By L. Konrad. Southwest University.
This was noted in a recent study of patients with schizophrenia taking atypical or typical antipsychotics by Dr cheap lipitor line. Gideon Koren and his associates at the University of Toronto lipitor 5 mg amex. More than half of the female patients were overweight discount lipitor online visa, and intake of folate was poor buy cheap lipitor 20 mg line. The investigators concluded that women who take atypical antipsychotics are therefore at a greater risk of having a baby with a neural tube defect (Am. As obstetricians see more patients in their reproductive years who are on these medications, these issues need to be considered in the context of relative risk. The absence of data does not imply safety, and the arbitrary use of these medications in women of reproductive age is the largest uncontrolled trial in the history of medicine. The newer treatments may be more effective but may pose greater risks. What we know leaves us to conclude that lithium is the safest treatment for those who need a mood stabilizer. We advise that if a woman has not responded to lithium but has had an excellent response to a mood stabilizer such as lamotrigine (Lamictal) or gabapentin, she would be better off staying on that drug. But patients who have not tried effective mood stabilizers like lithium should consider a trial of lithium before they get pregnant, if possible. What about the patient who conceives while taking one of those medications that we know nothing about? The clinician has the option to switch the patient to lithium, but this gets tricky because she may not respond. This may be the type of situation where you keep a patient on the drug if she is doing well to avoid a relapse. Physicians can report pregnancies exposed to any of these drugs to the manufacturers and, in the case of antiepileptics, to the antiepileptic drug pregnancy registry at 888-AED-AED4. Are psychiatric medications safe during pregnancy and breastfeeding? Detailed information on taking antidepressants, antipsychotics, mood stabilizers, antianxiety medications during pregnancy and breastfeeding. According to the Merck Manual, more than 90% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy. The Merck Manual says "in general, drugs, unless absolutely necessary, should not be used during pregnancy because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs other than alcohol. For instance, a British Medical Journal article on antipsychotics during pregnancy reports "Withholding antipsychotic treatment may expose mother and fetus to more harm than benefit as, in addition to behavioural disturbance which may put both at risk, physiological changes associated with psychosis could affect fetoplacental integrity and development of the central nervous system. Before taking any drug (including over-the-counter drugs) or dietary supplement (including medicinal herbs), a pregnant woman should consult her health care practitioner. A health care practitioner may recommend that a woman take certain vitamins and minerals during pregnancy. The Merck Manual states: "Most antidepressants appear to be relatively safe when used during pregnancy. Citalopram (Celexa), Fluoxetine (Prozac, Sarafem), Sertraline (Zoloft)Associated with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy. Tricyclic AntidepressantsAmitriptyline, Nortriptyline (Pamelor)Suggested risk of limb malformation in early studies, but not confirmed with newer studies. Phenelzine (Nardil), Tranylcypromine (Parnate)May cause a severe increase in blood pressure that triggers a stroke and should be avoided during pregnancy. Bleeding problems in the newborn, which can be prevented if pregnant women take vitamin K by mouth every day for a month before delivery or if the newborn is given an injection of vitamin K soon after birthSame as those for carbamazepine. Trimethadione (Tridione)Increased risk of miscarriage in the woman. High (70%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, hands, or abdominal organsSome (1%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, spine, or limbsLithium (Lithane, Lithonate)Birth defects (mainly of the heart), lethargy, reduced muscle tone, poor feeding, underactivity of the thyroid gland, and nephrogenic diabetes insipidus in the newbornolanzapine (Zyprexa), quetiapine (Seroquel)Possibility of low birth weight; premature births. Concerns have been raised that olanzapine in particular tends to be associated with significant weight gain. Theoretically, during pregnancy this could be associated with an increased incidence of outcomes, including increased rates for birth defects such as neural tube defects and an increased risk of obstetric complications. It is extremely important for you to discuss the issue of taking psychiatric medications during pregnancy with your doctor. The medical standard in deciding whether or not to administer psychiatric medication during pregnancy is the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis. Work with your doctor to make an informed choice that gives you and your baby the best chance for long-term health. Pregnancy outcome of women using atypical antipsychotic drugs: A prospective comparative study. Taking them safely while breastfeeding may require adjusting the dose, limiting the length of time the drug is used, or timing when the drug is taken in relation to breastfeeding. For example, the antianxiety drug diazepam (VALIUM, DIASTAT (a benzodiazepine) causes lethargy, drowsiness, and weight loss in breastfed babies. Babies eliminate phenobarbital (LUMINAL) (an anticonvulsant and a barbiturate) slowly, so this drug may cause excessive drowsiness. Because of these effects, doctors reduce the dose of benzodiazepines and barbiturates as well as monitor their use by women who are breastfeeding. Some drugs should not be taken by mothers who are breastfeeding. They include amphetamines, and illicit drugs such as cocaine, heroin, and phencyclidine (PCP). If women who are breastfeeding must take a drug that may harm the baby, they must stop breastfeeding. But they can resume breastfeeding after they stop taking the drug. While taking the drug, women can maintain their milk supply by pumping breast milk, which is then discarded. Women who smoke should not breastfeed within 2 hours of smoking and should never smoke in the presence of their baby whether they are breastfeeding or not. Smoking reduces milk production and interferes with normal weight gain in the baby. Alcohol consumed in large amounts can make the baby drowsy and cause profuse sweating. Is it safe and effective to switch from a psychiatric medication to an alternative treatment while trying to conceive or during pregnancy? A common scenario seen on our consultation service is a woman with an anxiety or mood disorder who is stabilized on a drug and who wants to switch to an alternative medicine during pregnancy or while trying to conceive. We also get questions about the use of kava supplements as an alternative treatment for anxiety. Many women make the intuitive leap that some of these widely used complementary or alternative therapies represent a more "natural" and therefore safer alternative to a more standard pharmacologic treatment during pregnancy or while they are trying to conceive. The problem is that we have very little, if any, reproductive safety data on these natural compounds. Many of these products do not contain just the specific herbal compound, but fillers and other components used for compounding, about which we know very little. Moreover, efficacy data for many of the herbals are limited. For example, there is still an ongoing debate about the efficacy of St. While omega-3 fatty acids are not presumed to be teratogenic, the data supporting their efficacy in patients with bipolar disorder have been based primarily on adjunctive use with other mood-stabilizing medications. There are very little data on monotherapy; even the experience with adjunctive therapy was based on an extremely small sample of people. Based on these uncertainties, an arbitrary switch to an alternative treatment may represent a failed risk-benefit decision, exposing a pregnant woman to both an unknown reproductive safety risk and an increased risk for relapse. A woman therefore will not be in a much better position regarding safety with one of these products than with a drug for which there are only limited reproductive safety data but which is known to be effective.
The effect of INVEGA??? on labor and delivery in humans is unknown generic 5 mg lipitor amex. In animal studies with paliperidone and in human studies with risperidone generic lipitor 10mg without prescription, paliperidone was excreted in the milk lipitor 5 mg with visa. Therefore buy cheap lipitor 40 mg on line, women receiving INVEGA??? should not breast-feed infants. Pediatric Use Safety and effectiveness of INVEGA??? in patients< 18 years of age have not been established. The safety, tolerability, and efficacy of INVEGA??? were evaluated in a 6-week placebo-controlled study of 114 elderly subjects with schizophrenia (65 years of age and older, of whom 21 were 75 years of age and older). In this study, subjects received flexible doses of INVEGA??? (3 to 12 mg once daily). In addition, a small number of subjects 65 years of age and older were included in the 6-week placebo- controlled studies in which adult schizophrenic subjects received fixed doses of INVEGA??? (3 to 15 mg once daily, see CLINICAL PHARMACOLOGY: Clinical Trials). Overall, of the total number of subjects in clinical studies of INVEGA??? (n = 1796), including those who received INVEGA??? or placebo, 125 (7. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in response between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. This drug is known to be substantially excreted by the kidney and clearance is decreased in patients with moderate to severe renal impairment (see CLINICAL PHARMACOLOGY: Pharmacokinetics: Special Populations: Renal Impairment), who should be given reduced doses. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function (see DOSAGE AND ADMINISTRATION: Dosing in Special Populations). The information below is derived from a clinical trial database for INVEGA??? consisting of 2720 patients and/or normal subjects exposed to one or more doses of INVEGA??? for the treatment of schizophrenia. Of these 2720 patients, 2054 were patients who received INVEGA??? while participating in multiple dose, effectiveness trials. The conditions and duration of treatment with INVEGA??? varied greatly and included (in overlapping categories) open-label and double-blind phases of studies, inpatients and outpatients, fixed-dose and flexible-dose studies, and short-term and longer-term exposure. Adverse events were assessed by collecting adverse events and performing physical examinations, vital signs, weights, laboratory analyses and ECGs. Adverse events during exposure were obtained by general inquiry and recorded by clinical investigators using their own terminology. Consequently, to provide a meaningful estimate of the proportion of individuals experiencing adverse events, events were grouped in standardized categories using MedDRA terminology. The stated frequencies of adverse events represent the proportions of individuals who experienced a treatment-emergent adverse event of the type listed. An event was considered treatment emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. Adverse Events Observed in Short-Term, Placebo-Controlled Trials of Subjects with Schizophrenia The information presented in these sections were derived from pooled data from the three placebo-controlled, 6-week, fixed-dose studies based on subjects with TM schizophrenia who received INVEGA at daily doses within the recommended range of 3 to 12 mg (n = 850). Adverse Events Occurring at an Incidence of 2% or More Among INVEGA??? -Treated Patients with Schizophrenia and More Frequent on Drug than PlaceboTable 1 enumerates the pooled incidences of treatment-emergent adverse events that were spontaneously reported in the three placebo-controlled, 6-week, fixed-dose studies, listing those events that occurred in 2% or more of subjects treated with INVEGA??? in any of the dose groups, and for which the incidence in INVEGA??? - treated subjects in any of the dose groups was greater than the incidence in subjects treated with placebo. Treatment-Emergent Adverse Events in Short-Term,Fixed-Dose, Placebo-Controlled Trials in Adult Subjects with Schizophrenia* Percentage of Patients Reporting Event INVEGA???Gastrointestinal disordersSalivary hypersecretionBlood insulin increasedBlood pressure increasedElectrocardiogram T wave abnormalconnective tissue disordersExtrapyramidal disorderRespiratory, thoracic andOrthostatic hypotensionDose-Related Adverse Events in Clinical Trials Based on the pooled data from the three placebo-controlled, 6-week, fixed-dose studies, adverse events that occurred with a greater than 2% incidence in the subjects treated with INVEGA???, the incidences of the following adverse events increased with dose: somnolence, orthostatic hypotension, salivary hypersecretion, akathisia, dystonia, extrapyramidal disorder, hypertonia and Parkinsonism. For most of these, the increased incidence was seen primarily at the 12 mg, and in some cases the 9 mg dose. Common and Drug-Related Adverse Events in Clinical Trials Adverse events reported in 5% or more of subjects treated with INVEGA??? and at east twice the placebo rate for at least one dose included: akathisia and extrapyramidal disorder. Extrapyramidal Symptoms (EPS) in Clinical Trials Pooled data from the three placebo-controlled, 6-week, fixed-dose studies provided information regarding treatment-emergent EPS. Several methods were used to measure EPS: (1) the Simpson-Angus global score (mean change from baseline) which broadly evaluates Parkinsonism, (2) the Barnes Akathisia Rating Scale global clinical rating score (mean change from baseline) which evaluates akathisia, (3) use of anticholinergic medications to treat emergent EPS, and (4) incidence of spontaneous reports of EPS. For the Simpson-Angus Scale, spontaneous EPS reports and use of anticholinergic medications, there was a dose-related increase observed for the 9 mg and 12 mg doses. There was no difference observed between placebo and INVEGA??? 3 mg and 6 mg doses for any of these EPS measures. The types of adverse events that led to discontinuation were similar for the INVEGA??? -and placebo-treated subjects, except for Nervous System Disorders events which were more common among INVEGA??? -treated subjects than placebo-treated subjects (2% and 0%, respectively), and Psychiatric Disorders events which were more common among placebo-treated subjects than INVEGA??? -treated subjects (3% and 1%, respectively). Demographic Differences in Adverse Reactions in Clinical TrialsAn examination of population subgroups in the three placebo-controlled, 6-week, fixed-dose studies did not reveal any evidence of differences in safety on the basis of age, gender or race (see PRECAUTIONS: Geriatric Use). Laboratory Test Abnormalities in Clinical Trials In the pooled data from the three placebo-controlled, 6-week, fixed-dose studies, between-group comparisons revealed no medically important differences between and placebo in the proportions of subjects experiencing potentially INVEGA??? clinically significant changes in routine hematology, urinalysis, or serum chemistry, including mean changes from baseline in fasting glucose, insulin, c-peptide, triglyceride, HDL, LDL, and total cholesterol measurements. Similarly, there were no differences between INVEGA??? and placebo in the incidence of discontinuations due to changes in hematology, urinalysis, or serum chemistry. However, INVEGA??? was associated with increases in serum prolactin (see PRECAUTIONS: General: Hyperprolactinemia). In the pooled data from the three placebo-controlled, 6-week, fixed-dose studies, the = 7% of body weight were similar for proportions of subjects having a weight gain of INVEGA??? 3 mg and 6 mg (7% and 6%, respectively) and placebo (5%), but there was a higher incidence of weight gain for INVEGA??? 9 mg and 12 mg (9% and 9%, respectively). Other Events Observed During the Premarketing Evaluation of INVEGA???The following list contains all serious and non-serious treatment-emergent adverse events reported at any time by individuals taking INVEGA??? during any phase of a trial within the premarketing database (n = 2720), except (1) those listed in Table 1 above or elsewhere in labeling, (2) those for which a causal relationship to INVEGA??? use was considered remote, and (3) those occurring in only one subject treated with INVEGA??? and that were not acutely life-threatening. Events are classified within body system categories using the following definitions: very frequent adverse events are defined as those occurring on one or more occasions in at least 1/10 subjects, frequent adverse events are defined as those occurring on one or more occasions in at least 1/100 subjects, infrequent adverse events are those occurring on one or more occasions in 1/100 to 1/1000 subjects, and rare events are those occurring on one or more occasions in less than 1/1000 subjects. Blood and Lymphatic System Disorders: rare: thrombocytopeniaCardiac Disorders: frequent: palpitations; infrequent: bradycardiaGastrointestinal Disorders: frequent: abdominal pain; infrequent: swollen tongue infrequent: edemaGeneral Disorders: Immune Disorder: rare: anaphylactic reaction rare: coordination abnormalNervous System Disorders: rare: coordination abnormalPsychiatric Disorders: infrequent: confusional stateRespiratory, Thoracic and Mediastinal Disorders: frequent: dyspnea; rare: pulmonary embolusVascular Disorders: rare: ischemia, venous thrombosisAdverse Events Reported With Risperidone Paliperidone is the major active metabolite of risperidone. Adverse events reported with risperidone can be found in the ADVERSE REACTIONS section of the risperidone package insert. INVEGA??? (paliperidone) is not a controlled substance. Paliperidone has not been systematically studied in animals or humans for its potential for abuse, tolerance, or physical dependence. It is not possible to predict the extent to which a CNS-active drug will be misused, diverted, and/or abused once marketed. Consequently, patients should be evaluated carefully for a history of drug abuse, and such patients should be observed closely for signs of INVEGA??? misuse or abuse (e. While experience with paliperidone overdose is limited, among the few cases of overdose reported in pre-marketing trials, the highest estimated ingestion of was 405 mg. Observed signs and symptoms included extrapyramidal INVEGA??? symptoms and gait unsteadiness. Paliperidone is the major active metabolite of risperidone. Overdose experience reported with risperidone can be found in the OVERDOSAGE section of the risperidone package insert. There is no specific antidote to paliperidone, therefore, appropriate supportive measures should be instituted and close medical supervision and monitoring should continue until the patient recovers. Consideration should be given to the extended- release nature of the product when assessing treatment needs and recovery. Multiple drug involvement should also be considered. The possibility of obtundation, seizures, or dystonic reaction of the head and neck following overdose may create a risk of aspiration with induced emesis. Cardiovascular monitoring should commence immediately, including continuous electrocardiographic monitoring for possible arrhythmias. If antiarrhythmic therapy is administered, disopyramide, procainamide, and quinidine carry a theoretical hazard of additive QT-prolonging effects when administered in patients with an acute overdose of paliperidone. Similarly the alpha-blocking properties of bretylium might be additive to those of paliperidone, resulting in problematic hypotension. Hypotension and circulatory collapse should be treated with appropriate measures, such as intravenous fluids and/or sympathomimetic agents (epinephrine and dopamine should not be used, since beta stimulation may worsen hypotension in the setting of paliperidone-induced alpha blockade). In cases of severe extrapyramidal symptoms, anticholinergic medication should be administered. The recommended dose of INVEGA??? (paliperidone) Extended-Release Tablets is 6 mg once daily, administered in the morning. Although it has not been systematically established that doses above 6 mg have additional benefit, there was a general trend for greater effects with higher doses. This must be weighed against the dose-related increase in adverse effects. Thus, some patients may benefit from higher doses, up to 12 mg/day, and for some patients, a lower dose of 3 mg/day may be sufficient.
Avoid exposure to the sun or sunlamps until you know how you react to this medicine order 40mg lipitor free shipping. Use a sunscreen or protective clothing if you must be outside for a prolonged period purchase generic lipitor on-line. The drug should not be administered to women of childbearing potential cheap 10 mg lipitor overnight delivery, particularly during the first trimester discount lipitor 10 mg without prescription, unless, in the opinion of the physician, the expected benefits outweigh the potential risks to the fetus. Seizures: Phenothiazines should be used with caution in patients with a history of convulsive disorders since grand mal seizures have been known to occur. Cardiac: Since hypotension and ECG changes suggestive of myocardial ischemia have been associated with the administration of phenothiazines, fluphenazine decanoate should be used with caution in patients with compensated cardiovascular or cerebrovascular disorders. Before using this medicine, inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. This includes guanethidine and medicines used to treat depression and bladder or bowel spasms. Inform your doctor of any other medical conditions including depression, seizure disorders, allergies, pregnancy, or breast-feeding. Use with other drugs: The effects of atropine or other drugs with similar action may be potentiated in patients receiving phenothiazines because of added anticholinergic effects. Paralytic ileus, even resulting in death, may occur especially in the elderly. Fluphenazine decanoate should be used cautiously in patients exposed to extreme heat or phosphorus insecticides. Side effects that may go away during treatment, include drowsiness, dizziness, nasal congestion, blurred vision, dry mouth, or constipation. If they continue or are bothersome, check with your doctor. CHECK WITH YOUR DOCTOR AS SOON AS POSSIBLE if you experience changes in vision; changes in breasts; changes in menstrual period; sore throat; inability to move eyes; muscle spasms of face, neck, or back; difficulty swallowing; mask-like face; tremors of hands; restlessness; tension in legs; shuffling walk or stiff arms or legs; puffing of cheeks; lip smacking or puckering; twitching or twisting movements; or weakness of arms or legs. Of the 354 cases of deliberate or accidental overdose involving fluvoxamine maleate reported, there were 19 deaths. Of the 19 deaths, 2 were in patients taking fluvoxamine maleate alone and the remaining 17 were in patients taking fluvoxamine maleate along with other drugs. No further injections should be given until the patient shows signs of relapse and the dosage then should be decreased. An unobstructed airway should be established with maintenance of respiration as required. Severe hypotension calls for the immediate use of an i. Extrapyramidal symptoms may be treated with antiparkinsonian agents. If you miss a dose of this medicine and you are using it regularly, take it as soon as possible. If you are taking 1 dose at bedtime and do not remember until the next morning, skip the missed dose and go back to your regular dosing schedule. When using the solution form: mix your dose in water, juice, soup, or other liquid before taking. For oral dosage form (elixir, solution, or tablets):Adults: At first, 2. However, the dose is usually not more than 20 mg a day. The onset of action generally appears between 24 to 72 hours after injection, and the effects of the drug on psychotic symptoms become significant within 48 to 96 hours. Maintenance/Continuation Extended Treatment: Patients can usually be controlled with 25 mg or less, every 2 to 3 weeks. Although doses greater than 50 mg are usually not necessary, doses up to 100 mg have been used in some patients. If doses greater than 50 mg are necessary, the next dose and succeeding doses should be increased in increments of 12. While the response to a single injection lasts usually 2 to 3 weeks, it may last for 4 weeks or more. Each mL of injectable solution contains: Fluphenazine decanoate 25 mg in sesame oil with benzyl alcohol 1. Concentrate: Each mL of injectable solution contains: Fluphenazine decanoate 100 mg in sesame oil with benzyl alcohol 1. Schizophrenia help, outside of regular visits to the doctor, takes a lead role in relieving the ravages of this mental disease ??? for both patient and family member caretakers. Patients and loved ones alike should take the reins and get informed about the available schizophrenia help resources and self help options for the illness. Accepting the illness, and all of the implications it brings, marks the first hurdle you must cross before you can provide meaningful schizophrenia help for your loved one. You may feel ashamed or worried about what outsiders will think, due to the stigma associated with mental illness. Even so, do not hide the patient???s illness from others. This only degrades your emotional well being and reinforces the stubborn negative attitudes Americans hold about schizophrenia and other mental disorders. As you talk openly about the disease and how you plan to provide your loved one with schizophrenia help, these uncomfortable feelings will diminish. Shame will turn into strength that you can use to bring greater awareness to the torment of schizophrenia. Build a strong foundation that allows you to offer meaningful schizophrenia help and support to your ill family member. Do this by educating yourself about the realities of the disorder, phases of psychoses, typical behaviors, available treatments, therapies, and common roadblocks to recovery. As you learn how to cope with the disease, you???ll become frustrated at times ??? maybe even resentful of your loved one. It???s important to join a support group for family members of the ill person. Here you will connect with others in the same situation. You can discuss issues, fears, behaviors, and solutions ??? what works and what remedies do not. It helps to know others are going through the same challenges. As always, mentally ill loved-one or not, pay attention to your health by exercising, eating right, and engaging in favorite hobbies. Your robust health and attention to self will fortify your arsenal of schizophrenia help tools. Empower your ill family member by allowing him to remain as independent as possible. Frequently, caretakers inadvertently take over tasks that the patient can accomplish, robbing him of dignity and confidence. When he or she rants about delusions, visions, and conspiracies, remember that you cannot reason these paranoid delusions away any more than you could reason cancer away. Strive to nurture the love in your heart for the person trapped within the torment, even if you hate the schizophrenia and its influence on your lives. Learn to discern the difference between unnecessary, neurotic suffering and embrace true suffering. By doing this, you???ll come out on the other side to a sunny outlook with each true passing storm of pain. Set boundaries and clear limitations on your giving of self. You may need to adjust these at times, but commit to staying within reasonable guidelines you set forth. Forgive yourself and others for the inevitable mistakes and poorly thought-out behaviors. Nurture and feed your relationships with other family members and close friends. People suffering from this traumatizing, neurological brain disorder need to first seek schizophrenia self help support from a mental health group. Participating in the meetings with other patients will help fill in the gaps between medical doctor visits and professional therapy sessions. The National Alliance for the Mentally Ill (NAMI) has 1200 local groups throughout the U.
In fact order lipitor 10 mg visa, the level of sexual interest and activity among people over the age of 65 is as diverse as the individuals who make up that population order cheap lipitor line. A recent survey of married men and women showed that 87% of married men and 89% of married women in the 60-64 age range are sexually active order lipitor with paypal. Those numbers drop with advancing years lipitor 5mg mastercard, but 29% of men and 25% of women over the age of 80 are still sexually active. So clearly, the older years can be a time of relief that children are no longer lurking in nearby bedrooms, and there is no longer a need to jump up early in the morning for work. For some, older age is a time of freedom to explore sexual expression in ways never before realized. A time to cast away the "shoulds" of earlier years, the societal expectations. For others, they are more than happy to forget about sexual performance, and to seek other forms of companionship and interpersonal sharing. One of the most significant losses with advancing age is the loss of intimacy. Many seniors have no opportunity for physical contact, affectionate dialogue, snuggling, or shared secrets. The actual act of intercourse is only one possible form of sexual expression. The continuing development of your sexual identity and the evolution of your own form of sexual expression with advancing years represents, in many ways, the most basic expression of your self. One fascinating recent study showed that men who have more than two orgasms per week have lower mortality statistics. But these numbers only demonstrate a correlation between sexual activity and longevity, they do not prove that sex prolongs life. What is probably true is that people who are well, and vigorous enough to engage in sexual activity are also healthier in general. But I believe that sexual activity, in its many forms, can be physically, intellectually, and even spiritually fulfilling. It is often a good form of exercise, and it can stimulate the brain and promote good mental function. For some, sexual expression represents the most elemental manifestation of true self. What is most important is to find the type of sexual expression that suits you best. Some people, either by choice or by necessity, find much gratification in sexual self-stimulation. There may be some resistance to this form of self-exploration by people who were raised with the idea that self-stimulation is "dirty" or perverted. But many who have overcome this resistance have been exhilarated by a whole new experience. Others explore sexual sharing in new ways with a longtime partner, or with a new partner. And still others, especially elderly women, have discovered new intimacies with same-sex partners, even after spending most of their adult lives in heterosexual relationships. Again, the key to satisfaction and fulfillment with sexual experience in later life is individual choice. There are many changes that happen in our bodies as we age, and some of these changes can modify sexual experience in later years. Both women and men experience slower arousal responses. This can lead to anxiety in people who do not understand that this change is normal. The clitoris can become highly sensitive, even too sensitive. Uterine contractions with orgasm may at times be painful. The entire male sexual response tends to slow down in the following ways:There is a delay in erection. There is a need for more manual stimulation to achieve an erection. The "plateau" phase, or period between erection and ejaculation, is prolonged. The penis loses its firmness rapidly after ejaculation. The "refractory period", or time interval before erection is able to be achieved again, can be quite long, even up to a week in very elderly men. Many chronic diseases that elderly people experience can also modify sexual expression. Coronary artery disease: Coronary artery disease may lead to chest pain with sexual activity, or fear of having a heart attack during sex. Chronic lung disease: Chronic lung disease can lead to breathlessness. Arthritis: Arthritis may impair the ability to use some positions for sex. Embarrassment: Some older persons may find that embarrassment over the loss of a breast, or the presence of a colostomy bag or some other apparatus, may inhibit free sexual expression, especially with a new partner. So is all of this enough to make older people pack it in and forget about sexual activity? The key is a willing spirit and the ability to be flexible and adapt to change. Here are some of the numerous ways men and women can adapt to aging changes and continue to be, or become, a sexual person:Slow down: Realize that sexual arousal takes longer and requires more manual stimulation. Use your sensory skill: Take time to explore in great detail all the tactile, visual, auditory, and even olfactory aspects of being intimate. Play with the mood: Take time to set the stage for a special experience - experiment with lighting, music, candles, oils, perfumes, and incense. Here are some suggestions for older women:Lubrication: Make adequate lubrication part of your routine, to avoid irritation of the vagina or painful intercourse. The first part of lubrication is adequate stimulation, but an over-the-counter lubricant can be a very helpful adjunct. A water-based lubricant, such as Astroglide, K-Y Jelly, or Today, is best; oil-based lubricants and petroleum products such as Vaseline may be difficult to flush out of the vagina, and may cause irritation or infection. Applying the lubricant yourself can be a good way to get in the mood. You could also make applying the lubricant part of your lovemaking routine! Vaginal estrogens: Some women with extreme vaginal dryness and irritation may benefit from a short course of vaginal estrogens, but remember that estrogens are absorbed through the vagina, and the systemic effects of estrogens, both positive and negative, should be considered and discussed with your doctor. If you use estrogen cream, use as little as is effective for as short a time as possible to get the desired effect. Of course, you may be taking oral estrogens for other reasons, in which case you will also experience beneficial effects on the vagina. Here are some thoughts for older men:Be patient: Realize that more stimulation is required to achieve an erection. For men with heart disease: Men who have heart disease may be particularly concerned about whether sex will put too much strain on their heart, and men who have had a heart attack or heart surgery wonder when or if they can ever resume sexual activity. For the most part, sexual activity may be resumed within about two to four weeks after a heart attack. If you can climb two flights of stairs without chest pain or shortness of breath, you should be able to engage in sexual activity without concern, as this is more vigorous exercise than having sex. If you are prone to chest pain with sex, discuss taking a nitroglycerine tablet under the tongue before sex, and experiment with positions to find one that is less physically demanding for youIf you are taking medications and think that one of the medications may be impairing your sexual performance, be sure to discuss it with your doctor. Let him or her know that sexual activity is important to you. Frequently, other medications can be substituted that have less effect on sexual activity.