Dr Scott Newsome explains "We're still learning [more about SPS]"
Current management approaches for SPS
I'd like to say thank you, to www.raredr.com (Rare Disease Report) for the segments.
Saturday, September 12, 2015
Stiff Person Syndrome Explained by Dr Scott Newsome
I'd like to say thank you, to www.raredr.com (Rare Disease Report) for the segments.
Saturday, July 4, 2015
intravenous methylprednisolone: Anti-GAD65 negative stiff person syndrome
- Sharma B, Nagpal K, Prakash S, Gupta P. Anti-GAD negative stiff person syndrome with a favorable response to intravenous methylprednisolone: An experience over evidence. Neurol India [serial online] 2014 [cited 2015 Jul 4];62:76-7. Available from: http://www.neurologyindia.com/text.asp?2014/62/1/76/128332
Wednesday, April 15, 2015
Saturday, April 11, 2015
Monday, March 30, 2015
Depression and A Review of the Research for Adults
Medicines for Treating Depression A Review of the Research for Adults
Source: http://www.effectivehealthcare.ahrq.gov/ehc/products/210/1142/sec_gen_anti_dep_cons_fin_to_post.pdf
Is This Information Right for Me? Yes, if: „ A doctor or other health care professional has told you that you have depression. Your doctor may call this condition major depressive disorder (MDD). „ Your doctor or other health care professional has suggested taking a specific kind of medicine for your depression called an “antidepressant.” „ You are over age 18. This information is from research on adults. What will this summary tell me? This summary will tell you what research found about the possible benefits and side effects of antidepressants. You can use this information to talk with your doctor about which medicine may be best for you. Where does the information come from? Researchers funded by the Agency for Healthcare Research and Quality (AHRQ), a Federal Government research agency, reviewed 248 studies published between January 1980 and January 2011 on second-generation antidepressants. This report updates research first reported in 2007 and includes newer medicines. You can read the report at www.effectivehealthcare.ahrq.gov/secondgenantidep.cfm. Antidepressants are only one kind of medicine used to treat depression. They are the most common medicine used for this condition. Your doctor may prescribe other types of medicines to treat depression. This summary will review only the research on antidepressants. It does not review research on non-medicine therapies. The research studies also did not look at patients with bipolar disorder, substance abuse, bulimia nervosa, or schizophrenia.
Understanding My Condition What is depression? Depression is a medical illness that involves the brain. It is a very common condition that affects around one in every five people in the United States. Many factors can cause depression, including your genes (DNA), the chemistry in your brain, or environmental factors like stress. Depression is different from feeling sad or down every now and then. People with depression feel sad, lack energy, feel tired, or have difficulty enjoying routine activities almost every day. Not everyone with depression feels sad or down. Other symptoms of depression include: „ Changes in your sleeping habits such as sleeping poorly or sleeping more than usual. „ Losing interest in usual activities such as favorite hobbies, time with family members, or evenings out with friends. „ Not eating as much or eating more, whether or not you are hungry. „ Strong feelings of despair, worthlessness, or hopelessness. „ Finding it hard to think or concentrate. „ Feelings of excessive or inappropriate guilt. „ Thoughts of suicide. You may not notice some of these symptoms, but people living and working around you may see them. Depression is a serious but treatable problem that should not be ignored. Many people require some form of treatment by a doctor or other health care professional for their depression. 1 Understanding Your Choices How is depression treated? Depression is treated with medicines, talk therapy (where a person talks with a trained professional about his or her thoughts and feelings; sometimes called “psychotherapy” or “counseling”), or a combination of the two. This summary looks at research only on the medicines used to treat depression called antidepressants. Your doctor may have you see a talk therapist in addition to taking medicine. Ask your doctor about the benefits and risks of adding talk therapy to your treatment. 2 Antidepressant Medicines* *Your doctor may use a medicine that is not included in this list to treat your depression. The listed medicines were the ones studied in the review of research used for this summary. **The brand name Serzone® is not available in the United States. Only the generic form of this medicine is available. Brand Name Generic Available? Drug Name Wellbutrin®; Wellbutrin SR®; Wellbutrin XL® Yes, for some doses Bupropion Celexa® Yes Citalopram Pristiq® No Desvenlafaxine Cymbalta® No Duloxetine Lexapro® No Escitalopram Prozac®; Prozac Weekly® Yes Fluoxetine Luvox® Yes Fluvoxamine Remeron®; Remeron SolTab® Yes, for some doses Mirtazapine Serzone®** Yes Nefazodone Paxil®; Paxil CR® Yes Paroxetine Zoloft® Yes Sertraline Desyrel® Yes Trazodone Effexor®; Effexor XR® Yes, for some doses Venlafaxine What do the letters SR, CR, XR, and XL after the brand name mean? Medicines with these letters are forms of the medicine that delay or extend the release of the medicine in your body. This means that the medicine stays in your body for longer periods of time and you may be able to take the medicine less often. „ Wellbutrin SR® is a sustained-release medicine. You take this medicine twice a day. „ Paxil CR® is a controlled-release medicine. You take this medicine once a day. „ Effexor XR®, Wellbutrin XL®, and Prozac Weekly® are extendedrelease medicines. You take Wellbutrin XL® and Effexor XR® once a day. You take Prozac Weekly® once a week. 3 How well do these medicines work? Although all the antidepressant medicines work about as well as each other, it is important to remember that some people will not feel better with the first medicine they try. They may need to try several medicines before finding one that works for them. Others may find that although the medicine helped for a while, their symptoms came back. It is important to follow carefully your doctor’s directions for taking your medicine for it to work. Only three people out of five will see their depression improve the first time they start taking an antidepressant. How do these medicines work? Antidepressant medicines help improve the way your brain uses certain chemicals that control mood or stress. What does research say about how well these medicines help people with depression? „ All of the antidepressant medicines work about as well as each other to improve the symptoms of depression and the quality of life for people with depression. „ All of the antidepressant medicines work about as well as each other in keeping depression symptoms from coming back. 4 What did research find about specific antidepressants? Research has found some specific information about the benefits of a few medicines: „ People who took mirtazapine (Remeron®) started feeling better faster than they did on other antidepressants. Remeron® took about 1 to 2 weeks to start working. All of the other antidepressants showed signs that they were working by 4 weeks. „ Prozac Weekly® and Paxil CR® worked as well as regular Prozac® and Paxil®. „ Fewer people stopped taking venlafaxine (Effexor®, Effexor XR®) because it was not working, compared with other antidepressants. People who did stop taking venlafaxine stopped it because of side effects such as nausea and vomiting. Can antidepressants help with other problems related to depression? „ Anxiety. People with depression saw improvements in their anxiety. The medicines studied all showed about the same amount of improvement. „ Pain. Paroxetine (Paxil®) and duloxetine (Cymbalta®) both helped people with depression and chronic pain about the same amount. „ Insomnia (when you cannot fall or stay asleep). Fluoxetine (Prozac®), mirtazapine (Remeron®), paroxetine (Paxil®), and sertraline (Zoloft®) helped people with insomnia about the same amount, but there is not enough research to know this for certain. 5 What are the side effects of antidepressants? The number of people who have some kind of side effect from taking an antidepressant is about the same for all the antidepressant medicines. However, the side effects of each medicine may be different, and some medicines are likely to cause some side effects more often than others. The most common side effects listed by the U.S. Food and Drug Administration (FDA) for the antidepressants discussed in this summary are: „ Nausea and vomiting Other more serious but much less common side effects listed by the FDA for the antidepressant medicines discussed in this summary can include seizures, heart problems, an imbalance of salt in your blood, liver damage, suicidal thoughts, or serotonin syndrome (a lifethreatening reaction where your body makes too much serotonin). Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff or rigid muscles. „ Weight gain „ Diarrhea „ Sleepiness „ Sexual problems If you are having suicidal thoughts or other serious side effects like seizures or heart problems while taking antidepressant medicines, contact your doctor immediately. The National Suicide Prevention Lifeline is available at 1-800-273-TALK (8255) or go to www.suicidepreventionlifeline.org. 6 Medicines Most Likely To Cause Certain Side Effects Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. Side Effect Medicines Most Likely To Cause This Side Effect Nausea/vomiting „ Venlafaxine (Effexor®, Effexor XR®) „ Paroxetine (Paxil®) Weight gain „ Mirtazapine (Remeron®, Remeron SolTab®) † Between 2 and 7 pounds in 6 to 8 weeks Diarrhea „ Sertraline (Zoloft®) Sleepiness „ Trazodone (Desyrel®) Sexual problems (such as decreased sex drive or difficulty getting an erection) „ Paroxetine (Paxil®, Paxil CR®) „ Escitalopram (Lexapro®), fluoxetine (Prozac®, Prozac Weekly®), paroxetine (Paxil®, Paxil CR®), or sertraline (Zoloft®) had more sexual side effects than bupropion (Wellbutrin®, Wellbutrin SR®, Wellbutrin XL®) 7 8 What happens if I stop taking my antidepressant? „ Some people have symptoms after they stop taking certain antidepressant medicines. These are called “withdrawal symptoms.” Withdrawal symptoms include headache, dizziness, light-headedness, nausea, and anxiety. You should never stop taking your medicine without first talking with your doctor. … More people had these symptoms after they stopped taking paroxetine (Paxil®, Paxil CR®) and venlafaxine (Effexor®, Effexor XR®). … Fewer people had withdrawal symptoms after they stopped taking fluoxetine (Prozac®, Prozac Weekly®). 8 Making a Decision What should I think about? You and your doctor can decide if taking a certain medicine for your depression is worth the risk of possible side effects. There are several things you may want to think about and discuss with your doctor: „ The types of depression symptoms you have and how much they are bothering you. „ The effect that not taking medicine for depression may have on your life, work, and relationships. „ Certain side effects and how they might affect your daily life or work. „ Which form of the medicine (immediate, sustained [SR], controlled [CR], or extended [ER] release) might be best for you. „ Other health problems you may be facing and how these medicines interact with others that you are taking. „ Whether some kind of talk therapy would be helpful while you are taking medicine. „ The cost of the medicine. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has side effects that you can manage. It is important to talk with your doctor about: „ The length of time it may take to try a medicine before knowing if it is helping you or if it causes a side effect. „ When you need to let your doctor know about a side effect from the medicine. „ What role your family and friends might take to support you while you are treating your depression. 9 Wholesale Prices of Prescription Antidepressants N/A = not available SR, XL, CR, and XR are all extended-release formulas. * Prices are the average wholesale prices listed from RED BOOK Online®. Generic prices are the middle value in the range of prices listed from different manufacturers. The actual prices of the medicines may be higher or lower than the prices listed here, depending on the manufacturer used by your pharmacy. What are the costs of these medicines? The following chart lists the wholesale price (the cost to the pharmacy) for each of the antidepressants discussed in this summary. The actual cost to you may be different, depending on: „ Your health insurance co-payment. „ The dose (amount) that you need to take. „ Whether a generic form of the medicine is available. Brand Name Doses Available Price per Month for Brand Name Generic Name Price per Month for Generic Celexa® 10 mg $126 Citalopram $72 20 mg $131 $75 40 mg $137 $78 Cymbalta® 60 mg $150 Duloxetine N/A Desyrel® 50 mg $60 Trazodone $5 100 mg $113 $6 Effexor® 25 mg $54 Venlafaxine N/A (all doses) 50 mg $69 75 mg $75 100 mg $81 Effexor XR® 37.5 mg $171 N/A N/A Lexapro® 5 mg $138 Escitalopram N/A (all doses) 10 mg $146 20 mg $152 Luvox® 25 mg $89 Fluvoxamine $69 50 mg $100 $78 100 mg $102 $79 Paxil® 10 mg $133 Paroxetine $79 20 mg $139 $80 30 mg $143 $85 40 mg $151 $90 Continued on next page 10 Wholesale Prices of Prescription Antidepressants (Continued) N/A = not available SR, XL, CR, and XR are all extended-release formulas. * Prices are the average wholesale prices listed from RED BOOK Online®. Generic prices are the middle value in the range of prices listed from different manufacturers. The actual prices of the medicines may be higher or lower than the prices listed here, depending on the manufacturer used by your pharmacy. ** The brand name Serzone® is not available in the United States. Only the generic form of this medicine is available. Brand Name Doses Available Price per Month for Brand Name Generic Name Price per Month for Generic Paxil CR® 12.5 mg $137 Paroxetine $109 25 mg $143 $114 37.5 mg $147 $117 Pristiq® 50 mg $163 Desvenlafaxine N/A 100 mg $163 (all doses) Prozac® 10 mg $90 Fluoxetine $78 20 mg $120 $80 Prozac Weekly® 40 mg $165 $160 Remeron® 25 mg $138 Mirtazapine $82 50 mg $142 $84 100 mg $145 $86 Remeron SolTab® 15 mg $110 N/A (all doses) 30 mg $113 45 mg $120 Serzone®** 50 mg N/A (all doses) Nefazodone $54 100 mg $56 150 mg $57 200 mg $58 250 mg $59 Wellbutrin® 75 mg $80 Bupropion $22 100 mg $107 $51 Wellbutrin SR® 100 mg $123 N/A 150 mg $132 $58 200 mg $246 $115 Wellbutrin XL® 150 mg $248 N/A 300 mg $327 N/A Zoloft® 25 mg $153 Sertraline N/A (all doses) 50 mg $153 100 mg $153 11 12 Other questions for your doctor: Write the answers here: Ask your doctor „ Which antidepressant medicine do you think might be best to treat my depression? „ What side effects should I be looking for, and when should I tell you about them? „ How will we know if it is time to try a different amount of medicine or a different medicine? „ Do any of my other health problems or medicines affect how well the antidepressant might work? „ Should I also see a talk therapist or counselor? 13 Source The information in this summary comes from the report SecondGeneration Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review, December 2011. The report was produced by the RTI International–University of North Carolina Evidence-based Practice Center through funding by the Agency for Healthcare Research and Quality (AHRQ). For a copy of the report or for more information about AHRQ and the Effective Health Care Program, go to www.effectivehealthcare. ahrq.gov/secondgenantidep.cfm. Additional information came from the MedlinePlus® Web site, a service of the National Library of Medicine and the National Institutes of Health. This site is available at www.nlm.nih.gov/medlineplus. This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. Patients with depression reviewed this summary. AHRQ Pub No. 12-EHC012-A July 2012
Source: http://www.effectivehealthcare.ahrq.gov/ehc/products/210/1142/sec_gen_anti_dep_cons_fin_to_post.pdf
Is This Information Right for Me? Yes, if: „ A doctor or other health care professional has told you that you have depression. Your doctor may call this condition major depressive disorder (MDD). „ Your doctor or other health care professional has suggested taking a specific kind of medicine for your depression called an “antidepressant.” „ You are over age 18. This information is from research on adults. What will this summary tell me? This summary will tell you what research found about the possible benefits and side effects of antidepressants. You can use this information to talk with your doctor about which medicine may be best for you. Where does the information come from? Researchers funded by the Agency for Healthcare Research and Quality (AHRQ), a Federal Government research agency, reviewed 248 studies published between January 1980 and January 2011 on second-generation antidepressants. This report updates research first reported in 2007 and includes newer medicines. You can read the report at www.effectivehealthcare.ahrq.gov/secondgenantidep.cfm. Antidepressants are only one kind of medicine used to treat depression. They are the most common medicine used for this condition. Your doctor may prescribe other types of medicines to treat depression. This summary will review only the research on antidepressants. It does not review research on non-medicine therapies. The research studies also did not look at patients with bipolar disorder, substance abuse, bulimia nervosa, or schizophrenia.
Understanding My Condition What is depression? Depression is a medical illness that involves the brain. It is a very common condition that affects around one in every five people in the United States. Many factors can cause depression, including your genes (DNA), the chemistry in your brain, or environmental factors like stress. Depression is different from feeling sad or down every now and then. People with depression feel sad, lack energy, feel tired, or have difficulty enjoying routine activities almost every day. Not everyone with depression feels sad or down. Other symptoms of depression include: „ Changes in your sleeping habits such as sleeping poorly or sleeping more than usual. „ Losing interest in usual activities such as favorite hobbies, time with family members, or evenings out with friends. „ Not eating as much or eating more, whether or not you are hungry. „ Strong feelings of despair, worthlessness, or hopelessness. „ Finding it hard to think or concentrate. „ Feelings of excessive or inappropriate guilt. „ Thoughts of suicide. You may not notice some of these symptoms, but people living and working around you may see them. Depression is a serious but treatable problem that should not be ignored. Many people require some form of treatment by a doctor or other health care professional for their depression. 1 Understanding Your Choices How is depression treated? Depression is treated with medicines, talk therapy (where a person talks with a trained professional about his or her thoughts and feelings; sometimes called “psychotherapy” or “counseling”), or a combination of the two. This summary looks at research only on the medicines used to treat depression called antidepressants. Your doctor may have you see a talk therapist in addition to taking medicine. Ask your doctor about the benefits and risks of adding talk therapy to your treatment. 2 Antidepressant Medicines* *Your doctor may use a medicine that is not included in this list to treat your depression. The listed medicines were the ones studied in the review of research used for this summary. **The brand name Serzone® is not available in the United States. Only the generic form of this medicine is available. Brand Name Generic Available? Drug Name Wellbutrin®; Wellbutrin SR®; Wellbutrin XL® Yes, for some doses Bupropion Celexa® Yes Citalopram Pristiq® No Desvenlafaxine Cymbalta® No Duloxetine Lexapro® No Escitalopram Prozac®; Prozac Weekly® Yes Fluoxetine Luvox® Yes Fluvoxamine Remeron®; Remeron SolTab® Yes, for some doses Mirtazapine Serzone®** Yes Nefazodone Paxil®; Paxil CR® Yes Paroxetine Zoloft® Yes Sertraline Desyrel® Yes Trazodone Effexor®; Effexor XR® Yes, for some doses Venlafaxine What do the letters SR, CR, XR, and XL after the brand name mean? Medicines with these letters are forms of the medicine that delay or extend the release of the medicine in your body. This means that the medicine stays in your body for longer periods of time and you may be able to take the medicine less often. „ Wellbutrin SR® is a sustained-release medicine. You take this medicine twice a day. „ Paxil CR® is a controlled-release medicine. You take this medicine once a day. „ Effexor XR®, Wellbutrin XL®, and Prozac Weekly® are extendedrelease medicines. You take Wellbutrin XL® and Effexor XR® once a day. You take Prozac Weekly® once a week. 3 How well do these medicines work? Although all the antidepressant medicines work about as well as each other, it is important to remember that some people will not feel better with the first medicine they try. They may need to try several medicines before finding one that works for them. Others may find that although the medicine helped for a while, their symptoms came back. It is important to follow carefully your doctor’s directions for taking your medicine for it to work. Only three people out of five will see their depression improve the first time they start taking an antidepressant. How do these medicines work? Antidepressant medicines help improve the way your brain uses certain chemicals that control mood or stress. What does research say about how well these medicines help people with depression? „ All of the antidepressant medicines work about as well as each other to improve the symptoms of depression and the quality of life for people with depression. „ All of the antidepressant medicines work about as well as each other in keeping depression symptoms from coming back. 4 What did research find about specific antidepressants? Research has found some specific information about the benefits of a few medicines: „ People who took mirtazapine (Remeron®) started feeling better faster than they did on other antidepressants. Remeron® took about 1 to 2 weeks to start working. All of the other antidepressants showed signs that they were working by 4 weeks. „ Prozac Weekly® and Paxil CR® worked as well as regular Prozac® and Paxil®. „ Fewer people stopped taking venlafaxine (Effexor®, Effexor XR®) because it was not working, compared with other antidepressants. People who did stop taking venlafaxine stopped it because of side effects such as nausea and vomiting. Can antidepressants help with other problems related to depression? „ Anxiety. People with depression saw improvements in their anxiety. The medicines studied all showed about the same amount of improvement. „ Pain. Paroxetine (Paxil®) and duloxetine (Cymbalta®) both helped people with depression and chronic pain about the same amount. „ Insomnia (when you cannot fall or stay asleep). Fluoxetine (Prozac®), mirtazapine (Remeron®), paroxetine (Paxil®), and sertraline (Zoloft®) helped people with insomnia about the same amount, but there is not enough research to know this for certain. 5 What are the side effects of antidepressants? The number of people who have some kind of side effect from taking an antidepressant is about the same for all the antidepressant medicines. However, the side effects of each medicine may be different, and some medicines are likely to cause some side effects more often than others. The most common side effects listed by the U.S. Food and Drug Administration (FDA) for the antidepressants discussed in this summary are: „ Nausea and vomiting Other more serious but much less common side effects listed by the FDA for the antidepressant medicines discussed in this summary can include seizures, heart problems, an imbalance of salt in your blood, liver damage, suicidal thoughts, or serotonin syndrome (a lifethreatening reaction where your body makes too much serotonin). Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff or rigid muscles. „ Weight gain „ Diarrhea „ Sleepiness „ Sexual problems If you are having suicidal thoughts or other serious side effects like seizures or heart problems while taking antidepressant medicines, contact your doctor immediately. The National Suicide Prevention Lifeline is available at 1-800-273-TALK (8255) or go to www.suicidepreventionlifeline.org. 6 Medicines Most Likely To Cause Certain Side Effects Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. Side Effect Medicines Most Likely To Cause This Side Effect Nausea/vomiting „ Venlafaxine (Effexor®, Effexor XR®) „ Paroxetine (Paxil®) Weight gain „ Mirtazapine (Remeron®, Remeron SolTab®) † Between 2 and 7 pounds in 6 to 8 weeks Diarrhea „ Sertraline (Zoloft®) Sleepiness „ Trazodone (Desyrel®) Sexual problems (such as decreased sex drive or difficulty getting an erection) „ Paroxetine (Paxil®, Paxil CR®) „ Escitalopram (Lexapro®), fluoxetine (Prozac®, Prozac Weekly®), paroxetine (Paxil®, Paxil CR®), or sertraline (Zoloft®) had more sexual side effects than bupropion (Wellbutrin®, Wellbutrin SR®, Wellbutrin XL®) 7 8 What happens if I stop taking my antidepressant? „ Some people have symptoms after they stop taking certain antidepressant medicines. These are called “withdrawal symptoms.” Withdrawal symptoms include headache, dizziness, light-headedness, nausea, and anxiety. You should never stop taking your medicine without first talking with your doctor. … More people had these symptoms after they stopped taking paroxetine (Paxil®, Paxil CR®) and venlafaxine (Effexor®, Effexor XR®). … Fewer people had withdrawal symptoms after they stopped taking fluoxetine (Prozac®, Prozac Weekly®). 8 Making a Decision What should I think about? You and your doctor can decide if taking a certain medicine for your depression is worth the risk of possible side effects. There are several things you may want to think about and discuss with your doctor: „ The types of depression symptoms you have and how much they are bothering you. „ The effect that not taking medicine for depression may have on your life, work, and relationships. „ Certain side effects and how they might affect your daily life or work. „ Which form of the medicine (immediate, sustained [SR], controlled [CR], or extended [ER] release) might be best for you. „ Other health problems you may be facing and how these medicines interact with others that you are taking. „ Whether some kind of talk therapy would be helpful while you are taking medicine. „ The cost of the medicine. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has side effects that you can manage. It is important to talk with your doctor about: „ The length of time it may take to try a medicine before knowing if it is helping you or if it causes a side effect. „ When you need to let your doctor know about a side effect from the medicine. „ What role your family and friends might take to support you while you are treating your depression. 9 Wholesale Prices of Prescription Antidepressants N/A = not available SR, XL, CR, and XR are all extended-release formulas. * Prices are the average wholesale prices listed from RED BOOK Online®. Generic prices are the middle value in the range of prices listed from different manufacturers. The actual prices of the medicines may be higher or lower than the prices listed here, depending on the manufacturer used by your pharmacy. What are the costs of these medicines? The following chart lists the wholesale price (the cost to the pharmacy) for each of the antidepressants discussed in this summary. The actual cost to you may be different, depending on: „ Your health insurance co-payment. „ The dose (amount) that you need to take. „ Whether a generic form of the medicine is available. Brand Name Doses Available Price per Month for Brand Name Generic Name Price per Month for Generic Celexa® 10 mg $126 Citalopram $72 20 mg $131 $75 40 mg $137 $78 Cymbalta® 60 mg $150 Duloxetine N/A Desyrel® 50 mg $60 Trazodone $5 100 mg $113 $6 Effexor® 25 mg $54 Venlafaxine N/A (all doses) 50 mg $69 75 mg $75 100 mg $81 Effexor XR® 37.5 mg $171 N/A N/A Lexapro® 5 mg $138 Escitalopram N/A (all doses) 10 mg $146 20 mg $152 Luvox® 25 mg $89 Fluvoxamine $69 50 mg $100 $78 100 mg $102 $79 Paxil® 10 mg $133 Paroxetine $79 20 mg $139 $80 30 mg $143 $85 40 mg $151 $90 Continued on next page 10 Wholesale Prices of Prescription Antidepressants (Continued) N/A = not available SR, XL, CR, and XR are all extended-release formulas. * Prices are the average wholesale prices listed from RED BOOK Online®. Generic prices are the middle value in the range of prices listed from different manufacturers. The actual prices of the medicines may be higher or lower than the prices listed here, depending on the manufacturer used by your pharmacy. ** The brand name Serzone® is not available in the United States. Only the generic form of this medicine is available. Brand Name Doses Available Price per Month for Brand Name Generic Name Price per Month for Generic Paxil CR® 12.5 mg $137 Paroxetine $109 25 mg $143 $114 37.5 mg $147 $117 Pristiq® 50 mg $163 Desvenlafaxine N/A 100 mg $163 (all doses) Prozac® 10 mg $90 Fluoxetine $78 20 mg $120 $80 Prozac Weekly® 40 mg $165 $160 Remeron® 25 mg $138 Mirtazapine $82 50 mg $142 $84 100 mg $145 $86 Remeron SolTab® 15 mg $110 N/A (all doses) 30 mg $113 45 mg $120 Serzone®** 50 mg N/A (all doses) Nefazodone $54 100 mg $56 150 mg $57 200 mg $58 250 mg $59 Wellbutrin® 75 mg $80 Bupropion $22 100 mg $107 $51 Wellbutrin SR® 100 mg $123 N/A 150 mg $132 $58 200 mg $246 $115 Wellbutrin XL® 150 mg $248 N/A 300 mg $327 N/A Zoloft® 25 mg $153 Sertraline N/A (all doses) 50 mg $153 100 mg $153 11 12 Other questions for your doctor: Write the answers here: Ask your doctor „ Which antidepressant medicine do you think might be best to treat my depression? „ What side effects should I be looking for, and when should I tell you about them? „ How will we know if it is time to try a different amount of medicine or a different medicine? „ Do any of my other health problems or medicines affect how well the antidepressant might work? „ Should I also see a talk therapist or counselor? 13 Source The information in this summary comes from the report SecondGeneration Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review, December 2011. The report was produced by the RTI International–University of North Carolina Evidence-based Practice Center through funding by the Agency for Healthcare Research and Quality (AHRQ). For a copy of the report or for more information about AHRQ and the Effective Health Care Program, go to www.effectivehealthcare. ahrq.gov/secondgenantidep.cfm. Additional information came from the MedlinePlus® Web site, a service of the National Library of Medicine and the National Institutes of Health. This site is available at www.nlm.nih.gov/medlineplus. This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. Patients with depression reviewed this summary. AHRQ Pub No. 12-EHC012-A July 2012
Sunday, March 22, 2015
Diagnosis gets 1% of healthcare spending
According to Pascale Wiltz
 |
| Time is of the essence in restoring health, order and well being. The sick cannot in all cases be expected to do the work of the physician. The tools are in the hands of the professionals. If a Doctor has an objection to consulting NIH, then why shall they ignore Watson (Expert System by IBM) if Watson is preloaded with all NIH and well founded adjacent healthcare information. |
Sunday, March 15, 2015
Calcium in good health and prevention
Used in the transmission of nerve impulses.
Muscle contraction
Release of neurotransmitters
Enzyme function
and more
Muscle contraction
Release of neurotransmitters
Enzyme function
and more
Saturday, March 14, 2015
SPS Awareness Day 3-15-2015
Please share! SPS (Stiff Person Syndrome/s) can show up like Fibromyalgia and or Lyme Disease (tests are negative), Autoimmune disease etc. There are three known antibodies that can contribute. Two are cancer indicators. One is more like the bodys' allergy to its own endocrine or metabolic pathways. If you are idiopathic, alternative trials of medication can be rotated to learn more. Keep coordinating your care with your MD.
My first pains were when I was unable to sleep on my side. My deltoids would get very sore like someone punched me a dead arm. I worked at the The State of Tennessee "TN Tower" in network and security operations at this time. I was in nearly top physical condition. I rarely took the shuttle up the steep incline from the parking lot. I probably logged 4-5 miles of foot traffic a day, and the first mile of the day was the most vigorous!
Only recently have we made more breakthroughs in my care. I have reviewed the body chemistry models in a handful of places including trade journals, NIH and online support groups (judiciously). I have additional ideas I am going to bounce off my healthcare provider. I have further questions on gabitril, but I need to wait until my late March appointments to discuss.
Thanks for sharing!
Friday, March 13, 2015
Lyrica and EMG silence
Based on this, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3393787/figure/F4/ I see why some stiff person syndrome studies may show EMG silence while on Lyrica.
Also, small fiber neuropathys may not show on NCS anyway. Based on the pain profiles I've reviewed today, see this slide deck for more information. http://www.slideshare.net/NeurologyKota/approach-to-peripheral-neuropathy-39338542.
Also, small fiber neuropathys may not show on NCS anyway. Based on the pain profiles I've reviewed today, see this slide deck for more information. http://www.slideshare.net/NeurologyKota/approach-to-peripheral-neuropathy-39338542.
Wednesday, March 11, 2015
SPS crossover part 2
I just came back from my Dr visit today. Based on everything I'm reading, this still smells a lot like SPS despite the negative GAD tests.
http://en.wikipedia.org/wiki/Pregabalin#Pharmacodynamics
Next on my list, I think it's time to read http://www.thetinman.org/gettingadx.html
My other light reading this week:
http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=4573http://search.nih.gov/search?utf8=%E2%9C%93&affiliate=nih&query=lyrica&commit.x=0&commit.y=0&commit=Search
http://en.wikipedia.org/wiki/Allosteric_modulator
http://en.wikipedia.org/wiki/GABA_receptor_agonist
http://en.wikipedia.org/wiki/GABA_receptor_antagonist
http://en.wikipedia.org/wiki/GABA_reuptake_inhibitor
http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/758/printFullReport
http://en.wikipedia.org/wiki/Paraneoplastic_syndrome
https://www.google.com/search?q=neuromyotonia
https://www.youtube.com/watch?v=-ovFTl77N50
https://www.google.com/search?q=Isaacs+Syndrome
http://www.ninds.nih.gov/disorders/isaacs_syndrome/isaacs_syndrome.htm
http://jnnp.bmj.com/content/65/5/633.full.pdf#page=1&view=FitH
http://www.livingwithsps.com/resources.html
https://www.rarediseases.org/rare-disease-information/rare-diseases/byID/326/viewAbstract
https://read.amazon.com/?asin=B00T9BAJ16
http://www.didihirsch.org/sites/default/files/pdf/annual-reports/DHMHS_AR_2013.pdf
http://www.nejm.org/doi/full/10.1056/NEJMcpc1114036
http://www.nejm.org/doi/full/10.1056/NEJMcpc1100924
http://www.rheumatology.org/assets/0/116/282/332/341/346/2147484151/b800a45b-5b27-4dea-9ca3-bed41a10bb11.pdf
Monday, March 9, 2015
Learning to write again
In the past few weeks, I'm am learning to write again. I recall handwriting becoming oddly difficult as we transitioned into 100% cursive writing for the year. I'd love to see my earliest writings. I chalked all this up to "It's just hard to write in cursive anyway." This SPS like working diagnosis is getting better and better. I have a follow up appt on the 11th. Cheers.
Saturday, March 7, 2015
EMG Stress test for cold?
While researching in Neuromuscular Disorders in Clinical Practice, I'm curious why no one mentions stress tests of cold for spasms during EMG's. I'm still not sure what they're looking for, but this book is the second place I've seen mention, some SPS patients may normal EMG's.
I really need to look at my file....
I really need to look at my file....
How bad can it hurt? Part 1
I'd like to make a shout out to the Journal of CLINICAL NEUROMUSCULAR DISEASE. I am accelerating my learning by diving into your material. I know my post primary education exams spoke highly of me in many disciplines of knowledge, but I wasn't expecting the bootstrap myself into medical investigations.
My next shot out was to this photo someone shared on FaceBook:
https://www.facebook.com/941KTFM/photos/a.10151751747718877.1073741832.319892343876/10152067880853877/?type=1
My point being, I'll take one of these "bull heads" to the foot (anything but the heel please!) over a muscle spasm. I've had the displeasure of striking these a few times squarely on the heel. My more severe muscle spasms have felt this way.
Back when I lived on Grandview Hill in Provo Utah, I walked behind a few homes in the alley aka old railbed of Independence Avenue. I remember walking headstrong into a patch. You know that voice in your head, you just got to suck it up for a sticker or two and move on? Well yeah, I had that voice. I plowed right into this field barefoot. I was about six or seven steps in until I maxed out my pain tolerance.
While in Morgan Hill, CA I had a pain "seizure". I am still researching what can cause this. Can we put Science to the test?
Stiff Person Syndrome is a bust on GAD antibody grounds.
SPS however may require looking at stiff limb syndrome. A different antibody may be at work. I'm looking into Amphiphysin now.
http://docs.justia.com/cases/federal/district-courts/california/candce/5:2011cv03472/242970/50/
http://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=900591&labCode=AMD
http://www.neurology.org/content/71/24/1955
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676978/pdf/6078.pdf
http://journals.lww.com/jcnmd/pages/results.aspx?txtkeywords=sps
http://journals.lww.com/jcnmd/Citation/2003/03000/Clinical_Approach_to_a_Patient_Presenting_With.9.aspx
Thursday, February 26, 2015
Monday, February 23, 2015
McArdle syndrome
McArdle syndrome
is the inability to break down glycogen. Glycogen is an important source of energy that is stored in all tissues, but especially in the muscles and liver.
Full Text http://www.nlm.nih.gov/medlineplus/ency/article/000329.htm
EMG can be electrically silent due to muscle contractures.
is the inability to break down glycogen. Glycogen is an important source of energy that is stored in all tissues, but especially in the muscles and liver.Full Text http://www.nlm.nih.gov/medlineplus/ency/article/000329.htm
EMG can be electrically silent due to muscle contractures.
See Also
EMG internal medicine books (Amazon)
Sunday, January 25, 2015
National Suicide Prevention Lifeline '1-800-273-TALK (8255)'
Google: National Suicide Prevention Lifeline - App Store links coming as I find them. (probably in their site someplace).
As of 02/2020 I've checked the phone number, and it is still current.
Utah Mobile Outreach Team (mobile) available upon request. see also receiving center.
Saturday, January 10, 2015
sps crossover 1
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Medline ® Abstract for Reference 70
of 'Chronic intestinal pseudo-obstruction'
70
PubMed
TIA novel approach to paraneoplastic intestinal pseudo-obstruction.
AUBadari A, Farolino D, Nasser E, Mehboob S, Crossland D
SOSupport Care Cancer. 2012;20(2):425.
Paraneoplastic neurologic syndromes (PNS) are uncommon, affecting fewer than 1 in 10,000 patients with cancer. PNS, while rare, can cause significant morbidity and impose enormous socio-economic costs, besides severely affecting quality of life. PNS can involve any part of the nervous system and can present as limbic encephalitis, subacute cerebellar ataxias, opsoclonus-myoclonus, retinopathies, chronic intestinal pseudo-obstruction (CIPO), sensory neuronopathy, Lambert-Eaton myasthenic syndrome, stiff-person syndrome, and encephalomyelitis. The standard of care for CIPO includes the use of promotility and anti-secretory agents and the resection of the non-functioning gut segment; all of which can cause significant compromise in the quality of life. There is significant evidence that paraneoplastic neurologic syndromes are associated with antibodies directed against certain nerve antigens. [A patient was successfully treated] with CIPO in the setting of small cell lung cancer with a combination of rituximab and cyclophosphamide. The patient, who had failed to respond to prokinetic agents, anti-secretory therapy, and multiple resections, responded to the immunomodulatory therapy, with minimal residuals with PEG tube feeding and sustained ostomy output. The use of rituximab and cyclophosphamide should therefore be considered in patients with CIPO, especially if it can avoid complicated surgical procedures.
ADUniversity at Buffalo, Buffalo, NY, USA. badariar@gmail.com
PMID22072051
The aforementioned article is (C) and is probably considered to be in the Public Domain, as the source is a U.S. Government public and social service.
Any remaining unclaimed (C) rights, belong to https://synapticmhz.blogger.com (C) Jan 2015.
Medline ® Abstract for Reference 70
of 'Chronic intestinal pseudo-obstruction'
70
PubMed
TIA novel approach to paraneoplastic intestinal pseudo-obstruction.
AUBadari A, Farolino D, Nasser E, Mehboob S, Crossland D
SOSupport Care Cancer. 2012;20(2):425.
Paraneoplastic neurologic syndromes (PNS) are uncommon, affecting fewer than 1 in 10,000 patients with cancer. PNS, while rare, can cause significant morbidity and impose enormous socio-economic costs, besides severely affecting quality of life. PNS can involve any part of the nervous system and can present as limbic encephalitis, subacute cerebellar ataxias, opsoclonus-myoclonus, retinopathies, chronic intestinal pseudo-obstruction (CIPO), sensory neuronopathy, Lambert-Eaton myasthenic syndrome, stiff-person syndrome, and encephalomyelitis. The standard of care for CIPO includes the use of promotility and anti-secretory agents and the resection of the non-functioning gut segment; all of which can cause significant compromise in the quality of life. There is significant evidence that paraneoplastic neurologic syndromes are associated with antibodies directed against certain nerve antigens. [A patient was successfully treated] with CIPO in the setting of small cell lung cancer with a combination of rituximab and cyclophosphamide. The patient, who had failed to respond to prokinetic agents, anti-secretory therapy, and multiple resections, responded to the immunomodulatory therapy, with minimal residuals with PEG tube feeding and sustained ostomy output. The use of rituximab and cyclophosphamide should therefore be considered in patients with CIPO, especially if it can avoid complicated surgical procedures.
ADUniversity at Buffalo, Buffalo, NY, USA. badariar@gmail.com
PMID22072051
The aforementioned article is (C) and is probably considered to be in the Public Domain, as the source is a U.S. Government public and social service.
Any remaining unclaimed (C) rights, belong to https://synapticmhz.blogger.com (C) Jan 2015.
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