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Other forms of ketamine not approved by the FDA for mental health conditions include IV infusion, a shot in the arm, or lozenges. Most research looks at ketamine given by IV. You can only get it by IV or shot in a doctor’s office. Some doctors will prescribe lozenges for at-home use — often to keep depression at bay between infusions. Christa Coulter-Scott says ketamine treatment eased the depression she’s had for most of her life. Yet, after ketamine therapy, she says, “My head feels lighter, and I don’t have that gloomy, dark, heavy feeling in my mind. And everything around me looks brighter — the sun, the lights in my office.” When she returned to work the next day after an infusion, she asked a co-worker whether the lighting had been changed. It hadn’t. “I don’t know if it’s a side effect of ketamine or a side effect of being less depressed.”

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Many people rely on over the counter pain killers to treat mild to moderate aches and pains. In general, take the lowest effective dose to reduce the risk of side effects. For self-limiting types of pain, such as a tension headache, you may only need one or two doses of a painkiller. For treating persistent types of pain, such as joint pain due to osteoarthritis, your doctor may suggest taking a painkiller regularly, as regular doses of an analgesic can be more effective for keeping pain at bay than waiting until pain breaks through to treat it. But regular daily use can increase the risk of side effects, including rebound headaches, as described below. Unfortunately, there is a growing recognition that the long-term use of painkillers – even paracetamol – is not as safe as once believed, and may increase the long-term risk of heart, liver or kidney problems.

Tramadol is a synthetic, atypical, centrally-acting analgesic that binds to the µ-opioid receptors and also inhibits the reuptake of serotonin and noradrenaline, resulting in both opioid and antidepressant-like effects. Tramadol is considered a “weak opioid” and is a prescribing option at Step two of the analgesic ladder, alongside codeine and dihydrocodeine (see: “The principles of managing acute pain in primary care”). There are no robust studies suggesting that tramadol provides either more or less analgesia than codeine or dihydrocodeine. Like codeine and dihydrocodeine, tramadol is metabolised by CYP2D6, which produces a metabolite that has substantially greater affinity for the µ-opioid receptor than its parent drug.2 Eight to 10% of people of European descent are poor CYP2D6 metabolisers and 3 to 5% are ultra-rapid metabolisers;2 there is no published data for Maori or Pacific peoples. People who are poor CYP2D6 metabolisers are likely to experience reduced analgesia with tramadol (and codeine) and ultra-rapid metabolisers may be more sensitive to adverse effects.

Side effects are a major area of concern for many parents considering medication for their child’s ADHD. Indeed, side effects might add to the overall stress of managing a child’s condition. Our survey found that parents of children taking amphetamines and methylphenidates reported a high frequency of side effects. Overall, 84 percent of the children who tried amphetamines and 81 percent who tried methylphenidates experienced side effects. And among those who reported no longer taking a specific medication, 35 percent said it was because of side effects. Decreased appetite, sleep problems, weight loss, irritability, and upset stomach were the side effects most frequently reported by parents for both types of medication. Amphetamines and methylphenidates were equally likely to produce these side effects with the exception of irritability, which was more likely to be reported as a side effect by parents whose children tried amphetamines. Although elevated mood or excessive energy wasn’t among the more frequently reported side effects, it was more commonly reported by parents whose children were taking amphetamines compared with methylphenidates. Talk with your doctor if irritability, anger, or manic behavior become an issue.

Zolpidem ( Ambien , Edluar, Intermezzo): These medicines work well at helping you get to sleep, but some people tend to wake up in the middle of the night. Zolpidem is now available in an extended release version, Ambien CR. This may help you go to sleep and stay asleep longer. The FDA warns that you should not drive or do anything that requires you to be alert the day after taking Ambien CR because it stays in the body a long time. You should not take zolpidem unless you are able to get a full night’s sleep — at least 7 to 8 hours. The FDA has approved a prescription oral spray called Zolpimist, which contains zolpidem, for the short-term treatment of insomnia brought on by trouble falling asleep.

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