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Zhongshan Suit – One of Chinese Clothing for Male
January 23, 2019 / jessica / 0 Comments
The Mao Suit, as it is known in the West, is known to the Chinese people themselves as the Zhongshan Suit, after Dr. Sun Zhongshan, better known in the West as Dr. Sun Yat-Sen (1866-1925), the Chinese revolutionary and political hero of late- and post-Qing (CE 1644-1911) Dynasty fame. Dr. Sun was the leader of the revolutionary movement that was instrumental in bringing down the Qing government, which it replaced with the Republic of China (1912-1949), ending China's 2000 year old Imperial era. Dr. Sun also served as the first head of the Republic of China, and continued as its military leader.
The Mao Suit (since this is written for an international audience, we will stick with the name by which the suit is best recognized, no disrespect meant to Dr. Sun) has more generally been referred to as the Chinese Tunic Suit. The following brief history of the origins of the Mao Suit is therefore in order.
A BRIEF HISTORY OF THE ORIGINS OF THE MAO SUIT
Though the Mao Suit is credited to Dr. Sun, it was inevitable that a new type of military suit, or dress uniform – which would replace the existing, all-purpose Manchu uniform, whose tunic was called the changshan ("long shirt") – was in the offing, so whether it was precisely the unform developed with the assistance of Dr. Sun or another, perhaps similar uniform, is not all that interesting, the interesting part being that China, as a country and a nation, was 'on the move', and the impetus for this was twofold.
The first and primary influence came from outside, in the form of increasing foreign commerce between China and the outside world (and, indeed, the so-called Unequal Treaties had given many of these foreign powers both trade and territorial concessions in China, the most prominent among these territorial concessions being Hong Kong, which had been leased to Great Britain for 99 years).
The other main influence on developing an alternative Chinese military dress uniform was the increasing unrest among China's ethnic Han majority group, who were becoming increasingly discontented with the Manchu government of the Qing Dynasty in general, and, in particular, with China's direct humiliation at the hands of foreign powers (viz. the Unequal Treaties) as well as China's indirect humiliation in practically every field of human endeavor, especially in the field of science, so replacing the traditional Manchu "changshan uniform" with a Han Chinese military uniform was a way of registering this discontent.
Toward the end of the 19th century, styles of Chinese dress – as was the case for styles of just about everything Chinese, from food to furniture – were coming under foreign influence, where the new Chinese style incorporated elements of Western and other styles, such as Japanese style, with traditional Chinese style. This tendency had long been underway when Dr. Sun decided to revamp the militay suit so as to incorporate some of the features of foreign military dress.
One of the first foreign influences was the addition of a hat (the "hat" in question was actually a sort of cloth or silk cap) to the changshan, which was worn over a robe that covered the body from the waist down. The changshan was a simply designed, front-buttoned garment that extended no farther than to the waist. It was in every respect utterly simple in design, resembling what today one might call a pajama top, albeit, a particularly nicely made pajama top, often of silk.
The Mao Suit that was developed at the end of the 19th century bore the stamp of both Western and Japanese influence: the tunic, or jacket, was essentially a Japanese cadet uniform designed to suit Chinese tastes, while the trousers – and recalling that trousers were alien to Chinese tradition at this time, as the "changshan uniform" mentioned above bears witness – were an adaptation of Western trousers. The jacket of the Mao Suit is actually a quite modest affair, not a great leap forward in comparison to the changshan, except for the pockets.
The Western tradition with dress jackets was to conceal the pockets, except for the flap which covered the opening at the top. Had Dr. Sun opted for this type of pocket, his new tunic would not have looked markedly different from the changshan, therefore Dr. Sun opted for external pockets, or what one calls "cargo pockets" in the U.S., i.e., the entire pocket sits atop the surface of the jacket, save the back side, meaning that the cargo pocket consists of five surfaces – top, bottom, left and right sides, and front – that are sewn to the garment, the sixth and final surface.
The top flap of the Mao Suit tunic's cargo pocket was held down by a centered button, just as similar pocket flaps are secured today (though some are secured by snaps today, others by velcro). The Mao Suit tunic originally had 7 buttons down the front, but this was later reduced to only 5. The difference seems to be in the fact that the original jacket was buttoned farther down than was practical, therefore the two lower buttons were eventually eliminated, making sitting considerably easier. In addition, the arrangement of the pockets, with two large pockets below and two smaller pockets on the chest, and with matching right and left sides, gave a two-dimensional balance and a pleasing sense of symmetry to the jacket, which had a short, fold-down collar (almost like a button-down collar but without the buttons) that was devoid of pointed ends – it was cut so as to stand up, and was probably worn starched in order to strengthen this effect.
The Mao Suit tunic (trousers are hardly worth mentioning in any suit, as the focus is almost always on the jacket) was in its own way simple yet elegant. It is no wonder, then, that China's Communists Party later adopted it as their formal military dress during the Second Sino-Japanese War (1937-1945) – which embraced WWII in the Pacific theatre – when the Nationalists, under Chiang Kai-shek, made an alliance with the Communists in order to better repulse the Japanese invaders. In fact, as we now know, it was a young, future Communist leader, Mao Zedung, who would make the Zhongshan Suit of Dr. Sun Yat-sen famous the world over.
During the period when "Chairman Mao", as he was best known in the West, held sway in China, the Mao Suit was wildly popular among Chinese males of all ages, even toddlers. This tradition continued long after Mao Zedung passed away, but after China opened up to the outside world under the guidance of Deng Xiaoping, Western influence again began to gain a foothold in China, the result of which is that the Mao Suit is perhaps more popular beyond China's borders today than within them. But I wouldn't write off the Mao Suit tunic just yet, as someone somewhere will surely re-introduce it in an updated version, and take the fashion world by storm.
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Mannerbund
Strength, Honor & Fraternity
Community & Profession
November 12, 2019 November 13, 2019 Guest	3 Comments
The chances of winning the lottery are remarkably small, yet people still buy tickets. On some level, these people know the bad odds but still want to spend their money on false hope. This cognitive dissonance proclaims "I know the likelihood is low, but I could be the one to beat the odds!" Our brain clearly has a dopamine response with this behavior, and this desire to beat the odds is found throughout our society: lottery tickets, Las Vegas, underdog stories and even healthcare.
We all have a terminal condition – called life. Some peoples' lives are more expectant than others. But frequently, and throughout life, there exists this same cognitive dissonance that they will be the one to beat the odds. There are many ways people rationalize poor health decisions, whether it's thinking about how Fidel Castro smoked his whole life as an excuse for their own tobacco use, or motivating grandma to undergo aggressive chemotherapy because of a human interest story on a local news channel about a cancer survivor. We like to try to beat the odds against us even though in the end the house always wins and everybody dies.
How do we design our healthcare delivery knowing these poor individual choices and cognitive dissonance tendencies? Currently in our quasi capitalistic system, individualistic poor choices are respected while cost overruns are socialized. We as a society want the Las Vegas treatment for our healthcare: fancy, shiny and new treatments that may provide marginal quality-of-life benefits. But our society can't stomach the bill for these treatments and uses the magic of government to socialize the costs across the tax base even to future generations. It's almost worse than buying a lottery ticket which is two bucks for a minuscule chance at several million dollars. With our society's healthcare, as is commonly seen in many end-stage terminal diseases, we buy the several million dollar ticket for the minimal chance of maybe a month or two of shitty existence for grandpa in a nursing home. It's not an exciting jackpot for most of the healthcare lottery tickets our society buys.
So how do we as a society change that? Many people may recognize that healthcare is broken, but the prescription is more of the same: individualism and capitalism that led to this Frankenstein to begin with. I believe that instead we need an authoritarian state to reign in these individualistic and capitalistic tendencies. I believe we should have the best care for the most people, not just lottery tickets for our terminally ill. I believe we need doctors who feel duty to their community and promote revival of a true fiduciary relationship.
However, this requires the community's trust and begs the question: who decides? Who will be in this trusted role as community and health advocate? Right now our healthcare system, instead of outsourcing, has insourced foreigners into our communities. Conglomerate Incorporated Hospitals abuse our country's visa system to flood primary care with doctors, usually from Asia, who are foreign to our culture and ideals. Do we as a society want to import foreigners to lead our communities? Is this the invisible hand at work?
On a fundamental level most people understand this is wrong, yet it continues apace by the forces of individualism and corporatism. The idea that healthcare has any relation to laissez fair ideals could only be believed by true idiots or libertarians, and Government intervention through Medicare probably makes healthcare the least free out of all industries.
My own unscientific observation at a major medical professional society would estimate that white male doctors in primary care represent 15 to 20% in a sea of foreigners. Whites make up decreasing proportions within medical schools, much to the celebration of the schools' administrations, and what few survive the gauntlet of antiwhite admissions policies frequently are chased into subspecialties that pay more but are further removed from the community fiduciary relationship.
We need doctors who speak our language and understand our culture. When asked "what would you do if this was your mother?" there must be a baseline of cultural communication. On some level our current system recognizes the problem of cultural differences within healthcare, and promotes "cultural understanding" seminars as if this learning can be presented on a PowerPoint slide or that true cultural understanding could ever span racial divides. Trusting that capitalism will respect this cultural communication was a terrible mistake, and has led to this dystopic Las Vegas with dying patients spending all our healthcare dollars on false hope while the corporatist hospitals and drug companies laugh all the way to the bank.
I believe in cultural self-determination, and would rather have a culturally cohesive healthcare system that can only offer aspirin rather than the imported profit driven monstrosity that sells bells and whistles with the bill sent to the next generation. I believe the best way to change our current system is to form a strong state that has its peoples' interests at heart, an ideal in mind, and severed ties with the capitalistic and profit motivated forces that have perverted our system.
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3 thoughts on "Community & Profession"
Very eye opening Cross. Something I think most people over look.
Seax
I have a number of stories that have motivated me to have as little to do with modern medical institutions as humanly possible.
The death of my (maternal) Grandma, and the death of my (paternal) grandfather.
My Grandma had the diabetes. Had a stroke, then a bad fall. It started with rehab. They never really enforced anything. She degraded. Had another stroke, gave her aphasia. Bad feels, man. She couldn't swallow no more. She was also terrified beyond reason of hospitals. We tried to get her out. Our Doctor, a wetback with a gnarly unibrow whose name was actually Honduras, looked my mother in the eye and said, "if she dies, that's on you." She was already dieing. The nurse's admitted as much. This gave my mother and I a complex, which has baggage to this day.
My Grandfather developed dementia. His second wife threw his ass in a home. I came to visit one day to find his forehead bloodied up. Nobody could tell me what happened. (Would tell me, really.) I sit down a spell and his nurse comes. Black as the bottom of my boot in mud season. Her English was nonexistent. My Grandfather, with advanced dementia, proceeded to begin headbutting the table, demanding to be taken to the US Embassy. He, in his state, believed he was a captive. And he wasn't really wrong. That lovely piece of diversity acted like nothing was the matter. I asked for a change of nurse. There were none available
This was a VA service.
They don't care about you and your necessities or vulnerabilities. They care about one thing.
Shekel.
The question of "who decides" is the conundrum. The question has no easy answer and would cause controversy no matter how it is answered. I think most would agree that things are out of control and like most everything in our society it is the almighty dollar that is the driver.
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Firstly the song has nice cheerful tune which links well to the Christmas theme.
Secondly the video mixes together clips from the past year, behind the scenes, photo shoots etc. Which is nice and interesting to watch.
Finally SHINee are always a strong group and their harmonies as well as individual performances in this release are top quality.
On the negative side; the christmas scenes from the video looked a little rushed and sightly boring.
For last weeks KPOP Song of the Week "Friday" by IU please click the link.
For our previous SHINee KPOP Song of the Week "Dream Girl" please click here.


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A Closer Look At Horizon Forbidden West's New Slitherfang, Rollerback, And Sunwing Machines
By DAMN OS on December 16, 2021
On February 18, Aloy will venture into the dangerous frontier of the Forbidden West, confronting a huge variety of deadly new machines. You saw many of these steel beasts revealed last week at The Game Awards, but today Guerrilla offers a closer look at the armored Rollerback, the graceful Sunwing, and the acid-spitting Slitherfang, plus several more. Some serve as guardians of the natural order, while others are built only to kill. Even worse, the power to control them has fallen into the wrong hands…
We hope you enjoy this sneak peek at the machines of the Forbidden West, but remember – it's only the beginning. The western wilds conceal new threats around every turn.
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Home Pumpkin Doodles
Pumpkin Doodles
Create whimsical doodled pumpkins using Zentangles.
Nov. 03, 2018 2:30 p.m. to 4:00 p.m.
Art Explorium 1142 Koko Head Ave., Honolulu, Hawaii 96816
Learn new drawing patterns, sometimes called Zentangles, in this workshop about design elements such as line, texture and repetition.
Instructor Sarah Hadmack is an Associate Professor at Windward Community College and a former gymnastics coach.
Location Art Explorium 1142 Koko Head Ave., Honolulu, Hawaii 96816
Date & Time Nov. 03, 2018 2:30 p.m. to 4:00 p.m.
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Q: Angular non-idempotent method issue I have a basic understanding of Angular's digest cycle, but I'm confused as to why this particular method is executing multiple times.  Here is what is in my Controller:
initializePage();
    function initializePage() {
        var promise = getPageInfo();
        promise.then(function () {
            $scope.dataLoading = true;
        })
    };
    function getPageInfo() {
        var deferred = $q.defer();
        deferred.resolve(lwsService.getLWSpageinfo()
        .success(function (data) {
            $scope.company = data.ContractorInfo;
            $scope.img = base64ArrayBuffer($scope.company.imgCompanyLogo);
            $scope.incompleteInfo = data.IncompleteInfo;
            $scope.sections = data.QuestionSections;
            $scope.verifications = data.Verifications;
            $scope.subscriptions = data.SubscriptionInfo;
            $scope.user = data.UserInfo;
            $scope.ssqstatus = data.SSQStatus;
            $scope.ssqdetails = data.SSQDetail[0];
            $scope.completionInfo = data.CompletionInfo[0];
            $scope.states = data.States;
            $scope.countries = data.Countries
            $scope.completionInfo.dteDateSSQLastUpdated = convertDate($scope.completionInfo.dteDateSSQLastUpdated);
                  return deferred.promise;
    };

Here is my HTML:

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                <accordion close-others="oneAtATime">
                    <accordion-group is-open="status.open">
                        <accordion-heading>

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                                                    {{text.WidgetStateText}}

                                                    Override

                    </accordion-group>
                </accordion>

    </tab>
    <tab heading="SSQ Information">

                             Subscription Expiration Date
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                             Subscription Expiration Date
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                                    SSQ Status

                                            Incomplete

                                            Complete

                                SSQ Last Edited By
                                Date Edited
                                Last Incident QTR Reported
                                Number of Employees
                                Number of Active Instructors

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                                    Reason of Status: {{completionInfo.IncompleteReason}}

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    <tab heading="Questionnaire">

                            Questionnaire

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@*  *@

<button type="button" class="btn btn-info" style="width:200px" ng-click="selectAll()">Select All</button>   <button type="button" class="btn btn-info" style="width:200px" ng-click="unselectAll()">Unselect All</button>

<button type="button" class="btn btn-primary" style="width:200px" data-toggle="modal" data-dismiss="modal" data-target="#stack4" ng-disabled="dataLoading" ng-click="printSections()">Print

Selected</button>

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    </tabset>

I tried using the the double colon operator but that didn't help.  I'm confused as to what I need to change or how to change this to make it idempotent.  The service makes a call to our web api (which it is calling about 4 times).  It brings back a lot of data so having it execute so many times is dragging down my application to a crawl.  Any assistance on how to improve this code is greatly appreciated.

A: You have an instance of your controller at the outer level of the app, but you are also creating additional instances inside an ng-repeat:

This means a fresh controller is created for every occurence of m and any time the value of majors changes you will have more controllers created and/or destroyed.
This is probably not what you intended, I would have thought one instance of the controller would be sufficient.

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Throughout the 1990s, the Columban Fathers continued to develop vocations from their mission nations. Accordingly, on October 1, 1995, the first Peruvian Columban, Father Diego Cabrera Rojas was ordained at the Parish of Los Santos Arcangeles in Lima, Peru, by Cardinal Archbishop Augusto Vargas Alzamora.
Prior to his ordination, Father Cabrera went through a great deal of adversity. As a young boy, he grew up in an orphanage. He served in the Peruvian Navy, and held a variety of jobs, including graphic arts instructor, when in 1986 he became acquainted with the Columbans.
He started to take theology courses, eventually joining the Columban formation program. The March 1996 issue of Columban Mission magazine contained a profile of Father Cabrera. He has served in Fiji, Peru and the United States since ordination, and has recorded several albums of Christian music.
By 1995, the Columban Fathers had maintained their mission in Peru for more than 40 years, and Father Cabrera's ordination punctuated the fruits of their labor in that nation.


Stuck In The Buckosphere: Snow is knocking our our Door!!!
No time to talk long this morning, typing this in between each fruity pebbles spoonful. Snow is approaching Richmond, and that is my first place of business.
The models are still showing snow still being the heaviest from around noon until nightfall today. Be sure to keep it tuned to ABC 22 and FOX 45 for team coverage throughout the day today. Drive safe and have a good one!!


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Biografia
Ha incominciato a cantare ai concorsi per bambini. Nel 1985 partecipa al varietà televisivo Fantastico, condotto da Pippo Baudo. L'anno successivo è al Festival di Sanremo nella sezione "Nuove Proposte" con un brano scritto da Mango, Nessun dolore, che non accede alla finale.

Incide altri due singoli, Il cielo (cover di un brano di Lucio Dalla) e In te (scritta da Paolo Vallesi) dopo di che scompare dalle scene.

Discografia

Singoli
 1986 – Nessun dolore/Ay ay ay ay (Fonit Cetra, SP-1838)
 1988 – Il cielo/Chissà chi sarà (Fonit Cetra, SP-1868)
 1990 – In te/L'amore quando non ci sei (Fonit Cetra, SP-1893)

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Junius Wilson (1908-2001) spent 76 years at a state mental hospital in Goldsboro, North Carolina, including 6 in the criminal ward. He had never been declared insane by a medical professional or found guilty of any criminal charge. But he was deaf and black in the Jim Crow South. Unspeakable is the story of his life.


text:
Label: DESIPRAMINE HYDROCHLORIDE tablet
NDC Code(s): 24724-067-03, 24724-067-50, 24724-068-03, 24724-068-50, view more
24724-069-03, 24724-069-50, 24724-070-03, 24724-070-50, 24724-071-03, 24724-071-50, 24724-072-03, 24724-072-50
Packager: INDICUS PHARMA LLC
Marketing Status: Abbreviated New Drug Application
Medication Guide: HTML
Suicidality and Antidepressant Drugs
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of desipramine hydrochloride tablets or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Desipramine hydrochloride is not approved for use in pediatric patients. (See WARNINGS: Clinical Worsening and Suicide Risk, PRECAUTIONS: Information for Patients, and PRECAUTIONS: Pediatric Use.)
Desipramine hydrochloride, USP is an antidepressant drug of the tricyclic type, and is chemically: 5 H - Dibenz [bƒ] azepine - 5 - propanamine, 10, 11 - dihydro - N - methyl -, monohydrochloride.
The following inactive ingredients are contained in all dosage strengths:
Lactose monohydrate, microcrystalline cellulose, sodium starch glycolate type A (potato), stearic acid and hypromellose, talc, polyethylene glycol and titanium dioxide.
Available evidence suggests that many depressions have a biochemical basis in the form of a relative deficiency of neurotransmitters such as norepinephrine and serotonin. Norepinephrine deficiency may be associated with relatively low urinary 3-methoxy-4-hydroxyphenyl glycol (MHPG) levels, while serotonin deficiencies may be associated with low spinal fluid levels of 5-hydroxyindoleacetic acid.
While the precise mechanism of action of the tricyclic antidepressants is unknown, a leading theory suggests that they restore normal levels of neurotransmitters by blocking the re-uptake of these substances from the synapse in the central nervous system. Evidence indicates that the secondary amine tricyclic antidepressants, including desipramine hydrochloride, may have greater activity in blocking the re-uptake of norepinephrine. Tertiary amine tricyclic antidepressants, such as amitriptyline, may have greater effect on serotonin re-uptake.
Desipramine hydrochloride is not a monoamine oxidase inhibitor (MAOI) and does not act primarily as a central nervous system stimulant. It has been found in some studies to have a more rapid onset of action than imipramine. Earliest therapeutic effects may occasionally be seen in 2 to 5 days, but full treatment benefit usually requires 2 to 3 weeks to obtain.
Tricyclic antidepressants, such as desipramine hydrochloride, are rapidly absorbed from the gastrointestinal tract. Tricyclic antidepressants or their metabolites are to some extent excreted through the gastric mucosa and reabsorbed from the gastrointestinal tract. Desipramine is metabolized in the liver, and approximately 70% is excreted in the urine.
The rate of metabolism of tricyclic antidepressants varies widely from individual to individual, chiefly on a genetically determined basis. Up to a 36-fold difference in plasma level may be noted among individuals taking the same oral dose of desipramine. The ratio of 2-hydroxydesipramine to desipramine may be increased in the elderly, most likely due to decreased renal elimination with aging.
Certain drugs, particularly the psychostimulants and the phenothiazines, increase plasma levels of concomitantly administered tricyclic antidepressants through competition for the same metabolic enzyme systems. Concurrent administration of cimetidine and tricyclic antidepressants can produce clinically significant increases in the plasma concentrations of the tricyclic antidepressants. Conversely, decreases in plasma levels of the tricyclic antidepressants have been reported upon discontinuation of cimetidine, which may result in the loss of the therapeutic efficacy of the tricyclic antidepressant. Other substances, particularly barbiturates and alcohol, induce liver enzyme activity and thereby reduce tricyclic antidepressant plasma levels. Similar effects have been reported with tobacco smoke.
Research on the relationship of plasma level to therapeutic response with the tricyclic antidepressants has produced conflicting results. While some studies report no correlation, many studies cite therapeutic levels for most tricyclics in the range of 50 to 300 nanograms per milliliter. The therapeutic range is different for each tricyclic antidepressant. For desipramine, an optimal range of therapeutic plasma levels has not been established.
INDICATIONSAND USAGE
Desipramine hydrochloride tablets, USP is indicated for the treatment of depression.
The use of MAOIs intended to treat psychiatric disorders with desipramine hydrochloride or within 14 days of stopping treatment with desipramine hydrochloride is contraindicated because of an increased risk of serotonin syndrome. The use of desipramine hydrochloride within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated (see WARNINGSand DOSAGE AND ADMINISTRATION).
Starting desipramine hydrochloride in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome (see WARNINGSand DOSAGE AND ADMINISTRATION).
Desipramine hydrochloride is contraindicated in the acute recovery period following myocardial infarction. It should not be used in those who have shown prior hypersensitivity to the drug. Cross-sensitivity between this and other dibenzazepines is a possibility.
Clinical Worsening and Suicide Risk
Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (selective serotonin reuptake inhibitors [SSRIs] and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18-24) with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older.
The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences (drug vs placebo), however, were relatively stable within age strata and across indications. These risk differences (drug-placebo difference in the number of cases of suicidality per 1000 patients treated) are provided in Table 1.
Drug-Placebo Difference in Number of Cases of
Suicidality per 1000 Patients Treated
Increases Compared to Placebo
14 additional cases
5 additional cases
Decreases Compared to Placebo
1 fewer case
6 fewer cases
No suicides occurred in any of the pediatric trials. There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide.
It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression.
All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.
The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality.
Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms.
Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for desipramine hydrochloride should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.
Screening Patients for Bipolar Disorder: A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that desipramine hydrochloride is not approved for use in treating bipolar depression.
Serotonin Syndrome: The development of a potentially life-threatening serotonin syndrome has been reported with serotonin norepinephrine reuptake inhibitors (SNRIs) and SSRIs, including desipramine hydrochloride, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John's Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue).
Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular changes (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Patients should be monitored for the emergence of serotonin syndrome.
The concomitant use of desipramine hydrochloride with MAOIs intended to treat psychiatric disorders is contraindicated. Desipramine hydrochloride should also not be started in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue. All reports with methylene blue that provided information on the route of administration involved intravenous administration in the dose range of 1 mg/kg to 8 mg/kg. No reports involved the administration of methylene blue by other routes (such as oral tablets or local tissue injection) or at lower doses. There may be circumstances when it is necessary to initiate treatment with an MAOI such as linezolid or intravenous methylene blue in a patient taking desipramine hydrochloride. Desipramine hydrochloride should be discontinued before initiating treatment with the MAOI (see CONTRAINDICATIONS and DOSAGE AND ADMINISTRATION).
If concomitant use of desipramine hydrochloride with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John's Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome particularly during treatment initiation and dose increases.
Treatment with desipramine hydrochloride and any concomitant serotonergic agents should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated.
Angle-Closure Glaucoma: The pupillary dilation that occurs following use of many antidepressant drugs including desipramine hydrochloride may trigger an angle closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy.
Extreme caution should be used when this drug is given in the following situations:
In patients with cardiovascular disease, because of the possibility of conduction defects, arrhythmias, tachycardias, strokes, and acute myocardial infarction.
In patients who have a family history of sudden death, cardiac dysrhythmias, or cardiac conduction disturbances.
In patients with a history of urinary retention or glaucoma, because of the anticholinergic properties of the drug.
In patients with thyroid disease or those taking thyroid medication, because of the possibility of cardiovascular toxicity, including arrhythmias.
In patients with a history of seizure disorder, because this drug has been shown to lower the seizure threshold. Seizures precede cardiac dysrhythmias and death in some patients.
This drug is capable of blocking the antihypertensive effect of guanethidine and similarly acting compounds.
The patient should be cautioned that this drug may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery.
In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage.
Use in Pregnancy
Safe use of desipramine hydrochloride during pregnancy and lactation has not been established; therefore, if it is to be given to pregnant patients, nursing mothers, or women of childbearing potential, the possible benefits must be weighed against the possible hazards to mother and child. Animal reproductive studies have been inconclusive.
Geriatric Use
Clinical studies of desipramine hydrochloride did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Lower doses are recommended for elderly patients. (See DOSAGE AND ADMINISTRATION.)
The ratio of 2-hydroxydesipramine to desipramine may be increased in the elderly, most likely due to decreased renal elimination with aging.
Desipramine hydrochloride use in the elderly has been associated with a proneness to falling as well as confusional states. (See ADVERSE REACTIONS.)
Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with desipramine hydrochloride and should counsel them in its appropriate use. A patient Medication Guide about "Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions" is available for desipramine hydrochloride. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.
Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking desipramine hydrochloride.
Clinical Worsening and Suicide Risk : Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.
Patients should be advised that taking desipramine hydrochloride can cause mild pupillary dilation, which in susceptible individuals, can lead to an episode of angle closure glaucoma. Pre-existing glaucoma is almost always open-angle glaucoma because angle closure glaucoma, when diagnosed, can be treated definitively with iridectomy. Open-angle glaucoma is not a risk factor for angle closure glaucoma. Patients may wish to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e.g., iridectomy), if they are susceptible.
Pediatric Use
Safety and effectiveness in the pediatric population have not been established (see BOX WARNINGand WARNINGS-Clinical Worsening and Suicide Risk). Therefore, desipramine hydrochloride is not recommended for use in children.
Anyone considering the use of desipramine hydrochloride in a child or adolescent must balance the potential risks with the clinical need (see also ADVERSE REACTIONS-Cardiovascular).
It is important that this drug be dispensed in the least possible quantities to depressed outpatients, since suicide has been accomplished with this class of drug (see WARNINGS-Clinical Worsening and Suicide Risk). Ordinary prudence requires that children not have access to this drug or to potent drugs of any kind; if possible, this drug should be dispensed in containers with child-resistant safety closures. Storage of this drug in the home must be supervised responsibly.
If serious adverse effects occur, dosage should be reduced or treatment should be altered.
Desipramine hydrochloride therapy in patients with manic-depressive illness may induce a hypomanic state after the depressive phase terminates.
The drug may cause exacerbation of psychosis in schizophrenic patients.
Both elevation and lowering of blood sugar levels have been reported.
Leukocyte and differential counts should be performed in any patient who develops fever and sore throat during therapy; the drug should be discontinued if there is evidence of pathologic neutrophil depression.
Clinical experience in the concurrent administration of ECT and antidepressant drugs is limited. Thus, if such treatment is essential, the possibility of increased risk relative to benefits should be considered.
This drug should be discontinued as soon as possible prior to elective surgery because of possible cardiovascular effects. Hypertensive episodes have been observed during surgery in patients taking desipramine hydrochloride.
Drugs Metabolized by P450 2D6.
The biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase) is reduced in a subset of the Caucasian population (about 7% to 10% of Caucasians are so called "poor metabolizers"); reliable estimates of the prevalence of reduced P450 2D6 isozyme activity among Asian, African and other populations are not yet available. Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses. Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large (8 fold increase in plasma AUC of the TCA).
In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. An individual who is stable on a given dose of TCA may become abruptly toxic when given one of these inhibiting drugs as concomitant therapy. The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type IC antiarrhythmics propafenone and flecainide). While all the SSRIs, e.g., fluoxetine, sertraline, paroxetine, inhibit P450 2D6, they may vary in the extent of inhibition. The extent to which SSRI TCA interactions may pose clinical problems will depend on the degree of inhibition and the pharmacokinetics of the SSRI involved. Nevertheless, caution is indicated in the co-administration of TCAs with any of the SSRIs and also in switching from one class to the other. Of particular importance, sufficient time must elapse before initiating TCA treatment in a patient being withdrawn from fluoxetine, given the long half-life of the parent and active metabolite (at least 5 weeks may be necessary).
Concomitant use of tricyclic antidepressants with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant or the other drug. Furthermore, whenever one of these other drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant may be required. It is desirable to monitor TCA plasma levels whenever a TCA is going to be co-administered with another drug known to be an inhibitor of P450 2D6.
Close supervision and careful adjustment of dosage are required when this drug is given concomitantly with anticholinergic or sympathomimetic drugs.
Patients should be warned that while taking this drug their response to alcoholic beverages may be exaggerated.
If desipramine hydrochloride is to be combined with other psychotropic agents such as tranquilizers or sedative/hypnotics, careful consideration should be given to the pharmacology of the agents employed since the sedative effects of desipramine and enzodiazepines (e.g., chlordiazepoxide or diazepam) are additive. Both the sedative and anticholinergic effects of the major tranquilizers are also additive to those of desipramine.
Concomitant use of Monoamine Oxidase Inhibitors (MAOIs) and serotonergic drugs may potentially cause life threatening adverse events (See CONTRAINDICATIONS, WARNINGS, and DOSAGE AND ADMINISTRATION).
Included in the following listing are a few adverse reactions that have not been reported with this specific drug. However, the pharmacologic similarities among the tricyclic antidepressant drugs require that each of the reactions be considered when desipramine hydrochloride is given.
Cardiovascular: Hypotension, hypertension, palpitations, heart block, myocardial infarction, stroke, arrhythmias, premature ventricular contractions, tachycardia, ventricular tachycardia, ventricular fibrillation, sudden death
There has been a report of an "acute collapse" and "sudden death" in an 8-year-old (18 kg) male, treated for 2 years for hyperactivity.
There have been additional reports of sudden death in children. (See PRECAUTIONS-Pediatric Use)
Psychiatric: Confusional states (especially in the elderly) with hallucinations, disorientation, delusions; anxiety, restlessness, agitation; insomnia and nightmares; hypomania; exacerbation of psychosis
Neurologic: Numbness, tingling, paresthesias of extremities; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures; alterations in EEG patterns; tinnitus.
Symptoms attributed to Neuroleptic Malignant Syndrome have been reported during desipramine use with and without concomitant neuroleptic therapy.
Anticholinergic: Dry mouth, and rarely associated sublingual adenitis; blurred vision, disturbance of accommodation, mydriasis, increased intraocular pressure; constipation, paralytic ileus; urinary retention, delayed micturition, dilation of urinary tract
Allergic: Skin rash, petechiae, urticaria, itching, photosensitization (avoid excessive exposure to sunlight), edema (of face and tongue or general), drug fever, cross-sensitivity with other tricyclic drugs
Hematologic: Bone marrow depressions including agranulocytosis, eosinophilia, purpura, thrombocytopenia
Gastrointestinal: Anorexia, nausea and vomiting, epigastric distress, peculiar taste, abdominal cramps, diarrhea, stomatitis, black tongue, hepatitis, jaundice (simulating obstructive), altered liver function, elevated liver function tests, increased pancreatic enzymes
Endocrine: Gynecomastia in the male, breast enlargement and galactorrhea in the female; increased or decreased libido, impotence, painful ejaculation, testicular swelling; elevation or depression of blood sugar levels; syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Other: Weight gain or loss; perspiration, flushing; urinary frequency, nocturia; parotid swelling; drowsiness, dizziness, proneness to falling, weakness and fatigue, headache; fever; alopecia; elevated alkaline phosphatase
Withdrawal Symptoms: Though not indicative of addiction, abrupt cessation of treatment after prolonged therapy may produce nausea, headache, and malaise.
Deaths may occur from overdosage with this class of drugs. Overdose of desipramine has resulted in a higher death rate compared to overdoses of other tricyclic antidepressants. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. As the management is complex and changing, it is recommended that the physician contact a poison control center for current information on treatment. Signs and symptoms of toxicity develop rapidly after tricyclic antidepressant overdose; therefore, hospital monitoring is required as soon as possible. There is no specific antidote for desipramine overdosage.
Oral LD50
The oral LD50 of desipramine is 290 mg/kg in male mice and 320 mg/kg in female rats.
Manifestations of Overdosage
Critical manifestations of overdose include: cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression, including coma. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically significant indicators of tricyclic antidepressant toxicity. Early changes in the QRS complex include a widening of the terminal 40 msec with a rightward axis in the frontal plane, recognized by the presence of a terminal S wave in Lead 1 and AVL and an R wave in AVR.
Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia, or any of the symptoms listed under ADVERSE REACTIONS.
Aggressive supportive care and serum alkalinization are the mainstays of therapy.
General. Obtain an ECG and immediately initiate cardiac monitoring. Protect the patient's airway, establish an intravenous line, and initiate gastric decontamination. A minimum of 6 hours of observation with cardiac monitoring and observation for signs of CNS or respiratory depression, hypotension, cardiac dysrhythmias and/or conduction blocks, and seizures is necessary. If signs of toxicity occur at any time during this period, extended monitoring is required. Follow ECG, renal function, CPK, and arterial blood gasses as clinically indicated. There are case reports of patients succumbing to fatal dysrhythmias late after overdose; these patients had clinical evidence of significant poisoning prior to death, and most received inadequate gastrointestinal decontamination. Monitoring of plasma drug levels should not guide management of the patient.
Gastrointestinal Decontamination. Emesis is contraindicated. Activated charcoal should be administered to patients who present early after an overdose.
Cardiovascular. A maximal limb-lead QRS duration widening to greater than 100 msec is a significant indicator of toxicity, specifically for the risk of seizures and, eventually, cardiac dysrhythmias. Serum alkalinization with intravenous sodium bicarbonate and hyperventilation (as needed) should be instituted in patients manifesting significant toxicity such as QRS widening. Dysrhythmias despite adequate alkalemia may respond to overdrive pacing, beta-agonist infusions, and magnesium therapy. Type 1A and 1C antiarrhythmics are generally contraindicated (e.g., quinidine, disopyramide, and procainamide).
CNS. In patients with CNS depression, early intubation is advised because of the potential for abrupt deterioration. Seizures should be controlled with benzodiazepines. If these are ineffective or seizures recur, other anticonvulsants (eg, phenobarbital, propofol) may be used.
Psychiatric Follow-up. Since overdosage is often deliberate, patients may attempt suicide by other means during the recovery phase. Psychiatric referral may be appropriate.
Pediatric Management. The principles of management of child and adult overdosages are similar. It is strongly recommended that the physician contact the local poison control center for specific pediatric treatment.
Not recommended for use in children (see WARNINGS).
Lower dosages are recommended for elderly patients and adolescents. Lower dosages are also recommended for outpatients compared to hospitalized patients, who are closely supervised. Dosage should be initiated at a low level and increased according to clinical response and any evidence of intolerance. Following remission, maintenance medication may be required for a period of time and should be at the lowest dose that will maintain remission.
The usual adult dose is 100 to 200 mg per day. In more severely ill patients, dosage may be further increased gradually to 300 mg/day if necessary. Dosages above 300 mg/day are not recommended.
Dosage should be initiated at a lower level and increased according to tolerance and clinical response.
Treatment of patients requiring as much as 300 mg should generally be initiated in hospitals, where regular visits by the physician, skilled nursing care, and frequent electrocardiograms (ECGs) are available.
The best available evidence of impending toxicity from very high doses of desipramine hydrochloride is prolongation of the QRS or QT intervals on the ECG. Prolongation of the PR interval is also significant, but less closely correlated with plasma levels. Clinical symptoms of intolerance, especially drowsiness, dizziness, and postural hypotension, should also alert the physician to the need for reduction in dosage.
Initial therapy may be administered in divided doses or a single daily dose.
Maintenance therapy may be given on a once-daily schedule for patient convenience and compliance.
Adolescent and Geriatric Dose
The usual adolescent and geriatric dose is 25 to 100 mg daily.
Dosage should be initiated at a lower level and increased according to tolerance and clinical response to a usual maximum of 100 mg daily. In more severely ill patients, dosage may be further increased to 150 mg/day. Doses above 150 mg/day are not recommended in these age groups.
Switching a Patient To or From a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders: At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with desipramine hydrochloride. Conversely, at least 14 days should be allowed after stopping desipramine hydrochloride before starting an MAOI intended to treat psychiatric disorders (see CONTRAINDICATIONS).
Use of desipramine hydrochloride With Other MAOI's, Such as Linezolid or Methylene Blue:
Do not start desipramine hydrochloride in a patient who is being treated with linezolid or intravenous methylene blue because there is increased risk of serotonin syndrome. In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered (see CONTRAINDICATIONS).
In some cases, a patient already receiving desipramine hydrochloride therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Desipramine hydrochloride should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with desipramine hydrochloride may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue (see WARNINGS).
The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with desipramine hydrochloride is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use (see WARNINGS).
Desipramine hydrochloride tablets, USP for oral administration are available as:
10 mg:white to off white, rounded square shape, biconvex, coated tablets with 'N6' debossed on one side and plain on other side.
NDC 24724-067-03: bottles of 30
NDC 24724-067-50: bottles of 500
25 mg: white to off white, round biconvex, coated tablets with 'I86' debossed on one side and plain on other side.
100 mg: white to off white, round biconvex, coated tablets with 'I84' debossed on one side and plain on other side.
Store at 20°-25°C (68°-77°F); [see USP Controlled Room Temperature]. Protect from excessive heat. Dispense in tight container.
Rev. July 2016
USV Private Limited,
H-13,16,16A,17,18,19,20,21,E-22, OIDC,
Mahatma Gandhi Udyog Nagar,
Dabhel, Daman 396 210, India
Manufactured for:
Indicus Pharma LLC,
12308 Richmond Run
Drive Raleigh, NC 27614
Desipramine Hydrochloride Tablets, USP
(des-IP-ra-meen HYE-droe-KLOR-ide)
Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions
Read the Medication Guide that comes with your, or your family member's, antidepressant medicine. This Medication Guide is only about the risk of suicidal thoughts and actions with antidepressant medicines. Talk to your, or your family member's, healthcare provider about:
all risks and benefits of treatment with antidepressant medicines
all treatment choices for depression or other serious mental illness
What is the most important information I should know about antidepressant medicines, depression and other serious mental illnesses, and suicidal thoughts or actions?
Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.
Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions.Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.
How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?
Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.
Who should not take desipramine hydrochloride tablets, USP?
You should not take desipramine hydrochloride tablets, USP if you take a monoamine oxidase inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid.
Do not take an MAOI within 2 weeks of stopping desipramine hydrochloride tablets, USP unless directed to do so by your physician.
Do not start desipramine hydrochloride tablets, USP if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician.
Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:
thoughts about suicide or dying
attempts to commit suicide
new or worse depression
new or worse anxiety
feeling very agitated or restless
trouble sleeping (insomnia)
new or worse irritability
acting aggressive, being angry, or violent
acting on dangerous impulses
an extreme increase in activity and talking (mania)
other unusual changes in behavior or mood
Visual Problems
changes in vision
swelling or redness in or around the eye
Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.
What else do I need to know about antidepressant medicines?
Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.
Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepressants.
Antidepressant medicines have other side effects. Talk to the healthcare provider about the side effects of the medicine prescribed for you or your family member.
Antidepressant medicines can interact with other medicines. Know all of the medicines that you or your family member takes. Keep a list of all medicines to show the healthcare provider. Do not start new medicines without first checking with your healthcare provider.
Not all antidepressant medicines prescribed for children are FDA approved for use in children. Talk to your child's healthcare provider for more information.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1800-FDA-1088.
This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL
Desipramine Hydrochloride Tablets, USP 10 mg - Container Label
NDC 24724-067-03
PHARMACIST: Dispense the enclosed Medication Guide to each patient.
Indicus Pharma
PHARMACIST: Dispense the Medication Guide provided separately to each patient.
Desipramine Hydrochloride Tablets, USP 100 mg - Container Label
DESIPRAMINE HYDROCHLORIDE
desipramine hydrochloride tablet
Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:24724-067
DESIPRAMINE HYDROCHLORIDE (UNII: 1Y58DO4MY1) (DESIPRAMINE - UNII:TG537D343B) DESIPRAMINE HYDROCHLORIDE 10 mg
CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U)
SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2)
STEARIC ACID (UNII: 4ELV7Z65AP)
HYPROMELLOSE 2910 (6 MPA.S) (UNII: 0WZ8WG20P6)
TALC (UNII: 7SEV7J4R1U)
POLYETHYLENE GLYCOL 8000 (UNII: Q662QK8M3B)
Color WHITE (White to Off White) Score no score
Shape SQUARE (Rounded Square) Size 4mm
Flavor Imprint Code N6
NDC:24724-067-03 30 in 1 BOTTLE; Type 0: Not a Combination Product 08/01/2016
NDC:24724-067-50 500 in 1 BOTTLE; Type 0: Not a Combination Product 08/01/2016
Shape ROUND (Round Biconvex) Size 6mm
Flavor Imprint Code I86
DESIPRAMINE HYDROCHLORIDE (UNII: 1Y58DO4MY1) (DESIPRAMINE - UNII:TG537D343B) DESIPRAMINE HYDROCHLORIDE 100 mg
Shape ROUND (Round Biconvex) Size 10mm
Labeler - INDICUS PHARMA LLC (793870606)
USV Private Limited, Daman 650434348 MANUFACTURE(24724-067, 24724-068, 24724-069, 24724-070, 24724-071, 24724-072)
1 1099288 desipramine HCl 10 MG Oral Tablet PSN
2 1099288 desipramine hydrochloride 10 MG Oral Tablet SCD
3 1099292 desipramine HCl 100 MG Oral Tablet PSN
4 1099292 desipramine hydrochloride 100 MG Oral Tablet SCD
10 1099304 desipramine hydrochloride 50 MG Oral Tablet SCD
11 1099316 desipramine HCl 75 MG Oral Tablet PSN
https://dailymed.nlm.nih.gov/dailymed/labelrss.cfm?setid=3bada7cf-8ca2-46e9-b7db-ff21b2af03f7
10 24724-071-50 (inactivated)


text:
INTERVIEWS / MEDIA / AWARDS
FILM WORK
FREE 4 BOOK BOX SET
Receive the latest news, exclusive offers and information first on new releases.
Tyler Matthews is desperate for change. Sick of his life and plagued by alcoholism, he makes the decision to divorce his wife, sell everything he owns and travel the world to try and find focus and rid himself of his addiction. Eventually arriving on the sun drenched shores of Australia and still plagued by his demons, he has spent all his savings and is facing the prospect of having to return to his old life.
It is here that he meets two men with an outlandish story about a horde of sunken drug money in an area known as the Devil's Triangle – Australia's answer to its Bermuda namesake and said to be the lair of a terrifying monster of the deep. Offered a share of the fortune if he helps retrieve it, Tyler agrees to go with the men to the location, sceptical and thinking only of prolonging his journey of self discovery.
He will learn, however, that this particular urban legend is real, and they encounter a giant of the seas, the previously thought to be extinct Megalodon which makes its home within the area of the Devil's triangle.
Barely escaping with their lives, the three men wash up on an isolated island – no more than a rocky outcrop with no vegetation, fresh water of food sources. As desperation to survive intensifies, horrifying decisions will be made that will illustrate how man is sometimes the most violent predator on earth and when left with no option will do anything, even the unthinkable, in order to survive.
Publication Date: February 27th, 2017
Publisher: Severed Press
REVIEWS (May Contain Spoilers)
INCONSISTENT PACING
MEAN MACHINE
PURCHASE LINKS (OPENS IN NEW WINDOW)
AUDIOBOOK EDITION (OPENS IN NEW WINDOW)
By: Michael Bray
Narrated by: Jamie Cutler
BUY NOW FROM:
© 2018 by MICHAEL BRAY
Darkcornersbook@gmail.com


text:
Q: Understanding the "Median" in this Graph I tried running the TSP in R using the following code (https://rstudio-pubs-static.s3.amazonaws.com/132872_620c10f340f348b88453d75ec99960ff.html):
library(GA)
data("eurodist", package = "datasets")
D <- as.matrix(eurodist)

tourLength <- function(tour, distMatrix) {
   tour <- c(tour, tour[1])
   route <- embed(tour, 2)[,2:1]
   sum(distMatrix[route])
}

#Fitness function to be maximized

tspFitness <- function(tour, ...) 1/tourLength(tour, ...)

GA <- ga(type = "permutation", fitness = tspFitness, distMatrix = D,
          min = 1, max = attr(eurodist, "Size"), popSize = 50, maxiter = 5000,
          run = 500, pmutation = 0.2)

plot(GA)

This produced the following graph:
I understand that each point on the x-axis represents the average value and the best value achieved at each iteration ("generation") - I connected some of these with red lines:
However, I am having difficulty understanding the significance of the "median" here. I would  have thought that the median would refer to a single point, but it seems like the median here is referring to a "range" of points at each iteration.

*

*What is the meaning of this "large green shaded region" on this graph and how exactly does it correspond to the "median"?

Thank you!

A: I agree in that this is a somewhat misleading visualisation choice.
The explanation seems to be in the examples at the bottom of ?plot.ga-method:
The relevant code for the shaded area (ribbon) is
geom_ribbon(aes(x = iter, ymin = median, ymax = max,
                  colour = "median", fill = "median"))

So the "median" ribbon seems to cover fitness values [median, max] on the y-axis.


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text:
Le paradoxe de la productivité (ou paradoxe de Solow) est un paradoxe économique selon lequel des inventions technologiques majeures, comme l'électricité ou Internet, peuvent ne pas provoquer d'augmentation de la productivité dans un pays.

Concept
Le progrès technique est l'un des principaux facteurs qui stimulent la croissance économique. Toutefois, la diffusion de l'innovation est difficile à observer, et ne n'est pas nécessairement retranscrite dans la comptabilité nationale. En 1987, Robert Solow fait remarquer qu'aux États-Unis, les ordinateurs sont visibles partout, sauf dans les statistiques nationales.

Explications

Temps de latence
Une explication est avancée par Paul A. David dans un ouvrage de 1990. Il relève que la diffusion des innovations est marquée par un temps de latence importante. Ainsi, il a fallu attendre longtemps pour que l'électricité n'affecte la productivité. Ainsi, le paradoxe de la productivité n'en est pas un dès lors que l'on se place dans le temps long.

Ainsi, une étude a posteriori de Jorgenson, Ho et Stiroh montre, en 2008, sur des données américaines entre 1995 et 2000, que les investissements dans les technologies de l'information et de la communication ont contribué à hauteur de 37 % à la croissance de la productivité du travail.

Références

Paradoxe en économie
Croissance économique


text:
var readline = require('readline'),
    util     = require('util'),
    colors   = require('colors'), // npm install colors
    rl       = readline.createInterface(process.stdin,
                                        process.stdout,
                                        completer),
    help     = [ '.help      ' + 'display this message.',
                 '.error     ' + 'display an example error.',
                 '.q[uit]    ' + 'exit console.'
               ].join('\n');

function completer(line) {
  var completions = '.help .error .exit .quit .q'.split(' ');
  var hits = completions.filter(function(c) {
    if (c.indexOf(line) === 0) {
      // console.log('bang! ' + c);
      return c;
    }
  });
  return [hits && hits.length ? hits : completions, line];
}

function welcome() {
  console.log([ '= readline-demo ',
                '= Welcome, enter .help if you\'re lost.',
                '= Try counting from 1 to 5!'
              ].join('\n').grey);
  prompt();
}

function prompt() {
  var arrow  = '> ',
      length = arrow.length;

  rl.setPrompt(arrow.grey, length);
  rl.prompt();
}

var state = 1;
function exec(command) {
  var num = parseInt(command, 10);
  if (0 < num && num < 6) {

    if (state === num) {
      state++;
      console.log('WIN'.green);
    } else {
      console.log(('Try entering a different number, like '
                   + state + ' for example').red);
    }
    if (state === 6) {
      console.log('WOW YOU ROX A LOT!'.rainbow);
      process.exit(0);
    }

  } else if (command[0] === '.') {

    switch (command.slice(1)) {
      case 'help':
        console.log(help.yellow);
        break;
      case 'error':
        console.log('Here\'s what an error might look like');
        JSON.parse('{ a: "bad JSON" }');
        break;
      case 'exit':
      case 'quit':
      case 'q':
        process.exit(0);
        break;
    }

  } else {

    // only print if they typed something
    if (command !== '') {
      console.log(('\'' + command +
                   '\' is not a command dude, sorryz').yellow);
    }

  }
  prompt();
}

// Set things up

rl.on('line', function(cmd) {
  exec(cmd.trim());
}).on('close', function() {
  // only gets triggered by ^C or ^D
  console.log('goodbye!'.green);
  process.exit(0);
});

process.on('uncaughtException', function(e) {
  util.puts(e.stack.red);
  rl.prompt();
});

// Make sure the buffer is flushed before
// displaying the prompt.

function flush(callback) {
  if (process.stdout.write('')) {
    callback();
  } else {
    process.stdout.once('drain', function() {
      callback();
    });
  }
};

redpajama_set_name: RedPajamaGithub


text:
'Mujuru's appeal may be exaggerated'
Zimbabwe Democracy Institute (ZDI) director Pedzisai Ruhanya speaks to Senior Assistant Editor Guthrie Munyuki about current Zanu PF squabbles and wobbly opposition politics.
Below are excerpts of the interview.
Q: Zimbabwe is facing myriad problems, both socio-economic and political, which are blamed on Zanu PF and President Robert Mugabe. Does the current opposition front provide hope for change?
A: The problems facing Zimbabwe are broader than simply accusing one particular actor, President Mugabe. My argument is that even if Mugabe retires, the decomposition of the political economy of Zimbabwe will not be rescued unless both political and partisan communities focus on a national transformative agenda that is bigger than individual actors.
The opposition movements, as they stand and just like Zanu PF and its leadership, are part of the problem. The ZDI believes that the articulation of the national question and practices in terms of the "will to power" is the fundamental problem facing Zimbabwe at this historical juncture.
"Will to power" refers to the corruption of politics leading to a cultural domination in the Zimbabwe society — a logic to grab, conquer and retain power by the ruling party, opposition parties and civil society actors in order to change society.
We argue that the "will to power" has superseded the most profound and needed "will to transform" which reflects the logic and quest to sustainably transform the embedded extractive and undemocratic political and economic institutions.
Therefore, I posit that the power struggles that are pervasive, omnipresent and ambiguous in opposition parties and civil society which generally reflect the power struggles in Zanu PF do not provide hope for these contra-movements.
There is need to relegate the will to power in opposition and civil spaces and concentrate on the transformation agenda if these groups are to make a difference, otherwise Zanu PF could remain dominant in the power game for some time because of its control of the repressive state apparatus.
Q: What is wrong with the current opposition politics and how far can the opposition go in attempting to change the direction of Zimbabwe politics?
A: As pointed above, the problem with the opposition is its mimicry of Zanu PF's political culture; the power grab activities and the relegation of the broader national democratic transformative agenda to the periphery of their struggles.
Currently, the opposition groups, especially all formations of the Movement for Democratic Change, from A to Z, are involved in internal power struggles, capturing power in their small circles and some rent-seeking activities.
There is no discernible national programme with a clear thought leadership grounded in a clear transformative or reform agenda.
Those that lead the opposition at various levels have lost the moral campus to provide national leadership. The other problem with the opposition is that there is a clear lack of appreciation of the significance of empirical researches to guide their programming for instance.
They do not do scientific studies such as opinion polls and surveys to measure their strengths or vote patterns and possible electoral outcomes ahead of time.
Most tragically, when research groups publish unpalatable reports, the opposition attacks such outcomes. Simply put, the opposition does not realise that any group that wants to rise to dominance and possibly take over power at any historical epoch should have its own agents of class projects or organic intellectuals whose role is to be the deputies of the emerging political force — who produce, reproduce, articulate and re-articulate the ideas of the an emerging hegemonic group.
Q: Does a coalition involving former vice president Joice Mujuru and other forces including Morgan Tsvangirai offer formidable challenge to Zanu PF in 2018?
A: Before we talk of those possible coalitions, it is crucial that such possibilities be guided by empirical researches that provide data on the strengths and weaknesses of such individuals and how the likely voters perceive them. It is not adequate to simply imagine in the absence of empirical evidence that Tsvangirai and Mujuru could be a formidable force.
Coalitions should not be made on imaginations or political romanticism of hatred of a ruling hegemonic group, but clear studies that put facts on the table and guide decision-making.
In this case, opposition politicians should not make decisions using their hearts and emotions but proven, tested and rigorous scientific studies.
My postulation is that there is need to have gigantic national research studies in the form of scientific surveys to guide such coalitions and their democratic efficacy.
Q: How influential can Mujuru and her allies such as Didymus Mutasa and Rugare Gumbo be in changing the direction of Zimbabwe politics?
A: There is no doubt that these expelled Zanu PF politicians command some respect, but how they can tilt the political balance of power requires scientific verification through proper studies not hallucinatory projections. It would be misleading to project their influence in the absence of evidence.
We should also not forget that their influence and significance while they were in Zanu PF, apart from their credentials as liberation nationalists, was mostly because of their romance with state institutions and their access to state resources through the patronage system and neo-patrimonial activities of Zanu PF administered by the centre of power, President Robert Mugabe.
In the absence of access to the state and the clientele activities of Zanu PF, it would be misleading to overrate the influence and power of these expelled Zanu PF politicians. Simply put, the support must be subjected to empirical testing beyond their politically seductive statements of invincibility.
Q: Mutasa and the likes of Gumbo have maintained that they belong to the "original" Zanu PF. Does this association with Zanu PF aid their cause to defeat Mugabe?
A: Is the "original" belonging a reference to values, customs and ideologies or the founders of that party? At the level of ideology, there is nothing that they are articulating that reflects the socialist authoritarian values of Zanu PF and its liberation ideas.
Figuratively, former vice president Mujuru was eight years old when Zanu PF was formed in 1963. Therefore she is not original and the original Zanu PF is led by Mugabe who was there in 1963. More so, the original vice president of Zanu PF is no more, the late Leopold Takawira who passed on in 1970. So what are these people talking about?
My point is that they (Mujuru camp) have been defeated in the hegemonic power struggles in Zanu PF and were thus later expelled. That is the political reality they should accept. With regards to suggestions that they will split from Zanu PF, how do expelled members split from a party that they are no longer members?
They should get on with their political lives and convince Zimbabweans that they are no longer part of a competitive electoral authoritarian regime headed by Mugabe and that they want to bring a new democratic political culture different from their old friends.
Q: You have studied the electoral set up which is characterised by narcissistic tendencies. In light of this, how do Mugabe's and Zanu PF's wrongs affect Mujuru and/or her allies such as Mutasa in their quest to defeat Zanu PF?
A: If this group continues to tell Zimbabweans, especially those whose rights have been abused by the ruling party, that they value their political romance with the misguided policies of the ruling party, it will not help them. However, every person has a history, every person makes mistakes and they did make profound mistakes in the construction of the political economy of the state for the past 35 years.
But if they show contrition and project a solid transformative and redemptive national agenda that show a clear shift from the policies of the past, and provide national thought leadership to steer the political and economic questions, surely citizens will give them a chance.
Zimbabwe is in constant search for a solid and focused national leadership to address the decomposing body politic and if they provide such vision, they can possibly make a difference.
Q: Was the decision by Tsvangirai and the MDC not to participate in by-elections a good one?
A: I disagree with their decision. It is too parochial and there is no clear alternative to their decision that can rally their supporters and Zimbabweans. Boycotting elections without a clear national transformative agenda to demand reforms is hollow.
There appears to be no sense in recalling MPs and then refuse to participate in those elections. It's illogical. If the MDC is sincere about participating in elections, they should also withdraw from Parliament and local government. You can see that the decision is not informed by any coherent policy position. It's largely informed by faction fighting and the "will to power" as opposed to the "will to transform".
Q: How big a mistake is this decision in the context of 2018 elections?
A: Zanu PF is going to occupy urban spaces that constitute the social base of the MDC and they are going to get resources such as cars to entrench themselves in the urban areas.
It also means that the tempering with the voters' roll in the communities nationally during the by-elections will happen without MDC oversight and when we get to 2018 the voter registration dynamics in these constituencies may actually favour Zanu PF.
The MDC would not be able to deal with these changes because they are not participating.
The party and its ideologies should appreciate that human rights and other democratic rights are born out of struggles. They don't come cheap and especially through electoral boycotts that do not provide alternative means of demanding reforms.
Q: Do you see a comeback by Welshman Ncube and Tendai Biti before 2018?
A: In the absence of evidence, I would desist from being a political sangoma and study their activities before I judge them. But they have equal chances of making a difference if they get focused. Remember these politicians contributed immensely to the democratisation struggles in Zimbabwe for the past two decades.
Q: What is the role of the Zimbabwe Democracy Institute (ZDI) in the local democratisation agenda?
A: The Zimbabwe Democracy Institute is a politically independent and not-for-profit public policy think-tank. Its mission is to promote cutting-edge research and robust public policy analysis for sustainable democracy. The institution serves to generate and disseminate innovative ideas on the political economy of Zimbabwe to advance democracy, good governance and human right.
It seeks to strengthen policy formulation and implementation through public policy debate, to inculcate a culture of critical debate on public affairs and stimulate citizen participation by strengthening the capacity of non-state actors in undertaking research and analysis on public policy.
We think that research-based programming can make a difference in a society that abhors scientific interventions based on empiricism. – This interview was first published by the Daily News


text:
Haradhan Roy (born 16 March 1926, date of death unknown) was an Indian politician belonging to the Communist Party of India (Marxist). He was elected to the Lok Sabha, lower house of the Parliament of India from Asansol in 1989,1991 and 1996 but later sidelined due to differences of opinion with CPI Marxist leadership and was denied a Lok Sabha ticket in 1998. Earlier he was member of the West Bengal Legislative Assembly. Roy is deceased.

References

External links
  Official biographical sketch in Parliament of India website

1926 births
Year of death missing
Communist Party of India (Marxist) politicians from West Bengal
People from Asansol
India MPs 1989–1991
India MPs 1991–1996
India MPs 1996–1997
Lok Sabha members from West Bengal