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What Is Depression? (From National Institute of Mental Health)
Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.
Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression.
What are the different forms of depression?
There are several forms of depressive disorders.
Major depression - severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person's lifetime, but more often, a person has several episodes.
Depression is a common but serious illness. Most who experience depression need treatment to get better.
Persistent depressive disorder - depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.
Some forms of depression are slightly different, or they may develop under unique circumstances. They include:
Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
Postpartum depression, which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.1
Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.2
Bipolar disorder, also called manic-depressive illness, is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression). More information about bipolar disorder is available.
What are the signs and symptoms of depression?
People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.
Signs and symptoms include:
Persistent sad, anxious, or "empty" feelings
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions
Insomnia, early-morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.
I started missing days from work, and a friend noticed that something wasn't right. She talked to me about the time she had been really depressed and had gotten help from her doctor.
What illnesses often co-exist with depression?
Other illnesses may come on before depression, cause it, or be a consequence of it. But depression and other illnesses interact differently in different people. In any case, co-occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder, often accompany depression.3,4 PTSD can occur after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat. People experiencing PTSD are especially prone to having co-existing depression.
In a National Institute of Mental Health (NIMH)-funded study, researchers found that more than 40 percent of people with PTSD also had depression 4 months after the traumatic event.5
Alcohol and other substance abuse or dependence may also co-exist with depression. Research shows that mood disorders and substance abuse commonly occur together.6
Depression also may occur with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease. People who have depression along with another medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co-existing depression.7 Treating the depression can also help improve the outcome of treating the co-occurring illness.8
What causes depression?
Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors.
Depressive illnesses are disorders of the brain. Longstanding theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in depression. But it has been difficult to prove this.
Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different. But these images do not reveal why the depression has occurred. They also cannot be used to diagnose depression.
Some types of depression tend to run in families. However, depression can occur in people without family histories of depression too.9 Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors.10 In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.
Research indicates that depressive illnesses are disorders of the brain.
Personal Story
It was really hard to get out of bed in the morning. I just wanted to hide under the covers and not talk to anyone. I didn't feel much like eating and I lost a lot of weight.
Nothing seemed fun anymore. I was tired all the time, and I wasn't sleeping well at night. But I knew I had to keep going because I've got kids and a job. It just felt so impossible, like nothing was going to change or get better.
How do women experience depression?
Depression is more common among women than among men. Biological, life cycle, hormonal, and psychosocial factors that women experience may be linked to women's higher depression rate. Researchers have shown that hormones directly affect the brain chemistry that controls emotions and mood. For example, women are especially vulnerable to developing postpartum depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.
Some women may also have a severe form of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD). PMDD is associated with the hormonal changes that typically occur around ovulation and before menstruation begins.
During the transition into menopause, some women experience an increased risk for depression. In addition, osteoporosis—bone thinning or loss—may be associated with depression.11 Scientists are exploring all of these potential connections and how the cyclical rise and fall of estrogen and other hormones may affect a woman's brain chemistry.12
Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It is still unclear, though, why some women faced with enormous challenges develop depression, while others with similar challenges do not.
How do men experience depression?
Men often experience depression differently than women. While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping.13,14
Men may be more likely than women to turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or behave recklessly. And although more women attempt suicide, many more men die by suicide in the United States.15
How do older adults experience depression?
Depression is not a normal part of aging. Studies show that most seniors feel satisfied with their lives, despite having more illnesses or physical problems. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms. They may be less likely to experience or admit to feelings of sadness or grief.16
Sometimes it can be difficult to distinguish grief from major depression. Grief after loss of a loved one is a normal reaction to the loss and generally does not require professional mental health treatment. However, grief that is complicated and lasts for a very long time following a loss may require treatment. Researchers continue to study the relationship between complicated grief and major depression.17
Older adults also may have more medical conditions such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or they may be taking medications with side effects that contribute to depression. Some older adults may experience what doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body's organs, including the brain. Those with vascular depression may have, or be at risk for, co-existing heart disease or stroke.18
Although many people assume that the highest rates of suicide are among young people, older white males age 85 and older actually have the highest suicide rate in the United States. Many have a depressive illness that their doctors are not aware of, even though many of these suicide victims visit their doctors within 1 month of their deaths.19
Most older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both.20 Research has shown that medication alone and combination treatment are both effective in reducing depression in older adults.21 Psychotherapy alone also can be effective in helping older adults stay free of depression, especially among those with minor depression. Psychotherapy is particularly useful for those who are unable or unwilling to take antidepressant medication.22,23
How do children and teens experience depression?
Children who develop depression often continue to have episodes as they enter adulthood. Children who have depression also are more likely to have other more severe illnesses in adulthood.24
A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depression. By age 15, however, girls are twice as likely as boys to have had a major depressive episode.25
Depression during the teen years comes at a time of great personal change—when boys and girls are forming an identity apart from their parents, grappling with gender issues and emerging sexuality, and making independent decisions for the first time in their lives. Depression in adolescence frequently co-occurs with other disorders such as anxiety, eating disorders, or substance abuse. It can also lead to increased risk for suicide.24,26
An NIMH-funded clinical trial of 439 adolescents with major depression found that a combination of medication and psychotherapy was the most effective treatment option.27 Other NIMH-funded researchers are developing and testing ways to prevent suicide in children and adolescents.
Childhood depression often persists, recurs, and continues into adulthood, especially if left untreated.
How is depression diagnosed and treated?
Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is.
The first step to getting appropriate treatment is to visit a doctor or mental health specialist. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation.
The doctor may refer you to a mental health professional, who should discuss with you any family history of depression or other mental disorder, and get a complete history of your symptoms. You should discuss when your symptoms started, how long they have lasted, how severe they are, and whether they have occurred before and if so, how they were treated. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide.
Once diagnosed, a person with depression can be treated in several ways. The most common treatments are medication and psychotherapy.
I called my doctor and talked about how I was feeling. She had me come in for a checkup and gave me the name of a specialist, who is an expert in treating depression.
Antidepressants primarily work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work. The latest information on medications for treating depression is available on the U.S. Food and Drug Administration (FDA) website .
Popular newer antidepressants
Some of the newest and most popular antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are some of the most commonly prescribed SSRIs for depression. Most are available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta).
SSRIs and SNRIs tend to have fewer side effects than older antidepressants, but they sometimes produce headaches, nausea, jitters, or insomnia when people first start to take them. These symptoms tend to fade with time. Some people also experience sexual problems with SSRIs or SNRIs, which may be helped by adjusting the dosage or switching to another medication.
One popular antidepressant that works on dopamine is bupropion (Wellbutrin). Bupropion tends to have similar side effects as SSRIs and SNRIs, but it is less likely to cause sexual side effects. However, it can increase a person's risk for seizures.
Tricyclics are older antidepressants. Tricyclics are powerful, but they are not used as much today because their potential side effects are more serious. They may affect the heart in people with heart conditions. They sometimes cause dizziness, especially in older adults. They also may cause drowsiness, dry mouth, and weight gain. These side effects can usually be corrected by changing the dosage or switching to another medication. However, tricyclics may be especially dangerous if taken in overdose. Tricyclics include imipramine and nortriptyline.
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. They can be especially effective in cases of "atypical" depression, such as when a person experiences increased appetite and the need for more sleep rather than decreased appetite and sleep. They also may help with anxious feelings or panic and other specific symptoms.
However, people who take MAOIs must avoid certain foods and beverages (including cheese and red wine) that contain a substance called tyramine. Certain medications, including some types of birth control pills, prescription pain relievers, cold and allergy medications, and herbal supplements, also should be avoided while taking an MAOI. These substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help reduce these risks. If you are taking an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid.
MAOIs can also react with SSRIs to produce a serious condition called "serotonin syndrome," which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions. MAOIs should not be taken with SSRIs.
How should I take medication?
All antidepressants must be taken for at least 4 to 6 weeks before they have a full effect. You should continue to take the medication, even if you are feeling better, to prevent the depression from returning.
Medication should be stopped only under a doctor's supervision. Some medications need to be gradually stopped to give the body time to adjust. Although antidepressants are not habit-forming or addictive, suddenly ending an antidepressant can cause withdrawal symptoms or lead to a relapse of the depression. Some individuals, such as those with chronic or recurrent depression, may need to stay on the medication indefinitely.
In addition, if one medication does not work, you should consider trying another. NIMH-funded research has shown that people who did not get well after taking a first medication increased their chances of beating the depression after they switched to a different medication or added another medication to their existing one.28,29
Sometimes stimulants, anti-anxiety medications, or other medications are used together with an antidepressant, especially if a person has a co-existing illness. However, neither anti-anxiety medications nor stimulants are effective against depression when taken alone, and both should be taken only under a doctor's close supervision.
More information about mental health medications is available on the NIMH website.
Report any unusual side effects to a doctor immediately.
FDA warning on antidepressants
Despite the relative safety and popularity of SSRIs and other antidepressants, studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and unpublished controlled clinical trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4 percent of those taking antidepressants thought about or attempted suicide (although no suicides occurred), compared to 2 percent of those receiving placebos.
This information prompted the FDA, in 2005, to adopt a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A "black box" warning is the most serious type of warning on prescription drug labeling.
The warning emphasizes that patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The warning adds that families and caregivers should also be told of the need for close monitoring and report any changes to the doctor. The latest information from the FDA can be found on their website .
Children, adolescents, and young adults taking antidepressants should be closely monitored.
Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.30 The study was funded in part by NIMH.
Also, the FDA issued a warning that combining an SSRI or SNRI antidepressant with one of the commonly-used "triptan" medications for migraine headache could cause a life-threatening "serotonin syndrome," marked by agitation, hallucinations, elevated body temperature, and rapid changes in blood pressure. Although most dramatic in the case of the MAOIs, newer antidepressants may also be associated with potentially dangerous interactions with other medications.
What about St. John's wort?
The extract from the herb St. John's wort (Hypericum perforatum) has been used for centuries in many folk and herbal remedies. Today in Europe, it is used extensively to treat mild to moderate depression. In the United States, it is one of the top-selling botanical products.
In an 8-week trial involving 340 patients diagnosed with major depression, St. John's wort was compared to a common SSRI and a placebo (sugar pill). The trial found that St. John's wort was no more effective than the placebo in treating major depression.31 However, use of St. John's wort for minor or moderate depression may be more effective. Its use in the treatment of depression remains under study.
St. John's wort can interact with other medications, including those used to control HIV infection. In 2000, the FDA issued a Public Health Advisory letter stating that the herb may interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and those used to prevent organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Consult with your doctor before taking any herbal supplement.
Several types of psychotherapy—or "talk therapy"—can help people with depression.
Two main types of psychotherapies—cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)—are effective in treating depression. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse. IPT helps people understand and work through troubled relationships that may cause their depression or make it worse.
For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back.27 Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years.23
More information on psychotherapy is available on the NIMH website.
Now I'm seeing the specialist on a regular basis for "talk therapy," which helps me learn ways to deal with this illness in my everyday life, and I'm taking medicine for depression.
Electroconvulsive therapy and other brain stimulation therapies
For cases in which medication and/or psychotherapy does not help relieve a person's treatment-resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.
Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses. Within 1 hour after the treatment session, which takes only a few minutes, the patient is awake and alert.
A person typically will undergo ECT several times a week, and often will need to take an antidepressant or other medication along with the ECT treatments. Although some people will need only a few courses of ECT, others may need maintenance ECT—usually once a week at first, then gradually decreasing to monthly treatments. Ongoing NIMH-supported ECT research is aimed at developing personalized maintenance ECT schedules.
ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes they can linger. Newer methods of administering the treatment have reduced the memory loss and other cognitive difficulties associated with ECT. Research has found that after 1 year of ECT treatments, most patients showed no adverse cognitive effects.32
Nevertheless, patients always provide informed consent before receiving ECT, ensuring that they understand the potential benefits and risks of the treatment.
Other more recently introduced types of brain stimulation therapies used to treat severe depression include vagus nerve stimulation (VNS), and repetitive transcranial magnetic stimulation (rTMS). These methods are not yet commonly used, but research has suggested that they show promise.
More information on ECT, VNS, rTMS and other brain stimulation therapies is available on the NIMH website.
The National Institute of Mental Health funds cutting-edge research into this debilitating disorder.
How can I help a loved one who is depressed?
If you know someone who is depressed, it affects you too. The most important thing you can do is help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment, or to seek different treatment if no improvement occurs after 6 to 8 weeks.
To help your friend or relative
Offer emotional support, understanding, patience, and encouragement.
Talk to him or her, and listen carefully.
Never dismiss feelings, but point out realities and offer hope.
Never ignore comments about suicide, and report them to your loved one's therapist or doctor.
Invite your loved one out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon.
Provide assistance in getting to the doctor's appointments.
Remind your loved one that with time and treatment, the depression will lift.
How can I help myself if I am depressed?
If you have depression, you may feel exhausted, helpless, and hopeless. It may be extremely difficult to take any action to help yourself. But as you begin to recognize your depression and begin treatment, you will start to feel better.
To Help Yourself
Do not wait too long to get evaluated or treated. There is research showing the longer one waits, the greater the impairment can be down the road. Try to see a professional as soon as possible.
Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.
Set realistic goals for yourself.
Break up large tasks into small ones, set some priorities and do what you can as you can.
Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
Remember that positive thinking will replace negative thoughts as your depression responds to treatment.
Continue to educate yourself about depression.
Everything didn't get better overnight, but I find myself more able to enjoy life and my children.
Where can I go for help?
If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.
Mental Health Resources
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
Mental health programs at universities or medical schools
State hospital outpatient clinics
Family services, social agencies, or clergy
Peer support groups
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies
You can also check the phone book under "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses. An emergency room doctor also can provide temporary help and can tell you where and how to get further help.
What if I or someone I know is in crisis?
If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.
Do not leave your friend or relative alone, and do not isolate yourself.
Call your doctor.
Call 911 or go to a hospital emergency room to get immediate help, or ask a friend or family member to help you do these things.
Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.
For More Information
Visit the National Library of Medicine's:
En Español
For information on clinical trials for depression
National Library of Medicine Clinical Trials Database
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NIH Publication No. 11-3561
Revised 2011
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23. Reynolds CF III, Dew MA, Pollock BG, Mulsant BH, Frank E, Miller MD, Houck PR, Mazumdar S, Butters MA, Stack JA, Schlernitzauer MA, Whyte EM, Gildengers A, Karp J, Lenze E, Szanto K, Bensasi S, Kupfer DJ. Maintenance treatment of major depression in old age. New England Journal of Medicine, 2006 Mar 16; 354(11):1130–1138.
24. Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P, Greenwald S, Klier CM, Ryan ND, Dahl RE, Wichramaratne P. Depressed adolescents grown up. Journal of the American Medical Association, 1999; 281(18):1701–1713.
25. Cyranowski JM, Frank E, Young E, Shear MK. Adolescent onset of the gender difference in lifetime rates of major depression. Archives of General Psychiatry, 2000; 57:21–27.
26. Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M. Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 1996; 53(4):339–348.
27. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J. Treatment for Adolescents with Depression Study (TADS) team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. Journal of the American Medical Association, 2004; 292(7):807–820.
28. Rush JA, Trivedi MH, Wisniewski SR, Stewart JW, Nierenberg AA, Thase ME, Ritz L, Biggs MM, Warden D, Luther JF, Shores-Wilson K, Niederehe G, Fava M. Bupropion-SR, Sertraline, or Venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine, 2006 Mar 23; 354(12):1231–1242.
29. Trivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, Ritz L, Nierenberg AA, Lebowitz BD, Biggs MM, Luther JF, Shores-Wilson K, Rush JA. Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine, 2006 Mar 23; 354(12):1243–1252.
30. Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher B, Pincus HA, Ren L, Brent DA. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment, a meta-analysis of randomized controlled trials. Journal of the American Medical Association, 2007; 297(15):1683–1696.
31. Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St. John's wort) in major depressive disorder: a randomized controlled trial. Journal of the American Medical Association, 2002; 287(14):1807–1814.
32. Lisanby SH. Electroconvulsive therapy for depression. New England Journal of Medicine. 2007; 357:1939–1945.


text:
Asia'h Epperson
- 'Married at First Sight' Season 12 couples revealed! Meet the couples and learn all about the cast! (PHOTOS)
- 'The Bachelorette' recap: Tayshia Adams scolds her bachelors before ousting Chasen Nick, Joe Park, Jordan Chapman and Kenny Braasch
- 'Married at First Sight' Season 12 cast and premiere date announced by Lifetime
- 'The Bachelor' host Chris Harrison: Matt James had a "rude awakening" while filming Season 25, he's a different man now
- 'The Bachelorette' Couples Now: Who did 'The Bachelorette' stars and their winners end up marrying? Where are they now? (PHOTOS)
- '90 Day Fiance: The Other Way' star Ariela Weinberg explains why she did the show despite being camera-shy
- Bachelorette spoilers: Who did 'The Bachelorette' star Tayshia Adams pick as her winner and end up with? Did she get engaged? What happens on 2020 finale of 'The Bachelorette'? (SPOILERS)
- Brendan Morais: 7 things to know about 'The Bachelorette' star Tayshia Adams' bachelor Brendan Morais
- Zac Clark: 7 things to know about 'The Bachelorette' star Tayshia Adams' bachelor Zac Clark

subset: commoncrawl


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RPS Asks: What Are Your Big PC Hopes For 2013?
For some reason 2013 doesn't sound as futuristic as 2012. It's more the sort of date you're used to seeing on tinned food than the year robot unicorns attack. But 2013 could well be the best year PC has ever seen. As you drift off toward your Newyearseving celebration of choice, why not leave a thought on what you're most hoping for?
And I'm not just saying 2013's going to be good because our livelihood relies on the success of PC gaming, no sirree. I'm saying it because I believe it's very true. 2013 is going to be the year where people grow increasingly reluctant to buy consoles, knowing that they'll be out of date and replaced by Christmas. And as console fatigue kicks in it puts the emphasis back on us, before 2014's TV-toy excitement kicks off. It's also a year where developers will be building 2014's games on devkits for the next gen, and thus freed up to explore the greater power the PC already possesses, meaning previews should get more intriguing.
Also, it's just a crazy good year for the games that we already know are coming out, let alone the unrevealed, unknown indie projects, delivery of so many Kickstarter promises, and break-out surprise mods that will sneak up on us along the way. And of top of that, the completely unpredictable, 2013's equivalent to the astonishing rise of crowd-funding and honour-payments that formed so much of 2012. I'm fairly certain it'll be a year that reveals the next twist on big budget game pricing, the evolution of F2P into something new.
2013 will give us BioShock: Infinite, Planetary Annihilation, ArmA 3, Tomb Raider, Crysis 3, Sim City, StarCraft: Heart Of The Swarm, The Elder Scrolls Online, GTA V, Metro Last Light, Watch Dogs, Total War Rome 2… And I'm scraping the surface – we'll have FAR more detail about the games of 2013 over the rest of this week.
So what are your big hopes for 2013 in PC Land? What games can't you wait to play? What changes do you expect to see? What new twists and turns do you predict? Let us know below.


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To Tonya:
If you've tried all the medicines, the other thing you can do is purchase a doctor visit. If it's something serious, the doctor should be able to help.
To Colleen:
The foreign candy causes a random activity. In your case, it caused running away both times. I've had it also cause them to go to the bathroom.
To Sariah:
The laundry room is not a career area. Only kitchen, office, and workshop. I would guess the workshop for a dress designer.
To Kylie:
Your artist likely works in the workshop. I'm going to get some screenshots of the exact spots to drop your people to get them to work in the three rooms (kitchen, office, and workshop).
To Jill:
Yes, the repair kit will turn up in the store. The game's developers have published an updated version that refreshes the store items every four hours, so it should go quicker if you download the new version.
To Stephanie:
Check the walkthrough located at the top of this page. Click the spoiler for repairs and you will find instructions for the bird bath and the holes in the floors.
Here are some screenshots of Virtual Families that may help everyone locate various things in and around the house. Look for the red circles in the screenshots.
Virtual Families FAQ (Frequently Asked Questions)
Below is a list of some of the questions that get asked often. If you have a question about something, chances are someone else has had the same question. Please check this list before posting a comment. If you don't find an answer here, ask us in the comment thread and we'll do our best to help!
What can I do to get my people's energy up?
There is an energy drink you can buy in the store, but it's random and is only one dose.
Also note that the problems with low energy have been corrected in an updated version of the game (1.00.05). If you have a previous version, go back to the site where you originally purchased the game and download it again.
How do I get rid of hiccups?
Have your person get a drink of water in the kitchen or in the bathroom.
How do I get my people to chase gophers?
This is something they do on their own. To get the trophy for chasing gophers, praise someone while "playing on the lawn" when there are gopher holes present.
Why isn't the item I need for a repair in the store?
The varied items in the store appear randomly and refresh every four hours in the most current version of the game (1.00.05). If the item you need isn't there, keep checking. It will turn up eventually.
If one of my children goes with the talent scout, will he/she come back?
No, they won't come back until you start the next generation. They'll be available along with the other children to take over the house when the time comes.
Will the children come back after going to college?
No, they don't come back from college. Same as with the talent scout, they will only be available to take over the house after the parents die.
At what age do women stop having babies?
As in Virtual Villagers 2 and 3, females cannot have babies after age 50. Even in their 40s, it's difficult.
How do I pause the game?
Use the space bar.
How high do the career levels go?
Careers top out at level 8 (master).
How do I help my people who are depressed?
They will get better over time. Give them treats like candy and fruit. Make sure there's plenty of food and they are fed. Buy household upgrades. Have them work on their career. Don't use the red hand on them for awhile. Praise them a lot. All of these things will help bring up their mood.
How do I play multiple families?
Click the player name on the menu screen and you will be given the option to start other families.
What happens to the money in the bank when the parents die?
The money will transfer to whichever child takes over for the new generation.
How can I make more money?
The best way is to gather duplicate collectibles. They are automatically sold online when one of your people picks them up. For extra, try dropping two people on the same collectible: pause using the space bar, drop first person, tap space bar twice to unpause and repause, drop second person. If your timing is good, both of them will pick up the collectible and you'll get double the money. Be careful, though, because children will often play train or have a giggle party when you drop them on top of each other!
How do I get my family to prepare a meal?
Drop an adult on the kitchen table.
Can children work once they reach age 14?
They can do adult chores and activities, but they can't work to earn money. Only the parents work on careers for money.
How do I get the next generation to take over?
When the parents die, a blue screen full of instructions will appear. Basically, it tells you that when you are ready for the next generation to take over, go to the family screen and click on the "New Generation" button at the top of the screen. You'll be able to scroll through all of the children of the current parents. Pick the one you want to carry on the family and click "adopt." Now the family will continue with that child.
What happens to the siblings of the child I chose to continue the family?
Nothing happens to them. They remain on the family tree, but they don't reappear in the game and you cannot play them after they have not been chose.
Why won't my store refresh?
There is a bug that prevents the store from refreshing. Press the R key while you are on the store screen to refresh the store and reset the schedule to where it will refresh every 4 hours. This is a one time only fix for the bug. You will not be able to refresh your store on demand.
How do I help my people who are very weak?
Being weak usually comes from being sick. Even after being cured, your people will be weak. Fruit and vitamins from the store helps a great deal. Also, make sure they have plenty of food and are fed. After that, it just takes time for them to get strong again.
How do I find the red ball and what is it for?
The red ball is just something extra the developers threw in. It's not required to solve any of the puzzles, nor can your people interact with it. To find the red ball, move the map to where you can reach the absolute upper and left most corner. Using just the hand cursor, pinch into that upper left corner and pull the red ball out. Note: you can't actually see the ball until you pull it out. Here's a screenshot:
Is there anything I can do to make my family have twins or triplets?
As best we can tell, twins and triplets are completely random. They can happen at any point in the game and are a bit rare, especially triplets. There's nothing that will make them happen or help it along. It's just luck of the draw. One thing to consider, though... Multiples will only happen early in a family because of the six child limit. If there have been no triplets by the time child number 3 is born, there won't be any triplets for that family at all because it would put it over the six child limit. The game doesn't let that happen.
Every time i try to close down the game it crashes?? and then when i go to go back to my family they arent there as obviously the game has crashed and not saved them :( anyone able to help me with this please. Really enjoying the game but this is annoying me and i have to restart a new family each time boohoo.
Thanks Michelle
[One Option is always to de- and reinstall the game. If the problem comes up then again, you should contact the (technical) support of the page, you purchased the game from :) ~ Kayleigh]
Well just besause it is made by Ldw does it need to be like VV???? I enjoy em both eventhough they are different.
Now i do have my 1st generation and the Latte trophy but do have problems getting anyone to catch the gopher...(darn thing grinned at me too)....
Furthermore i wanna contact childwelfare lol, I doused fires, took showers dug up weeds in the rain..all that with a baby tugged under my arm....lil hint for the developers.....a crib maybe???!!!
To Alison:
You just need to look for the remote somewhere in the house. It will be laying on the floor somewhere, so just drop someone onto it.
To Chicky:
Check the walkthrough section located at the top of this page. Click the spoiler under Repairs and Household Items. You will find instructions for the Leaky Hose.
To Dat Dude:
The salary of your person is for a day. He won't earn $90 in a single work cycle. It will be a portion of his salary in a work cycle. It actually adds up pretty quickly once they start getting raises.
To Bebe:
They will earn more money as they advance through their career. Also, the duplicate collectibles can be sold online for extra money. There are random events that also give you money, but you cannot control them.
To Kris:
The progress bar is how far your person has advanced on that level of his/her career. When they get to the end of the progress bar for level 1 beginner, for example, they will be promoted to level 2 novice and the progress bar starts over again for that level.
Your people have different progress on their bars because they are at different stages of their careers.
To Jen:
I haven't gotten the rotten fish trophy yet, but I suspect it comes from praising someone when they take out the garbage without being told.
To Kayce:
If the baby making worked, the mother will have a baby in her arms before she gets off the bed. You'll also get a blue screen telling you that you're had a baby.
To Sarahnicole1321:
Click on the menu button, then click on the name of the player. It will take you to a screen where you can make other profiles and you can have a family for each profile you make.
Finally got the fish! You'll notice one of your little people heading to the kitchen and when you click on him/her you'll see "checking out the funny smell". They will then look in the refrigerator and pull out a giant fish! Then throw it away.
I've noticed that this behavior and the making a latte have only come since I downloaded the 1.05 version. Maybe soon I'll see someone practicing Kung Fu. 74 trophies and counting!
The best thing about 1.05 is all the new behaviors, plus they will now interact with the home improvements like the pool, the hammock, the treadmill, etc.
Where can I download v 1.05? I just noticed that I'm using v1.00 I originally downloaded the game from Shockwave but they still only have v1.00.
I want the newest version!
[Edit: The new version is 1.00.05, not 1.05. If you download it anywhere but where you originally purchased the game, you'll have to pay for it again. I would suggest you go ahead and download it again from Shockwave because the 1.00.05 doesn't necessarily show up as the correct version number during the download. You'll need to check your main menu screen to see if it downloaded version 1.00.05. It's a bit inconvenient that way, but it can't be helped at this point. -Pam]
To Lunargoddess21
To help with depressed people -
They will get better over time. Give them treats like candy and fruit. Make sure there's plenty of food and they are fed. Buy household upgrades. Have them work on their career. Don't use the red hand on them for awhile. Praise them a lot. All of these things will help bring up their mood.
To Addicted:
Check the walkthrough section located at the top of this page under the repairs spoiler. You'll find instructions on how to fix the shed door. Also, here is a screenshot of the location of the doorknob.
To Tiontia:
Socks will appear on the floor randomly during the game. Not very often, though.
To Grinnyp:
Good to know about the fish. I was able to get the Kung Fu trophy before version 1.00.05. It usually happens after giving an energy drink.
I have a guy who is 63 now. His salary is $510 and I hope he lives longer because he really brings in the money. His wife is dead and there's one daughter left who will go to college in a couple of years. :)
Too funny! I have been playing 3 families since the first day this game became available. I love it. LDW did it again. I am laughing at myself. Being the money grubbing girl I am, I didn't let my fams have kids. They were too busy working. I figured they would eventually have a child they could adopt. NO GO! One family ended yesterday with no heirs. The other today. Now, I only have one family left to play. The funny thing is: the homes had almost all of the improvements and lots of cash in the accounts. As well as most of the trophies!
What message are they giving you "a bit sick" or "exhausted" or something else.
If they are ill you should try the doctor consult, I haven't used this yet but it might tell you what is wrong with them and possibly a solution. If you try the doctor consult will you post the results? I'm curious to know what happens when you use it
To caza68 and Nora:
It takes some time for their health to recover. You just need to keep an eye on them, make sure there is plenty of food, make sure they eat, and give them medicine if they get sick again. If you give me some more specifics about what they are doing, I might be able to help more. And yes, like Shauna suggested, try purchasing the doctor consultation.
To Jewell:
No, the front gate doesn't open.
The picture pieces start showing up after you get the shed open. They will be in that part of the yard.
To Nafisah:
The TV remote will be somewhere in the house on the floor. Sometimes in the laundry room, sometimes on the stairs. It varies each time.
Pam, I came to that conclusion because after my person has been working for a LONG time at their career, I hear a noise and money goes up by only 90 cents. The other person's salary is $60 and goes up by $60 each time, but now she has a baby and does not work. the only worker is the one who makes 90 cents. Please help! I purchased this game and would like to get my money back. This is crazy!
I just started a new family, and I just noticed something interesting. I was browsing through the profiles of who I was going to adopt, and I just wondered. Which profession makes the most money, I think once I saw a girl I almost adopted who maked 145$!!!! I'm mad I didn't adopt her, haha. Thanks and please answer my question..... :-)
To Miki:
Mine have been the same way, with only a fraction of the salary going into the bank at the end of a work cycle. But it always adds up to plenty of money to buy groceries and the less expensive upgrades. Over time, they get raises and you make more money. I would suggest you start a second family and see how they do with earning money. I don't really have another solution for you, but I'll see if I can find out anything.
To Bella:
There are so many different jobs, I have no idea which one pays the most. I've seen them range from $15 to $145 like you saw. One of my people was a poet who maxed out at $510 by the time he died. It was awesome!
Hey, just thought I'd share; One of the behaviors I consider bad is when they "play daddy" or play with the tools on the workshop. Even though my little babies can't be harmed by doing so, I feel that this is a dangerous game and should be discouraged. I also discourage TV watching and video games, as I feel they are unproductive and lazy activities. I would rather my babies play outside or study.
To Jojo:
That's really interesting! I let mine play in the workshop because I'm hoping they will learn how to do things and maybe get a better career when they grow up. I consider bad behavior to be poking at the plants, drawing on walls, and banging the pans. Lol.
Maybe we should ask everyone what they give the green hand to and what gets the red hand. Would be fun to compare different playing strategies.
Hi. I have been playing the game for a few days now. Got 5 kids and level 4 and 5 in careers. I dont seem to get the repair tape or the water pump in my store. I have an old version of the game the version with 1 on the end0Iif i download the new one, will I have to start again?
[Edit: If you go back to the site where you originally purchased the game, it will save on top of your existing game and you shouldn't lose any progress. -Pam]
Just thought I'd let you know. Give an energy drink to an adult member when exhausted and they will practice kung fu. I got my trophy that way. I haven't had any serious illness, only a bit sick. I have tried leaving them to see if they get worse, but they just heal themselves in the end, but end up weak. Any ideas of how they get very sick?
I see people here talking about having multiple families running at once, is that something you can do in the trial version or only in the full one?
I picked people who didn't want kids, so I'm pretty much doomed from the start - I didn't realise you pass the house on to the next generation. I personally think that it would be nice to have the Kid's Room as an upgrade, not as a given.
I still prefer VV to VF - I think the formula works better in the desert island setting. I wish you had the ability to learn a new profession like you do on the island - I know it's a different setting, but maybe have "retraining" available as a purhcase in the store - in real life we don't have to remain in one career and in VV, you get to redirect your little person to another speciality.
When it comes to discipline I only use the red hand when they are banging dishes or writing on the walls. When they are playing in the workshop or playing cook I actually encourage them in the hopes that they will have some proficiency in those professions.
Best job I've found so far is Lobbyist, which starts around $120 and ends up around $480.
Worst job I've found is envelope stuffer. Starts around $60 and ends at around $200.
To Nora:
It's possible that your person got sick and got very weak before you were able to give treatment. Even after being treated, it takes time for the health status bar to completely full. Check the details screen periodically to see if the health bar is rising. Keep following the suggestions I made before to gradually increase health.
To Resha:
Go to the main menu screen and click on the user name. If it brings up more slots for user names, then you can play more than one family. Just pick one of the empty slots and get started.
You sometimes get an option to change your profession while playing the game. However, you don't get to choose what it will be, so you're taking your chances with it.
To Jen:
While testing the game to write the help guide, I left a family alone to see what would happen. I didn't give them any food or medicine. The wife and daughter died. The husband was very weak, but once I stepped in and started taking care of him, I was able to nurse him back to health. He lived for 20 years by himself. Never remarried and didn't adopt any children.
We have compiled a good deal of information on how to play this game, including general information, repairs, frequently asked questions, and some screenshots to help anyone who needs it. Please check to see if your question has already been answered before posting it again here. The guide is located at the top of this page, just above the start of the comments section. Thanks!
To Becky:
It's gopher holes -
You don't fix them. There's a trophy for praising someone who is chasing gophers. When you see the gopher hole and a child is "playing on the lawn" as a description, that's when you'll get the trophy for praising. The holes go away and come back from time to time. No harm is done.
Found a strange vocation, Day Trader. At every level the salary is different, sometimes higher, sometimes lower. I think this one is neat because like a real Day Trader sometimes you make big bucks, sometimes you barely scrape by. Yesterday when she was at level 6 she was only earning $95. Today at level 7 she's earning $510! Wonder what happens when she hits level 8?
I was wondering if just downloading the newer version would work, I didn't buy from Big Fish, but got it from Going through HP Game Console. So do I just redownload it and will it be the newer version? And also wondered it's been days and my peeps won't embrace, they say too soon for another baby, the 2 boys are off in college lol and it's uhh, been awhile. Will they not because she is 55 & he is 52.
Ok baby question answered sorry didn't see it. And as for the sickies, sometimes when I can't afford the $175 for the doc I just try the cheap stuff til it works and a lot of times it works & I only end up paying aroundd $20 (buy lozenges, aspirin, etc.) to heal them. Just a suggestion, that doc is expensive if you have more than a few peeps.
Also, when your people are sick, if you watch them you may see their symptoms, they will sit down and hold their bellies when they have a tummyache, jump up and down for the hiccups and sneezes, and shake their heads for a sore throat. It will also occasionally tell you in their status bar if you are selected on them. Most times, the inexpensive meds work just fine.
A easy way to speed up your game!
Change the time on your computer (Right side on your task bar)to speed up the time in the game. Be sure to put the time back real time! Don't speed it up too much otherwise you might miss some important events!
[Edit: We strongly advise against changing your computer clock. Not only can it ruin the game, it can also mess up other functions that rely on the computer clock. -Pam]
To Kitty:
Your couple is too old to have kids now, I'm pretty sure. Females stop at age 50.
To Latindiamond:
When your first person dies, you'll get a screen of instructions on how to start the next generation.
To Luvthegame:
Check the screenshot in the walkthrough section located at the top of this page to make sure you're dropping them in the right spot.
Alright, I have read through all of the comments here and so far I haven't found an answer to my question. I know how to fix the shed. I dropped my lady on the door knob.. I went to praise her for going to fix the shed and she dropped the knob I guess. Needless to say she never actually went over to the shed to fix it. Now if i pick her up and put her in front of the shed it says confused and the shed is locked! if i bring her to the welcome mat to pick up the key all it says is confused and she sees a key. she won't pick it up. i've tried red paddling her but that doesn't make her pick it up either.. help? i don't want to start over, i already have tons of trophies..


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An amusing byproduct of a life of automotive obsession is coming across some weird and interesting automotive facts. This weekend we want to know about the best automotive fact or figure you've come across so far. What is your favorite piece of car trivia?
Appropriately enough, I came across my favorite piece of automotive trivia reading Jalopnik on the weekends. My favorite piece of automotive trivia is the fact Enzo Ferrari daily drove a Fiat 128. You heard it right, the creator of some of the best performing and most beautiful cars ever made daily drove a Fiat econobox. Everything about the concept of running a company that designs and builds some of the world's best performance cars only to hop in a Fiat 128 at the end of the day is amusing and bizarre enough to take the title of top car trivia in my book.
We've told you about Enzo's odd choice of daily driver, so tell us what is your favorite piece of car trivia?


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In today's market for financial products, the array of life insurance and annuity options that are available can seem staggering at times, especially for clients whose primary goal is to provide pure life insurance protection, whether business or personal. For these clients, the costs and complications required to secure many of the bells and whistles that can accompany today's most valuable life insurance products may deter life insurance planning entirely.
Fortunately, the reversionary annuity is gaining traction among carriers — as a product that combines features of both annuities and life insurance in order to provide guaranteed income to survivors — but with modifications that allow it to be stripped of the high-end price tag that often accompanies the modern financial product.
Reversionary annuities: the basics
A reversionary annuity is a type of combination annuity-life insurance product that a client purchases (by paying premiums over time) in order to provide a set benefit to a specified beneficiary after his death. The death benefit is also paid out to the beneficiary over time, whether monthly or annually, for the remainder of his lifetime in order to ensure that the survivor's income needs are met. In most cases, the beneficiary is chosen when the policy is purchased and cannot be changed.
Reversionary annuities do not provide any access to the value of the policy during the client's lifetime, so cannot be used as a source of retirement income. The real value of a reversionary annuity is that the beneficiary cannot outlive the income that the death benefit will provide, as would be possible with a traditional lump sum life insurance death benefit. This protects against the possibility that the beneficiary will make poor financial decisions and end up with insufficient income later in life.
As is the case with a traditional annuity, the beneficiary receives the value of the premium payments (the investment in the contract) tax-free, and interest that is earned is taxed on a pro rata basis over time.
A lower price point
Reversionary annuities are typically much less expensive than a traditional life insurance policy because a reversionary annuity has value only if the beneficiary outlives the policy owner. If the beneficiary predeceases the policy owner, the policy is terminated and no death benefit is paid out.
Further, the cost of the policy is based upon the medical histories and life expectancies of both the policy owner and the beneficiary. If the beneficiary has a much longer life expectancy than the policy owner (as would likely be the case if a parent purchased the policy for the benefit of a child), the premium cost generally increases. Conversely, if it is likely that the beneficiary will live for a relatively short period following the policy owner's death (as may be the case with a spousal beneficiary), the premium cost will be much lower.
Additionally, because the policy is paid for over time, a reversionary annuity may provide a much more affordable option than a traditional annuity, which often requires a significant up-front premium payment to fund the entire cost of the contract. As a result, a reversionary annuity may provide an insurance option even to clients who are otherwise unable to fund the cost of a traditional annuity or life insurance policy.
Even though a reversionary annuity may not provide the investment-type qualities that many clients have come to expect from a life insurance policy, for other clients this type of product can play a crucial role in providing additional security — in a form that the client's survivors cannot outlive.
For previous coverage of planning for guaranteed income in Advisor's Journal, see GLWBs and LIBRs—Which Rider Fits?
For in-depth analysis of annuity planning, see Advisor's Main Library: Types of Annuities.
Your questions and comments are always welcome. Please contact the Panel of Experts.


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The General Regulation and associated standards outline the requirements which must be successfully completed in order for a member to meet and maintain the Standard of Practice for Intravenous Infusion Therapy (IVIT). Those requirements include:
* successful completion of a College approved course in Intravenous Infusion Therapy;
* successful completion of a College approved or administered examination in Intravenous Infusion Therapy.
Additionally, a member of the College must also meet the Prescribing Standard of Practice prior to being
able to administer IVIT.
Similarly, members may not administer any drug or substance listed in Table 2 of the General Regulation by non-IVIT injection (IM, SubQ) until they meet the Prescribing Standard of Practice.
Members, who at the time of proclamation of the Naturopathy Act, 2007,
held active IVT (intravenous therapy) certification from the Board of
Directors of Drugless Therapy - Naturopathy (BDDT-N) had six (6) months
following the date of proclamation to meet the Standard of Practice for
Prescribing, and in doing the Standard of Practice for IVIT. As of January 1, 2016 this six month provision of the General Regulation expired, and IVT certified members who had not met the Prescribing Standard of Practice were required to cease providing IVIT to their patients until they successfully complete the Ontario Prescribing and Therapeutics course and examination, successfully complete a College approved course in IVIT and the College's IVIT examination.
Upcoming Exam Dates
For information regarding the examination, including requesting an exam deferral or an exam accommodation, please review the Ontario Intravenous Infusion Therapy Examination handbook available in the Resources Section. Members who are presently registered for an exam or who are looking at registering for a future exam session are strongly urged to read through this information.


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Everything was full steam ahead for Gina Carano until Monday.
According to her manager, the popular fighter had had a "phenomenal camp" in preparation for a fight with Sarah D'Alelio at "Strikeforce: Overeem vs. Werdum" before an "unfortunate setback" prompted her doctor to advise against her participation in the event, which takes place June 18 at American Airlines Center in Dallas.
"She's bummed out and trained her ass off for this fight," Scott Karp today told MMAjunkie.com (www.mmajunkie.com) via text.
Strikeforce CEO Scott Coker said today that the doctor had "revoked" Carano's medical clearance to fight and added that, "The timetable for Gina's return will be determined after further testing conducted this week."
Officially, though, Carano was cleared to fight. She had submitted all required paperwork to compete and had been granted a license by the Texas Department of Licensing and Regulation, which is in charge of regulating the event. The paperwork included a physical, blood-test results and an ophthalmologic exam.
"She had met all the state of Texas requirements," Susan Stanford, a representative for the Texas Department of Licensing and Regulation, today told MMAjunkie.com.
Today, the TDLR received notice from a representative of Strikeforce parent company Zuffa LLC that Carano would not be competing at the event. No reason was given for the withdrawal.
Likewise, Coker declined to comment on the circumstances surrounding Carano's withdrawal except to read a statement from the fighter.
"I'm seriously disappointed not to be fighting June 18," Carano's statement read. "I'd like to thank Greg Jackson and Team Jackson for such an amazing camp. I hope this is only a brief setback."
Carano had taken residence with Jackson's MMA academy in Albuquerque, N.M., several months prior to the fight. The trainer praised her abilities and said she had "all the potential in the world."
When contacted today by MMAjunkie.com, Jackson also declined comment, but he said that "the whole team loves Gina."
Of course, speculation has run rampant on the reason for the sudden change. However, Karp did say the withdrawal had nothing to do with cold feet.
"Had she been able to compete, she would have handled her business," he wrote. "That I'm sure of. Hopefully that will happen sooner than later."
But for now, the world will have to wait.
For more on "Strikeforce: Overeem vs. Werdum," stay tuned to the MMA Rumors section of the site.


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Here are 10 steps to be successful on any diet:
10. Don't Wait to Start Dieting - Start right now... right this very minute. Yes, NOW! Oh, you don't have all those weird foods recommended on the diet, that come from Whole Foods and cost a bundle? Who cares, you don't need them. Zucchini, cauliflower, spinach, plain oatmeal, eggs, chicken and some cheese will feed you for a week. The store down the street has that, right? Make the very next meal you have, be the first meal on the diet. Waiting makes room for excuses.
9. Don't Cheat - Obviously, right? But really, don't cheat. If you are truly hungry and have used up your Points, calories, carbs or sugar for the day (whatever unit of measure your diet dictates) then have some of the Freebies. For me, on the Belly Fat Cure that means instead of having a candy bar, have a few squares of the allowed dark chocolate. Instead of ice cream, make a protein shake with lots of ice cubes tossed in. You get my drift --> substitute the cheat food for an allowed food. You will thank me in the morning.
8. If You Do Cheat, Forgive Yourself and Forget About It - If you cheat or slip up, start the very next meal 100% on the plan. Don't say "oh I ruined today already, I'll make it a cheat day and start fresh tomorrow". Nope! Do it NOW. Recommit right this minute. Because your carb starved mind will think of a dozen excuses between now and morning as to why you should just quit. Don't give it another thought and make sure you are stocked up on good choices so it doesn't happen again.
6. Take it One Meal at a Time - It is easy to get overwhelmed when starting a new diet, especially if you have a lot of weight to lose or have failed before. Just take it one meal at a time, and baby steps will get you there. Don't over think it and start thinking "I can't do this forever" or "You mean I can NEVER eat pasta again?" Instead just determine "I stick to my diet for this meal" and remember that at each meal. The choices will become more natural and your cravings to certain foods will lessen with time.
5. Don't Rely on Others - You have to do this for yourself. It's okay to ask a friend or family member to join you in your weight loss plan, but maybe they aren't ready for big changes. So let them be, and remember - this is about you, not them. Maybe you will lead them by example, maybe not though. This is about you and your health, and others need to find their own way.
4. Keep it Simple, Stupid - KISS basically means to not over think or make it more difficult than it already is. If you are allowed X number of calories or carbohydrates, then have them! Don't arbitrarily pick a lower number, thinking you will lose the weight faster if you have even less. By restricting yourself even further, you are more likely to binge or cheat. Keep it simple and just follow the rules of your diet plan. Once you've had some success and learned more about what your own body really needs, then you can play around with your diet's formula a little. But not in the beginning, it just complicates things.
3. Every Pound Counts - Don't ever let me hear you say "I only lost 1 lb this week", because every single pound counts and every single, little bitty pound will get you closer to your goal. Congratulate yourself and commit to losing at least as much next week. Instead say "Wahoo! I lost a pound this week!' Celebrate every pound lost.
2. Get to Know Yourself - What is the hardest time of day with food for you? What food can you not, no matter what, control yourself with? For me that is evenings, after dinner and before bed. And just like the back of the Lay's Potato chip bag says, I cannot have just one. Only a bag will do :( So I avoid chips completely, I know for me they are trigger food. For the first few months of dieting I made a very low sugar shake right after dinner, to help with the old "full feeling" my body still craved.
1. Don't Let The Scales Dictate Your Success - Those scales can be so, so cruel! I remember standing on the scales Monday mornings, bladder empty and naked, with all my breath pushed out (cuz that air has to weigh something, right?) only to see the same old number. I'd curse at that scale, and sometimes even cry. That happens. But stop and take inventory: Don't you feel better? Is your clothing feeling looser? Keep up the good work, and next's week weigh-in will make it all pay off. Don't let one bad weigh in spoil your success.
If you have a tip to diet success, please share it in the comments!
More diet success advice HERE


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Search for Allen County, KS property appraisal information. A property appraisal search can provide information on property values, past property values, building improvements, renovations, property tax assessments, unpaid property taxes, tax liens, foreclosures, former owners, current owners, neighborhood appraisal values, building code violations, property inspections, property reports, and property descriptions.
The Allen County Assessor helps calculate property taxes by determining the appraisal value of the taxable property in Allen County, KS. Assessors maintain a number of documents related to property appraisals, including property inspections, buildings and any improvements or renovations, and Allen County property appraisal reports. Their office also has documents on property tax assessments, current and former owners, the property's size and location, and any unpaid property taxes or tax liens. These documents can be important resources for property owners or potential buyers, and may include historical property appraisals. These Allen County property appraisal records may be available online through the Assessor Office website.
Allen County Assessor's Office Iola KS 1 North Washington Street 66749 620-365-1415
The Allen County Recorder of Deeds keep a range of real estate and property records for a county or local government as part of their job to ensure the accuracy of property, land, and property tax records in Allen County, KS. Their records include information on property appraisals, including past appraisal values, property improvements and renovations, and property tax assessments. These property records typically list the current and former owners, the property's size and location, and its payment history such as tax liens, unpaid property taxes, or foreclosures. These documents can be an important source of information for property owners and potential buyers. Recorders of Deeds may provide online access to their Allen County property appraisals.
Allen County Recorder of Deeds Iola KS 1 North Washington Street 66749 620-365-1412
The Allen County Treasurer & Tax Collector Offices collects local taxes and disburse the funds, which includes property taxes in Allen County, KS. As part of this responsibility, they maintain records on Allen County property appraisals, including property tax assessments, historical appraisal values, and property improvements or renovations. These Allen County public records typically list the current and former owners of the property as well as a description of its size, location, and its payment history, such as tax liens, unpaid property taxes, or foreclosures. They may also include Allen County appraisal values for neighboring properties. These property appraisal records are an important source for property owners and potential buyers. Treasurer & Tax Collector Offices often provide online access to their Allen County property appraisal records.
Allen County Treasurer's Office Iola KS 1 North Washington Street 66749 620-365-1409


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Archived:How to write good problem report
Good problem report should include
0. Note that you are using V4L CVS.
1. Name of card
2. lspci -vn
3. Dmesg log of module tuning and probing. It also nice to add audio_debug options to modules, tuner_debug option to tuner module and debug option to tda9887
4. Television standard for your country.
5. Exact sequence of actions that causes your problem.
6. Generally, "your problem" is a combination of an app and a driver. Also generally, the problem only exists in one of those, but it isn't always easy to tell where. A big help is to check each part with various tools in the Test_Suite.


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U.S.-based private equity firm Cerberus Capital Management LP has sold a 1,900-square-meter land parcel in Tokyo to Japanese general contractor Shimizu Corp, riding on the property market boom in Japan due to Abenomics.
West Loop Holdings, a joint venture of GE Capital Healthcare Financial Services, KMF Senior Housing Investors and Senior Lifestyle Corporation, has sold a senior housing portfolio in the U.S. to Griffin-American Healthcare REIT II.
Frankfurt-based Deutsche Bank has purchased the WestendDuo office tower in Frankfurt from CBRE Global Investors Inc. for approximately €240 million ($326 million).
U.S.-based American Realty Capital Properties has purchased a property portfolio from affiliates of funds managed by Fortress Investment Group LLC for $601.2 million, excluding closing costs.
A consortium spearheaded by Perennial Real Estate Holdings has agreed to purchase a Singapore office and retail tower from the Asia Real Estate Income Fund, which is managed by the Pacific Star Group, for S$970 million ($766 million).
Philips Pension Fund has sold the Symphony Offices to Deka Immobilien GmbH for approximately €215.1 million ($294.5 million), making it the largest real estate transaction in the Netherlands in 2013 to date, according to CBRE.
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Nikit Abhyankar
Nikit Abhyankar
Energy/Environmental Policy Research Scientist/Engineer
(510) 486-5681
Dr. Nikit Abhyankar, a Scientist in the International Energy Analysis Department at the Lawrence Berkeley National Laboratory. He is also an Affiliate and Senior Scientist at the Goldman School of Public Policy, University of California, Berkeley.
Dr. Abhyankar has conducted extensive research and policy analysis on a range of key energy issues such as renewable energy, energy efficiency, electric vehicles, and energy access in United States and key emerging economies such as India, China, Indonesia, and Vietnam. In particular, his research focuses on the following areas: (i) renewable energy resource assessment and grid integration, (ii) electricity markets and policies, (iii) technology and policy / program assessments for appliance efficiency improvement, (iv) impact of transport electrification on the grid, and (v) technology solutions for expanding energy access.
Dr. Abhyankar has published over 40 peer reviewed journal papers, research reports, and conference papers, and his research has been widely covered in the media, for example - The Los Angeles Times, Forbes, The Verge, The Hindu, Fountain Ink, Outlook India, Live Mint , InsideClimateNews, DailyEnergyInsider, NewsWise, Down to Earth, Listening Brief etc.
Prior to joining LBNL, Dr. Abhyankar worked with Prayas Energy Group in India where he analyzed the prevalent regulatory and policy issues in the Indian power sector such as reforms, rural electrification, tariff design, and RPS, etc.
Dr. Abhyankar received a PhD from Stanford University in Environment and Resources. He has a master's degree in Economics and an undergraduate degree in Electrical Engineering.
"Modeling India's energy future using a bottom-up approach." Applied Energy 238 (2019). .
"Assessing the Cost-Effective Energy Saving Potential from Top-10 Appliances in India." 9th International Conference on Energy Efficiency in Domestic Appliances and Lighting (EEDAL). 2017. .
Techno-Economic Assessment of Deep Electrification of Passenger Vehicles in India. 2017. LBNL-1007121. .
"Data for development: The case for an Indian energy information administration." Energy Research & Social Science 25.March 2017 (2017). .


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Equity futures are roughly flat to slightly lower so far this Monday – hey, you know some HFT ramp attempt is coming, it will only take one knucklehead to get the ball rolling into ramp mode, the others computers will sniff out that transaction before it's even executed and it'll be game on! There's an open gap in the charts up to 1067 that everyone is watching… normally I would expect that gap to fill before resuming the downtrend:
Meanwhile, bonds are higher, the dollar is roughly flat, while oil and gold are both slightly lower. The Yen, is making a fairly sizable move higher as Japan's Central bankers said they will spend 920 billion yen on economic stimulus and the central bank added 10 trillion in "liquidity injections." What's another 11 trillion among friends, eh? Evidently not enough to really move the Yen lower like they want, so far they are getting the opposite reaction as the carry trade continues to unwind. While a trillion Yen is "only" the equivalent of about $11 billion (roughly $120B total), when talking injections in the multi-trillions like this, it is safe to say that the Yen is quickly on its way to a major restructuring, it's just a matter of time before it'll take a trillion yen just to buy a bowl of rice.
And here in the States, it's also getting harder to buy a bowl of rice as Disposable Incomes dropped after adjusting for inflation. Yet on the surface, Personal Income rose .2% in July. That was, however, below the consensus of .3%. Consumer Spending, as they track it, supposedly rose .4%, not a good thing when your income only rises .2% (unless you like debt). Here's Econoday's spin:
The consumer made a comeback in July-in both income and spending. Personal income in July posted a 0.2 percent gain, following no change in June. The July figure was a little lower than the consensus expectation for a 0.3 percent rise. More importantly, the wages & salaries component rebounded 0.3 percent after slipping 0.1 percent in June. This component would have been even stronger had it not been for a dip in government payrolls from laying off temporary Census workers. Private industry wages and salaries gained 0.5 percent in July, following a 0.1 percent dip in June.
The Fed is depending on the consumer to counter a faltering housing sector and Bernanke & Company got its wish at least for July. Overall personal consumption increased 0.4 percent in July, following a flat number in June. The latest beat the market forecast for a 0.3 percent gain. By components, durables jumped 0.9 percent, nondurables rose 0.3 percent, and services gained 0.4 percent
Who would have thought that an uptick in inflation would be good? Given the deflation mongering in some sectors, a 0.2 percent rise in the headline PCE price index for July looks good, following two months of down 0.1 percent. The core rate edged up 0.1 percent after a flat reading in June. The median forecast for the core had called for a 0.1 percent uptick.
Year on year, personal income growth for July came in at up 3.0 percent, advancing from up 2.4 percent in June. PCEs growth improved to 3.4 percent in July, compared to 3.2 percent in June. Year-ago headline PCE inflation firmed to 1.5 percent from 1.4 percent in June. Year-ago core PCE inflation is unchanged at 1.4 percent.
Today's report is not stellar but it is welcome news that the consumer sector bounced back and should help support overall economic growth.
Yes, who would have thought that an uptick in inflation would be good? Give us a break, I'm not buying it. The Fed is trying to create the illusion of inflation as they jawbone and manipulate data, but there is no way I believe that wages are rising for more than a nanosecond in this current environment. Wages won't make any progress until hiring picks up, and even this report shows that the consumer will be pressured as spending more than you earn is not a sustainable relationship no matter how much the Fed and the market pumpers would like it to be. How come we can't cheer and strive for balance? Could it be that it doesn't help the debt pushers?
Also keep in mind that the largest segment of the population, the Baby Boomers, are now past their peak earning years and that they are moving beyond it much faster than they are being replaced. This means that overall earnings in our nation will continue to be pressured as will outflows from the markets. The next significat demographic uptick in peak earners won't influence our economy until the year 2022 (unless the debt pushers can pull all of their income forward in time too – which is not likely especially as the social mood changes).
There is a lot of economic data coming this week, culminating with the Employment Report on Friday. Should be interesting.
From a technical perspective, I'm still counting the August 25th low as the bottom of wave 1 of 3. It looks like an a,b,c for wave 2 has occurred since that time and that we are near the completion of wave c. If that is correct, we should see significant declines soon. The alternative is that we bottomed the larger degree wave 1 and this is a more significant wave 2 which I give lower odds.
Friday's action was VERY interesting as the HFT machines all got on the long side all day long. On the surface it looked strong producing a 92% up day, the 12th 90%+ up day since the April top to go along with 13 90%+ down days! This is nutty action for sure, it shows great distress and internal conflict in the market – not something that is bullish. Amazingly, despite the 92% ramp, we still received yet another Hindenburg Omen, the 5th in this cluster as the number of new lows rose dramatically over Thursday's count, despite the ramp. That is a sign of sickness, a strong internal divergence.
I have heard a lot of talk that it's vacation time again in the Hamptons, so be careful as the trading volumes are likely to be low… yet as we exit the month of August and roll into September, keep in mind that September is statistically one of the weakest months of the year. And here we are poised with multiple layers of Head & Shoulders patterns, 5 Hindenburg Omens, and a wave count saying that 3 of 3 is soon up to bat in the rotation.
Beatles - You Never Give Me Your Money:


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Houston, TX – June 19, 2017 – CampusLATELY.com the #1 collegiate community and leading college marketing firm proudly announces its support with Roland Martin's initiative #HBCUGivingDay and is asking all HBCU Alumni to take the HBCU pledge #pledge60. The importance of the initiative is to donate money to support scholarships and research at institutions geared toward the education of minorities and first generation students. With around 70 percent of all HBCU students relying on federal grants and work-study programs to finance their studies, #HBCUGivingDay becomes more imperative.
The host, and managing editor of TV One's NewsOne Now, Roland Martin, recently shared the importance of HBCU graduates giving back to their institutions during an interview with The Breakfast Club. According to The U.S. News & World Report, as little as 3% of HBCU Alumni give back to the university that helped shape them.
It's time for a change, and CampusLATELY campaign is requesting that every HBCU Alumni pledge to give $60 to their Alma Mater with #pledge60. In pledging with CampusLATELY, each Alum is helping their HBCU gain additional funds. CampusLATELY has partnered with several companies to "Match" what is pledged.
"We can't rely on public dollars to save our institutions. When the foundation says, 'What's the giving of your graduates?' and they say 'Only 3 percent of our graduates give.' A foundation goes, 'You're asking me to give you $10 million, but only 3 percent of your graduates are giving?' That means 97 percent [of graduates] are not even sending a dollar back," said Roland Martin. "For me, we have to be about saving our institutions, building our institutions, and strengthening our institutions, whether it's our civil rights groups, whether it's our HBCUs, or whether it's our economic groups."
La' Shawn Chambers, CEO Chambers Media & Co. said, "We "Genuinely LOVE" our Historically Black Colleges and Universities and are so proud of them, in fact, most HBCU ALUM makes it a practice never to miss a Homecoming. However, most have also never given a dollar to their alma mater."
For the success of this campaign, CampusLATELY is also asking for sponsors to match the amount pledged by the Alumni to the top 5 schools. How does it work? Visit http://campuslately.com/pledge/ and pledge to give to your university of choice, after which you will be directed to the school you choose to complete the pledging process. Click the "Make a Donation" button and DONATE. It's important to start now and focus on its continuity as the target for this year is $60, and possibly more next year.
We are all aware of the importance of HBCU's, and it is your responsibility, not a right, but a requirement to help those who come after you. With this, CampusLATELY believes it's time for all HBCU Alumni to donate to strengthen OUR institutions.
For more information on the fundraising or to become a sponsor, CLICK HERE
About CampusLATELY
Founded by La' Shawn Chambers, a Prairie View A&M University graduate. CampusLATELY launched in 2013 and has since grown their mission to provide college students with the platform, tools, and resources needed to achieve success. CampusLATELY.com features social content on Campus Life, Style, College News, Entertainment, Relationships, Health & Fitness, and Career Development, written entirely by current and former top college journalists from 30+ college/universities nationwide.
Media Contact
Company Name: CampusLately
Contact Person: La\' Shawn Chambers
Email: email@example.com
City: Houston
State: Texas
Country: United States
Website: www.campuslately.com