CW: The Anxiety of Alma Fischer: A Webcomic About Anxiety, Depression & Obsessive-Compulsive Disorder

Many years ago, I took a theatrical script analysis class at Marymount Manhattan College. Back then, I was an awful student. I didn’t go to class more than I did go, and I loved a good party. At a rare occasion when I went to class, my professor talked about a one-act play that stayed with me.

I don’t remember the name of the play. I’m not sure I remember the plot particularly well. Still, the amorphous anti-plot, the loneliness, and the absurd realism of it all stuck with me decades later.

As someone who deals with anxiety, depression, and obsessive-compulsive disorder — just to name a few things — I’m well aware of the power of comics and graphic novels, particularly in memoir or non-fiction form. Comics felt like the perfect medium to express the crushing experience of living with intrusive thoughts and the debilitating weight of hopelessness depression causes.

I’m honored to have worked with artist Mair Sierra and editor Kat Vendetti on this webcomic.

Please heed our content warning moving forward!


The Anxiety of Alma Fischer by Justin Alba cover
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WCTC will host a movie screening and an expert panel discussion about obsessive-compulsive disorder

With Obsessive-Compulsive Disorder Week happening the second week of October, OCD Wisconsin, based in Oconomowoc, wants to educate people on the disorder that affects 1 in 100 adults and 1 in 200 children and teens.

Beginning at 6:30 p.m. Thursday, Oct. 11, “Unstuck: An OCD Kids Movie” will be screened at Waukesha County Technical College’s Richard T. Anderson Center in Pewaukee.

Additionally, a panel of experts will discuss OCD and open the floor for questions and answers. The event will conclude at 8 p.m.

OCD is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over, according to the National Institute of Mental Health website.

Dr. Bradley Riemann, who serves as chief clinical officer for Rogers Behavioral Health, will be one of the speakers at the event.


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“Dr. Riemann is a leading expert in the assessment of obsessive-compulsive disorder and anxiety disorders and use of cognitive behavioral therapy treatment,” a news release stated. “At Rogers, he serves as the clinical director of the adult OCD Center, one of the leading residential treatment centers for OCD and anxiety in the country. He also directs cognitive behavioral therapy services at Rogers.”

Riemann has also authored numerous scientific papers on obsessive-compulsive disorder and anxiety and has spoken at national and international conventions, according to the release.

Chad Wetterneck, a licensed clinical psychologist who specializes in using cognitive behavioral therapy in the treatment of anxiety and post-traumatic stress disorder, will also speak.

“Dr. Wetterneck has developed training modules and interventions for application in Rogers’ residential, partial hospitalization, and intensive outpatient programs,” the release stated. “He supervises the behavioral specialists treating residential adult patients with dual diagnoses in the Herrington Recovery Center, and developed and oversees the PTSD partial hospital programs at Rogers’ West Allis, Brown Deer, Oconomowoc, and Appleton locations.”

Psychologist Nicholas Farrell will also speak at the event. Farrell provides clinical consultation and supervises the work of the behavioral specialists in Rogers’ Eating Disorder Center as well as in the inpatient, partial hospitalization and intensive outpatient programs.

“Dr. Farrell embraces an integrated care model that promotes collaboration between patients and the health professionals involved in their care,” the release stated.

The event is free and open to the public, but registration is required. To register, email Kia LaBracke at ocdwisconsin@gmail.com.

OCD Wisconsin was founded in 2013 as the Wisconsin affiliate of the International OCD Foundation with the mission to be a trusted resource and voice for those affected by OCD.

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Paroxetine: Side effects, dosage, uses, and more

Highlights for paroxetine

  1. Paroxetine oral tablet is available in immediate-release and extended-release forms. It’s also available as both a generic drug and brand-name drugs. Brand names: Paxil, Paxil CR, and Pexeva.
  2. Paroxetine is also available as an oral capsule and oral suspension.
  3. Paroxetine oral tablet can be used to treat depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder.


Important warnings

FDA warning: Suicide warning

  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Antidepressant medications such as paroxetine may increase suicidal thoughts and behaviors, especially within the first few months of treatment or when your dose is changed. This risk is higher in children, teenagers, and young adults. You, family members, caregivers, and your doctor should pay attention to any unusual changes in your mood, behaviors, thoughts, or feelings.

Other warnings

  • Serotonin syndrome warning: This drug can cause a potentially life-threatening condition called serotonin syndrome. It can be caused by this drug alone or with the use of other medications that have similar effects. Symptoms of serotonin syndrome can include agitation, hallucinations, confusion, trouble thinking, coma, coordination problems, and muscle twitching (overactive reflexes).
  • Worsened depression warning: Paroxetine may worsen your depression. If you experience any unusual changes in behavior, especially during the first few months of treatment or when your dose changes, call your doctor. These can include anxiety, restlessness, panic attacks, sleeplessness, irritability, aggressiveness, acting on dangerous impulses, attempts to commit suicide, and extreme mood swings.
  • Stopping treatment warning: If you’re stopping treatment with this drug, it should be done gradually and with your doctor’s guidance. Don’t stop taking this drug abruptly. Withdrawal symptoms can occur when this drug is stopped too quickly. Symptoms of withdrawal include anxiety, irritability, restlessness, changes in sleep habits, headache, sweating, nausea, dizziness, shaking, and confusion. You should be monitored for these symptoms when stopping treatment with paroxetine.

What is paroxetine?

Paroxetine oral tablet is a prescription drug. It’s available in immediate-release and extended-release forms. These forms are available as the brand-name drugs Paxil, Paxil CR, and Pexeva. All brands do not treat all conditions.

Paroxetine oral tablet is also available as a generic drug. Generic drugs usually cost less than brand-name versions. In some cases, they may not be available in all strengths or forms as brand-name drugs.

Paroxetine also comes as an oral capsule and an oral solution.

Why it’s used

Paroxetine can be used to treat the following conditions:

Paroxetine may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Paroxetine belongs to a class of drugs called selective serotonin reuptake inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Paroxetine increases the amount of the hormone serotonin that your body makes and releases in your brain. Serotonin helps with symptoms of depression, compulsions, stress, and anxiety.


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Paroxetine side effects

Paroxetine oral tablet can cause drowsiness and may affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, use heavy machinery, or do other activities for which you need to be alert until you know how this drug affects you.

Paroxetine can also cause other side effects.

More common side effects

The more common side effects of paroxetine oral tablet can include:

  • nausea
  • sleepiness
  • weakness
  • dizziness
  • anxiousness or sleeplessness
  • delayed ejaculation
  • decreased sexual desire
  • impotence
  • sweating
  • shaking
  • decreased appetite
  • dry mouth
  • constipation
  • infection
  • yawning

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Changes in mood, anxiety or behavior, such as:
    • new or worsened depression
    • new or worsened anxiety or panic attacks
    • thoughts of suicide or dying
    • attempts to commit suicide
    • acting on dangerous impulses
    • acting aggressive or violent
    • agitation, restlessness, anger, or irritability
    • sleeplessness
    • increase in activity or talking more than what is normal for you
  • Serotonin syndrome or neuroleptic malignant syndrome-like reactions. Symptoms can include:
    • agitation, hallucinations, coma, confusion, and trouble thinking
    • coordination problems or muscle twitching (overactive reflexes)
    • muscle rigidity
    • racing heartbeat
    • high or low blood pressure
    • sweating
    • fever
    • nausea, vomiting, or diarrhea
  • Eye problems, such as:
    • eye pain
    • changes in vision
    • swelling or redness in or around your eyes
  • Severe allergic reactions. Symptoms can include:
    • trouble breathing
    • swelling of your face, tongue, eyes, or mouth
    • rash
    • hives (itchy welts)
    • blisters
    • fever
    • joint pain
  • Abnormal bleeding
  • Seizures or convulsions
  • Manic episodes. Symptoms can include:
    • greatly increased energy
    • severe trouble sleeping
    • racing thoughts
    • reckless behavior
    • unusually grand ideas
    • excessive happiness or irritability
    • talking more or faster than usual
  • Changes in appetite or weight
  • Low sodium levels. Symptoms can include:
    • headache
    • weakness or feeling unsteady
    • confusion, problems concentrating or thinking, or memory problems
  • Bone fracture. Symptoms can include:
    • unexplained bone pain
    • tenderness
    • swelling
    • bruising

Paroxetine and suicide

SSRIs, such as paroxetine, may cause or increase suicidal thoughts and behaviors. The risk is especially high during the first few months of treatment, or following a change in dosage. Children, teenagers, and young adults are at highest risk for these symptoms. Contact your doctor right away if you experience any unusual or sudden changes in behaviors, thoughts, or mood when taking this drug. Learn more about antidepressants and suicide risk here.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Paroxetine may interact with other medications

Paroxetine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with paroxetine are listed below.

Drugs you should not take with paroxetine

Do not take these drugs with paroxetine. Taking these drugs with paroxetine can cause dangerous effects in your body. Examples of these drugs include:

  • Thioridazine. Taking this drug with paroxetine can cause serious heart rhythm problems or sudden death.
  • Pimozide. Taking this drug with paroxetine can cause serious heart problems.
  • Monoamine oxidase (MAO) inhibitors, such as isocarboxazid, phenelzine, and tranylcypromine. Taking these drugs with paroxetine increases your risk of serotonin syndrome so much that they should not be taken with paroxetine. You should wait at least 14 days between use of paroxetine and these drugs.
  • Tryptophan (found in dietary supplements). Taking tryptophan with paroxetine increases your risk of serotonin syndrome. It should not be taken with paroxetine.
  • Linezolid, and intravenous methylene blue. Taking these drugs with paroxetine increases your risk of serotonin syndrome so much that they should not be used together.

Interactions that can increase your risk of side effects

Taking paroxetine with certain drugs raises your risk of side effects. Examples of these drugs include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as, ibuprofen and naproxen as well as aspirin and warfarin. Taking these drugs with paroxetine can increase your risk of bleeding or bruising.
  • Triptans such as sumatriptan
  • Lithium
  • Serotonergic drugs, such as fentanyl, tramadol, and St. John’s wort. Taking these drugs with paroxetine can increase your risk of serotonin syndrome.
  • Amphetamines, such as lisdexamfetamine and methamphetamine. Taking these drugs with paroxetine can increase your risk of serotonin syndrome.
  • Theophylline. Taking this drug with paroxetine can increase your risk of restlessness, trouble sleeping, and irritability.
  • Risperidone. Taking this drug with paroxetine can increase your risk of sleeping difficulty, anxiety, restlessness, and constipation.
  • Cimetidine
  • Antiarrhythmics, such as flecainide, and propafenone
  • Phenothiazines, such as chlorpromazine, and fluphenazine
  • Tricyclic antidepressants (TCAs), such as amitriptyline, imipramine and desipramine
  • Quinidine. Taking this drug with paroxetine can increase your risk of tiredness, decreased appetite, sweating, dry mouth, and decreased sexual desire.

Interactions that can make drugs less effective

Taking paroxetine with certain drugs may cause one or both of the drugs to not work as well. This is because the interaction between the drugs may cause a decrease in your body of paroxetine or the other drug. Examples of these drugs include:

  • Tamoxifen, a breast cancer drug
  • Digoxin
  • Protease inhibitors, such as fosamprenavir and ritonavir
  • Phenobarbital
  • Phenytoin

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.


Paroxetine warnings

Paroxetine oral tablet comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your face, tongue, eyes, or mouth
  • rash, itchy welts (hives), or blisters, alone or with fever or joint pain

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction

You should avoid drinks that contain alcohol when taking this drug.

Warnings for people with certain health conditions

For people with glaucoma: Paroxetine may dilate your pupils, which may trigger a glaucoma attack. Notify your doctor if you have glaucoma before taking this drug.

For people with bipolar disorder: Caution should be used when taking this drug if you have bipolar disorder. Taking paroxetine alone may trigger a mixed or manic episode.

For people with seizures: Caution should be used when taking this drug if you have a history of seizures. If seizures occur while you take this drug, you should stop taking it and contact your doctor.

For people with kidney disease: If you have kidney disease, your kidneys may not be able to get rid of this drug as well as they should. This may cause levels of the drug to build up in your body and cause more side effects.

For people with liver disease: If you have liver disease, your body may not be able to process this drug as well as it should. This may increase the levels of this drug to build up in your body and cause more side effects.

Warnings for other groups

For pregnant women: Paroxetine oral tablet is a category D pregnancy drug. That means two things:

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it’s needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should be only used if the potential risk is acceptable given the drug’s potential benefit. Call your doctor right away if you become pregnant while taking this drug.

For women who are breastfeeding: This drug passes into breast milk and may cause side effects in a child who is breastfed. Caution should be used when taking this drug while breastfeeding. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

If you’re over the age of 65, you may be at higher risk of developing side effects while taking this drug, including low sodium levels in your blood (hyponatremia).

For children: It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

How to take paroxetine

This dosage information is for paroxetine oral tablet. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: Paroxetine

  • Form: Immediate-release oral tablet
  • Strengths: 10 mg, 20 mg, 30 mg, 40 mg
  • Form: Extended-release oral tablet
  • Strengths: 12.5 mg, 25 mg, 37.5 mg

Brand: Paxil

  • Form: Immediate-release oral tablet
  • Strengths: 10 mg, 20 mg, 30 mg, 40 mg

Brand: Paxil CR

  • Form: Extended-release oral tablet
  • Strengths: 12.5 mg, 25 mg, 37.5 mg

Brand: Pexeva

  • Form: Immediate-release oral tablet
  • Strengths: 10 mg, 20 mg, 30 mg, 40 mg

Dosage for major depressive disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 20 mg per day.
    • If a 20-mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • Your maximum daily dose shouldn’t exceed 50 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The initial dose is 25 mg per day.
    • If you don’t respond to a 25-mg dose, your doctor will increase your dose each week by 12.5 mg per day.
    • The maximum dose is 62.5 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dosage is 12.5 mg per day.
    • The maximum dosage is 50 mg per day.

Dosage for obsessive-compulsive disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 20 mg per day.
    • The target dose is 40 mg day. Your doctor will increase your dose each week by 10 mg per day to get to the target dose.
    • The maximum dose is 60 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Dosage for panic disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 10 mg per day.
    • The target dose is 40 mg per day. Your doctor will increase your dose each week by 10 mg per day to get to the target dose.
    • The maximum dose is 60 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The initial dose is 12.5 mg per day.
    • If you don’t respond to a 12.5-mg dose, your doctor will increase your dose each week by 12.5 mg per day.
    • The maximum dose is 75 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dosage is 12.5 mg per day.
    • The maximum dosage is 50 mg per day.

Dosage for social anxiety disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil):
    • The typical starting dose is 20 mg per day.
    • If a 20 mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • The recommended dose to treat social anxiety disorder is 20–60 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The initial dose is 12.5 mg per day.
    • If you don’t respond to a 12.5-mg dose, your doctor will increase your dose each week by 12.5 mg per day.
    • The maximum dose is 37.5 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.

Dosage for generalized anxiety disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 20 mg per day.
    • If a 20-mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • The recommended dose to treat generalized anxiety disorder is 20–50 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Dosage for post-traumatic stress disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil):
    • The typical starting dose is 20 mg per day.
    • If a 20-mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • The recommended dose to treat post-traumatic stress disorder is 20–50 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

For severe liver disease

  • Immediate-release oraltablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Dosage for premenstrual dysphoric disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Extended-release oral (Paxil CR):
    • The typical starting dose is 12.5 mg per day, usually taken in the morning.
    • Depending on your symptoms, your dose can be increased up to 25 mg per day.
    • Dose changes should occur at intervals of at least one week.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Extended-release oral (Paxil CR):
    • The recommended starting dose is 12.5 mg once per day
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Extended-release oral (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Extended-release oral (Paxil CR):
    • The recommended starting dosage is 12.5 mg per day.
    • The maximum dosage is 50 mg per day.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.


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Take as directed

Paroxetine oral tablet can be used for long-term or short-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: If you don’t take it at all, your condition won’t get any better. If you suddenly stop taking it, you may see symptoms, such as anxiety, irritability, high or low mood, restlessness, changes in sleep habits, headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, and confusion.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • sleepiness
  • dizziness
  • nausea
  • vomiting
  • fast heart rate
  • tremor
  • confusion
  • coma

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working:

  • Major depressive disorder. You should have decreased feelings of depression and your mood should improve.
  • Obsessive-compulsive disorder. You should have decreased feelings of obsessions and compulsions.
  • Panic disorder. You should have decreased feelings of anxiety and panic.
  • Social anxiety disorder. You should have decreased feelings of anxiety.
  • Generalized anxiety disorder. You should have decreased feelings of anxiety.
  • Post-traumatic stress disorder. You should have decreased feelings of anxiety, memories, or dreams of traumatic events (flashbacks) and nightmares.
  • Premenstrual dysphoric disorder. You should have decreased tiredness, irritability, mood swings, sleeplessness, and anxiety.

Important considerations for taking paroxetine

Keep these considerations in mind if your doctor prescribes paroxetine oral tablets for you.

General

  • You can take this drug with or without food.
  • Take the oral tablet in the morning.
  • You can cut or crush the immediate-release oral tablet
  • You can’t chew, crush, or cut the extended-release tablet. It must be swallowed whole.
  • Not every pharmacy stocks all forms or brands of this drug. When filling your prescription, be sure to call ahead.

Storage

  • Store the oral tablets at room temperature between 59°F and 86°F (15°C and 30°C). Store the extended-release tablets at or below 77°F (25°C).
  • Keep this drug away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Mental health and behavior changes
  • Kidney function. Your doctor may have blood tests done to check how well your kidneys are working. If your kidneys aren’t working well, your doctor may decide to lower your dose of this drug.
  • Liver function. Your doctor may have blood tests done to check how well your liver is working. If your liver isn’t working well, your doctor may decide to lower your dose of this drug.

Insurance

Many insurance companies require a prior authorization for certain forms or brands of this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Jury in Kingston murder case due to start deliberating Wednesday

KINGSTON, N.Y. — Jury deliberations are expected to begin Wednesday in the murder trial of Seth Lyons.

The prosecution and defense rested their cases Tuesday after psychiatric experts offered conflicting testimony about Lyons’ mental health history and his mental state at the time he killed 49-year-old homeless man Anthony Garro.

Garro’s badly beaten body was found around 9 a.m. Nov. 29, 2017, beneath the Elmendorf Street overpass along the unused Ulster County-owned railroad corridor that runs through Midtown Kingston. Lyons, 20, of Ulster Park, has confessed to the attack, but the defense contends he didn’t mean to kill Garro and that he suffered from “extreme emotional disturbance.”

Lyons was spotted at a local convenience store a few hours after the fatal attack, still wearing the bloodstained clothes he had on at the time he beat Garro with his fists, a beer bottle, rocks, a brick and a tree stump.

He admitted to police that he pummeled Garro — first because he believed Garro had stolen his cell phone, then because he thought Garro was trying to sexually assault him.

On Monday, Dr. Stephen Price testified under questioning by defense attorney Bryan Rounds that Lyons suffered from bipolar disorder, schizoaffective disorder, obsessive-compulsive disorder, depression, anxiety, paranoia and post-traumatic stress disorder, and that he had a long history of significant drug abuse. Price said Lyons’ actions were brought on by mental illness and drugs and were “triggered” by the belief that Garro was trying to sexually assault him.

The prosecution says Lyons intended to kill Garro because he believed Garro had stolen his cell phone and wouldn’t empty his pockets to prove he didn’t have the device.

Under questioning by Ulster County Chief Assistant District Attorney Michael Kavanagh, Price testified that Lyons was aware of what he was doing when he struck Garro repeatedly.

“And when he picked up that boulder and dropped it on him?” Kavanagh asked.

“It was all part of the beating,” Price said, adding that Lyons “intended to assault” Garro.

Dr. Kevin Smith, the psychiatrist called by the prosecution, rejected Price’s findings, saying that, in his opinion, “Seth Lyons did not lack the requisite capacity to form intent to commit the crime” and “did not suffer extreme emotional disturbance.”

Smith said Lyons suffered from an antisocial personality disorder with substance-induced bipolar disorder. The psychiatrist said he rejected the notion that Lyons suffered from “extreme emotional disturbance” at the time he killed Garro because he was able to recall details of the incident.

Under cross-examination, Rounds tried to elicit from Smith testimony that would show the prosecution witness was cherry-picking the psychiatric information he shared with jurors, reading off a laundry list of diagnoses from other medical professionals that Smith had not detailed for jurors, including that Lyons had been diagnosed as bipolar from a young age and that he had been hospitalized on at least five occasions since he was 14 specifically related to bipolar and anxiety disorders.

The two sides will deliver are to their closing statements to jurors when court resumes at 9:30 a.m. Wednesday.

Ulster County Judge Donald A. Williams said he will give jurors the option of convicting Lyons of second-degree murder, first-degree manslaughter or second-degree manslaughter. Additionally, if jurors find that the facts support all the elements necessary to find Lyons guilty of murder, he will allow jurors to decide whether the defense has proven to them that Lyons’ actions were the result of “extreme emotional disturbance.”

Obsessive Compulsive Disorders Evident in Duchenne Patients and in Need of Treatment, Study Says

Obsessive compulsive disorder (OCD), a type of “internalizing disorder,” are evident in children with Duchenne muscular dystrophy, and particularly associated with anxiety and places considerable stress on the patient’s family, a small retrospective study reported.

Researchers call attention to the importance of care providers being alert to signs of OCD and anxiety in patients, and treating their mental as well as physical health.

Their study “Descriptive Phenotype of Obsessive Compulsive Symptoms in Males With Duchenne Muscular Dystrophy” was published in the Journal of Child Neurology.

Previous work has shown a higher-than-average prevalence of behavioral or emotional disorders like OCD — known as internalizing disorders — in boys with Duchenne muscular dystrophy (DMD). But these studies do not detail the clinical symptoms that mark this patient population.

A team of researchers at University of Iowa sought to characterize the clinical signs, impact on patients and families, and response to treatment of internalizing disorders in DMD patients.

They retrospectively reviewed medical charts of boys and men, ages 5 to 34, being treated at the University of Iowa Hospital and Clinics between 2012 and 2017.

In total, data on 107 patients were reviewed; the study focused on a final group of 39 Duchenne patients. Of these, 15 exhibited OCD spectrum symptoms (14.0%), anxiety was evident in 27 patients (25.2%), and 14 had signs of depression (13.1%), the study reported. Often, symptoms of more than one disorder were reported in patients.

The mean age at OCD onset was 12.1 years, but the study reported evidence of symptoms having started earlier — as young as age 5 — although not problematic until the patients were older. At the time of the study, these 15 people ranged in age from 5 to 23.

Anxiety was also more likely to affect Duchenne boys with evidence of OCD (73.3%) than is common; anxiety at notable levels is usually seen in about 50% of other young patients with OCD.

Patients’ daily life and that of their families were often unsettled by these internalized disorders. Three cases were emphasized in the study, detailing patients who began experiencing OCD symptoms at very early ages, ranging from 4 to 6.

Irritability and distress in these children significantly disturbed family routines and quality of life. Symptoms also worsened as patients grew older, but treatment with selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant, resulted in consistent improvements over time. 

Records showed that psychotherapy was recommended to all 15 OCD patients in the study — whether evaluated by psychiatrists (nine patients) or doctors in their healthcare team — but only five were getting routine treatment by a psychiatrist or a therapist.

Most, 14 of the 15, were using SSRIs prescribed to them, a finding the researchers attributed to limited access to psychotherapy or financial burden.  According to the study, SRRIs given these patients included fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and clonazepam.

These medicines did not completely resolve OCD symptoms, but patients and families reported their use helpful in easing anxiety and greatly improving quality of life.

“Our data affirm that internalizing disorders are prevalent in the Duchenne muscular dystrophy population, warranting clinical attention and screening, as generally early diagnosis and treatment are associated with greater symptom improvement,” the researchers concluded.

OCD and Muscular Dystrophy

Obsessive-compulsive disorder (OCD) is largely characterized by obsessions and compulsions which can overtake a person’s life. While previously labeled as an anxiety disorder, it is now listed in the DSM 5 under the heading of obsessive-compulsive and related disorders.

While not technically an anxiety disorder, the majority of people with OCD deal with anxiety issues and might even be diagnosed with a specific anxiety disorder, such as Generalized Anxiety Disorder (GAD) or social anxiety disorder. Indeed, comorbid conditions with OCD are not unusual, and OCD can often be seen with depression and, to a lesser extent, with Bipolar Disorder and schizophrenia.

Now researchers have found that compared to the general population there is a higher than average prevalence of obsessive-compulsive disorder in those with Duchenne Muscular Dystrophy (DMD). DMD is a genetic illness that leads to progressive deterioration of muscle fibers. It usually only affects males but females can carry the mutated gene.

The study was published in May 2018 in the Journal of Child Neurology and was conducted by researchers from the University of Iowa. They worked on characterizing the clinical signs of OCD in those with DMD as well as its impact on patients and their families. The participants’ response to treatment was also studied.

The team reviewed the medical charts of 107 male patients aged 5-34 who had been treated at the University of Iowa Hospital and Clinics between 2012 and 2017. The study focused on a final group consisting of thirty-nine patients with DMD.  These patients, on the whole, exhibited higher levels than average of anxiety, depression and OCD, with symptoms of the disorders often overlapping. A total of fifteen subjects ranging in age from 5 – 23 exhibited signs of OCD. The mean age at onset was 12.1 years, but the study reported evidence of symptoms starting as early as age five.

The researchers said:

“Common initial symptoms included difficulty with changes in routine, repetitive behaviors, and organizational compulsions. Many patients required a very specific bedtime routine.”

“Our data affirm that internalizing disorders [OCD] are prevalent in the Duchenne muscular dystrophy population, warranting clinical attention and screening, as generally early diagnosis and treatment are associated with greater symptom improvement.”

Not surprisingly, the lives of families and patients with DMD are often negatively affected by the presence of obsessive-compulsive disorder. Distress and irritability in those suffering with both DMD and OCD significantly disturbed family routines and quality of life. Symptoms also tended to worsen as patients grew older, but treatment with selective serotonin reuptake inhibitors (SSRIs) resulted in consistent improvements over time. While medication did not completely resolve OCD symptoms, patients and their families reported they helped ease anxiety and improved their quality of life.

What I find particularly interesting about this study is that while psychotherapy (I’m hoping in the form of exposure and response prevention therapy) was recommended to all fifteen participants with OCD, only five were actually getting this treatment. In contrast fourteen of the fifteen subjects were taking SSRIs. The researchers attributed these statistics to a lack of access to qualified therapists as well as financial constraints felt by the families.

Once again, we see how difficult it can be for those with obsessive-compulsive disorder to get the proper treatment. Exposure and response prevention (ERP) therapy is the recommended, evidence-based psychological therapy for the treatment of OCD, but it is often out of reach for so many people. Those with DMD and OCD are likely to face unique challenges in terms of family accommodations and dynamics, and could benefit greatly from expert care and advice.

At the very least, this study brings OCD awareness to the forefront for those with DMD and their families. If OCD is recognized early and properly treated, its effect on lives can be minimal. And for those already living with the burden of DMD, that would surely be a good thing.

Fast Five Quiz: Generalized Anxiety Disorder

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Omega-3 Polyunsaturated Fatty Acids May Ease Anxiety

Treatment with omega-3 polyunsaturated fatty acids (PUFAs) may help reduce symptoms of anxiety, according to a new study published in JAMA Network Open.

The review and meta-analysis tapped data from 19 clinical trials which included 2240 participants (1203 treated with omega-3 PUFAs and 1037 without) from 11 countries. Participants had a wide range of psychiatric and physical conditions, including borderline personality disorder, depression, obsessive-compulsive disorder, Alzheimer’s disease, test anxiety, acute myocardial infarction, and premenstrual syndrome. Others were from the general population and had no specific clinical conditions.

“Although participants and diagnoses were heterogeneous, the main finding of this meta-analysis was that omega-3 PUFAs were associated with significant reduction in anxiety symptoms compared with controls,” researchers wrote. “This effect persisted vs placebo controls.”

The Role of Omega-3 Fatty Acids in Mental Health Care

Researchers also discovered daily dosages higher than 2000 mg were linked with a significantly higher anxiolytic effect, compared with lower dosages. In addition, supplements with less than 60% eicosapentaenoic acid (EPA) were significantly associated with reduced anxiety symptoms, but supplements with 60% or more EPA were not.

“The depression literature supports the clinical benefits of EPA-enriched formulations (≥60% or ≥50%) compared with placebo for the treatment of clinical depression,” researchers noted. “This opposite effect of EPA-enriched formations on anxiety and depression is intriguing and possibly linked to a distinct underlying mechanism of omega-3 PUFAs.”

Researchers voiced the need for larger, well-designed clinical trials to further investigate high-dose omega-3 PUFAs, both as monotherapy and as adjunctive treatment, in patients with anxiety.

—Jolynn Tumolo

Reference

Su K, Tseng P, Lin P, et al. Association of use of omega-3 polyunsaturated fatty acids with changes in severity of anxiety symptoms. JAMA Network Open. 2018 September 14.

Carina draws from experience to write about mental illness

Carina McEvoy from Gorey was not yet 17 when her depression and anxiety disorder began. The outburst of tears on the way to school soon developed into a dangerous addiction of self-inflicted pain.

Now a successful novelist and tutor, and happily married with two girls, Carina has spent years battling the depression, anxiety, social phobia and obsessive compulsive disorder that controlled her life since her late teens. Throughout the years, Carina has learned about her condition and fought back with writing, talk therapy, cognitive behaviour therapy and hypnotherapy.

‘My background is in secondary school education teaching geography and business in Dublin,’ said Carina. ‘I took a career break when my second child was born and resigned after the five years so I could stay home and care for them myself.’

Carina also has a Diploma and Advanced Diploma in Hypnotherapy and Psychotherapy from the Institute of Clinical Hypnotherapy and Psychotherapy Ireland, a practitioners Certificate in Cognitive Behavioural Therapy and will have one in Neuro Linguistic Programming in two weeks times.

‘During the career break I wrote a women’s fictional novel entitled “To have, Not Hold”,’ said Carina. ‘I love writing and it has always been one of the ways I seem to be able to manage my own anxiety. Writing is a great therapy.’

Carina, who has two new books on the way later this month as well as a series of workshops for parents, has always had an interest in adolescent mental health which led her to be a teacher. However, she also developed an interest in children’s mental health well being in particular children’s anxiety when her own were born. She came to realise how prevalent it is.

‘I suffered with mental health issues as a teenager myself and my eldest daughter had quite bad anxiety,’ said Carina. ‘With the techniques and knowledge I have gained throughout my own experiences of poor mental health and through my studies, I managed to help my daughter Anna overcome her anxiety.’

Children’s mental health is becoming an increasing problem in this country, according to Carina. Within the past five years alone, Children and Adolescent Mental Health services (CAMHS) has received a 50 per cent increase in referrals.

‘CAMHS is over stretched in terms of staff and resources,’ said Carina. ‘They are struggling to cope with the volume of children on their waiting lists, which received bad publicity of late.’

The fact Carina has heard of some parents waiting up to two years for an appointment and GPs having no other choice but to refer mental health issues for children to CAMHS because they are not trained to deal with mental health issues, has encouraged her to write children’s books and hold courses for parents.

‘I decided to write the children’s books and courses simply due to the amount of children I have heard of that are suffering from this epidemic,’ said Carina. ‘I feel there is no resources available for them and nothing seems to be coming down to these children.’

Carina believes the low level anxiety is manageable and also believes that if tackled now it will prevent any further serious mental health issues in the future.

‘If we are, as a country, not equipped to deal with issues now what will we be like in 10 or 20 years time?,’ added Carina.

Of the mental health issues among children, anxiety seems to be the major issue. Carina witnessed this as a secondary school teacher and then when she had her own children. ‘I could see anxiety was an issue beginning in children as early as four years,’ she added.

She fully believes from her studies and research that anxiety is a manageable issue and with some knowledge and low-level intervention it can be prevented from becoming a more serious complex mental health issue.

Mental Health Ireland reported that 80 per cent of adults who suffer with mental health issues today said they suffered with anxiety as a child.

‘That statistic alone should make us want to tackle the issue of children’s anxiety,’ said Carina. ‘Anxiety is part of life, it is a biologically pre-determined emotion that actually keeps us safe.

‘It is that over-protectiveness part of anxiety that we want to be able to manage. And it is something that can be controlled in a healthy and positive way.’

At the end of the month, Carina will be launching two books around the issue of anxiety in Gorey Library, on Tuesday, September 25, at 7 p.m.

The children’s anxiety books are entitled ‘Sometimes I worry…how about you?’ and the sister support book for adults ‘Sometimes my child worries…what do I do?’.

Plus, she will also be tutoring two separate adult courses in Gorey Adult Education Centre, beginning on Monday, September 24, at 7 p.m., and will run five-weeks and six-weeks consecutively. The first course is ‘An Introduction to Understanding Child Development and Children’s Anxiety’, and the second is an ‘Advanced Course to Understanding and Managing Children’s Anxiety’.

Both the courses and the books contain innovative and pro-active material based around cognitive behavioural therapy, neuro linguistic programming, mindfulness, mantra use and diaphragmatic breathing.

Carina said: ‘It is my vision that these aides and resources can be used by the parent and guardian in the home as pre-emptive way to dealing with children’s anxiety before it reaches a level where professional psychological help is needed.’

‘Going forward I think this could be a real game changer in aiding our young children develop and maintain a good foundation for mental well being,’ said William Arrigan, who is a tutor of child psychology and social care.

Minister Michael D’Arcy praised Carina on her next venture and said it is a very positive sign to see such an aide made available to parents and guardian who can work with their child in their own home.

Places on the courses are limited so booking is advised. Contact Gorey Adult Education Centre on 053 94 21791 to enrol.

‘I would love to campaign to the Government to put something in place in primary education to make sure children’s mental well being is being cared for,’ said Carina. ‘I suppose the course and books are a way the parent, guardian or even a teacher has some aides available to them as how to approach children’s anxiety. I am by no means saying they are a solution, they are an aide only but it has to be a start.’

Gorey Guardian

Youth Service Bureau can help line up mental health appointments

PRINCETON — Solutions Counseling, a program of Youth Service Bureau of Illinois Valley, continues its outpatient mental health-counseling services including individual, family and couple counseling in the communities of Princeton and La Salle. All therapists are licensed including the most recent addition to the staff, Nancy Carper, LCPC.

YSB offers treatment for a large array of mental health conditions to people of all ages including suicide prevention, anxiety disorders, mood disorders, grief and loss, marriage and family challenges, obsessions and compulsions, and more.

For details, call (815) 431-3051 or visit www.ysbiv.org.

How one woman dealt with the loss of her twin while fighting depression and OCD


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OCD is an anxiety disorder which caused people to have unwanted, intrusive thoughts – over and over again

OCD is an anxiety disorder which caused people to have unwanted, intrusive thoughts – over and over again



TUCSON, Ariz. – At just 15-years-old, Amy Frederick was diagnosed with Obsessive Compulsive Disorder.

OCD is an anxiety disorder which caused people to have unwanted, intrusive thoughts – over and over again. 

It’s a disorder Frederick believes her Grandmother battled, too. 

For Frederick, it meant grouping things and people in her head. 

People who do the following may have OCD:

  • Repeatedly check things, perhaps dozens of times, before feeling secure enough to leave the house. Is the stove off? Is the door locked?
  • Fear they will harm others.​ ​​​​​​Example: A man’s car hits a pothole on a city street and he fears it was actually a pedestrian and drives back to check for injured persons.
  • Feel dirty and contaminated. Example: A woman is fearful of touching her baby because she might contaminate the child and cause a serious infection.
  • Constantly arrange and order things. Example: A child can’t go to sleep unless he lines up all his shoes correctly.
  • Are ruled by numbers, believing that certain numbers represent good and others represent evil. Example: a college student is unable to send an email unless the “correct sequence of numbers” is recalled prior to using his computer.
  • Are excessively concerned with sin or blasphemy in a way that is not the cultural or religious norm for other members of their community. Example: a woman must recite “Hail Mary” thirty-three times every morning before getting out of bed and is frequently late for work because of this.

“My mother and my sister and grandmother are all manic depression. It’s weird that I don’t have manic depression because I have an identical twin- you would think that we would have the same thing. But I don’t – I’m mostly major depression.”

MORE: What is Mental Illness

Frederick was diagnosed with major depression when she was 15. Her worst symptoms came when her twin sister died 21-years ago at the age of 27. She says the pain of losing her twin sister was too much to bear. 

Major Depression symptoms:

  • Changes in sleep
  • Changes in appetite
  • Poor concentration
  • Loss of energy.
  • Lack of interest.
  • Low self-esteem
  • Hopelessness or guilt
  • Movement changes

MORE: Depressive disorders in children adolescents

“She was half of me. I just didn’t know how I was going to go on without her.”

After her sister’s death – Frederick checked into the hospital to deal with her depression. She was released but says the thoughts of suicide continued.

MORE: Mental Illness in older adults

“When I came home from cottonwood I was laying in my bed thinking – how can I kill myself.”

Fast facts about Suicide Ideation

  • Most people who have suicidal thoughts do not carry them through to their conclusion.
  • Causes of suicidal thoughts can include depression, anxiety, eating disorders such as anorexia, and substance abuse.
  • People with a family history of mental illness are more likely to have suicidal thoughts.

Suicide ideation symptoms: 

  • feeling or appearing to feel trapped or hopeless
  • feeling intolerable emotional pain
  • having or appearing to have an abnormal preoccupation with violence, dying, or death
  • having mood swings, either happy or sad
  • talking about revenge, guilt, or shame
  • being agitated, or in a heightened state of anxiety
  • experiencing changes in personality, routine, or sleeping patterns
  • consuming drugs or more alcohol than usual, or starting drinking when they had not previously done so
  • engaging in risky behavior, such as driving carelessly or taking drugs
  • getting their affairs in order and giving things away
  • getting hold of a gun, medications, or substances that could end a life
  • experiencing depression, panic attacks, impaired concentration
  • increased isolation
  • talking about being a burden to others
  • psychomotor agitation, such as pacing around a room, wringing one’s hands, and removing items of clothing and putting them back on
  • saying goodbye to others as if it were the last time
  • seeming to be unable to experience pleasurable emotions from normally pleasurable life events such as eating, exercise, social interaction, or sex
  • severe remorse and self criticism
  • talking about suicide or dying, expressing regret about being alive or ever having been born

Seven years ago, Frederick ended up in the hospital again after her mother passed away. She says, her mother was the only person who understood what she was going through because of she dealt with a mental illness as well. 

It took another tragedy to seek grief therapy – Fredericks father died in 2017. 

“I just learned to deal with it. You need to deal with your grief and get help if you’re having a tough time,” says Frederick. 

In therapy, Amy wrote goodbye, forgiveness, and apology letters to her family. She says that treatment along with medication helped her focus on the happy thoughts and not the sadness. Amy says, managing her depression is still an everyday challenge but says you can live a normal life with a mental illness. “If you’re having trouble with anything – there is help available.” 

The confidential National Suicide Prevention Lifeline can be reached toll-free on 1-800-273-TALK(8255), 24 hours a day, 7 days a week.

For programs and services at the National Alliance on Metal illness Southern Arizona, click here.

Follow News Reporter Jennifer Martinez on Facebook, Instagram, and Twitter.

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