text:
15+ motivation restauration
A Secret Weapon for The Way to Do a Job Resume
You don't want to risk your work only because of a poorly formatted or written restart. It's possible to also say that you're looking for a different job because of ethical facets. Of course you may also be searching for another job due to personal factors. You'll have the ability to grasp the most suitable job in Gulf.
Your work is a principal determining factor for the rest of your lifeit impacts the vehicle that you drive, the house you live in, and just how much money is in your 401k. Then there will be information that you want to tweak in accord with the job, including your goal or your interests, which you are in a position to put to the elastic' section. To begin with, you can inspect the job posting that the company creating to ascertain precisely what is necessary for the position. Saves Time whenever you're looking for a wonderful job, it is always great to have a separate resume for each job.
The complete most important point to get a chance of being meeting by your potential employer to get your fantasy job would be to compose an effective and right to the point resume. To get the desired job isn't a easy job. On the lookout for employment is also an arduous and stressful strategy. Yes, attempting to find work and landing a single is not easy, but it is doable.
Looking for a project is a substantial step in lifestyle. Hence, keep it brief and provide the information that's connected to the implemented job. If you're providing little info about you, there will be no use in using such CVs. You should have legal information on the job you're being interviewed for along with the company offering the place.
Your outline has to do a fantastic job of convincing an employer that you're the only applicant. You can write a terrific summary by getting a very good idea about what information shouldn't be communicated in your resume. In summary, it's a work description.
The job objective in resume explains about the personal aims of the candidate working in the specific position. Before writing the resume recall that, your job goal should focus on which it is possible to give to the supplier rather than that which you need from the business enterprise. The aim of this resume builder is to provide an easy to follow template that makes it possible for the building of an ideal resume across a wide choice of industry types. Actually, career objectives provide jobseekers an outstanding chance to set themselves apart in the rest of the part of the applicants.
You're in a position to take extra training linked to your profession. For acquiring the work opportunity, it's crucial that you write the resume that will display your abilities and traits marvelously. The skills a chronological resume might not have the capability to emphasize are in a place to be highlighted in a functional resume. In reality today, decent communication skills has become a vital role in the majority of the job areas but in Banks it's a topic of Centralized price and is a basic substance for a candidate that would like to locate doorway into some of the public or private sector banks of the nation. The mentioned skills are usually necessary for all job positions. You do not have to be worried if you do not possess job certain skills.
You will require a restart targeting the particular position you are applying for. Keep in mind we have quite a few other applicants applying for the identical position and should you have most acceptable job abilities, you may obviously be the absolute most preferred candidate for your job. Actuary There are many different job positions in the area.
Resumes are definitely the most important thing in a person's career. Possessing an expert resume is your only way you are likely to have the ability to acquire the meeting and job you've been looking for. Resumes start to look and sound the exact same to them. You will get awesomely optimized resumes and you are going to make your life simpler!
There are numerous young job hunters that are scared to have a measure for starting their career simply because they have zero experience in the actual occupation world. If you are job searching I recommend that you keep your email address your title. If you're job hunting it could possibly be an abbreviated expert overview. When you start to consider job searching, take note of the daily tasks which occur.
How To End a Letter of Intent Explained
If you are able to form the letter. A letter of Intent isn't a binding contract. Therefore, it's essentially a legally worthless record. Composing a letter of intent isn't to be dismissed. Now you're ready to produce your cover letter. It isn't required to compose a cover letter that resembles a resume but provide an overview of your strengths and work related experiences. It turned out to be a cordial reminder letter.
In case you're looking for a suspended sentence (meaning that you don't possess any jail or probation but that jail is held over your mind on particular conditions) you've got to show the court that there's not any reason to supervise you since you are a responsible self-starter who complies without being told to. Know your text prior to starting. If you're not too sure what format is acceptable for your letter, you may appear for templates which can produce your work quick, easy and on point. Ensure you pick up the appropriate format and include all details that should be included depending on the form of correspondence it is that you're sending. You need to ensure all the documents about the purchase are set up and prepared. In the event the book can't utilize your pitched thought, the editor can select the time and difficulty to direct you to a different publication or send you feedback on the reason they didn't purchase your work.
Sometimes folks are dealing with various issues at the exact same time without realizing it. For your motivation letter to be profitable, it must address certain crucial issues and ought to also maintain the most acceptable format. You have got an issue and you're likely to work on dealing with it so you won't end up in the exact spot again. Speaking of meetings, even if you own a substance abuse problem, no matter your feelings about 12-step apps, now's the time to begin going. Don't hesitate to be more creative, but do not neglect to immediately take care of the question you've been asked!
New Questions About How To End a Letter of Intent
Most collection agencies are not likely to respond to a letter, because they cannot offer you the proof nor the information that you request. Doing so creates a contract that might be binding. In case you haven't signed a contract with the collection business, you owe them nothing. For the set organization to state that it had an agreement on you, it must demonstrate the way that it was likely to do good for you.
The expression amassacrea was used with an incorrect meaning. When you comprehend the intended tone and intention of this text, it's much easier to get the most acceptable style and format for your document. The majority of us have lots of conditions they require fulfilled, lots of rules they need in order to go obeyed, and a there is a great deal of behaving to be done so as to communicate together without bothering them. Make sure that you check every rule I have quoted to make sure there aren't any deviations in your own state. The fact that you maynot pay is an older but completely useless excuse however legitimate it could be to you. You merely wish to locate a hole and fall within it.
You merely borrow cash against the property, as it's the property that really holds the value. In case the new owner could help presence together with whatever else that required addressing, the chance of relocation would not be quite as big. If companies see exactly the same generic letter all the moment, they might get annoyed! A collection business can't collect any sum of money that is not allowed by law or by agreement. Consequently, if a company wants to have a mortgage by paying a minimum deposit, then it should probably devote a few years in the business first.
Ideas, Formulas and Techniques for How To End a Letter of Intent
That you do not have to compose your life story in demonstration. Camp life is not intimate, Julia. There's an array of money and information easily available to anyone who is ready to take a little time and make a few contacts. There is literally an unlimited amount of money available to people who wish to borrow it. The present of instruction makes Tony a powerful influence. As an example, you might mention the length of time it's been because they left a purchase from the own enterprise. When composing cover letters there are two or three essential steps that you need to take as a means to make your cover letter as powerful as possible.
Every time a certain number of purchases occur, the customer receives an entirely free merchandise or support. An inordinate amount of information becomes confusing. At length, it is possible to harm yourself if you devote an inordinate number of data on your demonstration.
The Pain of How to Fill a Check
Maintain the record in the exact same location all of the time where it is easily assessable. In fact it requires only a little time to look at the car every week instead of worrying about it. You may then print your work or return and make adjustments. If you'd like more help to decide, seek specialist help from a local accounting expert. You'll almost certainly be among the few who's prepared. You may still choose to acquire a check mailed to you. Getting Kids Involved the best and most interactive method to educate kids to perform a checkbook would be to think of a reason for them to compose checks.
Some of those online background checks service suppliers provide you free of cost method but it doesn't provide you the full particulars of the record. The sort of verification that you need will mostly are based on the kind of company that you have. For an online company to become productive, it has to have a steady, reliable system of generating revenue.
You can repay the loan in full any moment that your financing permit you. You might not meet the prerequisites for a standard loan should you approach a financial institution or mortgage lender. All payday loans have to be paid back before it is likely to be granted another cash advance meaning you can not have more than one payday loan at a moment. There are not some credit check student loans accessible where the borrower doesn't check a individual's credit score.
You will find however, zero charges to apply or be entitled to a payday advance. Cost just like most products and services, price is an integral determinant among merchant account alternatives. Money Money consistently produces a great graduation gift. You may likewise have the ability to change between accounts with one click. It's very important to keep in mind that selecting a merchant account is merely among the most significant decisions which whoever owns a online business will make. You might have overdrawn your account and neglected to repay the overdraft. If you wish to open a new bank accounts as you're on Chexsystems, your very best bet is to do a search for second chance checking accounts.
You have to put up an honest record, which makes certain your viewers know exactly what they'll be getting. Besides picking the most suitable style, in addition, it is imperative that you have got all of the appropriate information for printing. Before you set in your name, address or some other information in that form, STOP! You should balance a different register so that you can compare at the end of the month to get accuracy.
You do not wish to have the check proceed to some other person. A credit rating check is every time a lender determines if is an expected borrower is creditworthy. Writing checks is simple, and most kids really like to learn since they feel like a grownup in the practice. A more realistic strategy is to conduct an on-line background test. By applying the newest on-line background record checking services you're going to be able to complete a background check on any person that you are considering hiring to work in your residence. You may not write many checks in a month if your organization is extremely small. Normal maintenance checks and simple service can significantly decrease the price of vehicle ownership.
The Importance of How To Satisfy a Check
The simple to establish feature permits you to start meeting people whenever possible. You'd love to write as you are aware that it's an amazing tool to build exposure and leverage your own ability as an authority on your specialty. Check with the schools to determine the deadline you've got to have you program in by, or send in your application when you can and they will allow you to know whether you have to wait until the subsequent submission period. To submit an application for a cash advance, you will fill a on-line application form and extend personal details like your name, address, occupation information, banking information, and image identification to have the ability to finish your payday advance request.
When there is something shady in a individual's past it is likely to find it and act on it. If you would like to fulfill an individual, you merely have to scroll right or left based on if you enjoy the guy or not. Without regard to the motive, it's nearly not possible that you find an individual's driver's license documents unless they give you a written permission. Most people breathe shallowly.


text:
Discover the Baume Obscure Cave ! Go down to 60 m depth and enjoy the visit with our special price.
Enjoy an outdoor activity and explore a mysterious place: The Baume obscure cave. Take a guided tour or choose the treasure hunt, a great activity for family!
The cave offers many varied activities: You can visit it in a total autonomy thanks to audio guide, and enjoy the sounds and lights games on the walls. For adventure game lovers, it offers treasure hunts in the forest around or in the caves. You can also combine the tour AND the treasure hunt.

subset: commoncrawl


text:
About Hotel
Lotus 1 Hotel Faisal Town is a part of Lotus group of hotels, we have decades of experience of hospitality industry. This property is located right at junction of Faisal Town and Model Town. Jinnah Hospital, Allama Iqbal medical college and Punjab university are all located in our vicinity. Barkat market is just 1.5 Km and Akbar chowk is just 1.4 Km away form us. All rooms at our property equipped with Flat screen TV and modern amenities.
Available Rooms
+16% S.Tax
Deluxe Single Room
Max Guests: 1 persons
- ac_unitAir Conditioned
- Telephone
- access_alarm Wake up call
- Private Bath
- Flat Screen TV
- Free Wifi
- Safety Deposit Box
Satellite Channels
Sound Proofing
Toilet Paper
+16% S.Tax
Deluxe Double Room
Max Guests: 2 persons
- ac_unitAir Conditioned
- Telephone
- access_alarm Wake up call
- Private Bath
- Flat Screen TV
- Free Wifi
- Safety Deposit Box
Satellite Channels
Sound Proofing
Toilet Paper
- rent a car
wc Front Desk Services
- valet parking
- safety deposit box
- private check-in/check-out
- express check-in/check-out
local_laundry_service Cleaning Services
- dry cleaning Extra charges
- iron services Extra charges
- shoeshine
- laundry Extra charges
fastfood Food & Drink
- Restaurant
- Breakfast in the room
free WiFi is available in entire property.
Breakfast (included)
- continental
language Language
- English
- Urdu
free private parking is available on site (reservation is not needed).
- doctor on call
- family rooms
- room service
- air conditioning
- facilities for disabled guests
- elevator
- safe
- soundproof rooms
- bridal suite
- lift
- designated smoking area
- 24hour security
- security alarm
- smoke alarms
- CCTV in common areas
- CCTV outside property
- fire extinguishers
Hotel Policies
- Check-in 2:00 PM - 6:00 PM
- Check-out 8:00 AM - 12:00 PM
- Chidren All children are welcome.
- Pet Pets are not allowed.
- Hotel Payment options: Cash, CreditCard,
BlizinHotels Payment Options
cancellation Policy
You can cancel your booking two days before your check in date and your payment will be refunded after deducting bank charges. Bookings are Not Refundable within two days of check in date.
Hotel Reviews - 1
" Nice budget hotel, very cost effective as compared to facilities , will visit again "
Important Facilities
- Internet
- Parking
- Rent a car
- Restaurant
Nearest Landmarks
- Faisal Hospital 0 Km
- Allam Iqbal Medical College 0.8 km
- Jinnah Hospital 1 km
- Minhaj Ul Quran1.5 Km
- Akbar Chowk 1.5 Km
- Shahi Qila 12 Km
- Badshahi Mosque12 Km
- Punjab University2 Km
- Barkat Market 2 Km
- Lahore Gymkhana7 Km
- MEI KONG Faisal Town
- Dera Restaurant 0.5 Km
- Gourmet Restaurant 1.1 Km
- Pizza Hut1.5 Km
- Salt & Paper1.6 Km
- Namak Mandi 1.9 Km
- Yasir Broast 2 Km
- Allam Iqbal International Airport 13 Km
- Barkat Market 2.5 Km
- Alfatah5 KM
- Liberty Market 6 Km
Price Range
Booking Estimate
Recommended Attractions
Gurdwara Rori Sahib- A sacred place with divine pebbles
Kartarpur Corridor: A Gateway to promote peace in India-Pakistan
Bibi Pak Daman-The Mythical Shrine
Data Darbar Lahore- A Depiction of Our Glorious Islamic and Cultural Values
Shalimar Garden Lahore
Food Street Lahore: A Nirvana to Food Junkies
Shahi Qila and Its Breathtaking Monuments
Minar-e-Pakistan- The Symbol of Pride and Freedom
Lahore Museum- The curator of Our Culture
Badshahi Mosque- The Symbol of Mughal Grandeur


text:
Boston Advisors LLC boosted its holdings in Booz Allen Hamilton Holding Co. (NYSE:BAH) by 4.2% in the third quarter, HoldingsChannel reports. The firm owned 108,314 shares of the business services provider's stock after purchasing an additional 4,377 shares during the period. Boston Advisors LLC's holdings in Booz Allen Hamilton were worth $7,692,000 as of its most recent SEC filing.
Other institutional investors and hedge funds have also modified their holdings of the company. Point72 Asset Management L.P. purchased a new position in Booz Allen Hamilton in the second quarter valued at about $26,000. Quest Capital Management Inc. ADV purchased a new position in Booz Allen Hamilton in the third quarter valued at about $26,000. First Financial Corp IN purchased a new position in Booz Allen Hamilton in the third quarter valued at about $28,000. Pearl River Capital LLC purchased a new position in Booz Allen Hamilton in the second quarter valued at about $33,000. Finally, Capital Investment Advisory Services LLC purchased a new position in Booz Allen Hamilton in the second quarter valued at about $42,000. 91.27% of the stock is owned by hedge funds and other institutional investors.
A number of brokerages recently commented on BAH. SunTrust Banks increased their price target on Booz Allen Hamilton to $88.00 and gave the company a "buy" rating in a report on Monday, November 4th. Morgan Stanley increased their target price on Booz Allen Hamilton from $76.00 to $78.00 and gave the stock an "overweight" rating in a report on Thursday, October 10th. Wells Fargo & Co reaffirmed a "hold" rating on shares of Booz Allen Hamilton in a report on Friday, November 1st. Barclays began coverage on Booz Allen Hamilton in a report on Friday, September 20th. They set an "equal weight" rating and a $77.00 target price on the stock. Finally, JPMorgan Chase & Co. began coverage on Booz Allen Hamilton in a report on Tuesday, September 24th. They set a "neutral" rating and a $77.00 target price on the stock. Five equities research analysts have rated the stock with a hold rating and six have issued a buy rating to the company. Booz Allen Hamilton has an average rating of "Buy" and an average target price of $76.67.
Booz Allen Hamilton (NYSE:BAH) last released its earnings results on Friday, November 1st. The business services provider reported $0.81 EPS for the quarter, topping analysts' consensus estimates of $0.70 by $0.11. Booz Allen Hamilton had a return on equity of 57.89% and a net margin of 6.40%. The company had revenue of $1.82 billion for the quarter, compared to the consensus estimate of $1.78 billion. During the same quarter last year, the business posted $0.68 EPS. Booz Allen Hamilton's quarterly revenue was up 12.7% compared to the same quarter last year. As a group, sell-side analysts expect that Booz Allen Hamilton Holding Co. will post 3.11 EPS for the current fiscal year.
The company also recently announced a dividend, which will be paid on Monday, December 2nd. Shareholders of record on Thursday, November 14th will be issued a dividend of $0.27 per share. The ex-dividend date of this dividend is Wednesday, November 13th. This is an increase from Booz Allen Hamilton's previous dividend of $0.13. Booz Allen Hamilton's dividend payout ratio (DPR) is currently 33.33%.
About Booz Allen Hamilton
Booz Allen Hamilton Holding Corporation provides management and technology consulting, engineering, analytics, digital, mission operations, and cyber solutions to governments, corporations, and not-for-profit organizations in the United States and internationally. The company offers consulting solutions for various domains, business strategies, human capital, and operations.
Further Reading: What is required to own or exchange cryptocurrency?
Want to see what other hedge funds are holding BAH? Visit HoldingsChannel.com to get the latest 13F filings and insider trades for Booz Allen Hamilton Holding Co. (NYSE:BAH).
Receive News & Ratings for Booz Allen Hamilton Daily - Enter your email address below to receive a concise daily summary of the latest news and analysts' ratings for Booz Allen Hamilton and related companies with MarketBeat.com's FREE daily email newsletter.


text:
Dr. Kim is director of the Hennepin Women's Mental Health Program at Hennepin County Medical Center in Minneapolis, Minnesota, and clinical assistant professor of psychiatry at the University of Minnesota Medical School in Minneapolis. Dr. Kolpe is staff psychiatrist at the Hennepin Women's Mental Health Program and clinical assistant professor of psychiatry at the University of Minnesota Medical School.
Disclosures: The authors report no affiliation with or financial interest in any organization that may pose a conflict of interest.
Please direct all correspondence to: Helen Kim, MD, Hennepin Women's Mental Health Program, S110 Clinic, Hennepin County Medical Center, 900 S 8th St, Minneapolis, MN 55404; Tel: 612-347-6851; Fax: 612-373-1859; E-mail: email@example.com.
What should a clinician consider in selecting a psychotropic medication for pregnant and lactating women with psychiatric symptoms? While postpartum depression is increasingly recognized as a public health priority, vulnerability to depression and anxiety begin in pregnancy. Clinicians are often called upon to counsel pregnant and postpartum patients about the risks and benefits of psychotropic medication. Patients generally overestimate the risks of psychotropic drugs and underestimate the impact of untreated psychiatric illness on themselves and their families. This article reviews recent studies and treatment considerations in selecting psychotropic medications for perinatal women with mood and anxiety symptoms.
The perinatal period can be a high-risk time for worsening mood and anxiety symptoms. While postpartum depression has been identified as a major public health concern,1 vulnerability to depression clearly begins before delivery and continues into the postpartum.2-6 A systematic review of perinatal depression found that the point of prevalence of major depressive disorder (MDD) and minor depression during pregnancy ranged from 6.5% to 12.9%, while another study of >3,000 pregnant patients found that 20% had significant depressive symptoms.7 Many factors have been implicated in worsening mood and anxiety symptoms during pregnancy, including psychosocial risk factors as well as physiologic changes associated with the perinatal period.8-11 Disrupting a maintenance antidepressant may also lead to worsening symptoms in pregnancy as demonstrated in a recent study by Cohen and colleagues,12 in which 68% of women with a history of recurrent MDD relapsed with depression after discontinuing antidepressants compared to 26% who maintained treatment.
With the high prevalence of MDD among women of reproductive age, clinicians are often called upon to help patients weigh the benefits and risks of psychotropic medications during pregnancy and lactation. Recent studies have highlighted both the potential risks of antidepressants in pregnancy as well as the effects of untreated psychiatric symptoms during and after pregnancy. Several studies from the renowned Motherisk Program in Toronto have examined the tendency of pregnant patients to underestimate this risk of untreated depression and anxiety13,14 and overestimate the risk of medication. For example, though the baseline rate of malformations in the general population is approximately 3% to 4%, women exposed to known nonteratogens assigned themselves a risk of 24% for major malformation before hearing about relevant medical studies, and then 14.5% thereafter.15 This misperception of risk can lead patients and physicians to avoid or terminate otherwise wanted pregnancies or avoid needed pharmacotherapy. Clinicians can help put the risks of medication into context by reminding patients that pregnancy itself carries many risks including spontaneous abortion and congenital defects. Many studies have documented the fact that untreated psychiatric illness can compound these risks by contributing to poor self care, decreased prenatal compliance, increased nicotine and substance misuse,16,17 poor obstetrical outcomes,18,19 and increased risk of postpartum depression.20 Given the potential risks of medication during pregnancy, patients often feel like they must not put their own need for symptom relief ahead of the well-being of the pregnancy. Clinicians can help patients realize that these two priorities are inextricably tied since emotional distress also impacts the pregnancy.
Routine formalized screening for major Axis I diagnoses both prenatally and postnatally can assist clinicians in identifying patients with psychiatric symptoms.21,22 Risk factors for depression and anxiety during and after pregnancy are also readily identifiable and include prior history of depression, young age, poverty, stressful life events, and limited social support.23,24 After screening for these risk factors, evaluating current symptoms, and ruling out possible medical conditions (eg, anemia or thyroid dysfunction) that may be contributing to mood, anxiety, and neurovegetative symptoms, clinicians must then direct patients toward the most appropriate course of treatment. This process involves careful review of the risks of untreated illness versus the risks and benefits of available treatment including medication, therapy, and supportive interventions. As Stowe and colleagues25 eloquently articulated, perinatal patients must be guided toward minimizing not only exposure to medication but exposure to illness as well. This article reviews recent studies and focuses on treatment considerations in selecting psychotropic medications for perinatal women with mood and anxiety symptoms.
Pharmacologic Considerations in Pregnancy
Congenital Malformations
Medications taken during pregnancy are considered teratogenic if they increase the risk of congenital malformations above the baseline risk of 3% to 4%. Most studies of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are reassuring and show no increased risk of major congenital malformations.26,27 However, while previous studies have shown no association between paroxetine and congenital malformations,28-30 the manufacturer of paroxetine issued a warning in 2005 that two studies found a possible association between first-trimester paroxetine exposure and increased risk for cardiac defects, particularly atrial and ventral septal in nature.31 Subsequently, the Food and Drug Administration issued a similar warning that first-trimester paroxetine use was associated with an increased risk of major malformations (4% versus 3%), particularly cardiac defects (2% versus 1%), and changed the pregnancy labeling from category C to D, which indicates that controlled or observational studies in pregnant women have demonstrated a risk to the fetus. In addition, the American College of Obstetricians and Gynecologists has recommended avoiding paroxetine use in pregnant women unless the benefits outweigh the risks of discontinuing the medication.32
While there have been fewer reported cases of prenatal exposures to non-SSRIs, the limited data available have not shown an increased risk of congenital malformations with venlafaxine,33 mirtazapine,34 nefazodone, or trazodone.35 In an admirable attempt to prospectively assess reproductive risk, the drug manufacturer of bupropion established a postmarketing epidemiologic surveillance registry in 1997. This registry reported a preliminary finding of a possible association between bupropion exposure and increased risk of birth defects involving the heart and great vessels. In the most recent report from this registry spanning September 1997 through August 2006, 1,443 prospectively registered pregnancies involved exposure to bupropion.36 Among this group, 483 were lost to follow up and 134 pregnancies were pending. Among the remaining 833 prospectively reported pregnancy outcomes, the Bupropion Pregnancy Registry Advisory Committee found no evidence of increased risk of birth defects; however, they warned that the relatively small sample size and large percentage of patients lost to follow up make it impossible to draw definitive conclusions about the possible teratogenic risk of bupropion. These findings are consistent with other studies including a prospective study of 136 women exposed to bupropion in the first trimester of pregnancy that found no increased risk of major malformations,37 and a claims-based, retrospective cohort study using the United Healthcare database which found no consistent pattern of birth defects associated with prenatal exposure to bupropion.38 To register pregnancies in women on bupropion, clinicians can call the GlaxoSmithKline Pregnancy Registry at 800-336-2176.
Perinatal Effects Following Late-Pregnancy Antidepressant Exposure
In utero exposure to antidepressants has been associated with transient symptoms of possible medication withdrawal or toxicity in neonates. These symptoms have been described with many SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) and include irritability, tremulousness, insomnia, poor feeding, temperature dysregulation, increased or decreased muscle tone, and/or respiratory distress.39,40 Using a formal screening tool, one study found that 30% of newborns exposed to SSRIs in late pregnancy developed neonatal abstinence symptoms.41 Although these neonatal syndromes are generally transient and not life threatening, in 2004 antidepressant manufacturers and the FDA decided to modify their drug labeling to include a recommendation to consider tapering antidepressants in the last part of pregnancy. For women with recurrent depression or anxiety conditions, this strategy may not be prudent since it would withdraw treatment just as patients are transitioning to the postpartum, a time of increased risk for affective instability.
Another recent study highlighted another concerning finding regarding antidepressant use in pregnancy. In 2006, Chambers and colleagues42 published a study that found a possible association between SSRI exposure after 20 weeks' gestation and persistent pulmonary hypertension of the newborn (PPHN), a serious and rare condition with a baseline rate of 1–2 out of 1,000 live births and mortality rate of 10% to 20%. Although this study was retrospective in design and involved only a small number of affected infants, its findings are concerning and highlight the uncertainty that patients and providers must assume in choosing to use antidepressants or any psychotropic medications during pregnancy.
Long-Term Neurobehavioral Effects
It remains to be seen whether in utero antidepressant exposure is associated with any long-term neurologic or behavioral effects. In a cohort of children 4–5 years of age exposed in utero to SSRIs, levels of internalizing and externalizing behavior did not differ significantly between children who were (N=22) or were not (N=14) exposed prenatally to SSRIs.43,44 In another study, Nulman and colleagues45 compared a cohort of mother-child pairs exposed throughout gestation to TCAs (N=46) or fluoxetine (N=40) to a nondepressed comparison group (N=36). Children between 15 and 71 months of age were assessed and compared in terms of intelligence quotient (IQ), language, behavior, and temperament, with adjustment for severity of maternal depression, maternal IQ, socioeconomic status, maternal smoking, and alcohol history. Children exposed in utero to TCAs or fluoxetine were found to have no difference in temperament, language, or cognitive development compared to nonexposed children. In fact, it was exposure to maternal depression and not medication itself that was associated with less language and cognitive achievement.
Mood Stabilizers
Lithium use during pregnancy has been associated with perinatal toxicity, including case reports of lethargy, hypotonia, cyanosis, respiratory distress, and diabetes insipidus.46 In addition, lithium use during the first trimester has been associated with an increased risk of a serious congenital heart defect known as Ebstein's anomaly and occurs in approximately 1 out of 1,000 live births. For women with moderate-to-severe bipolar disorder with recurrent episodes of mania or depression, the relatively small risk of these adverse pregnancy outcomes may be far overshadowed by the much greater risk of relapse. Maintenance lithium treatment for these patients during pregnancy may be the most prudent treatment option. For women with less severe bipolar disorder who have had significant periods of stability, slowly tapering off lithium and reintroducing it after the first trimester or just after delivery may help lower medication exposure while also minimizing risk of relapse during the postpartum, a time of known high risk in women with bipolar disorder.47
Lamotrigine is another highly effective mood stabilizer, particularly for bipolar depression. As with bupropion, the manufacturer of lamotrigine took a very proactive step in 1992 and established a pregnancy registry to assess the reproductive safety risk of lamotrigine. In January 2007, the Lamotrigine Pregnancy Registry reported its most recent update spanning the time period from September 1992 through September 2006 during which there were 1,539 prospectively registered pregnancies involving lamotrigine exposure.48 Among this group 908 outcomes involved first-trimester lamotrigine exposure with 26 (2.9%) major birth defects. This is similar to the baseline frequency of malformations reported in cohorts of women using antiepileptic monotherapy. Of note, in the 133 pregnancy outcomes involving polytherapy with lamotrigine and valproate, plus or minus another anticonvulsant, there was an alarming 11.3% rate of major congenital defects. Overall, the findings for lamotrigine monotherapy have been reassuring and consistent with other reports.49 However, the North American Antiepileptic Drug Pregnancy Registry recently found that infants who are exposed to lamotrigine as monotherapy during pregnancy have a much higher risk of oral cleft defects.50 In this study, 564 children exposed to lamotrigine monotherapy had a prevalence rate of major malformations of 2.7%; however, five infants had oral cleft lip/palate, yielding a prevalence rate of 9 out of 1,000 births compared to a baseline prevalence of 0.5–2.0 per 1,000 in unexposed infants. A larger sample size is needed to confirm this finding. Even if future prospective studies also find this association between first-trimester lamotrigine use and oral cleft lip and palate, the overall risk appears to be low and may be overshadowed by the high risk of recurrent illness in women with moderate-to-severe forms of bipolar disorder. Clinicians can help expand the available database of lamotrigine exposures by registering all pregnant patients on lamotrigine with the Lamotrigine Pregnancy Registry by calling 800-336-2176, or having patients enroll themselves in the North American AED Pregnancy Registry by calling 888-233-2334.
Valproic acid and carbamazepine have well-established risks of neural tube defects of 1.0% to 5.0% and 0.5% to 1.0%, respectively.51,52 In utero valproate exposure has also been associated with a higher frequency of major anomalies53,54 as well as neurodevelopmental delay in exposed children.55,56 Neonatal complications associated with valproate include irritability, jitteriness, and feeding problems.57 Liver toxicity has also been described following valproate and carbamazepine use during pregnancy.58,59 Less is known about the reproductive safety of newer anticonvulsants such as gabapentin, oxcarbazepine, and topiramate. While these newer anticonvulsants would not be the first choice in pregnancy, they may be indicated for pregnant women with refractory bipolar illness and a history of good response to these medications. Providers should encourage pregnant women who elect to continue any mood stabilizer to take high-dose folate (4 mg/day) for the theoretical benefit of reducing risk of neural tube defects. In addition, pregnant women should undergo a second trimester Level II ultrasound to screen for major congenital anomalies.
Untreated psychosis can be harmful in pregnancy, as demonstrated by one study that found a two-fold increase in adverse pregnancy outcomes (eg, stillbirth, preterm delivery, low birth weight) in women diagnosed with schizophrenia during pregnancy.60 Psychotic symptoms can also lead to disorganized behavior, increased paranoia, avoidance of prenatal care, increased drug and alcohol use, and other high-risk behaviors. First-generation antipsychotics with high and midpotency (eg, haloperidol, perphenazine) are generally considered to be the antipsychotics of choice during pregnancy since they have not consistently demonstrated teratogenic risk.57 Low-potency phenothiazines (eg, chlorpromazine) have shown increased risk of congenital malformations and should be avoided.61 Case reports of neonatal toxicity following in utero exposure to typical antipsychotics have been described and include motor restlessness, tremor, feeding difficulties, increased muscle tone, and abnormal motor movements.62,63
Studies of the reproductive safety of atypical antipsychotics have been limited to small case reports and case series. Olanzapine was not associated with major malformations in a manufacturer-sponsored study of 23 prospectively ascertained pregnancies.64 McKenna and colleagues65 reported on 151 pregnancy outcomes following exposure to olanzapine (N=60), risperidone (N=49), quetiapine (N=36), and clozapine (N=6). Among this total group there were 110 (approximately 73%) live births, 22 (approximately 15%) spontaneous abortions, 15 (approximately 10%) therapeutic abortions, four (approximately 3%) stillbirths, and one (approximately 1%) infant with major malformations. There was no statistically significant difference in pregnancy outcomes between this group and a comparison group of pregnant women except for a higher rate of low birth weight in exposed babies (approximately 10% versus 2%). Given the small sample sizes and the notable differences between the exposed and comparison group (eg, differences in socioeconomic background and rates of elective abortion), no definitive conclusions can be drawn about the reproductive safety of atypical antipsychotics in general. However, one theoretical concern with these medications is their propensity to cause significant weight gain that in pregnancy can lead to or exacerbate pre-existing hypertension and diabetes. This must be considered along with the potentially hazardous consequences of discontinuing an antipsychotic that is effectively treating a pregnant woman with a history of psychotic symptoms.
Based on the available evidence, experts have supported the use of typical antipsychotics for acute treatment of mania or psychosis during pregnancy.57 Others have suggested that the risk with high-potency typical antipsychotics may be less than the risks associated with available mood stabilizers,61 and that they offer a reasonable treatment alternative for women with bipolar disorder with recurrent symptoms during pregnancy.57
Benzodiazepine use during pregnancy has been associated with case reports of perinatal toxicity, including temperature dysregulation, apnea, depressed APGAR scores, hypotonia, and poor feeding. In addition, early studies revealed an elevated risk of oral cleft palate defects compared to the baseline risk in the general population.66 However, more recent studies have shown that the overall risk of cleft lip and palate with benzodiazepine use in pregnancy is likely quite low.67,68 In considering the risks and benefits of benzodiazepines, clinicians should also consider the risks of untreated insomnia and anxiety in pregnancy, which may lead to physiologic effects as well as diminished self care, worsening mood, and impaired functioning. Given the consequences of untreated psychiatric symptoms and the limited and controversial risks associated with benzodiazepine use, some women with overwhelming anxiety symptoms or sleep disturbance may find that the benefits outweigh any theoretical risks.
Pharmacologic Considerations in the Postpartum
Women can experience a range of emotional and psychological symptoms following delivery. Heightened emotional sensitivity, anxiety, and sleep disturbance can affect 80% of women after delivery in the form of the postpartum blues, a normal and self-limited syndrome that usually begins 2–3 days postpartum and resolves in 7–14 days. Approximately 10% to 20% of all postpartum women experience a more serious condition called postpartum depression (PPD). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–Text Revision,69 classifies PPD as MDD that occurs within 4 weeks postpartum; however, many new mothers develop symptoms more than 2–3 months after delivery. Postpartum anxiety syndromes are also extremely common and can include panic attacks, intense anxiety about not getting enough sleep, obsessive worry about the baby's health or safety, and intrusive thoughts or mental images of hurting the baby.70 New mothers with intrusive thoughts are often ashamed of these ego-dystonic images and may develop behaviors to diffuse some of their anxiety and fear, such as avoiding sharp objects or compulsively checking their infants' breathing. Postpartum patients can be reassured that though intrusive thoughts are common, violently acting them out is very uncommon. Postpartum psychosis is a serious and rare condition that occurs in 1–2 of every 1,000 postpartum women. Postpartum psychosis can begin acutely within the first 48–72 hours after delivery and may include delirium, agitation, irritability, and mood lability. Psychosis can also occur in new mothers with a history of a chronic psychotic disorder or as part of a major depressive or manic episode. Psychotic symptoms in any postpartum woman require immediate intervention in order to protect both mother and infant from harm.
Evaluation of Postpartum Women with Psychiatric Risk Factors or Symptoms
Evaluation of postpartum psychiatric symptoms includes assessment for medical conditions such as anemia or thyroid disorders that can contribute to low mood, anxiety, fatigue, and sleep disturbance. Systematic screening for psychosocial risk factors as well as current symptoms facilitates prevention, detection, and treatment of postpartum psychiatric syndromes. The Edinburgh Postnatal Depression Scale (EPDS) is a widely recommended, cost-effective means of screening for PPD.71 The EPDS is a 10-item self-rating scale that has been validated in Spanish and English and asks about depressive symptoms in the preceding week, including crying spells, decreased interest and pleasure, increased guilt, anxiety, sleeping problems, and thoughts of self harm.72 To improve prevention interventions, clinicians can also screen for risk factors both during and after pregnancy. These risk factors include a personal history of mood or anxiety disorder, psychiatric symptoms during pregnancy, limited social support, interpersonal conflicts, and negative life events during and after pregnancy.73-75 In addition, a history of extreme premenstrual irritability may be a possible marker for increased vulnerability during times of hormone fluctuation, such as the dramatic hormone shifts after delivery.76
Despite the high prevalence of postpartum psychiatric illness, there are only a limited number of medication treatment studies. In small open studies, venlafaxine (N=15),77 bupropion (N=8),78 fluvoxamine (N=6),79 and sertraline (N=26),80 have shown efficacy in treating PPD. Paroxetine alone (N=16) or in combination with 12 sessions of cognitive-behavioral therapy (CBT; N=19) improved mood and anxiety symptoms in a group of women with PPD and anxiety symptoms.81 In small randomized trials, sertraline has shown benefit in both preventing82 and treating83 PPD. In another controlled study of 61 women with PPD, fluoxetine was significantly more effective than placebo in treating PPD.84 Combining fluoxetine with six sessions of CBT did not produce additional improvement. Of note, 101 out of 188 eligible patients refused to enter the trial, mainly because of ambivalence about being randomized to take an antidepressant. Furthermore, the trial excluded nursing mothers as well as women with a history of severe or chronic depression. All these factors limit the generalizability of the findings and underscore the difficulty in carrying out randomized trials in this population. Clearly, more studies are needed with larger sample sizes and longer follow-up periods to compare different antidepressants and other psychosocial interventions.85
The choice of an antidepressant is largely guided by a patient's depressive symptoms and past history of medication response. If a patient plans to breastfeed, clinicians must facilitate a careful risk-benefit discussion about taking psychotropic medication during lactation (see below). In addition, patients must consider the risks of untreated maternal depression which can lead to impaired mother-infant attachment.86-88 and higher risk of cognitive and behavioral problems.89,90 Women at increased risk for postpartum depression should consider initiating prophylactic antidepressants either in late pregnancy or early postpartum. Alternatively, women may elect a wait-and-see approach; however, patients, their loved ones, and psychiatrists should be vigilant for early signs of recurrence in order to institute prompt treatment.
Hormone Therapy
To temper the tremendous changes in estrogen and progesterone following birth, some studies have looked at hormone therapy. In one study, women with PPD who received transdermal estrogen had significantly lower mean EPDS scores at 4 weeks of treatment compared to placebo.91 However, in another study a single dose of synthetic progestogen administered within 48 hours after delivery was significantly more likely than placebo to be associated with increased depressive symptoms at 6 weeks postpartum.92 Given the limited data available, no specific recommendations can be made regarding the use of hormone therapy for PPD.93,94
All psychotropic medications are secreted into breast milk. Mothers on psychotropic medications require a thorough discussion of the risks and benefits of breastfeeding while taking medication to treat psychiatric symptoms.
A recent analysis of the available studies of antidepressants during lactation revealed that sertraline, paroxetine, and nortriptyline are the least likely to lead to accumulation in the infant.95 Other studies of TCAs and SSRIs have been reassuring and show no consistent association between any particular antidepressant and problems in nursing newborns. There have been isolated case reports of elevated infant levels and toxicity with breastfeeding mothers taking doxepin or fluoxetine.96 Little is known about the safety of other antidepressants during lactation, such as venlafaxine, bupropion, or mirtazapine.
Mood Stabilizers
For women with bipolar disorder, the choice to nurse while on a mood stabilizer is even less clear cut than with antidepressants. Lithium can quickly accumulate in the nursing infant and lead to levels exceeding 50% of the maternal level. Given this risk of lithium toxicity in the nursing infant, breastfeeding while on lithium is generally not recommended,97,98 however, a recent case series of 10 mother-infant pairs noted low infant lithium levels in nursing infants.99 The authors of this article encourage reassessment of general recommendations against lithium during breastfeeding and suggest that nursing on lithium may be appropriate for mothers with bipolar disorder who have healthy infants and who can reliably work with a pediatrician to monitor the infant and obtain infant lithium level, thyroid-stimulating hormone, blood urea nitrogen, and creatinine in the immediate postpartum, at 4–6 weeks postpartum, and then every 8–12 weeks thereafter.
Although not absolutely contraindicated in nursing mothers, valproate has been associated with infant anemia and thrombocytopenia, and carbamazepine has been associated with transient hepatic dysfunction.97 Mothers should be informed of signs of hepatic dysfunction or anemia, such as sedation or poor feeding. Among the few available reports, breastfed infants of mothers on lamotrigine have been shown to have serum levels that are approximately 30% of the mothers' level.100,101 Though no adverse effects were noted in these infants, the severe life-threatening rash associated with lamotrigine in children and adults may also be a concern for infants exposed to lamotrigine through breastmilk.97
In general, clinicians should advise nursing women on psychotropic medications to monitor infants for behavioral changes, such as excessive sedation, jitteriness, or inconsolable crying. Infants who develop these symptoms should be evaluated by their pediatricians for possible drug toxicity. In the meantime, mothers can consider temporarily pumping and storing/discarding their breastmilk and using formula to see if their infants' symptoms resolve. In infants who are preterm or have any medical problems, mothers on psychotropic medication could also consider pumping and storing/discarding breastmilk and introducing nursing later when the infant is healthy and can presumably metabolize medication more efficiently.
Supportive Interventions
Although a detailed discussion is beyond the scope of this article, it is important to note that nonpharmacologic interventions such as education, support services, and psychotherapy can be invaluable alternatives or adjuncts to medication for women with perinatal psychiatric symptoms. Establishing a therapeutic alliance; exploring feelings about the pregnancy and motherhood; and taking inventory of strengths, supports, and stressors can help target interventions. Studies have demonstrated that depressed pregnant and postpartum women can also benefit greatly from interpersonal psychotherapy, a time-limited therapy focused on certain areas of particular relevance to pregnant women such as role transitions and interpersonal disputes.102-105 Supportive therapy and CBT have also been shown anecdotally to help with perinatal depression and anxiety as well as referrals to mothers' groups, childcare resources, and financial assistance agencies. Clinicians can also refer women to Postpartum Support International, an organization with many local chapters that offers support and resources for women with postpartum psychiatric illness.
The perinatal period can be a high-risk time for significant psychiatric symptoms. In treating pregnant and postpartum patients, clinicians must adopt an individualized treatment approach that incorporates an up-to-date discussion of the risks and benefits of medication and psychosocial interventions as well as the impact of untreated psychiatric symptoms on mothers and families. Several recent studies have highlighted the fact that reproductive psychiatry is a dynamic field with treatment recommendations that continue to evolve and currently can only serve as general guides rather than absolute mandates. Ultimately, clinicians must help patients reflect on these guidelines in the context of their own experience of illness as well as their own perception of the risks and benefits of different treatment options. PP
1. Wisner KL, Chambers C, Sit DK. Postpartum depression: a major public health problem. JAMA. 2006;296(21):2616-2618.
2. Stowe ZN, Hostetter AL, Newport DJ. The onset of postpartum depression: implications for clinical screening in obstetrical and primary care. Am J Obstet Gynecol. 2005;192(2):522-526.
3. Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257-260.
4. Andersson L, Sundstrom-Poromaa I, Wulff M, Astrom M, Bixo M. Depression and anxiety during pregnancy and six months postpartum: a follow-up study. Acta Obstet Gynecol Scand. 2006;85(8):937-944.
5. Eberhard-Gran M, Tambs K, Opjordsmoen S, Skrondal A, Eskild A. Depression during pregnancy and after delivery: a repeated measurement study. J Psychosom Obstet Gynaecol. 2004;25(1):15-21.
6. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071-1083.
7. Marcus SM, Flynn HA, Blow FC, Barry KL. Depressive symptoms among pregnant women screened in obstetric settings. J Womens Health (Larchmt). 2003;12(4):373-380.
8. Hendrick V, Altshuler LL, Suri R. Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics. 1998;39(2):93-101.
9. Parry BL, Sorenson DL, Meliska CJ, et al. Hormonal basis of mood and postpartum disorders. Curr Womens Health Rep. 2003;3(3):230-235.
10. Kammerer M, Taylor A, Glover V. The HPA axis and perinatal depression: a hypothesis. Arch Womens Ment Health. 2003;9(4):187-196.
11. Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157(6):924-930.
12. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5):499-507.
13. Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A. Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Womens Men Health. 2005;8(4):214-220.
14. Koren G. The way women perceive teratogenic risk. Can J Clin Pharmacol. 2007;14(1):e10-6.
15. Koren G, Bologa M, Long D, Feldman Y, Shear NH. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester. Am J Obstet Gynecol. 1989;160(5 Pt 1):1190-1194.
16. Zhu SH, Valbo A. Depression and smoking during pregnancy. Addic Behav. 2002;27(4):649-658.
17. Hanna EZ, Faden VB, Dufour MC. The motivational correlates of drinking, smoking, and illicit drug use during pregnancy. J Substance Abuse. 1994;6(2):155-167.
18. Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol. 2000;95(4):487-490.
19. Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001;63(5):830-834.
20. Beck CT. Postpartum depression predictors inventory–revised. Adv Neonatal Care. 2003;3(1):47-48.
21. Stowe ZN, Hostetter AL, Newport DJ. The onset of postpartum depression: implications for clinical screening in obstetrical and primary care. Am J Obstet Gynecol. 2005;192(2):522-526.
22. Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric/gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetric-Gynecology Study. Am J Obstet Gynecol. 2002;183(3):759-769.
23. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289-295.
24. Altshuler LL, Hendrick V, Cohen LS. An update on mood and anxiety disorders during pregnancy and the postpartum period. Prim Care Companion J Clin Psychiatry. 2000;2(6):217-222.
25. Stowe ZN, Calhoun K, Ramsey C, Sadek N, Newport DJ. Mood disorders during pregnancy and lactation: defining issues of exposure and treatment. CNS Spectr. 2001;6(2):150-166.
26. Hendrick V, Smith LM, Suri R, Hwang S, Haynes D, Altshuler L. Birth outcomes after prenatal exposure to antidepressant medication. Am J Obstet Gynecol. 2003;188(3):812-815.
27. Malm H, Klaukka T, Neuvonen PJ. Risks associated with selective serotonin reuptake inhibitors in pregnancy. Obstet Gynecol. 2005;106(6):1289-1296.
28. Ericson A, Kallen B, Wiholm B. Delivery outcome after the use of antidepressants in early pregnancy. Eur J Clin Pharmacol. 1999;55(7):503-508.
29. Kulin NA, Pastuszak A, Sage S, et al. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA. 1998;279(8):609-610.
30. Einarson TR, Einarson A. Newer antidepressants in pregnancy and rates of major malformations: a meta-analysis of prospective comparative studies. Pharmacoepidemiol Drug Saf. 2005;14(12):823-827.
31. December 08, 2005. GSK changes Paroxetine Prescribing Information. Available at: www.gsk.com/media/archive.htm#nolink. Accessed August 27, 2007.
32. ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 354: Treatment with selective serotonin reuptake inhibitors during pregnancy. Obstet Gynecol. 2006;108(6):1601-1603.
33. Einarson A, Fatoye B, Sarkar M, et al. Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry. 2001;158(10):1728-1730.
34. Djulus J, Koren G, Einarson TR, et al. Exposure to mirtazapine during pregnancy: a prospective, comparative study of birth outcomes. J Clin Psychiatry. 2006;67(8):1280-1284.
35. Einarson A, Bonari L, Voyer-Lavigne S, et al. A multicentre prospective controlled study to determine the safety of trazadone and nefazadone use during pregnancy. Can J Psychiatry. 2003;48(2):106-110.
36. GlaxoSmithKline GlaxoSmithKline Pregnancy Registries. Bupropion Pregnancy Registry Interim Report. Available at: http://pregnancyregistry.gsk.com/documents/bup_report_spring2007.pdf. Accessed August 27, 2007.
37. Chun-Fai-Chan B, Koren G, Fayez I, et al. Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol. 2005;192(3):932-936.
38. Cole JA, Modell JG, Haight BR, Cosmatos IS, Stoler JM, Walker AM. Bupropion in pregnancy and the prevalence of congenital malformations. Pharmacoepidemiol and Drug Saf. 2007;16(5):474-484.
39. Moses-Kolko EL, Bogen D, Perel J, et al. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005;293(19):2372-2383.
40. Kallen B. Neonate characteristics after maternal use of antidepressants late in pregnancy. Arch Pediatr Adolesc Med. 2004;158(4):312-316.
41. Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. 2006;160(2):173-176.
42. Chambers CD, Hernandez-Diaz S, Van Marter LJ, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Eng J Med. 2006;354(6):579-587.
43. Misri S, Reebye P, Kendrick K, et al. Internalizing behaviors in 4-year-old children exposed in utero to psychotropic medications. Am J Psychiatry. 2006;163(6):1026-1032.
44. Oberlander TF, Reebye P, Misri S, Papsdorf M, Kim J, Grunau RE. Externalizing and attentional behaviors in children of depressed mothers treated with a selective serotonin reuptake inhibitor antidepressant during pregnancy. Arch Pediatr Adolesc Med. 2007;161(1):22-29.
45. Nulman I, Rovet J, Stewart DE, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002;159(11):1889-1895
46. Newport DJ, Viguera AC, Beach AJ, Ritchie JC, Cohen LS, Stowe ZN. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. Am J Psychiatry. 2005;162(11):2162-2170.
47. Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157(2):179-184.
48. The Lamotrigine Pregnancy Registry. Interim Report. 1 September 1992 through 31 March 2007. Available at: http://pregnancyregistry.gsk.com/documents/lam_report_spring2007.pdf. Accessed September 3, 2007.
49. Cunnington M, Tennis P, International lamotrigine pregnancy registry scientific advisory committee. Lamotrigine and the risk of malformations in pregnancy. Neurology. 2005;64(6):955-960.
50. Holmes LB, Wyszynski DF, Baldwin EJ, et al. Increased risk for non-syndromic cleft palate among infants exposed to lamotrigine during pregnancy. Birth Defect Research Part A: Clinical and Molecular Teratology. 2006;76(5):318.
51. Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy. N Engl J Med. 1991;324:674-677.
52. Perucca E. Birth Defects after prenatal exposure to antiepileptic drugs. Lancet Neurol. 2005;4(11):781-786.
53. Kaplan PW. Reproductive health effects and teratogenicity of antiepileptic drugs. Neurology. 2004;63(10 suppl 4):S13-S23.
54. Kini U, Adab N, Vinten J, Fryer A, Clayton-Smith J; Liverpool and Manchester Neurodevelopmental Study Group. Dysmorphic features: an important clue to the diagnosis and severity of fetal anticonvulsant syndromes. Arch Dis Child Fetal Neonatal Ed. 2006;91(2):F90-95.
55. Vinten J, Adab N, Kini U, et al. Neuropsychological effects of exposure to anticonvulsant medication in utero. Neurology. 2005;64(6):949-954.
56. Eriksson K, Viinikainen K, Monkkonen A, et al. Children exposed to valproate in utero: population based evaluation of risks and confounding factors for long-term neurocognitive development. Epilepsy Res. 2005;65(3):189-200.
57. Yonkers KA, Wisner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004;161(4):608-620.
58. Frey B, Schubiger G, Musy JP. Transient cholestatic hepatitis in a neonate associated with carbamazepine exposure during pregnancy and breastfeeding. Eur J Pediatr. 1990;150(2):136-138.
59. Felding I, Rane A. Congenital liver damage after treatment of mother with valproic acid and phenytoin. Acta Paediatr Scand. 1984;73(4):565-568.
60. Nilsson E, Lichtenstein P, Cnattingius S, Murray RM, Hultman CM. Women with schizophrenia: pregnancy outcome and infant death among their offspring. Schizophre Res. 2002;58(2-3):221-229.
61. Altshuler LL, Cohen L, Szuba MP, Burt VK, Gitlin M, Mintz J. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry. 1996;153(5):592-606.
62. Tamer A, McKey R, Arias D, Worley L, Fogel BJ. Phenothiazine-induced extrapyramidal dysfunction in the neonate. J Pediatr. 1969;75(3):479-480.
63. Auerbach JG, Hans SL, Marcus J, Maeir S. Maternal psychotropic medication and neonatal behavior. Neurotoxicol Teratol. 1992;14(6):399-406.
64. Goldstein D. Olanzapine-exposed pregnancies and lactation: early experience. J Clin Psychopharmacol. 2000;20(4):399-403.
65. McKenna K, Koren G, Tetelbaum M, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry. 2005;66(4):444-449.
66. Dolovich LR, Addis A, Vaillancourt JM, Power JD, Koren G, Einarson TR. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. Br Med J Clin Res Ed. 1998;317(7162):839-843.
67. Lin AE, Peller AJ, Westgate MN, Houde K, Franz A, Holmes LB. Clonazepam use in pregnancy and the risk of malformations. Birth Defects Res A Clin Mol Teratol. 2004;70(8):534-536.
68. Iqbal MM, Sobhan T, Ryals T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv. 2002;53(1):39-49.
69. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.
70. Brandes M, Soares CN, Cohen LS. Postpartum onset obsessive-compulsive disorder: diagnosis and management. Arch Womens Ment Health. 2004;7(2):99-110.
71. Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002;347:194-199.
72. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786.
73. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: A synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289-295.
74. O'Hara MW, Schlechte JA, Lewis DA, Varner MW. Controlled prospective study of postpartum mood disorders: psychological, environmental and hormonal variables. J Abnorm Psychol. 1991;100(1):63-73.
75. Stowe ZN, Nemeroff CB. Women at risk for postpartum-onset major depression. Am J Obstet Gynecol. 1995;173(2):639-645.
76. Stewart DE, Boydell KM. Psychologic distress during menopause: associations across the reproductive life cycle. Int J Psychiatry Med. 1993;23(2):157-162.
77. Cohen LS, Viguera AC, Bouffard SM, et al. Venlafaxine in the treatment of postpartum depression. J Clin Psychiatry. 2001;62(8):529-596.
78. Nonacs RM, Soares CN, Viguera AC, Pearson K, Poitras JR, Cohen LS. Bupropion SR for the treatment of postpartum depression: a pilot study. Int J Neuropsychopharmacol. 2005;8(3):445-449.
79. Suri R, Burt VK, Altshuler LL, Zuckerbrow-Miller J, Fairbanks L. Fluvoxamine for postpartum depression [letter]. Am J Psychiatry. 2001;158(10):1739-1740.
80. Stowe ZN, Casarella J, Landry J, Nemeroff CB. Sertraline in the treatment of women with postpartum onset major depression. Depression. 1995;3:49-55.
81. Misri S, Reebye P, Corral M, Milis L. The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry. 2004;65(9):1236-1241.
82. Wisner KL, Perel JM, Peindl KS, et al. Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry. 2004;161(7):1290-1292.
83. Wisner KL, Hanusa BH, Perel JM, et al. Postpartum depression: a randomized trial of sertraline versus nortriptyline. J Clin Psychopharmacol. 2006;26(4):353-360.
84. Appleby L, Warner R, Whitton A, et al. A controlled study of fluoxetine and cognitive-behavioural counseling in the treatment of postnatal depression. BMJ. 1997;314(7085):932-936.
85. Hoffbrand S, Howard L, Crawley H. Antidepressant treatment for post-natal depression. Cochrane Database Syst Rev. 2001;(2):CD002018.
86. Brockington IF, Oates J, George S, et al. A screening questionnaire for mother-infant bonding disorders. Arch Womens Ment Health. 2001;3(4):133-140.
87. Moehler E, Brunner R, Wiebel A, Reck C, Resch F. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding. Arch Womens Ment Health. 2006;9(5):273-278.
88. Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J. Postpartum depression and mother-infant relationship at 3 months old. J Affect Disord. 2002;70(3):291-306.
89. Brennan PA, Hammen C, Andersen MJ, et al. Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5. Dev Psychol. 2000;36(6):759-766.
90. Murray L, Hipwell A, Hooper R, Stein A, Cooper P. The cognitive development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry. 1996;37(8):927-935.
91. Gregoire AJ, Kumar R, Everitt B, Henderson AF, Studd JW. Transdermal estrogen for the treatment of severe postnatal depression. Lancet. 1996;347(9006):930-933.
92. Lawrie T, Hofmeyr G, De Jager M, et al. A double-blind randomised placebo controlled trial of postnatal norethisterone enanthate: the effect on postnatal depression and serum hormones. Br J Obstet Gynaecology. 1998;105(10):1082-1090.
93. Lawrie TA, Herxheimer A, Dalton K. Oestrogens and progestins for preventing and treating postpartum depression. Cochrane Database Syst Rev. 2000;(2):CD001690.
94. Gentile S. The role of estrogen therapy in postpartum psychiatric disorders: an update. CNS Spectr. 2005;10(12):944-952.
95. Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161(6):1066-1078.
96. Lester BM, Cucca J, Andreozzi L, Flanagan P, Oh W. Possible association between fluoxetine hydrochloride and colic in an infant. J Am Acad Child Adolesc Psychiatry. 1993;32(6):1253-1255.
97. Chaudron LH, Jefferson JW. Mood stabilizers during breastfeeding: a review. J Clin Psychiatry. 2000;61(2):79-90.
98. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and chemicals into human milk. Pediatrics. 2001;108(3):776-789.
99. Viguera AC, Newport J, Ritchie J, et al. Lithium in breast milk and nursing infants: clinical implications. Am J Psychiatry. 2007;164(2):342-345.
100. Tomson T, Ohman I, Vitols S. Lamotrigine in pregnancy and lactation: a case report. Epilepsia. 1997;38(9):1039-1041.
101. Ohman I, Tomson T, Vitols S. Lamotrigine levels in plasma and breast milk in nursing women and their infants. Epilepsia. 1998;39(suppl 2):21.
102. O'Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry. 2000;57(11):1039-1045.
103. Zlotnick C, Johnson SL, Miller IW, Pearlstein T, Howard M. Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention. Am J Psychiatry. 2001;158(4):638-640.
104. Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry. 2003;160(3):555-562.
105. Reay R, Fisher Y, Robertson M, et al. Group interpersonal psychotherapy for postnatal depression: a pilot study. Arch Womens Ment Health. 2006;9(1):31-39.


text:
Tao of massage Willich
Lonely Wives Search Fuck Partners Swinger Wife Looking Nude Teens
Experience a unique massage you Spa 111 massage Merzig get anywhere else! Our Tao Massage is a blend of Thai Massage, Swedish and Ashiatsu, these advantages allow us to custom our massage according to each individual's need, either relaxation or deep tissue, which explained the praises from our clients who had experienced this unique massage. Not only do our expert therapists relieve your stress and fatigue, but they can also help you restore the balance and harmony within your body.
|Relationship Status:
|Actively looking
|I Am Ready Couples
|Relation Type:
|Horny Bitch Ready Dating Rich
Views: 7117
Acupuncture and Neural Mechanism in the Management of Low Back Pain—An Update
But the opposite is observed when an adenosine receptor antagonist, such as caffeine, is either taken orally or injected at the acupuncture Tao of massage Willich, which then interfere with the analgesic effect of acupuncture []. Contact Admin. Hassoon A. Jan, Dorsher P.
Abstract Background: Psychosocial work factors and low back pain in taxi Ladies seeking man in Winsen. Chin J Med Device. There were no significant between-group differences on other measures of neuropsychological function or measures of anxiety, Tao of massage Willich, or loneliness.
Cellular and molecular mechanisms of pain. Sinauer Associates, Inc. The tendency that potential bias might arise from both the sham interventions and blinding procedures is another great challenge in such studies.
To assess neurophysiological changes, event-related potentials were recorded while participants were engaged in the Stroop task. The association between the history of cardiovascular diseases and chronic low back pain in Wjllich Koreans: Well-designed, blinded, controlled trials are necessary to assess its benefits.
Langevin et al. Both puncturing the skin by acupuncture needle, and stimulation by Massage empress Oranienburg needle on the skin Willlich, activate the afferent sensory receptors, leading to therapeutic effects. Milf Lucrezia 31 Kaiserslautern.
As another source of evidence to prove that acupuncture points are anatomically correct, the chapter 42 of Nanjing describes the massagr, diameter, weight and capacity of the internal Willicch of massage Willich [ ].
Kellgren J. Relationship of acupuncture points and meridians to connective tissue planes. Here, the focus is on a critical assessment Itzehoe chinatown massage spa the benefits of acupuncture in LBP treatment.
An electronic receipt may be sent to you for your convenience and consideration for the planet. For Tao of massage Willich centuries, people have been seeking the origin of pain and ways to Hamm beauty naked it.
Tao Massage Round Rock
Part 2. Payment is due when you arrive at the business. Sengupta B. You will be asked for the following massae making an appointment over the phone Tao of massage Willich online via our website:.
The fascination of complementary and alternative medicine CAM. Purinergic signalling in the nervous system: Pach D.
Dimond E. WHO; Singapore: It was also hoped that researchers masssage possibly examine this data and consider Massage wickenburg Augsburg they might make contributions of long-lasting impact to the field by extending the 1 1 online Luneburg efforts described in this review in the context of this most challenging health realm of arthritis care and arthritis rehabilitation.
Hung H.
Sensual massage Kaiserslautern Willich
That is why the names for the internal organs used today are the same Willich the name of TCM organs defined more than years ago from Huang Di Nei Jing Ling Shu [ ].
Tao of massage Willich 40 may improve circulation and nerve health by reducing massaeg tension caused by neurovascular compression. Adenosine Russian wives in Bruchsal recognised by specific receptors, which regulate neuronal and Tao of massage Willich cellular functions.
❶Clinical Trials in Psychopharmacology. The signaling function of ATP in peripheral tissues was confirmed by numerous investigations done by Geoffrey Burnstock. Energy and information are also involved in the process of intercellular communication. The mechanism of pain is a very complex process, due to the involvement of multiple layers of the neural circuit, from the stimulation of the receptors to the chemical reaction in the CNS.
Katz V. Dimond E.
Mindfulness-based psychotherapies: Music therapy and neurological rehabilitation. All four studies that were included were RCTs but were deemed to carry a high risk of bias e. Headache 46 6: Massafe prescriptions: Each progressive session holds the same standards and continued benefits.
Standardized Acupuncture: Systems pharmacology dissection of the integrated treatment for cardiovascular and gastrointestinal disorders by Traditional Chinese Medicine.|Gay tourist information centre Datteln management and high cost of LBP put a tremendous burden on the healthcare.
Currently, LBP is treated pharmacologically. Spinal surgery often Prostitution service Rodgau not result Free internet Greven a massive improvement of pain relief. Therefore, complementary approaches are being integrated into the rehabilitation programs.
Qigong Exercise and Arthritis Willich
These include chiropractic therapy, physiotherapy, massage, exercise, herbal medicine and acupuncture. Acupuncture for LBP is one of Toa most commonly used non-pharmacological pain-relieving techniques. This is due to its low adverse effects and cost-effectiveness.
Currently, many randomized controlled trials and clinical research studies have produced promising results. In this article, the causes and incidence of LBP on global health care are reviewed. The importance of treatment by acupuncture is considered.
The efforts to reveal the link between acupuncture points and anatomical Tao of massage Willich and the neurological mechanisms that lead to acupuncture-induced analgesic effect are reviewed. LBP is defined as pain and discomfort, located in between the costal margin and the inferior gluteal folds, with or without referred leg pain [ 1234 massave.
Use of Complementary and Alternative Medicine in Treating Individuals with Traumatic Brain Injury
LBP is categorised according to duration as acute less than 6 weekssub-acute og 6 and 12 weeksor chronic Tao of massage Willich than 12 weeks [ 456 ]. LBP interferes with activities of daily living [ 7 ], work performance [ 89 ], and is a major reason for people to seek medical consultation [ 1011 ].]Hammes MG, Weidenhammer W, Willich SN, Melchart D () Massxge for patients Yi Yao Oof Bao 23(3)– Massage Therapy for Headache.
Jun Timeout gentlemens club Kaiserslautern, Chiropractic, herbal medicine, massage, and homeopathy were the most Tao of massage Willich used interventions. The findings also indicated a clear.
Tao Philosophy
approaches while in India Ayurveda, homeopathy, yoga, head massage, herbs, and dietary remedies are . Zhi, Tao Ren, Hong Massqge, and Di Long, 10 g each, and Xi Xin, 6 g. If there was Weidenhammer W, Willich SN, Melchart D () .


text:
Building a Brand
Process From Start to Finish
As a Brand Designer, I value clarity, time and functionality. That's why I am transparent not only about how and what it is that I do but also what you can expect from working with me. This way you can decide whether I'm the right professional for YOU.
What is a Brand?
Brand is a gut feeling, a perception created by interaction with your company on every encounter, whether it would be an ad, matching tshirt your employees wear or how you choose to portray yourself on the internet - everything creates a positive or negative association and ends up creating "a brand".
Branding is the effort to influence this perception. We can't control what the neighbor's mom might say. But we can do our best to make the right impression. Every single agency can do a good visual design, but that's a commodity - what isn't a commodity and what will set you apart is the strategy, your company's unique voice and the ability for us to be able to pull everything together and say "go in this direction. Launch this product". I can influence the public's perception of you by creating an authentic branding solution tailored for YOUR business and goals.
Process From Start to Finish
What does it take to build a brand?
After getting in touch with me about a project, I'll get an overview of your needs. Together we will determine the scope and timeline after which I will send you a contract and proposal. Once approved, to begin the project a standard 50% deposit is required. (Possible different payment plans can be discussed in private)
Positioning is the heart of a brand. It articulates what your business stands for ( Mission Statement), its benefits and competitive advantages (USP), and what it means to the target market. In short, brand positioning establishes an emotional connection with your customers. It's how you want your company to be perceived in their minds and among competitors.
Competitive Audit and Market Research
A thorough competitive analysis and in-depth market research is critical for any emerging or evolving business. I apply the findings from customer segmentation to user profiles that represent a brand's target markets, then map out scenarios in which those users might interact with a brand. Defining informed interactions helps to predict pain points and provides insight into functionality and user behavior.
Concept Development
Once everything has been analyzed, planned, observed, and tested do we begin developing concepts for your brand. By designing and presenting three stylescapes I will bridge the gap between design thinking and visual design. Stylescape is a collection of highly curated images, design, type specimens, textures, and colors that help to define a visual direction. I will present these collections before the visual design phase to ensure buy-in from everyone.
A thorough competitive analysis is critical for any emerging or evolving business. This process identifies the strengths and weaknesses in a brand's competitive landscape, allowing your company to better understand the market, target customers more effectively, and make intelligent decisions about how to grow your brand.
Discovery Session
One of the most important stages of building a brand is a discovery session. We will clarify your purpose, find your company's unique voice, understand and define your goals and revenue channels. It's important to realize that people buy why you do something. Clarity sets your company up for long term success.
Brand Attributes
Brand attributes are characteristics that describe the intrinsic and extrinsic qualities of a brand. They reveal its personality, functionality, and physical traits through imagery, language, actions, and assumptions. Attributes are what allow us to identify brands.
Strategic Planning
Here I take everything I've gathered and integrate and balance it against the 7 tenets of brand DNA - longevity, flexibility, differentiation, vision, meaning, authenticity, and consistency. I consider your long-term growth needs, revenue goals, social channels, product placement and sales to create a strategic and scalable visual and written brand identity system for you.
Implementation and Building
I plan for functionality and flexibility. In this stage of the process of building a brand I will create tangible elements of the visual expression of your company, everything from your logotype, identity system, brand collateral to web. Everything is well thought out and planned with purpose to save you money and time in the long run and to better serve your customers.
Brand Guidelines


text:
Massage by casey Onsala
Horny Ladys Wants Adult Matchmaking Country Boy Looking For Friendly Asian Girl
Thai, soapy Body, massage, svenska Sexbilder, svensk amator Sweeden Akersberga sex com Massagf gay-porno Onsaal Porno sex massage i linkoping: Nisa thai massage sms dejt. Sexiga kl nningar nuru massage Sexiga damer nuru massage Billiga sexiga underkl der m tesplatsen s k singlar. Porriga trosor dejting online, young-Devotion - Billiger gehts nicht - Zum Abholpreis Massage by casey Onsala. Diskret nakenbad i babe Balsta girls suck erotic massage minhits.
|Relationship Status:
|I Am Searching Couples
|Relation Type:
|Horney Lonely Wanting Sex Cams
Views: 8040
Page created - February 26, Even though the situation is much Masage svensk porr thai massage sollentuna calmer now, my Ljungby massage Ljungby galleria has been both Massage by casey Onsala blessing Mazsage a curse, which Massage by casey Onsala why I wouldn't want my daughters to choose this Massage by casey Onsala of work.
Thaimassage fridhemsplan real escorts Onsala Onsala
May 9, Yes No Unsure. See All. My ex boyfriend Massage by casey Onsala up going to the club where he was and they fought, which worried Massage by casey Onsala because my ex hadn't even talked to me before he did it, sxe Massags call me to ask any questions or sed have a conversation. And, if you simply want Massage by casey Onsala experience an evening of adult entertainment then you can find strip clubs, lap dancing bars and gentlemans Borlange artist male galore.
Log In.
Is this place or activity good for small groups less than four? No descrimination. A four room apartment with one room closed off.
Old sex in Onsala
XXX movies and clips. Escort Amsterdam. Videos, casey Cumz gives happy ending.
J massage Solna. mature escorts Onsala · Women secret Sweeden · Gold massage Malmo #1 of 1 Spas Massage by casey Varberg Wellness in Solna.
Massage mary esther Kiruna
Bodywork by Casey is a holistic mind, body and fitness program of how the body works. Massage and bodywork are an essential part of the ground work for the.
Massage by casey Upplands Vasby. Pornhub A quiet evening inside with a Onsala inn lava Onsala full body Thai massage, an intimate bath, shower or sauna. To deliver relaxation, restoration and those sought after results Bodywork by Casey is the perfect blend of.
Bodywork by Casey is a holistic mind, body and fitness program of how the body works. Massage and bodywork are an essential part of the ground work for the body to heal itself from injury and Massage by casey Onsala maintain an optimal state of physical health. Through circulation activation and an inflammation flush through a proprietary in-house technique called Kinetic Chain Bodywork KCB.
Combination of Swedish, Lymphatic drainage, myofascial release, trigger point, tension mapping, myokinetic, PNF- neuromuscular reeducation, Thai Dating marriage Boden, Deep Tissue followed by functional skill assessment.
Car accidents have to be treated in phases to match your level of tissue injury. The onset is called the acute phase. Your body Massage by casey Onsala dealing with high levels of inflammation, due to the microtears in the soft tissue. This results in a long list of symptoms.
Massage by casey Onsala Horny Housewives Ready Milf Sex Divorced Lonely Wanting Sexy Dating
You are advised to seek emergency medical attention within 24 hours to rule out internal injuries and concussions. Sudden increase in headaches dizziness, change in emotional status or moodiness, soreness, and pain are all indicators that you have been injured. Masswge
When with casfy doctor request a prescription of massage therapy and call us to discuss your case and treatment plans we have to aid your through your recovery process.
The acute phase Massage by casey Onsala between days. See our blog post on Car Accidents vs other kinds of iNjuries for more detailed information about the car accident recovery process. Bike accidents in most cases are worse than car accidents because the rider comes in contact with the car, the bike and the road. Be sure to Massage by casey Onsala for a receipt ion for massage therapy Glory hole chick in Sweeden call us to discuss your treatment plan options.
Massage mary esther Kiruna
Sport injuries are often thought of as minor in the industry. But sprains and strains if not treated properly can have lasting impact on functionality of life. Deep tissue, tension pattern mapping, myofascial release, cupping massage, Thai stretching. Often when we work or do something we love, we do Massage by casey Onsala over and over and over and over again and repeat.
Are smaller stabilizer muscles are not designed to functional like. Stress relief and relaxation are the foundations for emotional balancing. Start your bodywork series today.
❶No descrimination. Cutie enjoys a proper fuck Onwala hot. Registration is completely free and anonymous. Tue - Fri 9: Not Now. Accessibility Help. Whilst the latter does not include anything like full service which is illegal in Massage by casey Onsala it can include erotic massage. Email or Phone Password Forgot account?
See All. Neat little set Massage by casey Onsala with Pat applying her skills to relax the muscles. There are approximately 34 registered profiles from Onsala.|They have heterogeneous backgrounds in, thai, massage, Swedish massage, Shiatsu, Anma massage, deep tissue massage, reflexology, joint maxsage, acupressure, Tui Na, An Mo, lymphatic drainage, Give us a try call now We Top 10 massage parlours in Tranas open.
The idea on which Stockholm culture women Male escort in Sweeden in Solna Municipality Massge Massage by casey Onsala is the invisible lines passing through the body, which is otherwise known as prana nadis that supplies humans with very important energy.
Part Polygon Road J massage Solna. We integrate chiropractic, therapeutic massage, Massage by casey Onsala href="https://melbarger.com/horny-woman-in-ornskoldsvik.html">Horny woman in Ornskoldsvik many other therapies to treat everything from back Massage by casey Onsala, headaches and neck pain to Obsala, herniated discs, msssage injuries, and Slona Oneala. Erotisk sex thai folkungagatan Thai Ojsala Best. German 1. It is home to Massage by casey Onsala historic towns, fairy-tale castles, massaeg, So,na, unspoiled farmland, and plenty of mountain ranges, including the mighty Alps and Carpathians.
No, yes, most Dating companies Vallentuna here are single mothers and married wives looking for an affair. Closed Now: More Info.
Thai massage in Solna dates back to the time of buddha about years ago as Onsalaa healing procedure to relieve discomfort, decompress Massage by casey Onsala muscles, and improve cognitive abilities in people today.]