Learn about the benefits, side-effects and disadvantages of SSRI antidepressants (Prozac, Lexapro, Luvox) for treatment of anxiety and panic attacks.

C. Serotonin Reuptake Blocking Agents (SSRIs)

A newer type of antidepressant medication was introduced into the U.S. in the 1980s, beginning with Prozac (fluoxetine). These drugs offer a different chemical structure than the cyclic antidepressants and therefore produce different effects on the brain. Primarily they assist the brain in maintaining enough supply of the neurotransmitter serotonin. For instance, researchers associate a deficiency of serotonin with depression and obsessive-compulsive disorder and implicate it in panic disorder and other psychological problems. These medications are called selective serotonin reuptake inhibitors, abbreviated SSRIs.

Possible Benefits. SSRIs can be helpful for depression, panic disorder, social phobia and obsessive compulsive disorder. They are well tolerated medications that are safe for medically ill or frail patients and safe in overdose. There are no withdrawal effects unless the patient stops them abruptly, and no dependency develops. They generally do not promote weight gain.

Possible Disadvantages. It takes four to six weeks to notice significant therapeutic benefits from the SSRIs. The full range of benefits can take twelve weeks. Patients often experience a temporary worsening of anxiety symptoms during the first two weeks of treatment. Abrupt discontinuation of the SSRIs could cause flu-like symptoms. All the SSRIs can be expensive.

SSRIs cause sexual problems more than other antidepressants or benzodiazopines. In fact, this may be their principle limitation, occurring in as many as 35 to 40% of patients. It is unclear whether these problems are evident in one SSRI more than others. If these difficulties arise, your choices are to wait several weeks to determine if this side effect diminishes, to lower the dose or to change to a different medication.

Possible Side Effects. Nausea, insomnia, headaches, sexual difficulties, initial agitation.

Fluoxetine (Prozac)

Possible Benefits. Reduces depression, helps control obsessive-compulsive disorder. Blocks panic attacks. Current research suggests some benefits for social phobias. Few side effects. No dependency. A well tolerated and safe medication.

Possible Disadvantages. May cause anxiety or insomnia. Therapeutic response can take four to six weeks. It is best to be off of Prozac for two menstrual cycles prior to attempting pregnancy. Do not use when breast-feeding.

Possible Side Effects. Nervousness and tremors, sweating, nausea, anxiety, diarrhea, difficulty falling asleep or frequent awakenings, difficulty achieving orgasm, decreased libido, headache, loss of appetite, postural hypotension, drowsiness or fatigue, upset stomach.

Dosages Recommended by Investigators. Prozac comes in 10 and 20 mg capsules and liquid oral solution that the patient usually takes in the morning. If you have a side effect of upset stomach, take it with food. Typically the initial dose is low, at 2.5 to 5 mg per day and gradually raised to 20 mg per day. If there is no response to this dose after four to eight weeks, raise the dose by 20 mg a week until there is a response, to a maximum dose of 80 mg.

Sertraline (Zoloft)

Possible Benefits. Useful for obsessive-compulsive disorder, panic disorder and depression. Low level of nervousness or agitation as side effect.

Possible Disadvantages. May cause anxiety or insomnia. Therapeutic response can take four to six weeks. Get your physician's approval before use during pregnancy or breast-feeding.

Possible Side Effects. Headache, dry mouth, sleepiness, dizziness, tremors, diarrhea, agitation, confusion, nausea, delayed ejaculation in men.

Dosages Recommended by Investigators. Start with 50 mg in morning or evening. Maximum dose is 200 mg. Taper slowly.

Paroxetine (Paxil)

Possible Benefits. Useful for obsessive-compulsive disorder, panic disorder and depression.

Possible Disadvantages. Therapeutic response can take four to six weeks. Discuss possible pregnancy or breast-feeding with your physician.

Possible Side Effects. Nausea, sleepiness, constipation, dry mouth, dizziness, insomnia, delayed ejaculation.

Dosages Recommended by Investigators. Start with 10 mg once a day. If no response after several weeks, can increase 10 mg per week up to 60 mg. For OCD the minimum therapeutic dose is often 40 mg.

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Fluvoxamine (Luvox)

Possible Benefits. Helpful for obsessive-compulsive disorder, depression.

Possible Disadvantages. Therapeutic response can take four to six weeks. Avoid alcohol. Do not take during pregnancy or breast-feeding.

Possible Side Effects. Nausea, sleepiness, insomnia, dry mouth, headache, dizziness, delayed ejaculation.

Dosages Recommended by Investigators. Start at 50 mg at night. Increase to between 100 and 300 mg per day. Doses over 100 mg should be divided into morning and night, with larger dose at night. To reduce nausea, take with food.

Lexapro (Escitalopram oxalate)

Possible Benefits. Helpful for generalized anxiety disorder, social anxiety disorder, depression.

Possible Disadvantages. Therapeutic response can take four to six weeks. Avoid alcohol. Do not take during pregnancy or breast-feeding.

Possible Side Effects. Nausea, diarrhea, constipation, loss of appetite, stomach pain, dizziness, drowsiness, trouble sleeping, fatigue, increased sweating, or dry mouth may occur.

Dosages Recommended by Investigators. 10 mg per day, may be increased to 20 mg.

Citalopram (Celexa)

Possible Benefits. Helpful for depression, OCD, panic.

Possible Disadvantages. Therapeutic response can take four to six weeks. Avoid alcohol. Do not take during pregnancy or breast-feeding.

Possible Side Effects. Nausea, vomiting, lack of appetite, diarrhea, drowsiness, dizziness, trouble sleeping, dry mouth, muscle/joint pain, fatigue, or yawning may occur.

Dosages Recommended by Investigators. start with 10 mg per day, may be increased to 20-60 mg.

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Learn about the benefits, side-effects and disadvantages of tricyclic antidepressants (Tofranil, Pamelor, Norpramin) for treatment of anxiety and panic attacks.

A. Tricyclic Antidepressants (TCAs)

Physicians use tricyclic antidepressants in the treatment of severe depression or depression that occurs with anxiety. Several also have broad anti-obsessional and anti-panic effects.

Possible Benefits. Often effective in reducing panic attacks and elevating depressed mood. Well researched. Usually a single daily dose. Some generics available, which reduces cost. Tolerance does not develop. Non-addicting.. Often effective in reducing panic attacks and elevating depressed mood. Well researched. Usually a single daily dose. Some generics available, which reduces cost. Tolerance does not develop. Non-addicting.

Possible Disadvantages. Delayed onset (take from 4-12 weeks). Anticholinergic effects. Postural hypotension. Possible side effects initially (including insomnia, tremor, or both) may last up to the first two to three weeks of treatment. Weight gain can be as much as one pound per month with about 25% of patients gaining 20 pounds or more. Dangerous in overdose. Should not be used by patients with narrow-angle glaucoma or certain heart abnormalities. Men with an enlarged prostate should avoid certain antidepressants. Delayed onset (take from 4-12 weeks). Anticholinergic effects. Postural hypotension. Possible side effects initially (including insomnia, tremor, or both) may last up to the first two to three weeks of treatment. Weight gain can be as much as one pound per month with about 25% of patients gaining 20 pounds or more. Dangerous in overdose. Should not be used by patients with narrow-angle glaucoma or certain heart abnormalities. Men with an enlarged prostate should avoid certain antidepressants.

Possible Side Effects. The anticholinergic effects of dry mouth, blurred vision, constipation, and difficulty in urination; postural hypotension; tachycardia, loss of sex drive; erectile failure; increased sensitivity to the sun; weight gain; sedation (sleepiness); increased sweating. Some of these side effects will disappear with the passage of time or with a decrease in the dosage. Some people may experience side effects on dosages as low as 10 mg per day: jitteriness, irritation, unusual energy, and difficulty falling or staying asleep.. The anticholinergic effects of dry mouth, blurred vision, constipation, and difficulty in urination; postural hypotension; tachycardia, loss of sex drive; erectile failure; increased sensitivity to the sun; weight gain; sedation (sleepiness); increased sweating. Some of these side effects will disappear with the passage of time or with a decrease in the dosage. Some people may experience side effects on dosages as low as 10 mg per day: jitteriness, irritation, unusual energy, and difficulty falling or staying asleep.

Dosages Recommended by Investigators. One-third of panic-prone individuals become jittery and actually experience more anxiety symptoms for the first two to three weeks. For this reason, the medication trial should probably be initiated with a very low dose -- as little as 10 to 25 milligrams (mg) per day of imipramine, for example. If uncomfortable side effects appear, one approach is to wait two to three weeks for them to diminish before increasing to the next higher dose. If the patient adjusts to the side effects, the physician increases the dosage every two or more days until the patient is taking the preferred dosage. . One-third of panic-prone individuals become jittery and actually experience more anxiety symptoms for the first two to three weeks. For this reason, the medication trial should probably be initiated with a very low dose -- as little as 10 to 25 milligrams (mg) per day of imipramine, for example. If uncomfortable side effects appear, one approach is to wait two to three weeks for them to diminish before increasing to the next higher dose. If the patient adjusts to the side effects, the physician increases the dosage every two or more days until the patient is taking the preferred dosage.

If daytime sedation or other side effects are bothersome to the patient, the physician may suggest taking the full dosage at night before bed.

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Tapering. Your doctor may suggest that you begin to taper your TCA six months to a year after you have controlled your panic attacks. You can taper it gradually over a two- to three-week period as a way to avoid the flu-like symptoms that commonly occur if you abruptly stop the medication, however even more gradual tapering can help monitor for a relapse in panic attacks. If you stop this medication abruptly, withdrawal symptoms may begin in twenty-four hours, including nausea, tremor, headache, and insomnia. Few symptoms should be evident with a gradual decrease in dose. Panic attacks will not usually return immediately after you stop the medication, but may recur several weeks later. Your doctor may suggest that you begin to taper your TCA six months to a year after you have controlled your panic attacks. You can taper it gradually over a two- to three-week period as a way to avoid the flu-like symptoms that commonly occur if you abruptly stop the medication, however even more gradual tapering can help monitor for a relapse in panic attacks. If you stop this medication abruptly, withdrawal symptoms may begin in twenty-four hours, including nausea, tremor, headache, and insomnia. Few symptoms should be evident with a gradual decrease in dose. Panic attacks will not usually return immediately after you stop the medication, but may recur several weeks later.

Of this family, imipramine has been the focus of most of the panic treatment research.

 

Imipramine (Tofranil and others)

 

Possible Benefits. Blocks panic attacks in 70% of people. Non-addicting. Tolerance doesn't develop. Helps depression. Continued improvement for several months. Because it is slowly metabolized by the body, you can take it once daily, usually at bedtime. . Blocks panic attacks in 70% of people. Non-addicting. Tolerance doesn't develop. Helps depression. Continued improvement for several months. Because it is slowly metabolized by the body, you can take it once daily, usually at bedtime.

Possible Disadvantages. Not very helpful for anticipatory anxiety. Response takes weeks or months. One quarter to one half of imipramine patients relapse after tapering from the drug. Not recommended while breast-feeding and used only with physician consent while pregnant. . Not very helpful for anticipatory anxiety. Response takes weeks or months. One quarter to one half of imipramine patients relapse after tapering from the drug. Not recommended while breast-feeding and used only with physician consent while pregnant.

Possible Side Effects. Initial use of imipramine occasionally causes an increase in anxiety that usually diminishes in several weeks. Anticholinergic effects are stronger than most other antidepressants. If they are bothersome to you, it may be possible to switch to a different TCA with less anticholinergic effects. Dizziness from a lowering of blood pressure is moderate. If postural hypotension troubles you, nortriptyline may work more effectively. Imipramine causes some jitteriness in about 20 to 25% of subjects, which usually lasts one to three weeks, but can be often avoided by starting with as little as 10 mg before bed. The tendency toward weight gain is moderate. Some patients, especially males, experience reduced sex drive or responsiveness while taking this drug. Other side effects are palpitations (changes in heart beat), sweating and drowsiness. One third of patients are unable to tolerate side-effects and must switch to another medication. Initial use of imipramine occasionally causes an increase in anxiety that usually diminishes in several weeks. Anticholinergic effects are stronger than most other antidepressants. If they are bothersome to you, it may be possible to switch to a different TCA with less anticholinergic effects. Dizziness from a lowering of blood pressure is moderate. If postural hypotension troubles you, nortriptyline may work more effectively. Imipramine causes some jitteriness in about 20 to 25% of subjects, which usually lasts one to three weeks, but can be often avoided by starting with as little as 10 mg before bed. The tendency toward weight gain is moderate. Some patients, especially males, experience reduced sex drive or responsiveness while taking this drug. Other side effects are palpitations (changes in heart beat), sweating and drowsiness. One third of patients are unable to tolerate side-effects and must switch to another medication.

Dosages Recommended by Investigators. Once daily dosing. The best way to reduce the early anxiety symptoms with the start of imipramine is to begin with a very small dose, typically 10 mg at bed time, and increase the dose 10 mg every day until you reach the dose of 50 mg per day. It can block panic in some patients with 50 mg per day, so maintaining this dose level for several days is a good strategy. If the dose is not effective, then the physician can increase it 25 mg every third day up to 100 mg. After one week, if panic continues, then the dose can increase by 50 mg every third day. Although some patients require a smaller or larger dosage, the usual maintenance dosage is between 150 mg and 250 mg per day. . Once daily dosing. The best way to reduce the early anxiety symptoms with the start of imipramine is to begin with a very small dose, typically 10 mg at bed time, and increase the dose 10 mg every day until you reach the dose of 50 mg per day. It can block panic in some patients with 50 mg per day, so maintaining this dose level for several days is a good strategy. If the dose is not effective, then the physician can increase it 25 mg every third day up to 100 mg. After one week, if panic continues, then the dose can increase by 50 mg every third day. Although some patients require a smaller or larger dosage, the usual maintenance dosage is between 150 mg and 250 mg per day.

 

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Desipramine (Norpramin, Pertofrane and others)

 

Possible Benefits. Helpful for depression as well as panic. Continued improvement for several months. Tolerance does not develop. Non-addicting. Causes little or no drowsiness. Helpful for depression as well as panic. Continued improvement for several months. Tolerance does not develop. Non-addicting. Causes little or no drowsiness.

Possible Disadvantages. Not much help for anticipatory anxiety. Response requires weeks or months. Use in pregnancy or breast-feeding only with physician's approval. Avoid alcohol completely. Increases sensitivity to sun.. Not much help for anticipatory anxiety. Response requires weeks or months. Use in pregnancy or breast-feeding only with physician's approval. Avoid alcohol completely. Increases sensitivity to sun.

Possible Side Effects. Postural hypotension, memory impairment, jitteriness, tremor, insomnia (especially on initiation) and the anticholinergic effects of dry mouth, blurred vision, constipation, urinary retention. Insomnia and the tendency for weight gain are mild. Sedation is rare. Postural hypotension, memory impairment, jitteriness, tremor, insomnia (especially on initiation) and the anticholinergic effects of dry mouth, blurred vision, constipation, urinary retention. Insomnia and the tendency for weight gain are mild. Sedation is rare.

Dosages Recommended by Investigators. Once daily, 25-300 mg per day. Taper gradually.. Once daily, 25-300 mg per day. Taper gradually.

 

Nortriptyline (Pamelor, Aventyl)

 

Possible Benefits. Helps depression as well as panic. Continued improvement for several months. Helps depression as well as panic. Continued improvement for several months.

Possible Disadvantages. Not much help for anticipatory anxiety. Response requires weeks or months. Often requires several blood tests over the first weeks to establish the proper level of the medication. Avoid use during first three months of pregnancy. Increases sensitivity to the sun.. Not much help for anticipatory anxiety. Response requires weeks or months. Often requires several blood tests over the first weeks to establish the proper level of the medication. Avoid use during first three months of pregnancy. Increases sensitivity to the sun.

Possible Side Effects. Less jitteriness than imipramine; less postural hypotension than other tricyclic antidepressants; lightheadedness, mild sedation (sleepiness), weight gain, insomnia, impaired urination and anticholinergic effects (20% experience dry mouth).. Less jitteriness than imipramine; less postural hypotension than other tricyclic antidepressants; lightheadedness, mild sedation (sleepiness), weight gain, insomnia, impaired urination and anticholinergic effects (20% experience dry mouth).

Dosages Recommended by Investigators. Once a day, starting at 10 to 25 mg. Therapeutic dose is typically between 50 and 75 mg per day, with some individuals requiring up to 150 mg, based on blood level. Taper slowly. . Once a day, starting at 10 to 25 mg. Therapeutic dose is typically between 50 and 75 mg per day, with some individuals requiring up to 150 mg, based on blood level. Taper slowly.

 

Clomipramine (Anafranil)

 

Possible Benefits. Helps control obsessive-compulsive disorder by reducing the duration and intensity of these symptoms and the corresponding anxiety. May help as much as imipramine for panic attacks. Relieves depression. Helps control obsessive-compulsive disorder by reducing the duration and intensity of these symptoms and the corresponding anxiety. May help as much as imipramine for panic attacks. Relieves depression.

Possible Disadvantages. Strong side effects. Takes about four to six weeks to work. Patients with certain abnormal electrocardiograms, with narrow-angle glaucoma, or with an enlarged prostate should not take this medication. Avoid during last three months of pregnancy to prevent withdrawal symptoms in infant. Can be expensive.. Strong side effects. Takes about four to six weeks to work. Patients with certain abnormal electrocardiograms, with narrow-angle glaucoma, or with an enlarged prostate should not take this medication. Avoid during last three months of pregnancy to prevent withdrawal symptoms in infant. Can be expensive.

Possible Side Effects. Like imipramine, you may experience more general anxiety the first few days up to three weeks. The most common side effects are headaches, drowsiness, dry mouth, constipation and insomnia. Other common side effects are blurred vision, urinary retention, fatigue, weight gain, postural hypotension, nervousness, muscle twitching, decreased ability to have orgasm (42% of men), increased sweating, and sedation (sleepiness). Increases sensitivity to the sun. Elderly patients may experience confusion and memory impairment.. Like imipramine, you may experience more general anxiety the first few days up to three weeks. The most common side effects are headaches, drowsiness, dry mouth, constipation and insomnia. Other common side effects are blurred vision, urinary retention, fatigue, weight gain, postural hypotension, nervousness, muscle twitching, decreased ability to have orgasm (42% of men), increased sweating, and sedation (sleepiness). Increases sensitivity to the sun. Elderly patients may experience confusion and memory impairment.

Dosages Recommended by Investigators. Ranging from 150 to 300 mg per day. Usually start at 25 mg for a few days. Increase by 25 mg every three to four days to 100 mg per day, usually taken in one dose. Raise the dose over the next few weeks to a maximum of 300 mg. Taking the dose at night can sometimes reduce the side effects. It takes four to six weeks to notice significant therapeutic benefits from clomipramine. Ranging from 150 to 300 mg per day. Usually start at 25 mg for a few days. Increase by 25 mg every three to four days to 100 mg per day, usually taken in one dose. Raise the dose over the next few weeks to a maximum of 300 mg. Taking the dose at night can sometimes reduce the side effects. It takes four to six weeks to notice significant therapeutic benefits from clomipramine . The full range of benefits may take twelve weeks. Taper slowly, over three to four weeks or longer.

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Amitriptyline (Elavil)

 

Possible Benefits. Helpful for panic attacks and depression. Causes less potential for insomnia. Is sometimes used when patients are having trouble sleeping, because of its sedating effects.. Helpful for panic attacks and depression. Causes less potential for insomnia. Is sometimes used when patients are having trouble sleeping, because of its sedating effects.

Possible Disadvantages. Not much help for anticipatory anxiety. Response requires weeks or months. The sedating side effects can limit productivity and concentration during the day. Avoid during first three months of pregnancy and consult physician before using last six months and before breast-feeding. Increases sensitivity to sun.. Not much help for anticipatory anxiety. Response requires weeks or months. The sedating side effects can limit productivity and concentration during the day. Avoid during first three months of pregnancy and consult physician before using last six months and before breast-feeding. Increases sensitivity to sun.

Possible Side Effects. Strong anticholinergic effects and moderate levels of drowsiness, weight gain and dizziness. . Strong anticholinergic effects and moderate levels of drowsiness, weight gain and dizziness.

Dosages Recommended by Investigators. Begin at 25 to 75 mg daily at bedtime and raised over two weeks to average of 200 and maximum of 300 mg. Taper gradually.. Begin at 25 to 75 mg daily at bedtime and raised over two weeks to average of 200 and maximum of 300 mg. Taper gradually.

 

Doxepin (Sinequan, Adapin)

 

Possible Benefits. Helpful for panic attacks and depression. . Helpful for panic attacks and depression.

Possible Disadvantages. Not much help for anticipatory anxiety. Response requires weeks or months. The sedating side effects can limit productivity and concentration during the day. Takes several weeks for therapeutic effects. Consult your physician before using during pregnancy or breast-feeding. . Not much help for anticipatory anxiety. Response requires weeks or months. The sedating side effects can limit productivity and concentration during the day. Takes several weeks for therapeutic effects. Consult your physician before using during pregnancy or breast-feeding.

Possible Side Effects. Anticholinergic effects, increased sensitivity to the sun, postural hypotension, weight gain, sleepiness, sweating.. Anticholinergic effects, increased sensitivity to the sun, postural hypotension, weight gain, sleepiness, sweating.

Dosages Recommended by Investigators. Start at 25 to 75 mg per day and increase over one or two weeks to an average dose of 75 to 150 mg and a maximum dose of 300 mg. Typically taken in one dose at bedtime, but can be divided.. Start at 25 to 75 mg per day and increase over one or two weeks to an average dose of 75 to 150 mg and a maximum dose of 300 mg. Typically taken in one dose at bedtime, but can be divided.

B. Other Cyclic Antidepressants

 

Venlafaxine (Effexor)

 

Possible Benefits. Helpful for obsessive-compulsive disorder and depression.. Helpful for obsessive-compulsive disorder and depression.

Possible Disadvantages. Takes several weeks for primary effects to begin. Nausea and dizziness can be be common side effects. Use during pregnancy or breast-feeding only after approval from your physician. Can be expensive.. Takes several weeks for primary effects to begin. Nausea and dizziness can be be common side effects. Use during pregnancy or breast-feeding only after approval from your physician. Can be expensive.

Possible Side Effects. Anticholinergic effects, chills, dizziness, muscle tension, insomnia, headache, nausea, sleepiness, nervousness.. Anticholinergic effects, chills, dizziness, muscle tension, insomnia, headache, nausea, sleepiness, nervousness.

Dosages Recommended by Investigators. Start with 75 mg per day, divided into two or three doses. Increase by 75 mg. every four or more days. Average maintenance dose is 150 mg per day, with a maximum dose of 300 mg per day. Take with food. Taper slowly.. Start with 75 mg per day, divided into two or three doses. Increase by 75 mg. every four or more days. Average maintenance dose is 150 mg per day, with a maximum dose of 300 mg per day. Take with food. Taper slowly.

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Take a peep into my OCD ~ Disorder

I thought it was about time I opened up my world a bit more and showed you just what it really was like for me and my husband to live with Obsessive Compulsive Disorder for all those years, so here goes:

I was frightened of anything that had any connection AT ALL with the place where I had worked (or that MIGHT have a connection). This is because I had developed a fear of the chemicals that we used to have to use. I was frightened of any type of substance that was used for abrasive cleaning - bleach, for instance. This was then extended to any shops that sold any of these products, DIY stores etc. Anything that could have been made by the company I had worked for also became terrifying to me, as did the people who did or had worked there. My Mum and Dad's house was contaminated because I used to go there every night from work, and so the list got longer. This extended and extended until there were so many links to to my old workplace, that my world closed in on me and there was hardly anywhere left that wasn't "contaminated."

If I went anywhere and saw anything that was on my mental list of avoidances then it would scare and panic me to such a degree that it would mean lots of washing when we returned home: of myself, my husband, my clothes, my hair, anything that we had gone near or touched, anything we MIGHT have gone near, taps, door handles, etc, everything, It all felt so contaminated to me and needed washing before the awful sicky panicky feeling inside me would subside. Even then, after washing everything and anything, I could still be lying in bed trying to sleep and suddenly worry in case we had forgotten to wash something or maybe a part of myself! It would take an awful amount of convincing to persuade me that everything had been washed as I needed it to be, and sometimes I just couldn't be convinced and I would have to wash something again, no matter how tired I was or how late in the night it was - it just had to be done.

This all got to be so stressful and upsetting, so mentally and physically exhausting, and it was putting such a strain on our relationship that it became oh so much easier to stay at home and not venture outside into the "big bad world" at all. Of course, my husband still had to go to work and to the shops - we still had to eat! But it was all left for him to do. Anything that came into the house would have to be washed. Food would have to be bought packaged so that it could be washed without getting the item wet inside and ruining it.

Then there were the rituals. Certain areas of the house, certain doors, chairs, objects, etc. had been, in my mind, contaminated at various times and by various events. So these were to be avoided, unless they could be thoroughly washed. Of course not everything in life can be, so there were a lot of things that had to be avoided. I would sometimes think I, or my husband, had gone near these things and then more washing would have to be done to bring some relief to the torment of the "worry thoughts." I was terrified of going to the doctor's because of the link that my OCD had invented, and so it went on.

We used to make the best of things, though, and on weekends we would try and enjoy ourselves as much as possible. In a way, because this went on for so long, we sort of began treating the "abnormal" behavior as "normal." Of course, we both knew it wasn't, but the disorder drew us in and it became very hard for us to see a way out.

I hardly went anywhere at all, and, of course, this eventually got too much for me, and I became somewhat depressed. It wasn't obvious that I was, though, as it was a clinical depression. I sometimes had trouble sleeping or else I would sleep for hours. I got hardly any exercise for all that time and so became very unfit. That, in itself, didn't help the OCD as it started to hurt if I did try to do anything. We settled into a routine way of living, doing the ordered rituals that the OCD instructed had to be done, and surprisingly we did manage to have lot's of fun, happy times together - just not exactly "normal" times. The nights out having a meal, going to the pub, going to cinemas, parties, etc. had stopped, but we enjoyed each other's company and being with each other.

The life that the OCD forced us to lead may sound very hard to understand and probably very sad, but OCD can do this to anyone. It draws you in and compels you to do things that are completely irrational. This continues until you can eventually get help and do something to stop it.

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Contents in the Sensate Focusing Site:

Introduction
Information on Sensate Focusing
Focusing Now
For Coaches
Emotions
Programs
How It Really Works

Introduction

• Sensate Focusing Homepage
• About Me and Why I Wrote this Guide for Self-Help

About Focusing

• What "Focusing" is and what it is not
• Prologue
• "It is all in the head"
• So what?
• For whom the following chapter are intended and for whom they are not
• The good news
• The bad news
• Respect for the suffering
• Only improvement
• The vengeance of psychology
• How and why to read this book
• Key to concepts, abbreviations and strange words

Focusing Now

• Do it yourself - now!
• A warning for beginners
• First stage - the beginning steps of guided sensate focusing
  • First step - know thyself
  • Second step - finding the exact address
  • The third step - more intimate acquaintance-ship with sensations
  • The fourth step
  • The fifth step
  • The sixth step
  • Summary of the first stage
• Daily Focusing
• The nape of the neck
• The facial muscles and the vocal cords

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continue story below


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• The mouth
• The muscles of the body in general
• The common excitations and itching
• The general survey
• Focusing on the emotional expressions of others
• Second stage - recycled emotions (for very advanced focusers only)
• Why to recycle
• Why not Psychoanalysis?
• Hurrah for the practical leftism
  • Reconstruction of neglected opportunities
  • Lost & Found
  • Changing behavioral patterns
  • A violent patrol
  • Popular scientific literature, art works, nostalgia
  • A most violent patrol
  • The provocations
• Synthetic emotion or "remedy before disaster"
• Special projects (for advanced focusers only)
• Impossible missions???
• Steps to be taken against psychosomatic disturbances
• Increasing the pleasure derived from smoking or curbing the habit
  • The first step - preliminaries
  • The second step - getting acquainted with the habit
  • The third step - the beginning of the real struggle
  • The fourth step - the real struggle itself
  • The fifth step - branching to restrictors and abolitionists
  • The sixth step - the decisive struggle
  • The seventh step - the final assault
  • Regular maintenance
  • Vicarious focusing on smoking
• Regulating the sexual functioning and reducing disturbances
• "Cultivating the voice" and the reduction of tension
• Controlling the body weight
  • First step
  • Second step
  • Third step
  • Fourth step
  • Fifth step
  • Sixth step
• Concluding remarks

For Coaches

• A short guide for the focusing "coach"
• General recommendations for professionals
• The main body of the guide to the focusing "coach"
  • A general introduction
  • The first focusing session
  • The first step of the first stage
  • The second to fifth steps
  • The sixth step
  • Summary of the first session
  • The following sessions

Emotions

• The emotions
• What are the emotions
• The biological basis of the emotions
• The basic emotions
• The list of 15 basic emotions:
• The essence of emotional phenomenon
• How are the emotions of daily life created?
• The emotional experience

Programs

• The activation programs
• Ad hoc activation programs
• Supra-Programs
• The emotional Supra-Programs
• The cover-programs
• The trash-programs
  • Why are programs trashy?
  • Common roots of trash-programs

How it Works

• How it really works
• Paying attention
• Biofeedback or how the head works
• The lost paradox
• Selected Bibliography Supplement: A form for marking the time when bad habits are activated

back to: Sensate Focusing Homepage

The Anxieties Site, a free internet self-help site for persons suffering from anxiety, panic attacks, phobias, obsessive-compulsive disorder - OCD, fear of flying and post traumatic stress disorder -PTSD

Welcome to The Anxieties Site, the free self-help site for people with anxiety. Here you will find a wealth of information, literally at your fingertips.

I'm Dr. Reid Wilson. One disclaimer before you begin:
The information on this site is not designed to give you a diagnosis or to treat an illness. This site contains general reference information and is not intended as a substitute for consulting with your physician. The author assumes no responsibility for any adverse effects that may result from your use of this information.

That said, let's get started...

• If you already know what you are looking for, then you may go directly to that self-help program (the list on the left or bottom of this page).
• If you think you are suffering from an anxiety problem, but aren't sure what kind of problem you have, then take our Self-assessment Questionnaire.
• If you would like to use a book or self-help kit at home, you may purchase one in our self-help store section.
• If you have worked with these skills already and are having trouble, or are needing one-on-one guidance, then I'd be happy to coach you directly on your self-help skills.

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Table of contents:

• Anxiety Disorder Self-Assessment Questionnaire
• Panic Attacks: Introduction
• Change Your Attitude! Change 1
• Step 1: Difficulty Breathing
• Step 1: Multiple Symptoms
• Step 1: Check Out All the Physical Symptoms
• Don't Panic: Taking Control of Anxiety Attacks
• Step 1 (GAD): How To Handle Worries I
• Welcome ! What are Social Phobias?
• The Seven Issues in Recovery From Social Anxiety
• Fear of Flying: Summary
• Have a Nice Flight!
• Anxiety Medication Profiles
• Benzodiazepines for Treatment of Anxiety and Panic Attacks
• STEP 2: (GAD) Practice Formal Relaxation Skills I
• Guidelines for Anxiety Medication Use
• Tricyclic Antidepressants (TCAs) for Treatment of Anxiety and Panic Attacks
• Welcome ! Generalized Anxiety: Summary
• STEP 3 (GAD): Practice Your Breathing Skills II
• Welcome ! Obsessive-Compulsive Disorder: Summary
• OCD Self-Help Resources for Home
• Stopping Your Compulsions
• About Dr. Reid Wilson
• Welcome ! Treating Anxiety Disorders: New Help Has Arrived!
• Anticonvulsants for Treatment of Panic Attacks
• Change Your Attitude! Change 3
• Beta-Blockers for Treatment of Anxiety and Panic Attacks
• About Dr. Reid Wilson
• Dr. Reid Wilson Resume
• Dr. Wilson as Your Anxiety Coach
• Change Your Attitude! Change 7
• Step 7: Approach Your Goals Through Small Steps
• How Safe is Commercial Flight?
• Increase Your Skills Through the Panic Attack Self-Help Program
• Learning How to Fly Comfortably
• Monoamine Oxidase Inhibitors Treatment of Anxiety and Panic Attacks
• Step 5: Practice Formal Relaxation Skills - Part 2
• OCD Self-Assessment Questionnaire
• Step 1: Physical Disorders with Panic-Like Symptoms
• Step 4: Practice Your Breathing Skills
• Step 1: Rapid or Irregular Heart Rate
• Step 1: Side Effects of Medications
• Social Anxiety: Challenge Your Negative Observer
• Social Anxiety: Practice Your Skills
• SSRIs for Treatment of Anxiety and Panic Attacks
• The Four Challenges of Recovery From OCD
• Step 2: Understand Your Body's Emergency Response

next: Anxiety Disorder Self-Assessment Questionnaire
~ anxiety-panic library articles
~ all anxiety disorders articles

The Post-Crisis Plan is different from other parts of your Wellness Recovery Action Plan in that it is constantly changing as you heal. It is anticipated that two weeks after the crisis you will be feeling much better than you did after one week and therefore your daily activities would be different.

As with the other parts of the Wellness Recovery Action, it is up to you to decide whether or not you want to develop a Post Crisis Plan. If you decide you want to develop a Post-Crisis Plan, it is up to you to decide when you will do it. Like the rest of the plan, the best time to develop your Post-Crisis Plan is probably when you are feeling quite well. Then you will have it if you ever do go into crisis. But again, it is up to you. It would probably be difficult to develop such a plan when you are in crisis or when you are trying to recover. It seems like it would be advantageous to have developed this plan in advance.

If you are hospitalized and you don't have a Post-Crisis Plan, you may want to develop one with your care providers or on your own before you are discharged-a kind of comprehensive discharge plan. While you are in the hospital you may want to ask your care providers to explain any possible discharge conditions and how these conditions would affect your post crisis plan if they were imposed on you.

You may decide to develop your plan when you are working with a group or with your counselor. You could do it with a supportive family member or friend. Others could give you suggestions or advice if you wish, but the final word should be yours. Or you could do it by yourself. It is also up to you to decide whether or not you want to show your Post Crisis Plan to others. It may be a good idea to share your plan with people who you want to assist and support you as you heal.

You may want to sit down one afternoon and spend three or four hours working on your plan until it is finished. Or you may want to take your time-work on it a bit today, and a little more another day.

In developing your Post Crisis Plan, you may find it helpful to refer to your Wellness tools and your lists of what you are like when you are well, your Daily Maintenance Plan and your list of things you might. You also may want to refer back to your Crisis Plan as you make plans to resume activities and take back responsibilities.

The forms for developing a Post Crisis Plan that follows are quite extensive. As with other sections of your Wellness Recovery Action Plan you can skip over sections that don't seem relevant to you or that you would rather address at some other time.

You may choose to use the worksheet at the end of this form to set up recovery timelines. In the first column you would write the task or responsibility you would like to resume, in the second column you would list the steps you would take to resume that task or responsibility and in the third column a possible day or days for accomplishing that step.

You may want to revise your plan after you have used it-especially if certain things weren't as helpful as you thought they would be or plans did not work as you expected.

next: Getting Well From Depression and Manic Depression
~ back to Mental Health Recovery homepage
~ depression library articles
~ all articles on depression

Thoughtful quotes about the importance of community and having a sense of community.

Words of Wisdom

 

"The ornament of a house is the friends who frequent it." (Emerson)

"Kinship is healing; we are physicians to each other." (author unknown)

"No man is an island entire of itself; every man is a part of the continent, a part of the main." (John Donne)

"Each friend represents a world in us, a world possibly not born until they arrive, and it is only by this meeting that a new world is born." (Anais Nin)

"Each man can learn something from his neighbor; at least he can learn to have patience with him- to live and let live." (Charles Kingsley)

"Never, if possible, lie down at night without being able to say; I have made at least one human being, at least, a little wiser, a little happier, or a little better this day." (Charles Kingsley)

"So long as we love we serve; so long as we are loved by others, I would almost say that we are indispensable; and no man is useless while he has a friend." (Robert Louis Stevenson)

"I not only use all the brains I have, but all I can borrow." (Woodrow Wilson)

"Large- scale success today is spelled -Teamwork." (Charles B Forbes)

"We are like the spokes on a wheel, all radiating out from the same center. If you define us according to our position on the rim, we seem separate and distinct from one another. But if you define us according to our starting point, our source - the center of the wheel - we're a shared identity. (Marianne Williamson)

"Never doubt that a small group of thoughtful, committed citizens can change the world, indeed, it's the only thing that ever has.". (Margaret Mead)

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"Who is wise? He who learns from all men, as it is said, from all my teachers have I gotten understanding." (Ben Zoma)

"To grow mature is to separate more distinctly, to connect more closely." (Hugo Von Hofmannsthal)

"There are no mothers and fathers for grownups, only sisters and brothers." (Shelden Kopp)

next:Courage

Lately, I've realized how essential setting boundaries is for a healthy relationship.

When a relationship is new, it can be very easy to let your Significant Other ignore your boundaries, especially if you have been starved for love, affection, or attention. You can become so enthralled at finally being real to another person, that you forget to take care of yourself. (You might even get spoiled and forget how to take care of yourself.)

By nature, I tend to be the solitary, independent type. I don't need a lot friends around me. I enjoy reading, listening to music, watching movies, exercising, and meditating—all of which I can enjoy quite contentedly by myself. But I also have a need for a healthy, fulfilling relationship. My nature requires that my relationship be one in which there are clearly defined times together and times apart. What Lebanese poet Khalil Gibran calls "spaces in your togetherness."

M. Scott Peck uses the mountain-climbing analogy. Each partner needs time to scale the mountain of self-growth in solitude and time to be in the base camp to give and receive support and encouragement. It is not necessary (or healthy) for two people to be constantly joined at the hip. Each partner needs the freedom to follow his or her own pursuits, unhindered by the other clinging on. In fact, each partner cannot grow as a person, without sufficient time for solitude, reflection, and synthesis of experiences and emotions.

Relationships, by their very nature, are about meeting needs—but without suffocating (or getting suffocated) in the process. It requires maturity and watchfulness to maintain and sustain the delicate, healthy balance of spaces in the togetherness. Boundaries are the tools that build the necessary space.

I know that if my wife becomes too needy and too demanding, requiring my constant attention to "take care" of her needs, I become resentful and angry. And vice-versa. No relationship needs that kind of pressure. Clearly defined boundaries, like these, ease the pressure:

• I can meet my wife's needs, but not to the point of neglecting my own needs.
• My wife can meet my needs, but not to the point of neglecting her own needs.
• I can meet my wife's needs, but I also understand that she can take care of herself.
• My wife can meet my needs, but she also understands that I can take care of myself.
• I can "be there" to meet my wife's needs, but she cannot suffocate me with her needs.
• My wife can "be there" to meet my needs, but I cannot suffocate her with my needs.

Such clearly defined boundaries help preserve a relationship's peace and friendship and attraction—the good stuff that we are all seeking.

Thank You, God, for blessing me with recovery and self-awareness. Thank You for showing me how to build a healthy, fulfilling relationship without losing myself in the process. Amen.

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next: Forgiveness

The first contact with your child's teacher, in many ways, is the most important, This is the time you are building rapport and developing a relationship of trust. Therefore, an appropriate time and setting is important for the first brief encounter. A phone call, a note, or, best of all, an initial face-to-face meeting is best. A good time to contact your child's teacher is during the first week of school. This gives you an opportunity to meet one another when neither has any complaints. Otherwise, the first teacher contact can be unpleasant. The teacher is usually calling to describe some unacceptable behavior or report a child's tack of progress and her concern that a learning problem may exist. This kind of contact usually puts a parent on the defensive, and communication can be hampered. Neither party wins, and the biggest loser is your child.

However, during the first week of school, the teacher probably knows very little about your child. Thus, you are in a position to provide some helpful information. This is the time to mention then identify these. And, last but not least, assure the teacher that she has your full support and cooperation. Provide the teacher with your phone number and tell her to feel free to call when help is needed from home. Let the teacher know from the start that you want to work with her, not against her, so your child will learn. Do not feel you are intruding or asking for special treatment. You are simply indicating that you are truly concerned that your child receives a good education.

After your child has spent six weeks in school, again call or drop a note to check on your child's progress. If a conference needs to be set up, do it immediately. Even if your child is doing well, you may still want a conference. If your child is in kindergarten or first-grade, die following questions may be the most appropriate:

1. Is my child able to get along with others?
2. Can my child participate well in group activities?
3. What can I do to encourage or help my child learn to read?
4. Can you describe my child's reading program?
5. In second and third grade you may want to ask these additional questions:
6. Is my child experiencing difficulty with any specific skills? If so, what are they! How can we help him with these skills?
7. Is my child experiencing any difficulty that may hinder him in the future?

Guidelines

Let's consider specific guidelines to help you communicate effectively with your child's teacher. Practice these guidelines, and your child will reap the benefits.

Guideline 1: Identify the purpose for the conference. Isit to become acquainted? Is it to alleviate your concerns about your child's poor attitude towards reading and/or school! Or is it to receive a report card and test scores? Each ofthese situations is vastly different and requires different preparation.

Guideline 2: Communicate the purpose for the conference. If youare requesting the conference, immediately tell the teacher the purpose. This helps to alleviate any imagined fears the teacher may have about your request to hold a conference.

Guideline 3: Arrange the conference at the teacher's convenience. The teacher then has sufficient time to plan and to have the necessary information at the conference. An unplanned conference can turn out to be a waste oftime for both teacher and parent and cause feelings of frustration.

Guideline 4: Plan for the conference. Write out the areas and questions you want the conference to cover. Combine, delete, and clarify these questions, and, finally, prioritize them. By using this process, your most important questions will be answered in a clear, succinct manner. Moreover, the teacher's responses will likely be clearer and more to the point.

Guideline 5: Restate the purpose of the conference at the onset. Tryto stay a on one topic since your time together is limited.

Guideline 6: Display a positive attitude during the conference. Be aware that not only what you say reflects your attitude, but also your tone ofvoice, facial expression, and body movements. A loud voice may imply dominance. Rigid posture may suggest anger or disapproval. Always listen attentively and show your enthusiasm.

Guideline 7: Remain open and supportive throughout the conference. Don't become antagonistic or defensive; otherwise the conference outcome can be disastrous. Strive for cooperation between you and your child's teacher. Even when teachers present a negative side of yourchild's behavior or inform you of other problems, try to remain objective. This can be difficult when it is your child, but he will experience as many or more difficulties if you and die teacher don't try to find a way to work together to solve these problems.

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Guideline 8: Make sure suggestions are provided to increase your child's growth. If your child is doing well, find out what you can do to ensure continued success and progress. If he has difficulties, make sure the teacher goes beyond merely pointing out a problem. The teacher needs to provide ideas for eliminating or reducing the difficulty. Many parents have been discouraged or aggravated because teachers point out problems but don't provide solutions. Don't let this situation occur! If immediate suggestions can't be provided, then a follow-up conference is needed.

Guideline 9: Ask for examples of daily work to better understand your child's strengths and weaknesses By reviewing your child's work, you will learn if progress has been made since the last conference. Have any weaknesses become more severe? If improvement hasn't been made, are other methods or materials being used? As a parent, what should you be doing at home with your child?

Guideline 10: Clarify mid summarize each important point as it is discussed. Thus, both teacher and parent are better able to develop a mutual understanding and agreement. Let's took at a conference in which a parent does a good job of clarifying and summarizing a major point.

Teacher Susan has difficulties with oral reading. She is not reading smoothly and tends to read in a word-by-word fashion. if Susan reads along with a taped version of a book, her oral reading would improve. Can you provide Susan with taped versions of books?

Parent: Susan is a poor reader. Do you want me to make tones of books so Susan can read along with the tape?

Teacher: Yes, you can make tapes, but the public and school library can also provide you with tapes and books. Also, I would like to clarify one point about Susan's reading ability. She has some difficulty with oral reading, but I would not classify her as a poor reader.

Parent: Thank-you for the clarification. Susan and I will work together on improving oral reading. We will check the school and the public library for some books and tapes.

If the parent hadn't summarized and clarified what was heard in this conference, a misconception might have developed- By suggesting that she would tape books for Susan, the parent was able to find out if the suggestion was appropriate as well as learning about alternatives. Notice that this parent summarized the conference at the end so both parties received the same message.

Guideline 11: Owe agreement is reached, discuss the next topic. During the conference, you may want the teacher to understand certain things about your child. or you may have a special request. Once your point is understood and the teacher has agreed, it is wise not to continue the same discussion. It may present new questions which may reverse the previously made agreement. Once a decision is made, it is best to start discussing the next point. You will find the conference to be much more productive.

Guideline 12: Make sure you understand the information the teacher is supplying. Often teachers use educational jargon, not realizing parents don't understand. Don't be afraid to ask for an explanation or definition. Make sure when the conference ends you have understood all the information reported. if you're confused or uncertain, your child won't benefit and learning may be hindered.

Guideline 13: Keep conferences short. Conferences that run more than 40 minutes can be tiresome for both parent and teacher. If you can't accomplish all that has been planned, ask for another conference. By scheduling a future conference, you will have an opportunity to follow up on previous agreements and revise them if necessary

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next: About Dr. Robert Myers
~ back to ADD Focus homepage
~ adhd library articles
~ all add/adhd articles

Detailed Cialis Pharmacology - Usage, Dosage, Side Effects.

Pronounced See-Al-iss

Cialis (tadalafil) Full Prescribing Information

Read the Patient Information about CIALIS before you start taking it and again each time you get a refill. There may be new information. You may also find it helpful to share this information with your partner. This leaflet does not take the place of talking with your doctor. You and your doctor should talk about CIALIS when you start taking it and at regular checkups. If you do not understand the information or have questions, talk with your doctor or pharmacist.

What important information should you know about CIALIS?

CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke.

Do not take CIALIS if you:

• take any medicines called "nitrates."
• use recreational drugs called "poppers" like amyl nitrite and butyl nitrite.
  (See "Who should not take CIALIS?")

Tell all your healthcare providers that you take CIALIS. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took CIALIS.

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After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications (see "Can other medications affect CIALIS?").

What is CIALIS?

CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.

ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his doctor for help if the condition bothers him. CIALIS may help a man with ED get and keep an erection when he is sexually excited.

CIALIS does not:

• cure ED
• increase a man's sexual desire
• protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your doctor about ways to guard against sexually transmitted diseases.
• serve as a male form of birth control

CIALIS is only for men with ED. CIALIS is not for women or children. CIALIS must be used only under a doctor's care.

How does CIALIS work?

When a man is sexually stimulated, his body's normal physical response is to increase blood flow to his penis. This results in an erection. CIALIS helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away.

Who can take CIALIS?

Talk to your doctor to decide if CIALIS is right for you.

CIALIS has been shown to be effective in men over the age of 18 years who have erectile dysfunction, including men with diabetes or who have undergone prostatectomy.

Who should not take CIALIS?

Do not take CIALIS if you:

• take any medicines called "nitrates" (See "What important information should you know about CIALIS?"). Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm.
  Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. Some recreational drugs called "poppers" also contain nitrates, such as amyl nitrite and butyl nitrite. Do not use CIALIS if you are using these drugs. Ask your doctor or pharmacist if you are not sure if any of your medicines are nitrates.
• you have been told by your healthcare provider to not have sexual activity because of health problems. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.
• are allergic to CIALIS or any of its ingredients. The active ingredient in CIALIS is called tadalafil. See the end of this leaflet for a complete list of ingredients.

What should you discuss with your doctor before taking CIALIS?

Before taking CIALIS, tell your doctor about all your medical problems, including if you:

• have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your doctor if it is safe for you to have sexual activity.
• have low blood pressure or have high blood pressure that is not controlled
• have had a stroke
• have liver problems
• have kidney problems or require dialysis
• have retinitis pigmentosa, a rare genetic (runs in families) eye disease have ever had severe vision loss, including a condition called NAION
• have stomach ulcers
• have a bleeding problem
• have a deformed penis shape or Peyronie's disease
• have had an erection that lasted more than 4 hours
• have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia

Can other medications affect CIALIS?

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. CIALIS and other medicines may affect each other. Always check with your doctor before starting or stopping any medicines. Especially tell your doctor if you take any of the following:*

• medicines called nitrates (See "What important information should you know about CIALIS?")
• medicines called alpha blockers. These include Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl) or Uroxatral® (alfuzosin HCl). Alpha blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
• ritonavir (Norvir®) or indinavir (Crixivan®)
• ketoconazole or itraconazole (such as Nizoral® or Sporanox®)
• erythromycin
• other medicines or treatments for ED

How should you take CIALIS?

Take CIALIS exactly as your doctor prescribes. CIALIS comes in different doses (5 mg, 10 mg, and 20 mg). For most men, the recommended starting dose is 10 mg. CIALIS should be taken no more than once a day. Some men can only take a low dose of CIALIS because of medical conditions or medicines they take. Your doctor will prescribe the dose that is right for you.

• If you have kidney problems, your doctor may start you on a lower dose of CIALIS.
• If you have kidney or liver problems or you are taking certain medications, your doctor may limit your highest dose of CIALIS to 10 mg and may also limit you to one tablet in 48 hours (2 days) or one tablet in 72 hours (3 days).
• If you have prostate problems or high blood pressure for which you take medicines called alpha blockers, your doctor may start you on a lower dose of CIALIS.

Take one CIALIS tablet before sexual activity. In some patients, the ability to have sexual activity was improved at 30 minutes after taking CIALIS when compared to a sugar pill. The ability to have sexual activity was improved up to 36 hours after taking CIALIS when compared to a sugar pill. You and your doctor should consider this in deciding when you should take CIALIS prior to sexual activity. Some form of sexual stimulation is needed for an erection to happen with CIALIS. CIALIS may be taken with or without meals.

Do not change your dose of CIALIS without talking to your doctor. Your doctor may lower your dose or raise your dose, depending on how your body reacts to CIALIS.

Do not drink alcohol to excess when taking CIALIS (for example, 5 glasses of wine or 5 shots of whiskey). When taken in excess, alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.

If you take too much CIALIS, call your doctor or emergency room right away.

What are the possible side effects of CIALIS?

The most common side effects with CIALIS are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose. These side effects usually go away after a few hours. Patients who get back pain and muscle aches usually get it 12 to 24 hours after taking CIALIS. Back pain and muscle aches usually go away by themselves within 48 hours. Call your doctor if you get a side effect that bothers you or one that will not go away.

CIALIS may uncommonly cause an erection that won't go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis including the inability to have erections.

CIALIS may uncommonly cause vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.

In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS) reported a sudden decrease or loss of vision in one or both eyes. It is not possible to determine whether these events are related directly to these medicines, to other factors such as high blood pressure or diabetes, or to a combination of these. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS, and call a doctor right away.

These are not all the possible side effects of CIALIS. For more information, ask your doctor or pharmacist.

How should CIALIS be stored?

• Store CIALIS at room temperature between 59° and 86°F (15° and 30°C).
• Keep CIALIS and all medicines out of the reach of children.

General Information about CIALIS:

Medicines are sometimes prescribed for conditions other than those described in patient information leaflets. Do not use CIALIS for a condition for which it was not prescribed. Do not give CIALIS to other people, even if they have the same symptoms that you have. It may harm them.

This leaflet summarizes the most important information about CIALIS. If you would like more information, talk with your healthcare provider. You can ask your doctor or pharmacist for information about CIALIS that is written for health professionals.

For more information you can also visit www.cialis.com, or call 1-877-CIALIS1 (1-877-242-5471).

What are the ingredients of CIALIS?

Active Ingredient: tadalafil

Inactive Ingredients: croscarmellose sodium, hydroxypropyl cellulose, hypromellose, iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, talc, titanium dioxide, and triacetin.

Cialis (tadalafil) Full Prescribing Information

Rx only

CIALIS® (tadalafil) is a registered trademark of Lilly ICOS LLC
*The brands listed are trademarks of their respective owners and are not trademarks of Lilly ICOS LLC. The makers of these brands are not affiliated with and do not endorse Lilly ICOS LLC or its products.

Literature revised July 8, 2005

Manufactured for Lilly ICOS LLC
by Eli Lilly and Company
Indianapolis, IN 46285, USA
www.cialis.com

back to: Psychiatric Medication Patient Information Index