When we talk about depression, it is important to keep in mind that most people will experience some of the symptoms of depression during their lifetimes. It is natural to feel depressed when you lose a loved one, your marriage breaks up, or you are fired from your job. What distinguishes chronic depression from feeling sad about a situation is that depression affects your mood, bodily functions, and daily behavior, and it usually does not go away without treatment.

While a stressful life event can be the “trigger” for depression, many times depression occurs spontaneously without any identifiable, specific cause. Depression may occur as repeated episodes over a lifetime, with depression-free periods in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime. Typically, the first episode occurs between the ages of 25 and 44. It is more common in older people, but it is also more likely to go unrecognized in this age group. Depression rates are lower among married people (especially married men) and those in long-term relationships. It is higher among divorced people and those who live alone.

Recognizing depression is not always easy since depressed people often tend to withdraw from family and friends and isolate themselves. And when they go to a doctor, they don’t complain that they are depressed. Instead, they talk about not being able to sleep, or having no energy. However, certain things that people may notice about themselves, or that someone else may notice about them, may be a sign that something is wrong.

Symptoms of depression

Depression can contribute to a wide variety of other health problems, such as generalized itching, blurred vision, excessive sweating, dry mouth, gastrointestinal problems (indigestion, constipation, and diarrhea), headache, and backache. For a doctor to diagnose depression, you must have the following signs and symptoms most of the day, nearly every day, for at least two weeks.

The two main symptoms of depression are:

• Loss of interest in normal daily activities. You feel no interest or pleasure in activities that you used to enjoy, like sports.
• Depressed mood. You feel sad, helpless, and hopeless and may have crying spells.

If you have either one of these, as well as four or more of the following
symptoms, you may be depressed:

• Significant weight loss or gain
• Sleep disturbances
• Fatigue
• Excessive restlessness
• Low self-esteem—feelings of worthlessness and excessive guilt
• Thoughts of death
• Impaired thinking or concentration

Complications of depression

Depression is not easy to manage. Since many people still view mental illness as a character flaw or a personal weakness, people are often afraid to admit they have it and delay seeking treatment or do not get treated at all. If left untreated, short-term complications of depression can lead to long-term complications.

Short-term complications include:

• Feelings of sadness, fatigue, hopelessness
• Inability to enjoy family and friends
• Job troubles

Long-term complications include:

• Cardiovascular complications
• Substance abuse
• Hospitalization
• Loss of income
• Divorce
• Suicide

Depressed people don’t usually follow healthy habits, including sensible diet and exercise. Studies have shown that people with depression suffer greater risk of heart disease than people who are not depressed.

The most dreaded complication of depression is suicide. Approximately 10 to 15 percent of patients hospitalized with depression commit suicide.

Brand name: Ultram, Ultram ER, Amadol, Tramadolor

Class of drug: Narcotic (opioid) analgesic.

Mechanism of action: Most likely produces analgesia by binding to opioid receptors. Also inhibits reuptake of norepinephrine and serotonin.

Indications/dosage/route: Oral only.

• Moderate to moderately severe pain

Adults: 50-100 mg q4-6h prn. Maximum: 400 mg/d.

Adjustment of dosage

• Kidney disease: Creatinine clearance <30 mL/min: 50-100 mg q12h. Maximum: 200 mg/d.
• Liver disease (cirrhosis): 50 mg q12h.
• Elderly: Maximum daily dose of 300 mg in patients >75 years.
• Pediatric: Safety and efficacy of tramadol have not been estab-
• lished in children <16 years.

Food: May take with food.

Pregnancy: Category C.

Lactation: Appears in breast milk. Best to avoid.

Contraindications: Hypersensitivity to tramadol or opioids; acute intoxication with alcohol; other analgesics, opioids, hypnotics, or psychotropic agents.

Warnings/precautions

• Use with caution in patients with increased cranial pressure, head injury, alcohol and drug withdrawal, respiratory depression, acute abdominal conditions, history of physical dependence on opioids, and in those concomitantly using (SSRIs), tricyclic antidepressants, neuroleptics, drugs decreasing seizure threshold, kidney or liver disease, elderly.
• Tramadol has been associated with seizures. There is an increased risk in patients with conditions that predispose to seizures, eg, head injury.
• Tramadol is not recommended for patients who have exhibited dependence on opioids or have received opioids previously for more than 1 week.
• Prolonged use of tramadol may result in physical or psychologic dependence although this is not as intense as with opioids.
• Do not give tramadol to patients with abdominal pain without adequate evaluation to rule out structural or pathophysiologic causes.
• Tramadol should be discontinued gradually after long-term use to avoid withdrawal symptoms.
• Patients who have exhibited a previous allergic reaction to opioids may experience seizures if given tramadol.
• It is recommended that tramadol be given on a regular basis rather than prn.

Advice to patient

• Avoid driving and other activities requiring mental alertness or that are potentially dangerous until response to drug is known.
• Change position slowly, in particular from recumbent to upright, to minimize orthostatic hypotension. Sit at the edge of the bed for several minutes before standing, and lie down if feeling faint or dizzy. Avoid hot showers or baths and standing for long periods. Male patients with orthostatic hypotension may be safer urinating while seated on the toilet rather than standing.
• Avoid alcohol.
• If experiencing constipation, increase intake of fluids and consume high-fiber foods (bran, whole-grain bread, raw vegetables and fruits).

Adverse reactions

• Common: dizziness, vertigo, headache, nausea, constipation, somnolence.
• Serious: CNS stimulation, seizures, anaphylaxis.

Clinically important drug interactions

• Drugs that increase effects/toxicity of tramadol: alcohol, antihistamines, opioids, sedatives, hypnotics, other psychotropic drugs, MAO inhibitors, tricyclic antidepressants, SSRIs, carbamazepine, quinidine.
• Tramadol increases effects/toxicity of digoxin, warafarin, MAO inhibitors.

Parameters to monitor: BP and respiratory rate before and periodically after drug administration.

Editorial comments

• This agent has proven to be highly beneficial for patients with chronic pain in whom other opioids and/or NSAIDs are to be avoided. It produces less respiratory depression than narcotic agents. In some clinical trials, tramadol was comparable or superior to adult dosages of codeine with/without acetaminophen.
• Abuse and dependence on tramadol have been reported; avoid overuse. Use caution if administering to individuals with a prior history of opioid dependence or abuse of other drugs.

The drugs associated with this class of substance-related disorders are the benzodiazepines [such as diazepam (Valium),  chlordiazepoxide (Librium), alprazolam (Xanax), triazolam (Halcion), and estazolam (ProSom)], the barbiturates [such as Seconal and pentobarbital (Nembutal)], and barbiturate - like substances including Quaalude, Equanil, and Doriden. Any of these drugs is capable of producing wakeful relief from tension, or sleep, depending upon dosage. Some non-psychiatric uses of anti-anxiety medications include treatment and prevention of seizures, muscle relaxants, anesthetics, and drugs to make other anesthetics work more effectively (known as “adjuvants”).

Although the types of central nervous system depressants work differently, they all produce a pleasant drowsy or calming effect. If used over a long period of time, tolerance develops, and larger doses are needed to achieve the initial effects. Continued use can lead both to physical dependence when use is reduced or stopped, and to withdrawal symptoms. When combined with each other or other CNS depressants, such as alcohol, the effects are additive.

In addition to the drugs available in the United States by prescription, there are three other drugs that are predominantly central nervous system depressants with significant potential for abuse. These are:

• gamma hydroxybutyrate (GHB)
• flunitrazepam (Rohypnol)
• Ketamine

GHB has been abused in the United States since about 1990, for its euphoric, sedative, and anabolic (bodybuilding) effects. It was widely available over the counter in health food stores until 1992. Bodybuilders used it to aid in reducing percentage of body fat, and to build muscle. Street names for GHB include “Liquid ecstasy,” “soap,” “Easy lay,” and “Georgia home boy.”

Rohypnol has been of particular concern during the last few years because of its abuse in date rape. When mixed with alcohol, Rohypnol can incapacitate its victims and prevent them from resisting sexual assault. It can also lead to anterograde amnesia, in which individuals cannot remember what they experienced while under the influence. Rohypnol can be lethal when mixed with alcohol and/or other depressants. Rohypnol is not available by prescription in the United States, and it is illegal to import it. Even so, illegal use of Rohypnol started appearing in the United States in the early 1990s, where it became known as “rophies,” “roofies,” “roach,” and “rope.”

Ketamine is an anesthetic used predominately by veterinarians to treat animals. It can be injected or snorted. Ketamine goes by the street names of “Special K,” or “Vitamin K.” At certain doses, ketamine can cause dream-like states and hallucinations. It has become particularly common in club and rave (large, all-night dance marathon) settings, and has been used as a date rape drug. At high doses, it can cause delirium, amnesia, impaired motor functioning, high blood pressure, and depression. It can also cause potentially fatal respiratory problems.

Source: The Gale Encyclopedia of Mental Disorders

Agoraphobia:
One of the most common phobias, agoraphobia affects women far more than men (roughly two-thirds of sufferers are female). Literally the fear of open spaces, agoraphobia is better known as the fear of being alone in a crowd, or in any place such as a theatre or a church or a shopping centre where escape might appear to be difficult. Such avoidance behaviour can lead to agoraphobia’s extreme effect: the trapping of a person in her home.

The phobia may come on suddenly or develop slowly.

Intimately connected with panic attacks, agoraphobia is at root an attempt to avoid the uncertainty of where next a panic attack might strike.

So you avoid the mall, or the street where you endured a previous panic attack, in order to feel safe.

Social Phobia:
This is the unreasonable fear of being embarrassed in social situations.

Some people with social phobia are afraid to speak in public.

Others cannot eat or drink or urinate in the presence of other people. Many social phobics are frightened of being introduced  to new people. Many are too scared to go for a job interview, or
to apply for a promotion if it means being questioned by a  couple of bosses.

Social phobia can ruin careers. A lawyer who has to avoid court appearances, a salesperson who feels unable to enter a mall, or a car leaser who is terrified of signing contracts in public, are all at risk.

Social phobia can not only block your advancement on the job, but prevent you from having fun. Fear of meeting new people can lead to searing loneliness.

One of the worst aspects of this irrational fear is that other people don’t take it seriously.

In social situations you may blush, shake, tremble, sweat, and feel your heart beat fast or your stomach turn over, or your skin go hot and cold.

If you do pluck up the courage to tell someone about these symptoms, they’ll likely tell you to “snap out of it”, or “pull yourself together.”

Men often respond to such stupid advice by ingesting drugs or alcohol to give themselves an artificial boost of courage.  Women often respond by withdrawing from social situations even further, ending up housebound and depressed.

Both male and female social phobics tend to condemn themselves.

Often they feel inferior to other people, fear rejection, refrain from asserting themselves, and are highly sensitive to criticism. Thus they continuously worry about what other people think of them.

They usually hide this narcissism so successfully that other people are often astonished when a social phobic reveals how fearful she or he is.

Social phobia can lead to panic attacks which lead to
anxiety which leads to further panic and the spreading of
the phobia.

And the whole vicious circle is fuelled with anticipatory anxiety. That is, the anxiety about what might happen brings on the panic and restricts you from improving your life.

Social phobia begins with our upbringing (what else is new?).

There may be family influences (“keep quiet; don’t embarrass the family”) or school pressures (“no, you can’t join our group”).

Expectations by society can also play a role. Lip service is paid to individuality in the West, but conformity is generally what’s rewarded. (e.g., “Don’t rock the boat”).

A traumatic experience can lead to social phobia. A child being humiliated by a teacher in front of a class, for instance. Or a woman being publicly scorned by her husband in a restaurant.

A person can react to such events by avoiding similar situations, thus compounding the original humiliation.

Often you don’t have a clear idea why you feel anxious.

Some years ago, I was invited to a party. At the door of the apartment where the party was being held I raised my hand to knock. At that moment I heard laughter inside. Immediately I lowered my hand, turned around and went home.

What was that? Fear of rejection? Feelings of inadequacy? Whatever it was, it ended when a colleague told me, “You’re still defining yourself as you used to be. Let your self-image catch up with reality. You’re on radio and television; you’re no longer the boy too scared to enter a restaurant.”

That comment was a form of cognitive therapy, which simply means to change the way you think.

(Social skills training, role-playing and participation in Toastmasters International are additional ways to combat social phobia.)

Paruresis:
(Bashful Bladder – a.k.a. Shy Bladder)  Paruresis is the inability to urinate in front of others.

Many people suffer with this phobia. A possible 7% or 17 million Americans, according to one source. Not being able to pee in public (i.e., when someone else is present in the same room) can make for some excruciating experiences.

Some men can only use the toilet where they live. Untreated, this can restrict the phobic person to a job within a short distance from home.

Some male paruresis sufferers regularly use the stalls in men’s rooms. Others find themselves unable to pee even in the stalls.

The problem becomes acute when the sufferer wants to travel – or produce a specimen for a drug test or medical exam. And although paruresis affects men more than women it is by no means exclusive to males. Or to heterosexuals.

Sometimes considered to be a subset of social phobia, paruresis can strike at any age.

Dentophobia:

Fear of dentists.

I used to be terrified of dentists, and with good reason. Many years ago all the children in my school in England were required to undergo dentistry.

We were lined up. One by one we went to the dentist’s chair. Those waiting would hear the drills and then watch kids stagger out of the dental room. We’d hear our classmates crying and throwing up in the nearby toilets.

Too soon it was my turn. A slimy-feeling rubber mask with a vile smell was put over my mouth, gas was administered and the dentist did his work.

Moments later I awoke. Blood and saliva swirled around my mouth and pain shot around my gums. Rinsing my mouth with tepid water didn’t seem to help much.

Subsequent to this and similar experiences I was terrified of dentists – or rather, of dentistry — for years. The so-called “laughing gas” was an absolute requirement for me to agree to receive any dental attention.

Eventually I came across hypnosis. And a hypnotherapist who jovially pointed out to me that few hypnotherapists use their skills on themselves. Revelation!

I resolved to use hypnotic techniques on myself. It was not long before self-hypnosis had me calm and reasonably relaxed about visiting the dentist.

At the dentist, my body still sweats with the memory of those distant horrors [note to self: must use EFT to rid body of such reactions] but I’m pleased at how effective hypnosis has been in freeing me from dental phobia.

Some other phobias
Chionophobia: fear of snow
Emetophobia: fear of vomiting
Frigophobia: fear of the cold
Gamophobia: fear of marriage
Genuphobia: fear of fear of knees
Lyssophobia: fear of insanity
Monophobia: fear of being alone
Nyctophobia: fear of darkness
Pathophobia: fear of disease
Pogonophobia: fear of beards
Scopophobia: fear of being stared at
Taphophobia: fear of being buried alive
Xenophobia: fear of the unknown
Zoophobia: fear of animals.

A client wrote:
“I’m terrified something awful is happening to me. Almost
every day I become really scared. I shiver, my chest hurts, my
throat goes dry, I feel dizzy, faint and frightened for fifteen or
twenty minutes of hell. When this happens I feel sure I’m going
insane, or I’m going to die. My doctor says there’s nothing
wrong, that I’m “just” having a panic attack.
She wouldn’t be so complacent if this happened to her! How
can this be ‘just in my head’?”

The pharmaceutical companies would like you to believe that panic attacks arise from something biological … and therefore can be fixed with a pill. 

But if a “chemical imbalance” triggers your panic attack, what triggers the “chemical imbalance”?  And if you are continually imbalanced chemically, then why are
you not suffering continuous panic?

The reason is, of course, that the panic attack gives rise to the chemical imbalance, not the other way around. And the surge of chemicals subsides. So what is it that brings on an attack?

Almost anything. Yet something which is significant to your subconscious.

This may be a thought, a smell, a sight or a sensation (e.g., the touch of velvet which triggers a subconscious memory of feeling abandoned at age four when your velvet-clad mother accidentally left you behind for an hour in the church at Aunt Susanna’s wedding).

Once the cue has been thought, smelled, seen, touched, tasted or heard, your body reacts. It automatically replays the emotions you experienced the first time.

Although you do not necessarily consciously remember feeling abandoned (for example) the fear is stored in your subconscious.

Your body has its own storehouse of memories. When a particular negative experience is thus recalled, the autonomic response of the body is also recalled. This is the adrenaline rush.

Our bodies have a built-in reflex that served our ancestors well. Whenever they were faced with danger—a sabre-toothed tiger about to spring on them, or an avalanche bearing down—their bodies would automatically prepare to run or to fight.

All temporarily unneeded bodily functions would shut down. Energy would be concentrated where it was most needed. Adrenaline would be pumped swiftly to increase the heart rate which in turn caused the lungs to gulp more air as the legs tensed for running away or the arms tensed to do battle.

We still have this automatic response to danger. But instead of tigers, we fear rejection, embarrassment, failure, shame, disappointment, etc. And we neither fight nor run.

However, as we stay still, anxiety causes that rush of adrenaline which in turn causes us to

• breathe rapidly,
• tense our muscles,
• increase our heart rate, and
• feel sick to out stomachs.

In other words, we panic.

A panic attack is often your body’s way of sending an urgent signal that something in your life needs to be fixed. Like phobias, the cause may be conscious or subconscious.

Since the symptoms resemble organic illnesses, it is of course sensible to have a medical check-up to make sure your chest pains are not a sign of heart trouble, or your sweaty palms a sign of a thyroid disorder.

Involuntary shaking, shivering and light-headedness might be signs of a neurological problem — or a result of ingesting too much caffeine.

But if medical causes are ruled out, then your panic attack points to an emotional or psychological issue. Undealt with, the attacks usually multiply in frequency and intensity.

The unpredictable timing of panic attacks leads to a fear of fear.

A panic attack is absolutely dreadful. Someone who has not experienced the terror cannot understand.

When a panic attack strikes  you feel sure you are going to die, or go insane.

If your first panic attack strikes you in a shopping mall the fear of being embarrassed and humiliated by another attack may cause you to avoid that mall.

Then you begin to fear that an attack may hit you if you go to a different mall, so you avoid that, too.

If you subsequently suffer an attack in an independent fruit store you’ll avoid that shop in future but perhaps you’ll also start to fear any shop that sells fruit, for fear of another attack hitting you.

Eventually you could end up trapped at home, afraid to venture anywhere, just in case.

This newly popular herb — also called kava-kava — has earned the nickname “nature’s Valium” for its ability to relieve anxiety and induce relaxation. In general, I don’t usually go for quick-fix solutions to conditions such as anxiety and stress. But for the 65 million Americans who suffer from anxiety and related insomnia, I see this calming herb as a much better alternative than prescription tranquilizers, which can have serious side effects and are highly addictive.

HISTORY AND RESEARCH: Derived from the knotty root of a large tropical shrub in the black-pepper family, kava has a rich history. In cultures of the South Pacific, it has been cultivated for centuries as a traditional psychoac-tive drug believed to have religious significance. In that part of the world, it is generally prepared as a drink made from the fresh or dried root and consumed at religious ceremonies and social gatherings. Today the herb is widely used in Europe as a natural relaxant and sleep aid, and Germany’s Commission E — the national agency that evaluates and regulates botanical medicines — gave kava its stamp of approval in 1990 for conditions of nervous anxiety and stress.

Studies have shown that kava’s relaxing properties are due to some 15 chemical compounds known as kavalactones (also called kavapy-rones), which act on the central nervous system and serve as muscle relaxants. Several well-designed German studies have demonstrated the herb’s positive effects. One double-blind randomized trial in 1996 showed that a standardized extract of kava improved symptoms of anxiety after just one week of use, with no adverse effects. An earlier study, which used EEG monitoring to measure the effects of kava versus Valium and a placebo, found that kava caused significant changes in brain activity that suggested a sedative mechanism different from that of the synthetic drug. Interestingly, the subjects who took kava showed improved performance on reaction-time tests of mental acuity, while those taking Valium did not.

HOW TO USE IT: For times of particularly high anxiety, such as that caused by a death in the family or a job crisis, start by taking one capsule of standardized kava extract a day and building slowly to three a day if necessary.

If you’re having insomnia due to anxiety and muscle tension, try taking a single dose of two or three capsules maybe an hour before going to bed (but don’t take more than three capsules in any given day).

While kava does not appear to be addictive, I would limit its use to no longer than two months without medical supervision. If you’re still suffering from significant anxiety after that time, I recommend that you consult a mental-health professional.

CAUTIONS: Some people who take very large doses of the herb for longer than two months develop a yellowing and thinning of the skin (which goes away when they stop using it), so be sure to keep to recommended doses. Don’t mix kava with other depressants such as alcohol, prescription sedatives, or valerian, as it may intensify their effects, and monitor kava’s effects on you before driving. Kava is not recommended for Parkinson’s patients, as it may cause increased muscular twitching in people with this disease.

BUYING TIPS:

• Look for kava extract in capsule form.
• The kavalactone content of kava root can vary widely, so be sure to select a reliable brand of the extract that is standardized to 70 to 85 mg of kavalactones (or kavapyrones) per capsule.

Author: Dr. Andrew Weil’s

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Codeine uses. Codeine was discovered in 1832 by French chemist Pierre-Jean Robiquet. Typically it is derived from the more potent drug morphine, which, depending on dosage route (oral, injection), is considered about 3 to 12 times stronger than codeine. After codeine is administered, body chemistry transforms it back into morphine; thus employer drug screens on someone who used a codeine cough remedy can be positive for morphine. Basically codeine is a prodrug, a substance having little medicinal effect itself but that the body transforms into a useful drug

Clonazepam uses. Clonazepam is considered one of the more powerful benzodiazepine class drugs. Primary medical uses are against some kinds of convulsions, particularly in certain kinds of epilepsy, and against panic attacks. For persons suffering from panic attacks, measurements indicate the drug improves both quality of life and work productivity. The drug is also used as an antidepressant and to treat anxiety, catatonia, obsessive-compulsive disorder, the manic phase of manic-depressive behavior, and social phobia in general. A two-year follow-up study of persons receiving brief clonazepam treatment for social phobia found their improvement to be sustained after dosage stopped, and at the two-year mark they were doing better than a control group that had received a placebo. Clonazepam is sometimes preferred over alprazolam in treating anxiety because that condition seems less likely to reappear between doses of clonazepam than between doses of alprazolam. Clonazepam can be substituted for alprazolam in order to withdraw persons who have dependence with the latter drug. Clonazepam has been used to fight tics and also to treat muscle control diseases such as akathisia and tardive dyskinesia. Among children with attention deficit hyperactivity disorder (ADHD) who also have tics, a study found clonazepam could help suppress tics without harming the psychiatric effect of ADHD medicine. Although clonazepam is
not a multiple sclerosis medicine, it is administered to relieve the affiction

There are valid health concerns associated with online prescriptions, including whether the patient has other health concerns which might be affected by a prescription drug. While most pharmacies that offer online prescription services limit themselves to offering drugs that are relatively safe even when misused, any presciption medication can pose health risks or can result in a negative interaction with other prescription and non-prescription medications, and even with dietary supplements. A doctor can advise a patient about side-effects, and warning signs that indicate that the patient should stop taking a medication. An online pharmacy may provide little guidance, typically at most providing written instruction about taking the drug.

Additionally, overseas pharmacies may be selling a different formulation of a medication. Even if the patient has been physically examined and was issued a prescription in person, the dosage may not be optimal if the overseas formulation is different.

Counterfeit Medication

Further, some pharmacies have been known to sell expired or counterfeit medication. While this risk is relatively low if a patient is able to confirm that the purchase is being fulfilled through a U.S. or Canadian pharmacy, or even a reputable Mexican pharmacy, some vendors intentionally defraud consumers. There is a secondary market for medications which are approaching their expiration dates, and an online pharmacy may be more interested in maximizing its profits than in providing quality product. For those which sell counterfeit drugs, the customer may be paying hundreds of dollars for nothing more than a few cents worth of sugar pills.

Pharmaceutical Industry Lobbying

The U.S. government has responded to intensive lobbying by the pharmaceutical industry by limiting the import of prescription medications. When people order presciption drugs from other countries, the lower prices they pay translate into lower profits for drug manufacturers. While groups that represent older Americans and concerns over rising health care costs are lobbying sympathetic members of Congress to legalize the import of prescription medications, the trend is toward increased restriction. At present, while you can bring up to a 90 day supply of a medication with you on your person when you return from a foreign country, you may no longer import a controlled substance. Import by other means, such as by mail order, is no longer permitted, and any drug shipments that are detected will be seized at the border.

Are Online Pharmacies Legal?

In general, a United States resident with a valid prescription may bring into the country up to ninety (90) days supply of a medication for personal use. While it was historically possible to order such medicines over the Internet, regulations now require that the medications be brought back in person, and exclude the import of controlled substances. While a number of online pharmacies operate from overseas locations, if their shipments of medicine into the United States are detected the medication will be seized.

At present, a number of online pharmacies have suspended operations due to a decision by the FDA to act against online pharmacies that engage in the online prescription of controlled substances. In addition, the FDA and DEA require that an individual be examined in person by the prescribing physician before receiving certain controlled substances from an online pharmacy, as opposed to completing an online questionnaire that is later reviewed by a doctor.

Why Do People Use Online Pharmacies?

There are two leading reasons why people choose to obtain prescription drugs online. The first is cost. Due to the economics of health care in the United States, consumers often must pay a significantly higher price for medication than consumers in other countries. A second reason is privacy. Some people prefer to obtain their prescriptions online, even at a higher cost, than to consult a doctor in person about issues such as depression, hair loss, or erectile dysfunction. Sales of antidepressant medications, Viagra, Propecia, and diet drugs such as Phentermine or Xenical are now an enormous business.

For many years, consumers near Canada have driven across the border to buy their drugs at considerable savings from Canadian pharmacies. Now consumers across the country can purchase from a Canadian pharmacy by mail. Canadian pharmacies typically require proof of identity and a valid prescription. Unless issued by a doctor who is also licensed to practice medicine in Canada, U.S. prescriptions will be reissued by a Canadian doctor. U.S. consumers near the Mexican border have also historically crossed the border to make drug purchases from Mexican pharmacies, but as described below there are special concerns raised by purchasing drugs from a Mexican pharmacy.

Is It Always Cheaper?

It is usually possible to obtain savings by purchasing prescription drugs online, even from a major U.S. pharmacy, when you have a prescription issued to you in person. It is usually not cheaper to obtain medications through an online prescription service, which usually marks up the price substantially even when nominally offering a “free” prescription. That mark-up may be comparable to the cost of an in-person medical examination, and may significantly exceed that cost when refills will be required.

Also, as noted above, price cannot always be the leading consideration. If you don’t know that you will be receiving the actual medication that was prescribed for you, you must put safety ahead of price.