Finding a Church, Visiting with Family

Attended the Blacksburg United Methodist Church. I liked it. Not certain that Vicki did. She wants to look around more which I will do with her to maintain harmony. After there church Wende and family came down for the rest of labor day weekend. Ate out, walked around the Virginia Tech campus, played Rummicube, and read to the kids.

On Our Own

Looking for land by ourselves while realtors and others take off for the Labor Day Weekend. Found some beautiful property in Deercroft, but will probably be too expensive and may not be for sale. Steep drive way, rock that is difficult to penetrate, lack of city water and sewage make the price of the land escalate beyond our means, but the view is terrific. Looked a numerous other lots that made us think of a poor man's college station priced for a prince. Dejected, but not discouraged and more determined to find the land God has picked for us. I will pray more specifically for him to take us directly to the land. God is faithful if one takes the time to develop and relationship with him and stores his ego in an impenetrable cave.

Land That Appears to Avoid Depreciating

Looking for more land with nancy Phillips. Later went to Coal Ridge Hollow where there exists beautiful land that appears to be bought up for investment opportunities. About a dozen or so homes have been built, but there is a vast forest land of 2-3 acre lots that have been untouched for several years. Later Nancy confirmed that people buy land for investment here and so for the bubble has failed to pop.

We Meet Nancy Phillips

Jim Wesel, manager of Oak Tree Town Homes who leased our house to us and who is quickly becoming a good friend and a source of information (The book, The Tipping Point, would designate him a Mensch.), gave us the name of Jim McAlister, President of First Bank and Trust, who gave us the name of Phi Beta Kappa graduate from Randolph Macon University, Nancy Phillips who is a desigener and builder as well as real estate agent. She will take Vicki through the entire building progress, going as far as taking her to pick out kitchen and bathroom fixtures. We immediately took a liking to this practical, honest, and knowledgeable builder. Vicki talked design with her and then we went traipsing around lots.

Later, met with Jim Wesel to finalise our lease. Called Atmos to have our gas turned on on the 27th of September and went by Christiansburg Municipal Building to sign up for water and sewage.

Met with Eric Roethlisberger, another builder to look at one of his homes and talk about land. After talking with Andrea's sister Nici and her husband Jason who told us of sealing and chinking required for log home maintenance we decided once and for all against the log house. Called Diane Boon and told her of our decision. She was very pleasant and in retrospect the least "pushy" realtor with which we have ever met.  

We Have Dinner with a Natural Leader who is a Christian.

Drove all over the New River Valley looking for land on which to build then a fabulous dinner and Frankie Roland's Steak House in Roanoke with the Medical Director ofthe Carilion psychiatric unit in Roanoke and New River Valley psychiatric unit in New River where I am section chief. He is a Christian and a medical visionary who seeks outstanding quality of care and innovation. He is eager to help make the physician owned Carilion the standard for all physician owned hospitals around the country. He also wants to develop a first class research program, and medical student and, and psychiatric  resident training programs within a spiritually based program. He is a devoted Christian who prays before eating in a fancy restaurant and abstains from hard drink. He is unashamed to speak of Jesus Christ and is a natural and kind leader who has the courage of his convictions with the assertiveness to pursue what he wants.

Some Important Future Associates

Had a long lunch with Dennis Means, MD, Vice President for Medical Affairs,  and Don Holliwell Administrator, Carilion New River Valley, Virginia at which time we discussed goals for the psychiatric unit and an informal partnership to improve the quality of care at Carilion. Also met briefly with Charlotte Ramsey, Chief Nursing Officer, Carilion New River Valley Medical Center and Elizabeth Wade LCSW, Director of Clinical Programs, Psychiatric Unit.

In between looked for land for building and the Preston Forest log cabin. Too expensive and too many problems--master bedroom on third floor along with a guest room that shares a bath with the master bedroom; unheated laundry in the basement; log burning fireplace instead of gas burning fireplace. Log burning fireplace creates messes when bringing to logs in the house and temperature inversions can cause smoke to drift back into the house.  

New Friends and New Temptations

Had breakfast with Rhonda Creger, recruiting coordinator for Carilion Hospitals and her husband, Wayman, Senior Pastor of God's House, A Church for all Generations in Pembroke, Virginia. They are both terrific people who add to the conviction that we did the correct thing in taking this new job.

Looked at a fabulous log cabin with realtor Diane Boon that was too expensive for us. You can look it up on Realtor.com by entering 4560 Chowning Trail in Preston Forest Blacksburg, Virginia. What do you think? The price is prohibitive, but the reduction in cost is tempting. The cabin has been reduced frmo $690,000 to $545,000.

A Friend and a Rental Home Found

Victoria and I drove all over the New River Valley in Virginia looking for property. We checked out a small house in Radford, Virginia that had been purchased by a realtor for her daughter to live in while the daughter attended Radford University. After the daughter graduated from college the 1500 square foot cottage was put on the market as a property to lease. It was a cute little home from the outside, but way to small for us on the inside. You can check out the property at 116 Hammet Drive, Radford, Virginia online at Realtor.com. It could be just right for you.

We then looked at a Victorian home on Tuckahoe Drive in Riner that looked great on the internet except that the Master BR was upstairs and all the ceilings were 8 feet. In person the place was a wreck--at least it looked like a wreck to us. You can't always trust the Internet when looking for homes. You might like it though. Check it out on Realtor.com

When I was looking for Tuckahoe Drive I pulled into a Shell Service Station at the corner of Highway 8 and Tuckahoe. I didn't realize that Tuckahoe bordered the Shell Station at the time. I asked two employees at the Shell Station if they knew where Tuckahoe was. They both said they had never heard of it. 

In small towns the post mistress at the post office is always a good source for gossip and real estate deals. This nugget proved true in Riner were the post mistress gave me details on all the real estate properties in the county. If I had bought something, I would have paid her a commission.

We drove all over the Riner area. Our initial impression was that the land was too wide open. There are beautifully green rolling hills with endless vistas. Sadly that means that on ridges you can see much more than you want to like house trailors, junk yards, and Interstates. Nothing is hidden when the land is cleared that the elevation high.

I showed Vicki the New River Hospital where I will begin working October 1, 2008. She liked it.

While we were driving all over Radford County, Vickie noticed an add in a real estate magazine for rent homes. We called Jim Wesel who met at this office in Christiansburg with some house keys. The first home he showed us we took. It was built in 2005. It had a nice yard with trees in the back and was clean and neat. The lease price was gracious and the house is seven miles from the hospital. You can check it out on Realtor.com by entering 215 Barkwood St., Christiansburg, VA.

Jim Wesel, a Methodist, was also a fount of information and stories such as the tale about the lady who flushed her potted plant down the commode and wondered why it kept stopping up and the women who kept 10 dogs in the house. The dogs lack of training left the walls and carpets malodorous and mildewed. When cleanup costs ran to over $10,000 she told Jim, "Go ahead and sue me. I don't have any money, so a law suit won't bother me." 

A Diary of Events

Went to Church with Wende and Greg and their family. Greg is Associate Pastor at Glenstone Chapel housed at Marvin Ridge High School, 2825 Crane Road, Waxhaw, NC. www.glenstonechapel.org  Greg is a wonderful example of a person who has received a spiritual gift. He couldn't lead a group of girl scouts in silent prayer until engulfed by the Holy Spirit. Now he preaches spirit filled sermons that are given to him as a gift from God. After church and lunch with the family, Victoria and I drove to Blacksburg, Virginia where we checked in at The Inn of Virginia Tech.

Enjoying the Fruits Left by Jim and Tammy Bakker

Victoria and I flew to Charlotte where we arrived on time and picked up an Enterprize rental car and drove to visit our daughter and her family in Ft. Mill, SC. Less than a mile south of Charlotte, Ft. Mill, South Carolina offers the advantages of the big city without big city taxes and big city congestion. Jim and Tammy Bakker who began the PTL (Praise the Lord) Television Network awoke the sleepy little town by developing Heritage USA in Fort Mill, South Carolina in the early 1980s. The Bakker's were brought to their knees and carted off to prison when their conspicuous consumption caught the attention of the Charlotte Observer. The debt they left behind allowed young couples like Greg and Wende to purchase beautiful homesites with Country Club amenities at a reasonable cost.

After Victoria and I unpacked, Wende and I played tennis on Tammy and Jim Bakker's tennis courts. I mention that I beat Wende 6-1, 6-1, only because that this will probably be the last time I will ever beat her in tennis. She is a tremendous athlete who excels in every sport and I was able to beat her because I have been taking lessons three days a week for the past four months from the best teaching tennis pro I have every encountered, Todd Taylor of Pebble Creek Country Club in College Station, Texas. Wende hasn't played tennis at all for almost a year. Nonetheless, I will savor the victory because time's swift clock hastens my physical decay with each passing day.

New Ventures

Headed for Charlotte to see Wende, Greg, Lori, Lindsey. Maybe Wende and I can get in a set of tennis and then some parlor games and perhaps review the business plan for Walker Communications--how to get encouragement to the most numbers. On Sunday to Greg's church. Then tennis again? And then on to Blacksburg.

Connectons

LifeWorks            Volume 12 No 8                                    August  2008

            Most nights our house is empty. Our kids are grown and gone; our grandchildren have moved away with them. So, to keep a family tradition going, I read at night to my wife, Vicki. For the past few nights, I’ve been reading one of our favorites of all read-out-loud-books, Peter Pan, by James M. Barrie. Later, Vicki and I began talking about J. M. Barrie and his connection with Daphne du Maurier author of Rebecca, The Scapegoat, The House on the Strand, and Jamaica Inn. J. M. Barrie and Daphne du Maurier were associated much closer than six degrees of separation.

            Six degrees of separation refers to the concept that if a person is one rung away from each person they know and two rungs away from each person who is known by one of the people they know, the mathematical progression indicates that everyone is approximately six rungs away from each person on Earth.

            In 1990, an American playwright John Guare wrote the play Six Degrees of Separation that, in 1993, was adapted for the screen. Soon other television and cinema scripts would incorporate the concept, launching the phrase into everyday lexicon. The game Six Degrees of Kevin Bacon posits the challenge to link any actor who has appeared in a movie with Kevin Bacon through no more than six connections. (A computer analysis has shown that the actor Rod Steiger has more connections with other actors than any other movie star.)

            In 2001, a Columbia University professor, Duncan Watts, used 48,000 e-mail senders in 157 countries to demonstrate that the average number of messages to deliver packages to strangers was around six. A 2007 study examining data from 30 billion conversations among 240 million people found that the degree of separation, before strangers were connected to each other was 6.6.

            Gregarious people have a smaller degree of separation. In the book, The Tipping Point, Malcolm Gladwell compared change in social phenomena with the spread of infectious diseases. The moment in an epidemic when a virus reaches critical mass is known as the tipping point. When the tipping point is reached the graph showing the rate of infection goes straight up. Gladwell contends that social actions sometimes behave just like outbreaks of infectious disease. A drop in crime rate, a book by an unknown author exploding into a best seller, the sudden development of a “must have” product, the popularity of a movie—all these sudden changes can result from social epidemics. According to Gladwell, the tipping point in social change results from the confluence of three types of people that he calls agents of change:

1. Mavens accumulate a wide-range of obscure knowledge and share it with others.
2. Salesmen are charismatic people who have an impalpable trait that makes others want to be in agreement with them.
3. Connectors have a special gift of making friends with just about everyone. Randomly take a list of 250 surnames from a phone book. Go down the list and give yourself a point every time you see a surname that is shared by someone you know. The higher the score, the more connected you are. Gladwell has given this test to almost 400 people. Of those 400, two dozen had scores under 20, eight had scores over 90, and four had over 100 points.

            Connectors bring to mind a friend of mine. Jeff Savell knows just about everyone. Go to a football game and the fans, the yell leaders, the coaches, and even Reveille wave at Jeff. At international conferences, everyone from all over the world knows Jeff. Go to a large party and all of the guests feel that Jeff is their best friend. Jeff’s reputation engenders this story: Jeff is so popular that he is given a private audience with the Pope. During their meeting, the Pope invites Jeff to accompany him on the balcony overlooking St. Peter’s Square and wave to the huge crowd below. Two people in the crowd look up at the two men waving from the balcony. One asks the other to identify the two people on the balcony. The man replies, “I don’t know the guy wearing the white cassock and zucchetto, but the man standing next to him is Jeff Savell.”

            J. M. Barrie was the Jeff Savell of his day. He counted Robert Louis Stevenson, George Bernard Shaw, H. G. Wells, and Thomas Hardy as his friends. Barrie founded a cricket team consisting of Conan Doyle, A.A. Milne, G. K. Chesterton, P. G. Woodhouse, and other luminaries. He was godfather to the son of Robert Falcon Scott, the Antarctica explorer. He told stories to the young daughters of the Duke of York, who would become Queen Elizabeth II and Princess Margaret. During the height of his career, Barrie was better known than any writer of his time.

            The Arthur Llewelyn Davies family consisting of the parents Arthur, Sylvia, née du Maurier, and their five sons George, John, Peter, Michael, and Nicholas (Nico) played an important role in Barrie’s career. Barrie met the boys in Kensington Gardens where he walked his Newfoundland dog Porthos. He entertained the boys with his stories. When Arthur Llewelyn Davies died in 1907, Barrie provided financial support for the family. Following Sylvia’s death in 1910 Barrie became the boys’ guardian. The boys served as inspiration for the characters in the play Peter Pan that had its first stage appearance in 1904.

            With Sylvia Llewelyn Davies and her children, we come to the connections between J. M. Barrie and Daphne du Maurier.           

Ø    George du Maurier—Daphne’s grandfather and author of Trilby, the story of a young girl transformed into a diva by the evil musical genius Svengali. Trilby inspired the 1910 novel, Phantom of the Opera, that was later adapted into the longest running Broadway show in history. The word “Svengali” has entered the language meaning a person who, with evil intent, manipulates another into doing what is desired.

Ø    Gerald du Maurier— Daphne’s father and actor acclaimed for his dual role of George Darling and Captain Hook in J. M. Barrie’s play, Peter Pan

Ø    Angela—Daphne’s sister and a beautiful actress who played Wendy in Peter Pan.

Ø    Peter—Daphne’s cousin and publisher of her first short story, identified as the name source of the play, Peter Pan.

            Now the circle closes in the dénouement: We are all connected, perhaps not as dramatically as the Barrie-du Maurier connection, but we are all linked nonetheless. This idea gives me great comfort, because Vicki and I are moving to Virginia to be nearer to our children and grandchildren who live in the Carolinas. As we move, we trust that the connections we have made in College Station will remain unseparated by six degrees.

Utility Numbers for New Move

UTITLITY INFO

Water, sewer, and garbage = will be turned on

           

            Town of Christiansburg                         540-382-6128

            100 East Main St.

 Water                                                                        540-382-9519

 

Atmos Energy (Gas)                                                540-951-9184

                                                                        540-639-1662 (local)

 

All connect                                                            866-269-4825

Ø    Account number = 8785582

 

AEP (Power) will be turned on Sept 23            800-956-4237

Ø    AEP account number = 02462166832

 

Verizon Phone                                                            540-954-6222

Ø    Our land line number is 540-381-2898

Ø    Cost = $49.99

Ø    Verizon Internet confirmation number = 779218096

 

Direct TV                                                            800-488-5069 or 628-5175

Ø    Account number = 81655270

Ø    Will be connected from 0800-1200 AM on October 1

Ø    Will get about 200 channels for $39.95 if file for two rebates

o      After activation of TV go to internet and enter DirectTV.com/rebate give the account number (81655270) and apply for rebate

o      The go to www.dstvgift.com and print off a form and complete form and mail in and will get first 6 months of free internet for $29.99 after that

 

Mowing = Harvey @ First Impressions            540-392-7783

 

Roanoke Times                                                540-381-1655

 

Jet Broadband Cable                                                1-877-743-8538

 

Internet NRV Unwired                                    540-239-0318           

 

$1300 rent due the first of each month to Oak Tree Town Homes

Ø    I E-mailed Wende this info

Ø    Jim Wesel 540-382-5885                        

Children Get Older Too

With my love walked up valleys and down

Climbed a mountain and turned around

Saw my reflection in sun shining souls

The heart’s joy brought me down.

Reflections in the eye

Where is love?

Can the child in my heart go with the ride?

Can I sail thru the changing ocean tide?

Can I handle the seasons rearranging?

Well, I’ve been afraid of changing

Cause I’ve built my life around you

But time makes you bolder

Children get older

I’m getting older too.

Take my love, take it around

Climb a mountain and turn back down

If you see my reflection in sun shining souls

May the new destinations make it shine on?

NEUROPSYCHIATRIC ASPECTS OF CEREBROVASCULAR DISEASE

The neuropsychiatric complications associated with cerebrovascular disease include a wide range of emotional and cognitive disturbances.

MAJOR DEPRESSION

Ø    Prevalence: 20% of patients with cerebrovascular disease

Ø    Clinical symptoms: Disheartened mood, gloominess, dreariness, pessimism, diurnal mood variation, anergia, weight loss, early-morning awakening

Ø    Associated lesion location: Left frontal lobe and left basal ganglia during the acute period after stroke

Ø    Treatment: Pamelor: proved effective in randomized placebo-controlled dbl studies

MINOR DEPRESSION

Ø    Prevalence: 10-40% of patients with cerebrovascular disease

Ø    Clinical symptoms: Lugubrious mood, disinclined to social interaction, decreased appetite, uneasiness, disquiet

Ø    Associated lesion location: Left posterior parietal and occipital regions during the acute poststroke period

Ø    Treatment: No controlled studies. SSRIs perhaps???

APATHY

Ø    Prevalence: 22% of patients with cerebrovascular disease

Ø    Clinical symptoms: Anhedonia, doleful demeanor, ennui, languor

Ø    Associated lesion location: Posterior internal capsule

Ø    Treatment: No controlled studies. Cognitive Behavior Therapy, perhaps???

MANIA

Ø    Prevalence: Rare

Ø    Clinical symptoms: Grandiloquent mood, libertine appetites, magniloquent well-being

Ø    Associated lesion location: Right basotemporal or right orbitofrontal lesions

Ø    Treatment: Depakote

ANXIETY DISORDER

Ø    Prevalence: 27% of patients with cerebrovascular disease

Ø    Clinical symptoms: Apprehensive dread, restiveness, insomnia, fretfulness, angst

Ø    Associated lesion location: Left cortical lesions, usually dorsolateral frontal lobe

Ø    Treatment: Avoid benzodiazepines because they impair cognition

CATASTROPHIC REACTION

Ø    Prevalence: 19% of patients with cerebrovascular disease

Ø    Clinical symptoms: Choleric agitation, strident acrimony, bellicosity, vitriolic brooding, menacing intimidation, obstreperous attitude, scurrilous vocabulary

Ø    Associated lesion location: Left anterior-subcortical region

Ø    Treatment: No studies. Depakote, perhaps???

MEDICATIONS TO AUGMENT ANTIDEPRESSANTS

         At least 40% patients treated with adequate doses of standard antidepressant medications fail to respond. That means four out of ten depressed patients are inadequately treated. Here are some suggestions for augmenting the effects of antidepressants.

 

BRAND NAME (GENERIC NAME)	HOW THE DRUG WORKS	APPROVED OR SPECIAL USES	DAILY DOSE
Provigil (Modafinil)	Enhances activity in the hypothalamic wakefulness center	Narcolepsy, shift work sleep disorder, sleep apnea, fatigue, ADD	200 mg once daily or 200 mg twice daily
Eskalith CR (lithium)	May alter second messenger systems	Bipolar depression, mania	450 mg twice daily
Trilafon (perphenazine)	Blocks dopamine D2 receptors	Used in combination with amitriptyline and sold under the trade name Triavil. Especially useful in patients with multiple physical complaints	Triavil 2/10 or 2/25 one to six tablets
Risperdal (risperidone)	Alpha 2 antagonist properties may contribute to antidepressant actions.	Schizophrenia, psychosis, bipolar disorders, impulse control disorders	0.5 mg-6 mg
Lamictal (lamotrigene)	Blocks sodium channels, inhibits release of glutamate	First line treatment option for bipolar depression	25 mg-400 mg
Adderall	Enhances dopamine actions	Attention deficit disorder	20-60 mg

Computer Heaven

Carey:

Just in case you decide to come back to the office, our computer has now taken the trip to pc heaven. When the people putting in the phones blew the Navasota hospital circuit our computer bleeped over. We called Code Blue but it could not be resuscitated. People from HISS came today and took the body parts away. No files could be recovered. Its all gone...gone...gone.  I called Wende and asked what we had lost and she couldn't think of much. The mailing list had already been sent to me. I have most of the important stuff on my home computer. We will have to get the daily census from one of the hospital's computers. This death brings good news that there is one less item to move to Virginia. It was good that our long suffering pc died here rather than be buried in a foreign land.

Dad:

Glad you can laugh about it, even if it is the hysterical, admit-me-to-the-BHU type of laughter!

Love,

Wende

Dear Wende:

What an unbelievable transition. Everything, literally, everything that could go wrong has gone wrong at the office. I don't know how much your mother has told you and the tragedy is too involved to write about. Your wonderful Mother deserves the Nobel Prize for Grace Under Pressure. She has done fantastically well. Anyone else, including Carey and Chrystal, would be in the hospital receiving ECT. 

Thankfully a few minutes ago Carey called on her way back from her vacation. I told her that I wanted her to return her bonus check for leaving us and that I her mother and father would be unforgiven forever for taking her away. With those threats she agreed to come back for a few days. Of course, she called to say she wanted to come back and help us. She was concerned about us even before she heard the American Office Tragedy. I want you to pay her $20/hour (this actually computes to a little under time-and-a-half, but sounds better) because she has been so faithful. Before she left Vicki and I decided that she did the work of three people and her absence proved our conviction. (Chrystal also did the work of three). Their absence makes me realize how lucky I have been these last eight years and how glad I am to get out of the office, because I would never be able to find another like them.

I really haven't suffered any except to watch the trials and tribulations of your mother. 

Love,

Dad

THIRD-GENERATION AND SPECIAL ANTIDEPRESSANTS

BRAND NAME (GENERIC NAME)	HOW THE DRUG WORKS	SPECIAL USES	DAILY DOSE
Desyrel (Trazodone)	Serotonin 2 antagonist	Insomnia—the drug of choice for insomnia because it is not addicting and boosts serotonin which often is the reason for insomnia. Very useful for alcoholics and drug abusers.	50-600 mg
Effexor XR (venlafaxine)	Boosts serotonin (and norepinephrine in doses greater than 150 mg)	Energizing antidepressant, generalized anxiety, panic disorder, chronic pain (at doses of 225 mg or higher). Taper dose slowly when discontinuing med.	75-300 mg
Cymbalta (duloxetine)	Boosts serotonin and norepinephrine in equal amounts	Energizing antidepressant, peripheral neuropathy, fibromyalgia, chronic pain, stress urinary incontinence	60 mg
Wellbutrin XL (bupropion)	Boosts dopamine and norepinephrine	Activating and motivating antidepressant, useful in cocaine-induced depression, improves cognitive slowing, reverses SSRI-induced sexual dysfunction, reduces craving during smoking cessation	150-450 mg
Remeron (mirtazapine)	Blocks alpha 2 adrenergic presynaptic receptors, blocks 5HT2A, 5HT2C, 5HT3 serotonin receptors	Boosts usefulness of Effexor XR, improves appetite, insomnia and anxiety. Good med for nausea because of 5HT3 effects. Ideal patient for this med is depressed, skinny, sleepless and anxious (or sad, skinny, sleepless and scared).	15-45 mg

CHOOSIING AN ANTIDEPRESANT BASED ON NEUROTRANSMITTER FUNCTION

            Currently three neurotransmitters—serotonin, norepinephrine and dopamine—have been implicated as the most important neurotransmitters in depression. Depletion of these neurotransmitters cause specific symptoms that can help the physician choose which antidepressant would be the first choice for each patient.

Symptoms of Neurotransmittor Depletion

SEROTONIN LOSS	NOREPINEPHRINE LOSS	DOPAMINE LOSS
Anxious depression	Lethargic depression	Joyless depression
Waking during night	Restless sleep	Sleeping too much
Panic symptoms	Worry	Apathetic
Obsessions and compulsions	Feeling tired all the time	No motivation
Anger, irritability	Lethargic	No pleasure
Traumatic dreams	Run down feeling	Decreased sexual drive and function
Flashbacks	Chronic pain symptoms	Poor concentration & attention

Specific Medications that primary work on the “Big” three neurotransmitters

SEROTONIN	NOREPINEPHRINE	DOPAMINE
Prozac	Effexor XR (“pure” serotonin med at doses below 150 mg daily; in doses higher than 150 mg increases both norepinephrine and serotonin)P	Wellbutrin XL
Paxil-CR	Cymbalta (Boosts serotonin & norepinephrine in equal amounts)	Vivactil
Zoloft	Norpramin
Celexa	Pamelor
Lexapro	Vivactil
Remeron