening illness - they have done nothing wrong- the behaviors can be embarrassing and scary at times, but the person with bipolar disorder is not flawed in any way. I would say that the people in this chat room are those who are doing what they can to get better.
The review of SAMe for the treatment of depression order viagra super active 100 mg online erectile dysfunction foods to eat, osteoarthritis generic 50mg viagra super active with mastercard erectile dysfunction protocol review article, and liver disease identified a number of promising areas for future research buy viagra super active 100mg with mastercard erectile dysfunction weed. For example buy 25mg viagra super active impotence psychological treatment, it would be helpful to conduct (1) additional review studies, studies elucidating the pharmacology of SAMe, and clinical trials; (2) studies that would lead to a better understanding of the risk-benefit ratio of SAMe compared to that of conventional therapy; (3) good dose-escalation studies using the oral formulation of SAMe for depression, osteoarthritis, or liver disease; and (4) larger clinical trials once the efficacy of the most effective oral dose of SAMe has been demonstrated. Two high-quality randomized controlled trials provide good evidence that cranberry juice may decrease the number of symptomatic urinary tract infections in women over a 12-month period. The fact that a large number of women dropped out of these studies indicates that cranberry juice may not be acceptable over long periods of time. Finally, the optimal dosage or method of administration of cranberry products (e. There has been some study of other popular dietary supplements. For example, valerian is an herb often consumed as a tea for improved sleep, and melatonin is a pineal hormone touted for the same purpose. Small studies suggest that these two supplements may relieve insomnia, and there may be little harm in a trial course of either one. Echinacea has long been taken to treat or prevent colds; other supplements currently used for colds include zinc lozenges and high doses of vitamin C. As yet, only moderate-sized studies have been conducted with echinacea or zinc, and their outcomes have been conflicting. Large trials of high doses of oral vitamin C showed little, if any, benefit in preventing or treating the common cold. Because of widespread use, often for centuries, and because the products are "natural," many people assume dietary supplements to be inert or at least innocuous. Yet, recent studies show clearly that interactions between these products and drugs do occur. For example, the active ingredients in ginkgo extract are reported to have antioxidant properties and to inhibit platelet aggregation. It has been shown to interact with a number of drugs that serve as substrates for the cytochrome P450 CYP3A enzymes responsible for metabolism of approximately 60 percent of current pharmaceutical agents. Other dietary supplements shown to potentiate or interfere with prescription drugs include garlic, glucosamine, ginseng (Panax), saw palmetto, soy, valerian, and yohimbe. In addition to interacting with other agents, some herbal supplements can be toxic. Misidentification, contamination, and adulteration may contribute to some of the toxicities. But other toxicities may result from the products themselves. For example, in 2001, extracts of kava were associated with fulminant liver failure. More recently, the FDA banned the sale of ephedra after it was shown to be associated with an increased risk of adverse events. Given the large number of dietary supplement ingredients; that dietary supplements are assumed to be safe in general; and that the FDA is unlikely to have the resources to evaluate each ingredient uniformly, a 2004 Institute of Medicine report offers a framework for prioritizing evaluation of supplement safety. The development of effective working relationships and partnerships between the FDA and NIH should continue. The FDA and NIH should establish clear guidelines for cooperative efforts on high-priority safety issues related to the use of dietary supplements. The FDA lists warnings and safety information on dietary supplements (e. Dietary Supplement Health and Education Act of 1994. Food and Drug Administration Center for Food Safety and Applied Nutrition Web site. Dietary Supplements: A Framework for Evaluating Safety. Herbal medicines today and the roots of modern pharmacology. Complementary and alternative medicine use among adults: United States, 2002. Use of dietary supplements in the United States, 1988-94. Vital and Health Statistics Series 11, Data from the National Health Survey. Dietary supplement use by US adults: data from the National Health and Nutrition Examination Survey, 1999-2000. Trends in use of vitamin and mineral supplements in the United States: the 1987 and 1992 National Health Interview Surveys. Use of vitamin and mineral supplements: demographics and amounts of nutrients consumed. Herbs and botanicals overview: sales continue to suffer as withering confidence and confusion reign supreme amongst consumers and companies for a little light at the end of this tunnel (Industry overview). Claims That Can Be Made for Conventional Foods and Dietary Supplements. Food and Drug Administration Center for Food Safety and Applied Nutrition Web site. Position of the American Dietetic Association: functional foods. Implementing a research agenda for complementary and alternative medicine. Effect of the Supplemental Use of Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cancer. Rockville, MD: Agency for Healthcare Research and Quality; 2003. Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease. Rockville, MD: Agency for Healthcare Research and Quality; 2003. Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects. Rockville, MD: Agency for Healthcare Research and Quality; 2000. S-Adenosyl-L-Methionine (SAMe) for Depression, Osteoarthritis, and Liver Disease. Rockville, MD: Agency for Healthcare Research and Quality; 2002. Cranberries for preventing urinary tract infections. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Efficacy and tolerability of valerian extract LI 156 compared with oxazepam in the treatment of non-organic insomnia--a randomized, double-blind, comparative clinical study. Melatonin in patients with reduced REM sleep duration: two randomized controlled trials. Evaluation of echinacea for treatment of the common cold. Echinacea for preventing and treating the common cold. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial.
If you have questions about the medicines you are taking or would like more information generic 50mg viagra super active free shipping erectile dysfunction self treatment, check with your doctor purchase viagra super active 100mg erectile dysfunction and heart disease, pharmacist discount viagra super active 25mg online erectile dysfunction doctors in queens ny, or nurse viagra super active 25mg online erectile dysfunction in young men. Generic name: GlimepirideAmaryl is an oral medication used to treat type 2 (non-insulin-dependent) diabetes when diet and exercise alone fail to control abnormally high levels of blood sugar. Like other diabetes drugs classified as sulfonylureas, Amaryl lowers blood sugar by stimulating the pancreas to produce more insulin. Amaryl is often prescribed along with the insulin-boosting drug Glucophage. It may also be used in conjunction with insulin and other diabetes drugs. Always remember that Amaryl is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan may diminish the results of Amaryl and can lead to serious complications such as dangerously high or low blood sugar levels. Remember, too, that Amaryl is not an oral form of insulin, and cannot be used in place of insulin. Do not take more or less of Amaryl than directed by your doctor. Amaryl should be taken with breakfast or the first main meal. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Amaryl should be stored at room temperature in a well-closed container. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Amaryl. Anemia and other blood disorders, blurred vision, diarrhea, dizziness, headache, itching, liver problems and jaundice, muscle weakness, nausea, sensitivity to light, skin rash and eruptions, stomach and intestinal pain, vomitingAmaryl, like all oral antidiabetics, can result in hypoglycemia (low blood sugar). The risk of hypoglycemia can be increased by missed meals, alcohol, fever, injury, infection, surgery, excessive exercise, and the addition of other medications such as Glucophage or insulin. To avoid hypoglycemia, closely follow the dietary and exercise regimen suggested by your doctor. Symptoms of mild low blood sugar may include:Blurred vision, cold sweats, dizziness, fast heartbeat, fatigue, headache, hunger, light-headedness, nausea, nervousnessSymptoms of more severe low blood sugar may include:Coma, disorientation, pale skin, seizures, shallow breathingAsk your doctor what steps you should take if you experience mild hypoglycemia. If symptoms of severe low blood sugar occur, contact your doctor immediately; severe hypoglycemia is a medical emergency. Avoid Amaryl if you have ever had an allergic reaction to it. Do not take Amaryl to correct diabetic ketoacidosis (a life-threatening medical emergency caused by insufficient insulin and marked by excessive thirst, nausea, fatigue, and fruity breath). If you have a heart condition, you may want to discuss this with your doctor. When taking Amaryl, you should check your blood and urine regularly for abnormally high sugar (glucose) levels. The effectiveness of any oral antidiabetic, including Amaryl, may decrease with time. This may occur because of either a diminished responsiveness to the medication or a worsening of the diabetes. Even people with well-controlled diabetes may find that stress such as injury, infection, surgery, or fever triggers a loss of control. If this happens, your doctor may recommend that you add insulin to your treatment with Amaryl or that you temporarily stop taking Amaryl and use insulin instead. If Amaryl is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Amaryl with the following:Airway-opening drugs such as albuterol sulfateAspirin and other salicylate medicationsCorticosteroids such as prednisoneDiuretics such as hydrochlorothiazide and chlorothiazideEstrogens such as conjugated estrogensHeart and blood pressure medications called beta blockers, including atenolol, metoprolol tartrate, and propranolol hydrochlorideMajor tranquilizers such as thioridazine hydrochlorideMAO inhibitors (antidepressants such as phenelzine sulfate and tranylcypromine sulfate)Nonsteroidal anti-inflammatory drugs such as diclofenac sodium, ibuprofen, mefenamic acid, and naproxenSulfa drugs such as sulfamethoxazole and trimethoprimThyroid medications such as levothyroxineUse alcohol with care; excessive alcohol intake can cause low blood sugar. Since studies suggest the importance of maintaining normal blood sugar levels during pregnancy, your doctor may prescribe injected insulin instead. Drugs similar to Amaryl do appear in breast milk and may cause low blood sugar in nursing infants. If diet alone does not control your sugar levels, your doctor may prescribe injected insulin. The usual starting dose is 1 to 2 milligrams taken once daily with breakfast or the first main meal. If necessary, your doctor will gradually increase the dose 1 or 2 milligrams at a time every 1 or 2 weeks. Your diabetes will probably be controlled on 1 to 4 milligrams a day; the most you should take in a day is 8 milligrams. If the maximum dose fails to do the job, your doctor may add Glucophage to your regimen. Weakened or malnourished people and those with adrenal, pituitary, kidney, or liver disorders are particularly sensitive to hypoglycemic drugs such as Amaryl and should start at 1 milligram once daily. Your doctor will increase your medication based on your response to the drug. Safety and effectiveness in children have not been established. An overdose of Amaryl can cause low blood sugar (see "What side effects may occur? Eating sugar or a sugar-based product will often correct mild hypoglycemia. For severe hypoglycemia, seek medical attention immediately. Apidra (insulin glulisine) is a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. It is a faster-acting form of insulin than regular human insulin. Apidra is used to treat type 1 (insulin-dependent) diabetes in adults and children who are at least 4 years old. It is usually given together with another long-acting insulin. Apidra may also be used for other purposes not listed here. Apidra is a fast-acting insulin that begins to work very quickly. You should use it within 15 minutes before or 20 minutes after you start eating a meal. Also watch for signs of blood sugar that is too high (hyperglycemia). These symptoms include increased thirst, loss of appetite, increased urination, nausea, vomiting, drowsiness, dry skin, and dry mouth. Check your blood sugar levels and ask your doctor how to adjust your insulin doses if needed. Apidra is only part of a complete program of treatment that may also include diet, exercise, weight control, foot care, eye care, dental care, and testing your blood sugar. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels.
Covering adult and youth suicide buy discount viagra super active 50mg online erectile dysfunction doctors in tulsa, suicide among seniors buy viagra super active 50mg visa erectile dysfunction protocol free copy, methods of suicide and more purchase viagra super active 50mg without a prescription erectile dysfunction freedom book. Studies indicate that the best way to prevent suicide is through the early recognition and treatment of depression and other psychiatric illnesses order viagra super active 25mg visa erectile dysfunction 40 year old man. Over 32,000 people in the United States kill themselves every year. Suicide is the 11th leading cause of death in the United States. Suicide is fourth leading cause of death for adults between the ages of 18 and 65 years in the U. A person dies by suicide about every 16 minutes in the U. Ninety percent of all people who die by suicide have a diagnosable psychiatric disorder at the time of their death. There are more than four male suicides for every female suicide. However, at least twice as many females as males attempt suicide. Every day, approximately 80 Americans take their own life, and 1500 attempt. There are an estimated eight to twenty-five attempted suicides to one completion. Suicide is the 5th leading cause of death among all those 5 to 14 years of age. Suicide is the 3rd leading cause of death among all those 15 to 24 years of age. The suicide rate for white males age 15 to 24 has tripled since 1950, while for white females, it has more than doubled. Among persons age 10 to 14 years, the rate has increased by 100%. Since the mid-1990s, the youth suicide rate has been steadily decreasing. Among young people aged 10-14 years, the rate has doubled in the last two decades. Between 1980-1996, the suicide rate for African-American males aged 15-19 has also doubled. Risk factors for suicide among the young include suicidal thoughts, psychiatric disorders (such as depression, impulsive aggressive behavior, bipolar disorder, certain anxiety disorders), drug and/or alcohol abuse and previous suicide attempts, with the risk increased if there is also access to firearms and situational stress. The suicide rates for men rise with age, most significantly after age 65. The rate of suicide in men 65+ is seven times that of females who are 65+. The suicide rates for women peak between the ages of 45-54 years old, and again after age 75. About 60 percent of elderly patients who take their own lives see their primary care physician within a few months of their death. More than 30 percent of patients suffering from major depression report suicidal ideation. Risk factors for suicide among the elderly include: a previous attempt, the presence of a mental illness, the presence of a physical illness, social isolation (some studies have shown this is especially so in older males who are recently widowed) and access to means, such as the availability of firearms in the home. Over 60 percent of all people who die by suicide suffer from major depression. If one includes alcoholics who are depressed, this figure rises to over 75 percent. Depression affects nearly 10 percent of Americans ages 18 and over in a given year, or more than 19 million people. More Americans suffer from depression than coronary heart disease (12 million), cancer (10 million) and HIV/AIDS (1 million). About 15 percent of the population will suffer from clinical depression at some time during their lifetime. Thirty percent of all clinically depressed patients attempt suicide; half of them ultimately die by suicide. Depression is among the most treatable of psychiatric illnesses. Between 80 percent and 90 percent of people with depression respond positively to treatment, and almost all patients gain some relief from their symptoms. Ninety-six percent of alcoholics who die by suicide continue their substance abuse up to the end of their lives. Alcoholism is a factor in about 30 percent of all completed suicides. Approximately 7 percent of those with alcohol dependence will die by suicide. Although most gun owners reportedly keep a firearm in their home for "protection" or "self defense," 83 percent of gun-related deaths in these homes are the result of a suicide, often by someone other than the gun owner. Death by firearms is the fastest growing method of suicide. Above figures from the National Center for Health Statistics for the year 2005. The Suicide FAQ is an attempt to raise awareness about suicide, so that we may be better able to recognize and help other people in crisis, and also to find how to seek help or make better choices ourselves. Suicide is a significant cause of death in many western countries, in some cases exceeding deaths by motor vehicle accidents annually. Many countries spend vast amounts of money on safer roads, but very little on suicide awareness and prevention, or on educating people about how to make good life choices. In many cases, the events in question will pass, their impact can be mitigated, or their overwhelming nature will gradually fade if the person is able to make constructive choices about dealing with the crisis when it is at its worst. Since this can be extremely difficult, this article is an attempt to raise awareness about suicide, so that we may be better able to recognize and help other people in crisis, and also to find how to seek help or make better choices ourselves. Here are a number of frequently asked questions to help raise awareness and dispel some of the common myths about suicide:Why do people attempt suicide? So what sort of things can contribute to someone feeling suicidal? How would I know if someone I care about was contemplating suicide? How do telephone counselling and suicide hot-line services work? People usually attempt suicide to block unbearable emotional pain, which is caused by a wide variety of problems. A person attempting suicide is often so distressed that they are unable to see that they have other options: we can help prevent a tragedy by endeavoring to understand how they feel and helping them to look for better choices that they could make. Suicidal people often feel terribly isolated; because of their distress, they may not think of anyone they can turn to, furthering this isolation. In the vast majority of cases a suicide attemptor would choose differently if they were not in great distress and were able to evaluate their options objectively. Most suicidal people give warning signs in the hope that they will be rescued, because they are intent on stopping their emotional pain, not on dying. No, having suicidal thoughts does not imply that you are crazy, or necessarily mentally ill.
Sildenafil citrate treatment for SRI-associated female sexual dysfunction viagra super active 50mg otc erectile dysfunction pills herbal. Program and abstracts of the American Psychiatric Association 156th Annual Meeting purchase viagra super active 25 mg mastercard erectile dysfunction at age 19; May 17-22 discount 100 mg viagra super active with visa injections for erectile dysfunction that truly work, 2003 buy viagra super active 50mg fast delivery erectile dysfunction age 21; San Francisco, California. Written by Gary Tucker, MD Sexual dysfunction associated with the use of serotonin reuptake inhibitors (SRIs) has been reported in 30% to 70% of treated patients and is a significant contributor to discontinuation of these medications. In a multicenter, university-based, double-blind, prospective study that was funded by the manufacturer of Viagra (sildenafil), 90 antidepressant-treated men with sexual dysfunction and remitted depression were randomized to receive 6 weeks of treatment with sildenafil (50 to 100 mg) or placebo (mean age, 45; duration of antidepressant use, 27 months). Sexual dysfunction was defined as erectile problems, delayed ejaculation, or lack of orgasm. On standardized rating scales, significantly more Viagra recipients than placebo recipients showed marked improvement in sexual function (55% vs. In both groups, scores on depression scales remained consistent with remission. Other than headache (reported by 40% of Viagra recipients) and flushing (17%), few adverse effects were noted. Comment: This patient group was highly selected: All participants were healthy, had no medical conditions that could impair sexual function, and had no sexual dysfunction prior to antidepressant treatment. Nevertheless, these results indicate that sexual dysfunction in at least half of these SRI-treated patients improved with Viagra treatment. Treatment of antidepressant-associated sexual dysfunction with sildenafil: A randomized controlled trial. Neuroleptics or antipsychotics are prescribed for Bipolar Disorder and Schizophrenia. They are used to treat a variety of psychiatric problems, such as preoccupation with troublesome and recurring thoughts, overactivity, and unpleasant and unusual experiences such as hearing and seeing things not normally seen or heard. Some of the benefits of these antipsychotics may occur in the first few days, but it is not unusual for it to take several weeks or months to see the full benefits. In contrast, many of the side effects are worse when you first start taking it. In women, this can lead to an increase in breast size and irregular periods. In men, it can lead to impotence and the development of breasts. Most of the typical antipsychotic drugs, risperidone (Risperidal) and amisulpride have the worst effect. The best known function of prolactin is the stimulation and maintenance of lactation, but it has also been found to be involved in over 300 separate functions including involvement in water and electrolyte balance, growth and development, endocrinology and metabolism, brain and behavior, reproduction and immunoregulation. In humans, prolactin is also thought to play a role in the regulation of sexual activity and behavior. It has been observed that orgasms cause a large and sustained (60 min) increase in plasma prolactin in both men and women, which is associated with decreased sexual arousal and function. Furthermore, increased prolactin is thought to promote behaviors that encourage long-term partnership. Studies of patients who are treatment-naive or who have been withdrawn from treatment for a period of time indicate that schizophrenia per se does not affect prolactin concentrations. He/she may be able to reduce your dose or change your medication. In fact, many discontinue treatment because of the sexual side effects. The effects of conventional antipsychotics on prolactin are well known. Over 25 years ago, the sustained elevation of serum prolactin to pathological levels by conventional antipsychotics was demonstrated by Meltzer and Fang. The most important factor regulating prolactin is the inhibitory control exerted by dopamine. Any agent that blocks dopamine receptors in a non-selective manner can cause elevation of serum prolactin. Most studies have shown that conventional antipsychotics are associated with a two-to ten-fold increase in prolactin levels. Prolactin is a hormone in the blood that helps to produce milk and is involved in breast development. However, increased prolactin can lead to a decrease in libido when it is not needed. The increase in prolactin that occurs through the use of conventional antipsychotics develops over the first week of treatment and remains elevated throughout the period of use. Once treatment stops, prolactin levels return to normal within 2-3 weeks. In general, second-generation atypical antipsychotics produce lower increases in prolactin than conventional agents. Some agents, including olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and clozapine (Clozaril) have been shown to produce no significant or sustained increase in prolactin in adult patients. However, in adolescents (age 9-19 years) treated for childhood-onset schizophrenia or psychotic disorder, it has been shown that after 6 weeks of olanzapine treatment prolactin levels were increased beyond the upper limit of the normal range in 70% of patients. Second-generation antipsychotics that have been associated with increases in prolactin levels are amisulpride, zotepine and risperidone (Risperidal). The most common clinical effects of hyperprolactinaemia (high prolactin levels) are:amenorrhoea (loss of period)gynaecomastia (swollen breasts)galactorrhoea (abnormal breast milk production)azoospermia (no sperm are present in the ejaculate)galactorrhoea (occasionally) (abnormal breast milk production)Less frequently, hirsutism (excessive hairiness) in women, and weight gain have been reported. Sexual function is a complex area that includes emotions, perception, self-esteem, complex behavior and the ability to initiate and complete sexual activity. Important aspects are the maintenance of sexual interest, the ability to achieve arousal, the ability to achieve orgasm and ejaculation, the ability to maintain a satisfying intimate relationship, and self-esteem. The impact of antipsychotics on sexual functioning is difficult to evaluate, and sexual behavior in schizophrenia is an area in which research is lacking. Data from short-term clinical trials may greatly underestimate the extent of endocrine adverse events. One thing we do know is that drug-free patients with schizophrenia have lower sexual libido, decreased frequency of sexual thoughts, a decreased frequency of sexual intercourse and higher requirements for masturbation. Sexual activity was also found to be reduced in patients with schizophrenia compared with the general population; 27% of schizophrenia patients reported no voluntary sexual activity and 70% reported having no partner. While untreated schizophrenia patients exhibit decreased sexual desire, neuroleptic treatment is associated with restoration of sexual desire, yet it entails erectile, orgasmic and sexual satisfaction problems. Atypical antipsychotics are also known to contribute to the development of hyperprolactinaemia. The PDR states that "olanzapine elevates prolactin levels, and a modest elevation persists during chronic administration. For Seroquel (quetiapine), the PDR states, "an elevation of prolactin levels was not demonstrated in clinical trials", and no adverse effects relating to sexual dysfunction are listed as "frequent". The PDR states that " Risperdal (risperidone) elevates prolactin levels and the elevation persists during chronic administration. Before initiating antipsychotic treatment, a careful examination of the patient is necessary. In routine situations, clinicians should examine patients for evidence of sexual adverse events, including menorrhagia, amenorrhoea, galactorrhoea and erectile / ejaculatory dysfunction. This is an important prerequisite to differentiate between adverse effects due to the current medication, those remaining from the previous medication or symptoms of the illness. Furthermore, such checks should be repeated at regular intervals. The current recommendation is that a rise in prolactin concentrations should not be of concern unless complications develop, and until such time no change in treatment is required. Increased prolactin may be due to the formation of macroprolactin, which does not have serious consequences for the patient. If there are doubts that hyperprolactineamia is related to antipsychotic treatment, other possible causes of the hyperprolactinaemia have to be excluded; these include pregnancy, nursing, stress, tumours and other drug therapies.