Lexapro

By W. Connor. Springfield College.

Investigators were to avoid the use of fluoroquinolone antibiotics (including ciprofloxacin) in all study patients following termination or completion of the study drug regimen through completion of the 12-month safety follow-up visit order lexapro 20mg with amex, insofar as clinically feasible and provided that a fluoroquinolone antibiotic was not absolutely clinically indicated at any time during this 1-year follow-up generic lexapro 5mg overnight delivery. All unused study drug was to be accounted for and was sent for destruction at the completion of the trial. Patients must have taken ≥80% of the scheduled doses in order to be considered compliant with the study protocol. Superinfections were considered microbiological failures and were assessed separately. Patients with indwelling catheters were to have had blood cultures (2 sets from 2 different sites) obtained simultaneously with the catheterized urine specimen at the time of study enrollment. If 2 or more pathogens grew from the baseline urine culture, all isolates were considered contaminants (i. If the method of obtaining a specimen for urine culture was switched between the baseline and the Test-of-Cure visit (e. Clinical Reviewer’s Comment: The applicant noted that because there were very few patients who switched the urine collection technique between the baseline and the Test-of-Cure visit (e. This approach is acceptable to the reviewer, since there were less than 10 patients affected. All pertinent laboratory tests or procedures that reflected the course of the infectious disease were also assessed. Absence of or reduction of signs and symptoms was used to assess clinical response. In the event that the patient failed study drug therapy and was prescribed alternative antimicrobial therapy, continued clinical evaluation of the patient focused on their response to the alternative antimicrobial therapy at a subsequent visit. An indeterminate designation at Test-of-Cure invalidated the patient for efficacy evaluation. The clinical outcome was determined to be failure as soon as there was one assessment of failure at any time point. Clinical Reviewer’s Comment: The protocol included a definition for an overall clinical assessment of efficacy, which was to be a combination of the Test-of-Cure clinical response and the long-term follow-up clinical response. In the analysis, the overall clinical assessment of efficacy was not used by the applicant, since for analysis purposes; clinical response at follow-up encompassed all the components of the planned overall clinical response assessment of efficacy. Responses were graded according to the following: Cure: resolution of signs and symptoms related to the current infection and not requiring further antibiotic therapy; Failure: persistent fever or flank pain or insufficient reduction in severity of the signs and symptoms of infection to qualify as resolution, requiring a modification of the antibacterial therapeutic regimen; Indeterminate: patients in whom a clinical assessment was not possible for various reasons, including early withdrawal due to adverse events, protocol violations, etc. The definition of arthropathy was generally considered as any condition affecting a joint or periarticular tissue where there is historical and/or physical evidence for structural damage and/or functional limitation that may have been temporary or permanent. This definition was seen as broad and inclusive of such phenomena as bursitis, enthesitis and tendonitis. The musculoskeletal safety assessments were carried out primarily through objective evaluations of joint appearance, structure and function (i. Patients with any pretreatment baseline musculoskeletal exam abnormalities were excluded from the study. Infants and children with spina bifida with total or near total paralysis of the lower extremities (i. Subjective complaints spontaneously volunteered by both patients and by their parents or caregivers, especially those attributable to the musculoskeletal system, were carefully recorded and followed up with additional objective clinical assessments regardless of the period on-study (i. For shoulders, knees, hips and ankles/feet, the motions tested were the following with the patient ranges of motion recorded: • shoulders: extension, flexion, abduction, internal and external rotation; • hips: extension, flexion, adduction, abduction, internal and external rotation; • knees: extension and flexion; • ankles/feet: plantar flexion, dorsiflexion. All joint examinations were performed by an examiner skilled in the evaluation of joint function/appearance; preferably the same individual in order to minimize inter-rater variability. Gait was evaluated in both the stance and swing phases with any abnormalities noted. A training video on physical therapy evaluations was provided by the applicant to all sites to ensure that all patients were examined using the same instructions. Neurological system adverse events were to be captured for up to 1­ year post-therapy. Urine was analyzed for semiquantitative and microscopic examination for appearance, specific gravity, occult blood, protein, pH, ketones, glucose, red blood cells, crystals, bacteria, epithelial cells, white blood cells, and casts. A urinary leukocyte count (cell count by hemocytometer or the sediment examination 3 method) was performed. Patients were then examined on Day 2 to 5 during therapy, with additional on- therapy visits every 2 to 5 days during an extended treatment course. The patient was evaluated again at the Day +5 to +9 post-therapy (Test-of-Cure) visit and the Day +28 to +42 follow-up (first follow-up) visit. Interim telephone calls were conducted at the 6- and 9-month time points to assess musculoskeletal and neurological safety. Joint and gait assessment was done prior to initiation of study drug treatment to exclude patients with pre-existing abnormalities and to establish a baseline values. If qualified personnel were not available at the time of initial patient presentation, the patient’s pretherapy gait/joint examination could be conducted from 48 hours prior to initiation of study drug therapy up to 24 hours after receipt of the first dose of study drug.

Carder cheap lexapro 5mg with mastercard, Vuckovic and Green (2003) conducted qualitative interviews with 83 adults with chronic illnesses buy lexapro 10mg cheap, including schizophrenia and schizo affective disorder, which investigated consumers’ perceptions of their need to take medication during the course of their illnesses. Unfortunately, it was not noted how many of the participants had schizophrenia or schizo affective disorder. Semi-structured interviews were transcribed and analysed following a grounded theory approach. For some, medications successfully managed their symptoms whilst others reported ongoing efforts to find the right medication, or combination of medications, to manage symptoms and minimise side effects. Most described changes over time, with periods of stability marred by either medication resistance or side effects that required a change in dose or type. The results of the study indicated that participants negotiated their need for medication internally (including struggles over self identity) and externally (through negotiations with health care providers). Interview data indicated that medication taking may prompt consumers to re-negotiate their self-identities as formerly well persons (Carder et al. When symptoms are under control, they may question whether they are cured, in remission, or if the medication is treating symptoms. Some participants resisted taking medication because it conflicted with their identities as a healthy person or someone who normally did not take medication. Some participants stated that they reduced their intake of medication to curtail side effects or discover the dosage that best met their personal threshold for 56 symptom management. Regarding external negotiations, participants described both battling and working with their physicians over medications, including decisions regarding whether to take medication, type of medication, how much and by what route. Many of the participants had taken medication for years and, thus, knew what worked and did not work for them. One source of resistance derived from participants’ dissatisfaction with physicians who simply prescribe medications whenever the individual has new or additional symptoms, leading to complex medication regimens. In addition to the physical effects of taking medication for an extended period of time, some participants reported an emotional toll associated with the trial and error involved in finding the right medication regimen (Carder et al. Indeed, two participants with schizophrenia reported feeling like a “human experiment” as a result of the long process of finding the right medication or combination of medications (Carder et al. More recently, Shoemaker and Ramahlo de Oliveira (2008) conducted a study focussing on the meaning of medication for 41 consumers, which included participants with diagnoses of schizophrenia (as with the previous study, the number of participants with schizophrenia was, unfortunately, not reported). A meta-synthesis of three different but complementary qualitative studies was conducted by researchers, which included unstructured and in- depth interviews as parts of phenomenological and ethnographic studies. The authors defined the medication experience as an individual’s subjective experience of taking medication in their daily life. The meaning of medication was captured by four codes of the medication experience: a meaningful encounter; bodily effects; unremitting nature; and exerting control, which the authors considered reflected stages of the medication experience. The meaningful encounter can be revealed as a sense of losing control, a sign of ageing or a signifier of illness, and often causes questioning and a meeting with stigma. Whilst questioning the need for medication upon diagnosis is typically interpreted as resistance by health care professionals, the authors propose that for participants, it can represent a means of regaining a degree of control. Participants sensed that their individual autonomy was undermined when taking chronic medications until the point that they questioned the taken-for-granted notion that medications are the right option. The first reactions to initiating a medication regime can also be shaped by the social views of the medical condition, including stigma. The bodily effects of medications code was revealed as the experience of a “magic elixir” or trade-offs. Some participants indicated that medication could “normalise” them, whereas others indicated that medication alleviated them from incapacitation and, thus, enabled them to function. Participants who experienced side effects were willing to accept them as a trade-off if the benefit experienced by medication was sufficiently good. The unremitting nature of a chronic medication is considered a burden and participants often recalled that they responded angrily to this realisation. The expectation of taking medication regularly positions the patient as a passive agent and the medication as a symbol of dependence. The last code of the medication experience was revealed as consumers exerting control over their medication. After encountering the meaning of a medication, questioning it, realising the bodily effects and the continuous nature of medications, participants experimented with becoming the managers of their treatment regimens. They discovered creative ways to manage their medications and exert control over them; in part because they were now knowledgeable (Shoemaker & Ramahlo de Oliveira, 2008, 2008). The views of consumers, carers and professionals from four different countries (England, Germany, Italy and the Netherlands) were combined in a study by Kikkert et al. The sample comprised of 27 people with schizophrenia, 29 carers and 28 professionals involved in the treatment of consumers. Participants were allocated selectively to groups which were comprised of members of each stakeholder group. The concept mapping procedure involved group discussions about factors that influence medication adherence. Brainstorming of factors related to adherence was conducted amongst groups and participants were asked to generate statements about influences on adherence.

Retrospective evaluation of medication appropriateness and clinical pharmacist drug therapy recommendations for home-based primary care veterans order 5 mg lexapro. Analysis of clinical intervention documentation by dispensing pharmacists in a teaching hospital 20mg lexapro with amex. Mapping the future of hospital information systems: priorities for nursing applications. The Electronic Pharmaceutical Dossier: an effective aid to documenting pharmaceutical care data. How frequently and in what amount: Medication breaks by transition between hospital and community care. Development of a pharmacist-coordinated system of chemotherapy protocols in an integrated healthcare delivery organization. Using computers to identify non-compliant people at increased risk of osteoporotic fractures in general practice: a cross-sectional study. The preliminary development and testing of a global trigger tool to detect error and patient harm in primary-care records. Proceedings - the Annual Symposium on Computer Applications in Medical Care 1993;144-8. Creating a healthcare culture of patient safety: A retrospective analysis of change readiness associated with the implementation of computerized provider order entry 2006. An extra dose of safety: Installation of a bar-coding system drives an entire workflow redesign at a non-profit hospital and healthcare network. Evaluation of a pharmacist-initiated E-script transcription service for discharged patients. Pen to keyboard: A multidisciplinary approach to transitioning from a paper to an electronic medication administration record. Design, implementation and evaluation of a clinical decision support system to prevent adverse drug events. Exclude - Not a Primary Study E-102 Delgado Sanchez O, Escriva Torralva A, Vilanova Bolto M, et al. Older adults’ attitudes towards and perceptions of ‘smart home’ technologies: A pilot study. Information integrity in healthcare enterprises: Strategies for mitigation of medical errors. A computer based medical consultation for antibiotherapy useful for mediccal practitioner. The new telemedicine paradigm: Fully automated real time web-centric expert system to support diabetes diagnosis. Evaluating the impact of an ambulatory computerized provider order entry system on outcomes in a community-based multispecialty health system. Prompting clinicians about preventive care measures: A systematic review of randomized controlled trials. Improving hypertension control: Impact of computer feedback and physician education. Journal of the American Health Information Management Association 2009;80(3):32-6. Journal of the American Health Information Management Association 2009;80(1):56-7. Adaption of bar code technology to an existing controlled drug record-keeping system. Chemotherapy error reduction: a multidisciplinary approach to create templated order sets. Clinic pharmacist’s use of prescription assistance programs to impact patient compliance. Description and outcomes of a custom Web-based patient occurrence reporting system developed for Baylor University Medical Center and other system entities. Struggling to invent high-reliability organizations in health care settings: Insights from the field. Reduction of clinic telephone consultation workload through a novel process using physician extenders and computer-based medication refill algorithms. Reducing drug costs at a Veterans Affairs hospital by increasing market-share of generic fluoxetine. Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice. Monitoring pharmacy expert system performance using statistical process control methodology. Medical decision making using the analytic hierarchy process: choice of initial antimicrobial therapy for acute pyelonephritis.

One who has used it will be satisfied that we have yet nothing that will take its place discount 10 mg lexapro overnight delivery. In chronic disease of bone purchase lexapro 20mg otc, and in caries, it exerts a most kindly influence upon the diseased tissues, promoting the removal of the dead bone, and at the same time stimulating the living. In disease of the soft tissues going on to suppuration, the same may be said, the local application promoting the removal of dying tissue in suppuration, yet strengthening the tissues adjoining. This may be noticed especially in the treatment of carbuncle, as the thorough injection with a saturated solution of sesqui-carbonate of potash arrests the progress of the disease, and establishes healthy suppuration. In using the remedy for these purposes we usually employ a full strength solution thoroughly applied, or in some cases the powder is applied. In many forms of disease it becomes necessary to remove old and broken down tissues before a cure can be effected. It is impossible to make good blood, if there are old and effete materials in it, as it is impossible to improve nutrition if the old tissues can not be gotten out of the way. Golding Bird, that ten days or two weeks of acetate of potash will cure when antiperiodics have wholly failed. I have been accustomed to say to my classes that I should rather have acetate of potash in cases of scrofula, and inflammations with cacoplastic deposits, than all the compound syrups that were ever concocted. With this indication prominent, the remedy will cure rheumatism, be a benefit in fevers and inflammations, and relieve many forms of chronic disease. It should be known that there is a marked difference between the action of soda and potash, even as a bath, and some care should be used in their selection. The “alkaline bath” so frequently used and steadily recommended by the earlier Eclectics, was not a soda bath. In cynanche maligna, and occasionally in diphtheria, we have the characteristic dissecting-room smell, as we have in the worst forms of influenza. In all of these cases we administer chlorate of potash, and use it as a local application. It is especially the remedy in the puerperal state, when puerperal fever is feared from retained placenta, decomposition of blood-clots, or from the absorption of an unpleasant lochial discharge. Of course the physician will not allow a placenta to be retained at full term, but previous to the fifth month it may not be so easy to remove it, and the patient suffers less from its retention than she would from forcible removal. In such cases I always feel that my patient is safe if I prescribe chlorate of potash. I am very careful not to administer chlorate of potash if the mucous membranes are dry, and there is a scanty secretion of urine, and I never employ it in scarlet fever. The danger in these cases is, that it irritates the kidneys, and may produce desquamative nephritis. Much injury has followed its injudicious use, and many lives have been lost because physicians have regarded it as so innocuous an agent. We find it in market in the form of prismatic crystals of a clear lemon-yellow color, inodorous, possessed of a sweetish-bitter saline taste. In chronic disease where there is marked irritability of the nervous system, with frequency of pulse, we will find it an excellent remedy. It lessens irritation of the nervous system, and acts as a special sedative to the circulation. In chronic disease of the reproductive organs in women, with hysterical manifestations, it exerts a direct and marked influence - so in hypochondriacal affections in the male. When they are pallid, lax, and give increased secretion, the Prussiate of Potash may be used with advantage. It makes little difference, whether of nose, throat, bronchial tubes, intestinal mucous membrane, or chronic vaginitis with leucorrhœa, the influence is the same. This will suggest to the practitioner the cases in which it may be tested: when there is excitation, but impaired nutrition of the nerve centres, and where there is feebleness of mucous membranes with increased secretion of mucus. It has been strongly recommended when puerperal fever is feared, and it is claimed that it will cure puerperal fever when developed. It has also been given in active uterine hemorrhage, leucorrhœa, vesical irritation, diarrhœa and dysentery. This remedy is a stimulant to the digestive and blood-making organs, and may be advantageously employed for the general purposes of a tonic. But beyond this, it influences the vegetative processes, probably through the sympathetic system of nerves, strengthening the circulation, aiding nutrition, and the removal of waste. We have used it but little, yet the testimony in its favor is such, that we strongly recommend its trial. The Propylamin of commerce is obtained from herring pickle, and is in the form of a colorless transparent liquid; the muriate is in the form of powder and is about two-thirds of its strength. We prepare it for use by adding twenty- four drops, or thirty-six grains of the muriate of Propylamin to six ounces of mint water, the dose of which will be from a tea to a tablespoonful. Investigation has determined that Propylamin is the same as the secalin derived from ergot. My use of the remedy clearly proved the analogy between the Propylamin and ergot in its poisonous effects.

Back rubs and other measures to increase comfort can assist in promoting sleep and rest cheap 20mg lexapro amex. Supporting Family Coping Having a loved one sustain a serious head injury can produce a great deal of prolonged stress in the family buy discount lexapro 5 mg on line. Such changes are associated with disruption in family cohesion, loss of leisure pursuits, and loss of work capacity, as well as social isolation of the caretaker. The family may experience marital disruptions, anger, grief, guilt, and denial in recurring cycles (Hsueh-Fen & Stuifbergen, 2004). To promote effective coping, the nurse can ask the family how the patient is different now, what has been lost, and what is most difficult about coping with this situation. Helpful interventions include providing family members with accurate and honest information and encouraging them to continue to set well-defined short-term goals. Support groups help the family members share problems, develop insight, gain information, network, and gain assistance in maintaining realistic expectations and hope. The Brain Injury Association (see Resources) serves as a clearinghouse for information and resources for patients with head injuries and their families, including specific information on coma, rehabilitation, behavioral consequences of head injury, and family issues. This organization can provide names of facilities and professionals who work with patients with head injuries and can assist families in organizing local support groups. Many patients with severe head injury die of their injuries, and many of those who survive experience long-term disabilities that prevent them from resuming their previous roles and functions. During the most acute phase of injury, family members need support and facts from the health care team. Many patients with severe head injuries that result in brain death are young and otherwise healthy and are therefore considered for organ donation. Family members of patients with such injuries need support during this extremely stressful time and assistance in making decisions to end life support and permit donation of organs. Bereavement counselors and members of the organ procurement team are often very helpful to family members in making decisions about organ donation and in helping them cope with stress. Any decrease in this pressure can impair cerebral perfusion and cause brain hypoxia and ischemia, leading to permanent damage. Impaired Oxygenation and Ventilation Impaired oxygen and ventilation may require mechanical ventilatory support. The patient must be monitored for a patent airway, altered breathing patterns, and hypoxemia and pneumonia. Interventions may include endotracheal intubation, mechanical ventilation, and positive end-expiratory pressure. Impaired Fluid, Electrolyte, and Nutritional Balance Fluid, electrolyte, and nutritional imbalances are common in the patient with a head injury. Undernutrition is also a common problem in response to the increased metabolic needs associated with severe head injury. If the patient cannot eat, enteral feedings or parenteral nutrition may be initiated within 48 hours after the injury to provide adequate calories and nutrients (Bader et al. Nutritional support in the form of early feeding after head injury is associated with better survival outcomes and decreased disability (Yanagawa, Bunn, Roberts, et al. Post-traumatic Seizures Patients with head injury are at an increased risk for post-traumatic seizures. Post- traumatic seizures are classified as immediate (within 24 hours after injury), early (within 1 to 7 days after injury), or late (more than 7 days after injury) (Somjen, 2004). Seizure prophylaxis is the practice of administering antiseizure medications to patients with head injury to prevent seizures. However, many antiseizure medications impair cognitive performance and can prolong the duration of rehabilitation. Therefore, it is important to weigh the overall benefit of these medications against their side effects. Research evidence supports the use of prophylactic antiseizure agents to prevent immediate and early seizures after head injury, but not for prevention of late seizures (Somjen, 2004). The nurse must assess the patient carefully for the development of post-traumatic seizures. Risk factors that increase the likelihood of seizures are brain contusion with subdural hematoma, skull fracture, loss of consciousness or amnesia of 1 day or more, and age older than 65 years (Somjen, 2004). The nurse explains to the patient and family, verbally and in writing, how to monitor for complications that merit contacting the neurosurgeon. If the patient is at risk for late posttraumatic seizures, antiseizure medications may be prescribed at discharge. The patient and family require instruction about the side effects of these medications and the importance of continuing to take them as prescribed.

Medication use review process and information systems utilized for oncology chemotherapy quality improvement cheap 5 mg lexapro visa. A gero-informatics tool to enhance the care of hospitalized older adults with cognitive impairment discount lexapro 10 mg with mastercard. Impact of a real-time peer review audit on patient management in a radiation oncology department. The relationship between physician practice characteristics and physician adoption of electronic health records. Development of on-line drug specific information screens to improve the quality of medication use. Shared care for diabetes: supporting communication between primary and secondary care. The point-of-care evolution drives providers to rethink nursing workflow and medication management. Barriers to the successful and timely implementation of electronic prescribing and medicines administration. Electronic prescribing and medicines administration: Are we overcoming the barriers to success? Special applications in health telematics: electronic prescription/electronic patient file/digital archiving. InforMatrix as an alternative tool in rational and transparent drug-decision making. Development and evaluation of an ontology for guiding appropriate antibiotic prescribing Columbia UniversityEditor. Scanning the horizon: A health system upgrades its bar coding and patient auto-identification for improving patient care enterprisewide. Automated drug-dispensing system in a general psychiatric hospital surpassing unit dosage. Exclude - Unable to Retrieve Foreign Broverman C, Kapusnik-Uner J, Shalaby J, et al. A concept-based medication vocabulary: an essential requirement for pharmacy decision support. Overcoming obstacles to medication decision support at point-of-care: Interim report on standardization efforts. Early detection of adverse drug events within population-based health networks: Application of sequential testing methods. Reconcilable differences: A Washington healthcare enterprise works collaboratively to create a comprehensive medication reconciliation solution. Potentially inappropriate medication prescribing in outpatient practices: prevalence and patient characteristics based on electronic health records. Development and impact of computerized clinical decision support alerts on prescribing for elderly outpatients The University of Utah. Electronic antibiotic stewardship--reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting. El Camino Hospital: using health information technology to promote patient safety. Innovative approaches to increase deep vein thrombosis prophylaxis rate resulting in a decrease in hospital-acquired deep vein thrombosis at a tertiary-care teaching hospital. Use of computerized patient medication profiles as an aid to prescribing, prescribing review and dispensing. Knowledge based functions for routine use at a German university hospital setting: the issue of fine tuning. Impact of an automated antibiotic refrigerator and an online medication administration record on timeliness of postoperative antibiotics on a spinal surgical unit. A controlled trial of the cost benefit of computerized bayesian aminoglycoside administration. Evaluation of the ability of pharmacists to extract specific data from their pharmacy information management system. Glycemic control after coronary bypass graft: using intravenous insulin regulated by a computerized system. Use of bar coding to reduce the time required for relational database entry of data from an antibiotic order form. Effect of computer-assisted insulin delivery on glycemic control of type I diabetic patients: a preliminary experience. Technological innovation management in the implementation of computer-assisted prescription. Human factors perspectives on a systemic approach to ensuring a safer medication delivery process.

Nursing Considerations: Cimetidine (Tagamet - stomach) buy lexapro 10mg fast delivery, Erythromycin (antibiotic) lexapro 5 mg low price, Fluoxetine (Prozac - antidepressant), Fluvoxamine (Luvox - anticonvulsant), Isoniazid (antitubucular), Nefazodone (Serzone, antidepressant, be cautious of for Batten children), and Ranitidine (Zantac - stomach) may increase Halcion (sedative) level. Recent newspaper reports suggest that the Medicines Control Agency has written to the suppliers of the synthetic hormone to tell them that in future it will only be available on prescription. A survey of the medical literature reveals investigations are being done by many workers to determine the efficacy and side effects of the use of Melatonin in a number of conditions. The main focus of attention is on sleep disturbances, seasonal affective disorder, neuroendocrine disorder and cancer therapy. It is not recommended that Melatonin should be taken unless prescribed by a qualified medical practitioner and according to the Drug Enforcement laws of the country in which it is taken. Tryptophan is converted to Serotonin and finally converted to Melatonin, which is an Indole. The suprachiasmatic nuclei of the hypothalamus have Melatonin receptors and Melatonin may have a direct action on the nuclei to influence "circadian" rhythms. Jet Lag and Sleep Disturbances Jetlag is the result of long distance travel east/west crossing time zones at a rapid rate. Symptoms such as sleep disturbance, loss of appetite, reduced psychomotor efficiency and general malaise may occur. The problem for aircrews on long haul schedules has been coped with by alterations in sleep patterns. Synchronizers (time givers) are environmental factors that help to keep the organism in phase. One adapts more easily after a flight west, because there is a longer day and we have an endogenous clock of about 25 hours. In other words 5 hours time difference will require approximately 5 days adaptation. The current recommendation is for pilots having sleep disturbance to take a Benzodiazepine such as Temazepam. A 356 combination of treatment including light, Melatonin and Diazepams may be needed. No "hangover " effects were noted as assessed by mood and performance tests administered the morning after treatment. There were no adverse side effects and behavioral and social benefits were significant. The authors concluded that Melatonin has an important role in the treatment of certain types of chronic sleep disorders. One of the potential major causes of age related destruction of neuronal tissue is toxic free radical that are a natural result of aerobic metabolism. The brain is particularly susceptible to free radical attack, vitamin antioxidants, vitamin E and vitamin C aid in protecting the brain from oxidative stress by directly scavenging toxic radicals. There are data, which indicate that Melatonin antagonizes the mitogenic effects of estrogens. The benefit appeared to be related to light rather than Melatonin inhibition as these workers found that pharmacological suppression of Melatonin did not improve their depression. Changes in magnetic fields alter Melatonin secretion and affect circadian rhythms. Both acute exposure to light and exposure to magnetic fields suppress Melatonin secretion and may be beneficial for patients with winter depression. It has been proposed that the synergistic effect of light and magnetic therapy in these patients may be superior to photo therapy alone. Low Melatonin levels have been observed in depressed subjects, unipolar or bipolar affective disorders, and chronic schizophrenia. Low nocturnal Melatonin has been proposed as a trait marker for major depressive disorders. Other psychotropic drugs, which interfere with monoamine pathways, also affect pineal Melatonin. Receptors for Benzodiazepines have been reported to exist in the pineal gland of several animal species. In humans, Alprazolam (Xanax) given before lights out suppressed nocturnal Melatonin and Cortisol. The conventional view that the underlying abnormality in endogenous depression is due to an abnormality in the body clock has been challenged. They suggest that the circadian system in endogenous depression resembles its state in healthy individuals after time zone transitions or in shift work maladaptation syndrome and disturbances result from changes in the phasing of external time givers rather than from an abnormality in the clock itself. Melatonin and Endocrine Disorders External magnetic fields have been found to synchronize Melatonin secretion in experimental animals and humans and may be beneficial in the treatment of postmenopausal osteoporosis.