Posttraumatic Stress Disorder

Pharmacotherapy of Combat-Stress-related Post Traumatic Stress Disorder

ANNALS Winter 2007 www.americanpsychotherapy.com

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By Harpriya A. (Sonya) Bhagar, MBBS and Alan D. Schmetzer, MD, Fellow of the American Psychotherapy Association, and Master Therapist

A number of veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) are returning home with signs of combat-stress-related Post Traumatic Stress Disorder (PTSD). In a recent study, 16.6% of the soldiers met the screening criteria for PTSD. On average, they showed a significant increase in sick visits, missed workdays, severity of somatic symptoms, and poorer overall health (Hoge et al., 2007). In another study, the youngest age group, 18–24 years, was at greater risk compared with veterans 40 years of age or above. Diagnosis was made early (median of 13 days), and most of them were detected in primary care clinics (Seal et al., 2007).

Upon return from the war zone, veterans frequently report intrusive thoughts, flashbacks, increased vigilance, avoidance of social situations, hyperarousal, and nightmares. Treatment involves integration of mental health, primary care, physical medicine, attention to substance abuse, and vocational services. The mental health portion involves an initial screening of the combat veteran for PTSD and other mental illnesses, followed by a full assessment. Both pharmacotherapy and psychotherapy (individual, couple, and group) are offered for treatment.

From a pharmacological perspective, several studies have found the traditional anti-depressants effective in PTSD. Selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft®), paroxetine (Paxil®), and fluoxetine (Prozac®), have been studied extensively for PTSD, and sertraline and paroxetine have been approved by the Food and Drug Administration for PTSD. SSRIs have been found to be effective both in short-term trials and long-term maintenance treatment for relapse prevention (Asnis et al., 2004). However, earlier studies have focused mainly on PTSD secondary to interpersonal trauma in a civilian setting. In a multicenter study, venlafaxine extended release (Effexor XR®), a serotonin norepinephrine reuptake inhibitor, was found to improve both the re-experiencing and the avoidance symptoms of PTSD, but not hyperarousal. The drug was effective and well tolerated in both short-term and continuation treatment of PTSD (Davidson et al., 2006). In a small study, mirtazapine (Remeron) was found to be effective in both short-term and continuation treatment of combat-stress-related PTSD without any serious side effects (Kim et al., 2005). In addition, sedation from mirtazapine can even prove beneficial in improving sleep in PTSD. In a randomized trial comparing phenelzine (a monoamine oxidase inhibitor) and imipramine (a tricyclic antidepressant), both significantly reduced combat stress related PTSD symptoms (Kosten et al., 1991). Benzodiazepines are used in PTSD for panic attacks or Anxiety states. They provide temporary relief but run the risk of tolerance and addiction.

Veterans with PTSD find it hard both to fall asleep and to maintain sleep due to hyperarousal and vivid nightmares related to combat. Significant others often report that patients scream in their sleep and may even wake up soaked in sweat. Prasozin and clonidine both decrease the central nervous system’s noradrenergic activity. They have been found to be effective in decreasing hyperarousal symptoms and improving sleep (Boehnlein, 2007). Other drugs used for sleep are the benzodiazepine class of drugs, like temazepam, and non-benzodiazepines, like zolpidem (Ambien™) and ezopiclone (Lunesta™). However, caution must be taken regarding the habit-forming potential of these drugs (Bhagar and Schmetzer, 2006).

The presence of psychotic symptoms in PTSD can further complicate the clinical picture. In one study, 20% of the 91 males with combat-stress-related PTSD were found to be suffering from hallucinations and delusions, and hyperarousal was positively associated with the occurrence of psychotic symptoms (Kastelan, 2007). In a small study, augmentation of SSRI with olanzapine (Zyprexa), an atypical antipsychotic, was effective in treating SSRI-resistant combat-related PTSD symptoms, especially sleep (Stein, 2002). In another study, monotherapy with typical or atypical antipsychotics, reduced both PTSD and psychotic symptoms, and antipsychotics seemed to offer another approach to treat the psychotic subtype of combat–related PTSD resistant to previous antidepressant therapy (Pivac, 2006).

Overall, PTSD pharmacotherapy involves several drugs based on our experience with PTSD in general, but well-designed studies are needed to establish treatment guidelines specifically for combat-stress-related PTSD.

References

Asnis, G. M., Kohn, S. R., Henderson, M., & Brown, N. L. (2004). SSRIs versus non-SSRIs in post traumatic stress disorder: an update with recommendations. Drugs, 64(4), 383–404.

Bhagar, H. A., & Schmetzer, A. D. (2006). The newest medicines for sleep. Annals of American Psychotherapy Association, 9(2), 25–26.

Boehnlein, J. K., & Kinzie, J. D. (2007). Pharmacologic reduction of CNS noradrenergic activity in PTSD: The case for clonidine and prazosin. Journal of Psychiatric Practice, 13(2), 72–78.

Davidson, J., Baldwin D., Stein, D.J., Kuper, E., Benattia, I., Ahmed, S., et al. (2006). Treatment of post traumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial. Archives of General Psychiatry, 63(10), 1158–1165.

Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of post traumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry,164(1), 150–153.

Kastelan, A., Franciskovi,? T., Moro, L., Roncevic-Grzeta, I., Grkovic, J., Jurcan, V., et al. (2007). Psychotic symptoms in combat-related post traumatic stress disorder. Military Medicine, 172(3), 273–277.

Kim, W., Pae, C. U., Chae, J. H., Jun, T. Y., & Bahk, W. M. (2005). The effectiveness of mirtazapine in the treatment of post-traumatic stress disorder: A 24-week continuation therapy. Psychiatry and Clinical Neurosciences, 59(6), 743–747.

Kosten, T. R., Frank, J. B., Dan, E., McDougle, C. J., & Gille, E. L., Jr. (1991). Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine. Journal of Nervous and Mental Disease, 179(6), 366–370.

Martényi, F. (2005). [Three paradigms in the treatment of posttraumatic stress disorder]. Neuropsychopharmacol Hung, 7(1), 11–21.

Pivac, N., & Kozari?-Kovaci,? D. (2006). Pharmacotherapy of treatment-resistant combat-related posttraumatic stress disorder with psychotic features. Croatian Medical Journal, 47(3), 440–451.

Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2007). Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167(5), 476–482.

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an TEA stress 2 fl oz $13.8 anTEAstress- Effective over all well being & stress relief formula loaded with WHITE TEA EXTRACT, B Vitamins, eleuthero root, St Johns wort flowers, american ginseng root. Natural blueberry flavor.White Tea concentrate St. John?s wort & B vitamins. TeaZen is a totally different experience that makes drinking tea fun. It?s not a typical tea bag. It?s not the same way to drink tea. It?s not artificial. It?s not boring. It?s definitely not expected!

Boiron sedalia tablets for stress – 60 ea $7.97 Sedalia combines homeopathic medicines used to treat nervousness hypersensitivity and irritability due to stress.

Anti-Stress Massage Gel-Cream $46.99 Men’s 100ml/3.16oz . An anti-stress gel-cream for men Helps eliminate tensions knots & signs of fatigue through massages With a plant-based micro-emulsion formulation Contains sugar beet & cane sugar plus palm coprah & colza oils Offers hydrating & smoothing benefits Unveils a suppler soothed & invigorated complexion Perfect for all skin types

Stress Relief Eye Mask $45.99 Women’s 10Pads . A 10-minute revitalizing beauty mask Greatly reduces puffiness & other signs of fatigue Effectively improves your skin hydration level up to 40% Helps soothe your skin while moisturizing Leaves skin looking more hydrated & smooth Suitable for all skin types

Anti Aging Stress Cream $187.99 Women’s 50ml/1.7oz . This cream provides moisturizing & energizing benefits Contains active plant extracts to minimize muscle contractions Reduces appearance of lines wrinkles & expression lines Natural mushroom complex boosts natural collagen production Improves skin natural firmness & elasticity Leaves skin smooth resilient supple & youthful

De-Stress Massage Oil $57.99 Women’s 100ml/3.4oz . Contains highly soothing oils of Rosewood Melissa Chamomile Marjoram Geranium Rosemary & Lavender Helps enliven spirit while banishing tension & comforting body Leaves skin calm smooth & relaxed To use: Massage into the chest at night for a more peaceful sleep

Similasan Healthy Relief Homeopathic Stress and Tension Relief Globules – 154 Doses $8.19 Similasan Healthy Relief Homeopathic Stress and Tension Relief Globules relieving symptoms of stress and simple nervous tension.

SAF Stress & Anxiety Formula 90 Caps $21.07 May enhance mood. Natrol’s patented SAF? stress and anxiety formula provides key nutrients to help support mental focus and relaxation. Together with proper rest and nutrition, Natrol SAF can help you combat the effects of daily stress.

B Complex Stress Formula 60 Tabs $15.15 Balanced, comprehensive stress relief with vitamins, minerals and herbs. B vitamins and fast actingco-enzymes are provided in appropriate ratios as demanded by the body under stress. Calming herbs include chamomile, hops, and passion flower. Green foods for added trace mineral nutrition.

B complex Stress Formula 120 Tabs $25.31 Balanced, comprehensive stress relief with vitamins, minerals and herbs. B vitamins and fast acting co-enzymes are provided in appropriate ratios as demanded by the body under stress. Calming herbs include chamomile, hops, and passion flower. Green foods for added trace mineral nutrition.

Mega-Stress Complex Sustained Release 30 Tabs $9.31 For those who experience anxiety and nervous energy as a result of extremely stressful or emotional conditions, Mega-Stress Complex was designed to replace the water-soluble vitamins lost during stress. Standardized potency Valerian Root and Chamomile are mild, yet effective, herbs included for their calmative properties.

Stress-Defy Balanced & Relaxed 120 Gels $22.49 Stress-Defy Balanced & Relaxed-Finding calm in a world of constant stress can seem an impossible task at times but is essential to attaining mental, emotional and physical health. Stress-Defy Balanced & Relaxed is specially formulated to create a healthy stress response by promoting relaxation, mental clarity and replenishing stress-fighting reserves. ? Calms Nerves: A blend of botanicals, minerals and 5-HTP work to gently relax the body and mind. ? Increase Mental Clarity: Ginkgo and L-Theanine, two nutrients studied to support memory and brain function, support mental clarity under times of stress. ? Restore Stress-Fighting Reserves: A blend of B vitamins and botanicals support energy producing pathways and may improve the body’s resistance to stress. Liquid Soft-Gels-The nutrients in these easy-to-swallow Liquid Soft-Gels are released faster than harder tablets and dry capsules. These other forms contain binders and fillers that can cause stomach upset and offer no nutritional value. Advanced Liquid Soft-Gels provide an optimum delivery system.

Supreme Anti-Stress Formula 60 Caps $15.81 Nature’s Renewal Supreme Anti-Stress Formula is designed to provide a natural alternative for individuals who may experience certain levels of stress and anxiety. Working together, GABA and L-Theanine, produce mental and physical relaxation decreasing stress and anxiety, without inducing drowsiness. While a 5-HTP improves your sleep, PS (Phosphatidyl Serine) will increase sociability throughout the day.

Futurebiotics stressassist l-theanine stress complex for stress function 60 veg capsules $12.73 Help the body adapt to stress support adrenal function calm and maintain a healthy nervous system

Stretchy Octopus Stress-Reliever (Assorted Colors ) $2.4 Overview:Its very squishy and the build quality is good – as in, it won’t burst when squeezed like some fluid filled stress relievers do.

Whole Body Stress Cleanse 1 Kit $17.84 Every challenge to the mind and body creates a demand on your health and well-being. It’s important to find ways to control stress before it controls you.Your body can create stress-induced toxins.If you’re in a state of constant high alert, stress-induced toxins can affect your energy levels, mood, sleep, productivity and overall wellness.In the daytime, the Purifying Cleanse Formula fuels your body’s stress defenses with high-ORAC antioxidant power, which:Deactivate harmful free radicalsPrevent production of stress-induced toxinsAt night, Cortisol Modifying Formula helps your body relax, rebuild, and reenergize while you sleep. Even though you “sleep through it,” this formula provides support that extends into the next day by:Reducing cortisol levelsPromoting a natural sleep cycleThe Whole Body Stress Cleanse Kit Delivers Day & Night Protection.

Stress Less Birthday – American Greetings – Birthday Card $2.99 Help take away any stress with a Birthday Card that encourages the birthday boy or girl to enjoy some cake and wine on their day. With such great advice, it’s a card with instructions everyone will want to follow. 5″ x 7″ Folded Card

Natures Answer Rhodiola root alcohol free for stress support – 1 oz $7.6 Produced using alcohol water and natural extracts for stress support.

Organic India ashwagandha formula capsules for stress and builds vitality – 90 ea $12.14 Allows the body to successfully adapt to stress including mental physical emotional and environmental.

Stress Formula Tablets With Vitamins B C And E – 60 Tablets $3.8 Stress Formula Tablets contains all eight B Complex vitamins.

Hylands Homeopathic Nerve Tonic stress relief tablets – 500 ea $9.89 Provides temporary symptomatic relief of simple nervous tension and stress.

Neutrogena Oil Free stress control power foam wash – 5.1 oz $7.01 Neutrogena Oil Free stress control power foam wash makes acne one less stress and treats acne even before emerges

Stress B Complex + Vitamin C 120 Caps $7.23 Each member of the B-complex has a unique structure and performs unique functions in the human body. Optimum Nutrition’s High Potency Stress B-Complex plus Vitamin C is made with the finest raw materials. Two capsules provide all the B-Complex Vitamins, Vitamin C, Choline, Inositol and PABA in appreciable amounts. High Potency Stress B-Complex plus Vitamin C is produced and packaged in our own state-of-the-art, OTC approved facility.

Lancome – Hydrazen Neurocalm Soothing Anti-Stress Moisturising Cream ( Unboxed ) $350 Hydrazen Neurocalm Soothing Anti-Stress Moisturising Cream ( Unboxed )

4-Way Stress Support System 60 Tabs $20.69 Stress is among the most difficult of all health challenges. Because it involves the entire body, a wide range of actions are required to address it completely.The world’s great holistic traditions explain that the extreme stress stems from blockages of the energy known as Liver QI (chee). These blockages weaken the blood, permit dampness and heat to accumulate in the Liver System, and cause the Liver to overact on the Spleen System. Such problems also extend to the Heart System and cause the Heart energy (known as Shen) to be weakened and destabilized. Thus, the holistic approach to stress must free the flow of energy and cleanse dampness and heat from the Liver System, harmonize the Liver and Spleen Systems, nourish the digestive tract and the Heart, and strengthen and anchor the Heart’s Shen energy.Because 4-Way Stress Support System stands alone in doing all these things, it helps you feel not just better, but your very best, while also guarding against more severe health challenges. 4-Way Stress Support System is 100% hypoallergenic (no wheat, gluten, corn, soy, sugar, dairy, yeast, etc.) and contains no animal products, GMO’s, or artificial flavorings, colorings, etc.

Lierac – Thekoa Relaxing Anti-Stress Oil $339 An relaxing anti-stress beauty oil Instantly relaxes your dry skin Calms & soothes your whole body Can be used in the bath Leaves skin feeling marvelously relaxed & smooth

stretchy polvo stress alívio (cores sortidas) $1.89 Resumo: seu muito molinho e construir a qualidade é boa – como nos, não vai estourar quando comprimida como algum fluido apaziguadores do stress encheu fazer.

dehnbar Tintenfisch, Stress abzubauen (Farben sortiert) $1.89 Übersicht: ihre sehr matschig und die Build-Qualität ist – wie in, gute es wird nicht platzen, wenn wie eine Flüssigkeit gefüllt Stress relievers drückte zu tun.

stretch polpo stress decongestionamento (colori assortiti) $1.89 Panoramica: la sua molto morbido e la qualità costruttiva è buona – come in, non scoppia alla spremuto come un fluido mitigatori di stress riempito fare.

stress poulpe extensible releveur (couleurs assorties) $1.89 Vue d’ensemble: son très moelleux et de la qualité de construction est bonne – comme, il n’éclate pas pressés comme certains releveurs stress ne remplis de liquide.

Kava Stress Relief Organic Tea 16 Bags $3.83 Kava Stress Relief tea helps you calm down as it relieves stress, anxiety and minor pain, as well as lending gentle support to the digestion and the kidneys.* A member of the peppercorn family, Kava (Piper methysticum) is a highly prized medicinal and beverage plant, whose primary benefit is alleviating anxiety. “Kava-kava,” native to Oceania and the South Pacific Islands, has been used and cultivated for its ability to calm the body and mind, and encourage a good night?s sleep.* A powerful antispasmodic, this herb promotes a state of “relaxed unconcern” while compromising neither mental functions nor clarity of thought when used appropriately.* Furthermore, Kava has been shown to relax the uterus and relieve menstrual cramps and minor menopausal symptoms.* The Herb Research Foundation (2000) indicates that scientific data supports the use of kava for minor anxiety, stress, restlessness, muscle tension and mild pain. For added flavor, our formula has been complemented with Stevia, Sarsaparilla and Organic Carob. Enjoy a warm soothing cup of Kava Stress Relief, a delicious way to relax.

Anti Stress Bath & Shower Gel 16 Oz $7.56 Aromatherapeutic (TM) Anti-Stress Bath and Shower Gel calm your body and mind. Allow the time-tested herbs of Ginseng, Gotu Kola, Ivy, Lavender, Linden, Orange Blossoms, Rosemary, Wild Cherry and Yarrow to rejuvenate, soothe, and refresh. You’ll be ready to face the world.

Hydrosoluble Bath Oil – Anti-Stress ( Salon Size ) $84.99 Women’s 500ml/17oz . A non-greasy anti-stress bath oil Formulated with Hazel Nut Oil & Safflower Seed Oil Blended with Lavender Flower Oil & Petit Grain Oil Helps relieve & pacify tensioned body & mind Skin appears calm & smooth For professional use only

Pevonia Botanica – Anti-Stress Aromatic Seaweed Bath $186 Pampers your body with this anti-stress bath Gives mineralizing and nourishing benefits Helps reduce tension & fatigue Enriched with Seaweed & Pine Needle Essential Oil Awakens your senses & detoxifies your body Leaves body skin fresh & healthy

Dermalogica – SPA Stress Relief Treatment Oil $274 Aromatic stress relief treatment oil Effectively helps smooth & calm your body skin Provides a deep relaxation for your body Greatly softens & hydrates your body skin Ideal for massage, bath therapy & skin conditioning Fragrance-free

Ella Bache – Anti-Stress Massage Gel-Cream $284 An anti-stress gel-cream for men Helps eliminate tensions, knots & signs of fatigue through massages With a plant-based micro-emulsion formulation Contains sugar beet & cane sugar, plus palm, coprah & colza oils Offers hydrating & smoothing b

Elizabeth Arden – Intervene Stress Recovery Night Cream $312 Lightweight & intensive moisturizer Contains Biodormin technology & youth preserving complex Incredibly regenerates skin during sleep Acts throughout the night to repair skin from daytime stress Skin appears relaxed, energized & radiant when wake up i

Calm Wellness Oil $15.95 We?ve combined a power pack of lavender, vetiver, and frankensence essential oils which when used together work to calm the mind to work as An effective aid when experiencing anxiety and or panic attacks. A useful aid in Post Traumatic Stress Disorder.

Less-Stress Weight Control 75 Gel Caps $14.96 Bioperine Enhanced Less-Stress Weight Control is not just a diet pill, it is a complete lifestyle program with an easy-to follow diet and exercist program enclosed right inside this bottle. Supplements can support a weight loss program, but the bottom line is that you have to make some simple changes to your daily routine that are far easier and simpler than you might think. The enclosed simple and suprisingly easy-to-follow program will have you looking lean and slim within no time at all. And the powerful liquid-gel capsules included with this program will (1) supercharge your diet by providing you with the energy you need to stick with your new program and (2) help you better deal with stress so you don’t overeat and snack.

3-Way Stress Management System 90 Tabs $17.91 Drawing on nutritional science as well as the Chinese and Western traditions of herbalism, Rainbow Light’s 3-Way Stress System formula is ideal for those concerned with the effects of a fast-paced, modern lifestyle and wanting to achieve a natural state of calm and ease. The perfect nutritional component of an overall stress-management program, it delivers: Essential nutrients often depleted by stressors, including a complete B-complex, vitamin C, calcium, magnesium, and vitamin e. A 1,245 mg comprehensive herbal formula featuring herbs traditionally used and recognized to support a state of calm and ease, including valerian, ziziphus, gambir, kava kava, hops, and ginger. Superfood nutrition from bee pollen and spirulina for a broad range of cofactors and easier digestion.

Genesis Resources Anxiety & Stress Calming Formula Dog Supplement 120 Tablets $37.99 Dietary supplement designed for dogs exhibiting nervousness, hyperactivity, anxiety or responding to environmentally induced stress.

Hylands homeopathic Nerve tonic stress relief 3 gain tablets – 100 ea $7.14 Relief of symptoms of simple nervous tension and stress.

Organic India tulsi holy basil anti-stress anti-aging capsules – 90 ea $12.14 To promote immunity and stress resilience support strength and stamina.

BABOR Anti-Stress Set Relaxation To Go $48 The best things come in small packages! Perfect for on-the-go. Ideal for your vacation skin care regimen – especially when flying. Contains a CLEANSER, SKINOVAGE face cream and a shower gel, plus a trendy bag that can be used again and again! BABOR Anti-Stress Set includes: BABOR HY-?L (50 ml) BABOR Phytoactive Sensitive (30 ml) BABOR Anti-Jetlag Cream (30 ml) BABOR ScenTao Shower Milk (50 ml) 

Rebel & Redneck Tees – No Stress Rebel T-Shirt $12.99 Rebel & Redneck Tees – No Stress Rebel T-Shirt. It’s A southern Thang! Our fine selection of redneck tees feature shirts that whistle dixie and show love and support for the confederate mentality. Each shirt is as loud and southern as a rebel yell! If your idea of the good time is puttin’ back a 12 pack, eatin’ your wifes down home cookin’ and firing off several hundred rounds after dinner in your back yard to digest then this shirt is for you!

Natural Formula Stress Out Dietary Supplement Tablets – 30 Ea $5.79 Natural Formula Stress Out Tablets gives temporary relief of nervous tension and helps relieve sleeplessness and restlessness.

Stresstabs high potency stress formula Advanced tablets 60 ea $8.52 Stress tabs Advanced formula is designed to replace the key nutrients that you need to defend your body.

Aveeno active naturals stress relief body wash – 12 oz $5.68 Aveeno Stress Relief Body Wash with Natural Colloidal Oatmeal. Helps to calm and relax in the shower while cleansing and moisturizing.

Mason natural stress formula tablets with iron – 60 ea $5.19 With iron plus complete B complex and folic acid 400mcg compare to stress tabs.

Mason natural stress formula tablets compare to stresstabs – 60 ea $5.19 With Antioxidants C & E Plus Complete B Complex and Folic Acid 400mcg compare to stress tabs.

Aveeno active naturals stress relief moisturizing lotion – 12 Oz $7.28 Aveeno active naturals stress relief moisturizing lotion calms and relaxes with Lavender Chamomile and ylang ylang oils.

Elemis – De-Stress Massage Oil $350 Contains highly soothing oils of Rosewood, Melissa, Chamomile, Marjoram, Geranium, Rosemary & Lavender Helps enliven spirit while banishing tension & comforting body Leaves skin calm, smooth & relaxed To use: Massage into the chest at night for a

Ergobeads Spirit Ball Stress Relief Ball By Imak #10408 – 12 Ea $38.12 Ergo beads Spirit Ball Stress Relief Ball for Isometric hand exercise & strengthening and works great as a wrist rest for laptop users.

Lancome – Hydrazen Neurocalm Soothing Anti-Stress Moisturising Cream ( Dry Skin ) $552 Oil-in-water texture instantly melts onto skin Delivers intense, long lasting hydration Unique Neurocalm complex with natural plant extracts Fights against external aggressors & emotional stress Soothing fragrance offers calming & anti-stress effects

Food Source Stress Formula 120 VCaps $23.91 Food Source? EcoGrown nutrients are cultivated in a nutrition media of Saccharomyces cerevisiae and combined with enzymes to produce 100% food-grown nutrients with maximum bioavailability. Nutrients that do not exist in natural yeast have been prepared in a special food media for optimal absorption. In addition, the Pro-Nutrient Food Base provides high-power harvested foods, while the Nutrient-Activating Enzymes are intended to aid in liberating the nutrients for use by the body. The Synergistic Herbal Base provides further support for overall well-being. This Food Source? Stress Formula provides essential B-Vitamins and other nutrients intended to provide nutritive support for normal, healthy metabolism and energy production. The combination of these food-grown vitamins and minerals is intended to support good health and well-being, especially during stressful periods.The 7 Keys to Absorption100% Food-Grown NutrientsPro-Nutrient Food BaseNutrient-Activating EnzymesRapid Dispersion of ActivesFresh-Packed Vegetarian CapsulesDairy-Free ProbioticsSynergistic Nutrients and Co-Factors

TLS® ACTS Adrenal, Cortisol, Thyroid & Stress Support Formula $59.99 What Makes TLS® ACTS Adrenal, Cortisol, Thyroid & Stress Support Formula Unique? Your job demands a lot of your time. Your family demands just as much, if not more. Trips to the mailbox are greeted by bills. Every day, life is taking its toll on you. Even in seemingly good times, stress is something we cannot escape; not only does it have a harmful affect on us mentally, but it can also wreck havoc on us physically – including …

Natures Bounty Time Released Super Stress B-Complex with C-500 vitamin supplement tablets – 60 ea $10.33 Time Released Super Stress B-Complex with C-500 supports nervous systemhealth.

Buried Treasure Stress B gone with kava kava high potency 16 oz $15.83 Help fight stress anxiety nervousness and insomnia while promoting mental clarity.

Avesta Ashwagandha stress stamina and healthy aging highest potency capsules 60 ea $10.88 Helps to manage normal daily stress and supports healthy aging and brain function.

De-Stress Eye Treatment Ginkgo Biloba Sheet Mask ( Salon Size ) $56.99 Women’s 10pcs . An anti-stress eye treatment Contains Gingko Biloba extracts to stimulate lymphatic capillaries to drain toxins Minimizes dark circles & puffiness Restores vibrant & ageless looking eye contours

Molton Brown Seamoss Stress Relieving Hydrosoak 10 oz $27.95 Everyone would like to have a spa in their own house. Molton Brown Seamoss Stress Relieving Hydrosoak turns your tub into a spa. ? A unique combination of salt, seaweed, and chestnut extracts relax tired and sore muscles.? Naturally detoxifies the body, m

Pevonia Botanica – Bath Salts with Essential Oils Anti-Stress $164 Treats yourself with a truly pleasurable bath from this bath salts Contains Lavender, Ylang-Ylang, and Tangerine Essential Oil Awakens your senses & soothes your body Offers mineralizing & calming benefits Perfectly refreshes skin from daily stress &

Lancome – Hydrazen Neurocalm Soothing Anti-Stress Moisturising Cream Fluid ( Moist ) $520 Lightweight fluid cream that gently soothes & calms skin Provides intense, immediate & long-lasting hydration Relieves environmental & emotional stress Fast absorbing & makes skin feel comfortable Leaves skin soft, smooth & radiant Suitable for all s

Lancome – Hydrazen Neurocalm Soothing Anti-Stress Moisturising Cream $271 This delicious cream gently soothes & calms skin Provides intense, immediate & long-lasting hydration Relieves environmental & emotional stress Oil-in-water texture instantly melts onto skin Leaves skin soft, smooth & radiant Suitable for all skin ty

Pevonia Botanica – Hydrosoluble Bath Oil – Anti-Stress ( Salon Size ) $476 A non-greasy anti-stress bath oil Formulated with Hazel Nut Oil & Safflower Seed Oil Blended with Lavender Flower Oil & Petit Grain Oil Helps relieve & pacify tensioned body & mind Skin appears calm & smooth For professional use only

Pevonia Botanica – Anti-Stress Aromatic Seaweed Bath ( Salon Size ) $772 Pampers your body with this anti-stress bath Gives mineralizing and nourishing benefits Helps reduce tension & fatigue Enriched with Seaweed & Pine Needle Essential Oil Awakens your senses & detoxifies your body Leaves body skin fresh & healthy

Lancome – Hydrazen Neurocalm Soothing Anti Stress Moisturising Cream SPF 15 $463 A lightweight cream that gently soothes & calms skin Provides intense, immediate & long-lasting hydration Relieves environmental & emotional stress Shields skin against damaging UV rays with SPF 15 Fast absorbing & makes skin feel comfortable Leaves

Dermalogica – SPA Stress Relief Oil – Professional Strength ( Salon Size ) $507 An aromatic body treatment oil Ideal for massage, bath therapy & luxurious skin conditioning Concentrated with essential oils Helps relax muscle, minimize stress & awaken senses Infused with silicones to mildly dissolve into skin Helps e

Stress Relieving Massage Oil with organic Eucalyptus $20 /category/~category_id=8700/~pcategory=7000′ title=’Media Darlings’>/images/catalog/stickers/en/mediadarling.jpg’>Essential oils – true quintessence of plants – are very active and concentrated ingredients.Yves Rocher Botanical Biology Laboratories have specially selected organic eucalyptus essential oil for its tension-relieving properties. Gently rub into areas of tension and massage away tightness while inviting a soothing calm. Our certified organic essential oil meets special requirements (in terms of culture, distillation) in order to deliver best results.5 fl.oz. Bottle / 150 ml

Spirit Essences Holiday Stress Stopper Dog & Cat Flower Essences 1 oz $19.99 This special edition of the popular Stress Stopper formula has added ingredients to help cope with the increased holiday hustle and bustle.

Elizabeth Arden Intervene Stress Recovery Night Cream 1.7oz $49.5 Recover with Intervene Stress Recovery Night Cream. This lightweight, intensive moisturizer, with new youth preserving complex, helps recover skin from daytime damage. Benefits:Defends skin cells from the aging effects of stress.Minimizes the appearance of pores.Provides a more revitalized and radiant appearance.Retinyl Linoleate provides a smoother and firmer look.Formulation is lightweight but an intensive treatment.Non comedogenic and approved for sensitive skin types.

HomeoPet Storm Stress Cats & Kittens for cats and dogs $31.49 A safe and effective homeopathic remedy that promotes calm in pets exhibiting fear from thunderstorms, fireworks, loud noises, hurricanes.

Neutrogena Oil-Free Acne Stress Control Triple-Action Toner – 8 Oz $7.01 Neutrogena Oil-Free Acne Stress Control Triple-Action Toner treats acne even before it emerges.

Bach original flower esscence rescue remedy natural stress relief liquid 0.7 oz $11.23 All natural form of healing that can reduce everyday stress and help maintain control of your health.

Earth Therapeutics anti-stress microwaveable sinus pillow Lavender Chamomile – 1 ea $9.72 The Anti-Stress Sinus Pillow enfolds you in its comforting embrace to relax and soothe.

Bach original flower essences rescue remedy pastilles orange Natural stress relief 1.7 oz $4.71 Ideal for coping with exam stress driving tests first day of school nerves job interviews and high pressure environments.

Neutrogena oil-free acne stress control night cleansing pads – 60 Pads $7.02 Neutrogena oil-free acne stress control night cleansing pads removes more dirt oil and makeup.

Stress formula tablets with zinc B C and E By Natural wealth – 60 tablets $3.94 Stress Formula Tablets with Zinc B C And E by Natural Wealth provide high potency Vitamin and mineral supplement.

Neutrogena Oil Free Acne Stress Control Power Cream Face Wash – 6 Oz $7.02 Neutrogena Oil Free Acne Stress Control Power Cream Wash reduces redness and irritation for exceptionally soft and clearer skin.

A.S.F. Anti-Stress Factors 60 Caps $7.7 This formula is intended to provide nutritive support for normal, healthy well-being during stressful periods. Guaranteed Potency (GP) Valerian extract and the extracts of Passion Flower and Chamomile have also been added to support a normal, healthy calm disposition.

Stress Management Drops 1.7 fl. oz. $16.19 Supports the body’s ability to cope with stressful situations.Avena sativa (Oats) has been used for centuries as a food for its nourishing and healthful properties. Alfred Vogel knew that when the oats are just breaking into flower and the seeds are beginning to form, the plant is the most healthful. The oats used in this tincture were grown organically and harvested at the time of optimum potency.

Nutritionally Balanced B-Stress 100 caps $9.17 Essential B Vitamins are necessary for proper metabolism and energy production. This formula provides B Vitamins in a ratio that more closely mirrors the nutritional needs of our body. We provide it to you in a natural whole food base of whole rice concentrate and aloe vera gel.

SPA Stress Relief Oil – Professional Strength ( Salon Size ) $83.99 Women’s 207ml/7oz . An aromatic body treatment oil Ideal for massage bath therapy & luxurious skin conditioning Concentrated with essential oils Helps relax muscle minimize stress & awaken senses Infused with silicones to mildly dissolve into skin Helps eliminate fine lines & sleek skin texture Can be used in bath for an aromatherapeutic skin suppling soak To use: For massage & scalp treatments: Apply a small amount onto palms massage onto body or scalp. For aromatherapy bath: Apply moderate amount into bath

Stress Formula High Potency Tablets – 60 Ea $3.94 Provides a unique combination of ingredients specially formulated to help you stay healthy.

Aveeno Bath Stress Relief Foaming – 10 Oz $5.57 Natural Colloidal Oatmeal lavender and Essential Chamomile and Ylang-Ylang Oils.

Anti-Stress Eye Lotion ( Salon Size ) $41.99 Women’s 500ml/17oz . Contains Chamomile Flower Extract & Lettuce Leaf Extract Blended with Calendula Officinalis Flower Extract Provides soothing anti-inflammatory & nourishing benefits Unveils calmer smoother & brilliant looking eye contours For professional use only

Peace of Mind – Cease & De-Stress Diffuser ( Unboxed ) $13.99 Women’s 0.8g/0.028oz . A sensory therapy to help you release tension Formulated with basil peppermint & eucalyptus Offers a rapid relaxation to unwind your brain Shuts out all the worries for a while To use: Slide open & breathe deeply The quality of this unboxed item will be as fresh & genuine as the original packing

Lancome – Hydrazen Neocalm Multi-Relief Anti-Stress Moisturising Cream – Dry Skin ( Box Slightly Damaged ) $592 Hydrazen Neocalm Multi-Relief Anti-Stress Moisturising Cream – Dry Skin ( Box Slightly Damaged )

Infinite Pop Bubble Wrap Keychain Stress Relieve Toy Green (QWN153) $3.99 FeaturesNothing beats the fun (and, perhaps, the stress-relieving benefits) of popping all the little cells on a sheet of bubble wrap. Now, with this cool toy, you can pop and blast as many bubbles as you want! Make sure you have one in your pocket. Have fun anywhere! 100% brand new Simulate both mimic sound and feeling of popping little plastic bubbles Besides popping sound, there are many surprising sounds generated randomly, discover all yourself Never used up! The ‘bubbles’ will be rebounded after each press, feel free to pop it till the end of the world Great for pressure and stress relieve Funny to play with when you are bored Can be hanged on your bag or used as keychain Perfect gift for both adults and kids Size: 4cm 4.5cm 1cm Color: green

Cute Stress Face Ball/ Gag Toys/Birthday Gift For Girl $15.19 Cute face ball help to reduce your stress; Black and white available; Four faces express different mood; Four in one set; Adopt polyurethan paint material; Colors ship at random unless you select a white set or a black set.   Size Packing: W80 x D80 x H80mm Ball: W55x D65 x H65mm

Just Women Stress 60 Instant Dissolve Micro-Tablets $13.74 “Instant Dissolve Mini-Tablets” may be small but they are full potency! Their concentrated properties are distinguished by their very high ratio of active ingredients to inactive binders and filters. This high level of active ingredients when combined with the unique manufacturing process, of hydration and drying, bonds bonds the nutrients and allows Superior Source “instant Dissolve Mini-Tablets” to facilitate the transit of nutritional compounds instantly into the body.Benefits of Just Women Stress:No pills to swallowInstantly dissolves on contactPlace on or under tongue

Estee Lauder – Stress Relief Eye Mask $357 A 10-minute revitalizing beauty mask Greatly reduces puffiness & other signs of fatigue Effectively improves your skin hydration level up to 40% Helps soothe your skin while moisturizing Leaves skin looking more hydrated & smooth Suitable for all sk

Estee Lauder – Stress Relief Face Mask $381 This pre-moistened facial sheet instantly revitalizes skin Reduces facial puffiness, the appearance of lines & wrinkles Quenches skin with optimal moisture continuously Refreshes tired skin, provides new radiance & glow Soothes red, irritated skin & c

Elemis – Aromatherapy De-Stress Massage Oil $312 An aroma-therapeutic massage oil for an evening massage Contains essential oils of Rosewood, Geranium, Rosemary & Lavender Helps relax & enliven stressed spirit Leaves body skin soothed & comfortable To use: Massage into chest at night for a

Molton Brown – Stress Release Firming Mask $120 A nutritious, hydrating anti-aging treatment Enriched with oat complex to improve suppleness Reduces fine lines & wrinkles Leaves skin firm, flexible & youthful looking

La Prairie – Anti Aging Stress Cream $1462 This cream provides moisturizing & energizing benefits Contains active plant extracts to minimize muscle contractions Reduces appearance of lines, wrinkles & expression lines Natural mushroom complex boosts natural collagen production Improves skin n

Molton Brown – Seamoss Stress-Relieving Hydrosoak $227 This bath gives you a marine hydro-therapy experience Uniquely blends Dead Sea salts, seaweed with horse chestnut extracts Effectively detoxifies & rebalance your body as well as your soul Helps relaxes & refreshes tired body Definitely a treat after

Manage Your Stress and Pain Through Music $29.99 Berklee Guide. Softcover with CD. 180 pages. Published by Berklee Press

Stress-Relieve LED Flashing Bouncy ball $1.99 Overview Blinking multi-LED sound balls Super bounce Flashing light show with every bounce Great as gift Special ball design

Stress-entlasten LED blinkt Bouncy Ball $1.57 Überblick Multi-LED blinkt Sound Kugeln Super Bounce Blinklicht zeigen, mit jedem bounce großer als Geschenk spezielle Kugel-Design

soulager le stress-Ball a mené gonflable clignotant $1.57 vue d’ensemble clignote multi-balles conduit son Super Bounce spectacle de lumière clignote à chaque rebond grand comme un don design à billes spéciaux

Stretchy Frogs Stress-Reliever (Assorted Colors 2-Pack) $3.91 Specifications:Dimensions: 2.68 in x 2.68 in x 2.68 inWeight: 2.4 oz

dehnbar Frösche, Stress abzubauen (Farben sortiert 2-Pack) $3.08 Spezifikationen: Abmessungen: 2,68 mm x 2,68 mm x 2,68 in Gewicht: 2.4 oz

Stress-Reliever Screaming Hen Squeezy Toy (Large) $5.57 Overview:Crows in pain when you squeeze, hit or shake itLet the chicken have it whenever work’s got you down and it’ll be sure to make you feel all plucky againGreat toy if you want to take out all your pent up rage on an innocent chicken

stress-reliever gallina urlante squeezy giocattolo (grande) $4.39 Panoramica: corvi in dolore quando spremere, battere o scuotere la lasciare che il pollo si hanno quando il lavoro vi scese e sarà certo per farvi sentire tutta coraggioso di nuovo giocattolo grande se si vuole prendere tutti la tua rabbia repressa su un pollo innocente

Stress abzubauen schreien Henne squeezy Spielzeug (groß) $4.39 Übersicht: Krähen im Schmerz, wenn Sie drücken, drücken und schütteln Sie es lassen die Hühner haben, wann immer Arbeit’s got you down und es wird sicher, dass Sie alle fühlen sich mutig wieder große Spielzeug, wenn Sie wollen, nehmen Sie alle Ihre aufgestaute Wut an einem unschuldigen Hühnchen

stress releveur hurlant jouet squeezy poule (grand) $4.39 Vue d’ensemble: corbeaux dans la douleur lorsque vous presser, frapper ou de le secouer laissez le poulet ont chaque fois le travail’s Got You Down et il sera sûr de vous faire sentir tout nouveau courageuse des jouets si vous voulez sortir tous vos refoulée rage sur un poulet innocent

BABOR Anti-Stress Fluid (7 Ampoules x 2 ml) $44 Skin that is sensitive and irritated can take a deep breath, because this fluid will instantly reduce redness and irritations while calming the skin immediately. Effective anti-stress ingredients such as bisabolol and ginger also instantly work to make redness and itching disappear. Skin instantly looks even, less red and more relaxed. Directions: Apply in the evenings, after cleansing with Babor products. Shake the ampoule and place a tissue around its neck. With your other hand hold the ampoule firmly at the top and snap it open at the lower, colored ring. Pour the contents of the ampoule of BABOR Fluid into the palm of your hand and smooth evenly over the face, neck and decolette. Pat gently into the skin, so the fluid absorbs quickly. Then apply cream. Net Weight: (7 Ampoules x 2 ml)

Bubble Pop stress infinito avvolgere portachiavi alleviare verde giocattolo (qwn153) $3.14 caratteristiche niente batte il divertimento (e, forse, l’anti-stress benefici) di tutte le cellule che appaiono poco su un foglio di pluriball. Ora, con questo giocattolo fresco, è possibile pop e blastica come bolle che vuoi! assicuratevi di avere uno in tasca. divertirsi ovunque! 100% nuovo simulare sia mimica del suono e la sensazione di popping poco bolle di plastica Oltre suono popping, ci sono molti suoni sorprendenti generato casualmente, scoprire tutto da soli mai utilizzato! le ‘bollicine’ sarà rimbalzato a ogni pressione, sentitevi liberi di pop fino alla fine del mondo ideale per alleviare la pressione e lo stress divertente con cui giocare quando si è annoiati può essere appeso alla borsa o utilizzato come portachiavi regalo perfetto per grandi e bambini Dimensioni: 4 cm 4,5 centimetri 1 centimetro colore: verde

Johnsons Softwash Melt Away Stress 24 Hour Moisturizing Wash – 20.3 Oz $5.06 Johnsons Softwash Melt Away Stress 24 Hour Moisturizing Wash helps melt away daily tension so you feel relaxed like after a warm bath.

unendlichen Pop Luftpolsterfolie Schlüsselanhänger Stress Spielzeug grün (qwn153) $3.14 Merkmale nichts geht über den Spaß (und vielleicht die Entspannungsglühen Vorteile) tauchen all die kleinen Zellen auf ein Blatt Luftpolsterfolie. Jetzt, mit diesem coolen Spielzeug können Sie Pop sprengen und so viele Blasen, wie Sie wollen! Vergewissern Sie sich, ein in der Tasche. Spaß haben überall! 100% brand new simulieren, sowohl imitieren Klang und Gefühl popping wenig Plastikblasen Neben knallte, es gibt viele überraschend klingt nach dem Zufallsprinzip generiert, entdecken Sie nie auf! die quot;bubbles quot; wird nach jedem Tastendruck erholt werden, Sie können ihn bis zum Ende der Welt pop ideal für Druck und Stress funny, um mit zu spielen, wenn man sich langweilt finden Sie auf Ihrer Tasche gehängt werden oder als Schlüsselanhänger verwendet perfekte Geschenk für Kinder und Erwachsene Größe: 4cm 4,5 cm 1cm Farbe: grün

Pevonia Botanica – De-Stress Eye Treatment – Eye Puffiness Ginkgo Biloba Sheet Mask ( Salon Size ) $350 An anti-stress eye treatment Contains Gingko Biloba extracts to stimulate lymphatic capillaries to drain toxins Minimizes dark circles & puffiness Restores vibrant & ageless looking eye contours

Anxiety Relief Spray & Stress Supplement Kit Kit (1 fl oz & 30 Tabs) $16.45 Anxiety Spray: For relief of minor mood swings, fear, anxiety or nervousness, stage fright, upset and tightness in the stomach.Stress Supplement: Calcium: Nerve conduction, muscle contraction. Magnesium: Calcium transport and utilization. Niacinamide: Required for conversion of phenylalanine to tryptophan. Passion Flower and Hops: Historical and traditional use.

Anti-Stress Program: Creme De Choc 50ml + Serum De Choc 5ml + Masque 15ml + Lip Balm 5ml $70.99 Women’s 4pcs . Anti-Stress Program: 1x Creme De Choc Energizing Day Care 50ml/1.6oz 1x Serum De Choc Energetic Serum 5ml/0.16oz 1x Masque Reveil Eclat Flash Energizing Care 15ml/0.5oz 1x Baume A Levres Hydratant SPF 15 Long Lasting Hydrating Lip Balm 5ml/0.16oz

Lancome – Hydrazen Neurocalm Soothing Anti-Stress Moisturising Cream Fluid SPF 30 $469 Lightweight fluid cream that gently soothes & calms skin Provides intense, immediate & long-lasting hydration Relieves environmental & emotional stress Fast absorbing & makes skin feel comfortable Leaves skin soft, smooth & radiant Suitable for dry s

Mini Handheld Whack-A-Mouse Mole Stress Relieving Game Keychain (3 LR44) $3.99 Overview:Whack-A-Mouse is the perfect size for your hand and makes a great mid-day stress relieverTwo modes: sound amp; mute modeFeatures 7 micesPowered by 3 x LR44 batteries (included)Specification:Dimensions:2.95in 1.89in 0.91in Weight:1.41oz

AVEENO Stress Relief Daily Moisturizing Foaming Bath 10 oz $9.95 This moisturizing foaming bath keeps your skin feeling soft and moisturized long after you bathe. This lightly foaming bath combines Natural Colloidal Oatmeal, long known to soothe skin, with a unique blend of natural oils and emollients to lock in moisture all day long. The result is healthy-looking skin that\’s perfectly clean, soft and smooth. Gentle enough for even sensitive skin: it\’s soap free, dye-free, hypoallergenic and lightly fragranced.

HomHomeoPet Storm Stress 80 lbs. & Up for cats and dogs $31.49 A safe and effective homeopathic remedy that promotes calm in pets exhibiting fear from thunderstorms, fireworks, loud noises, hurricanes.

LoveMyPet Stress Relief Dog & Cat Herbal 2 oz $24.99 Calm pets that upset easily in unfamiliar or startling situations such as travel, thunder, fireworks, or separation.

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