Principles of Psychopharmacology: Expert Solutions for Success

The cumulative writing assignment is an integrative research paper (12-14 pages). For this paper, please choose one form of psychological distress my pick is ( ANXIETY ) (either you have been close to someone who has struggled with it, or you, yourself, have struggled with it). 

Part One: 

Please discuss your overall point-of-view from a personal perspective, as follows (6- 7 pages): 

• Provide an understanding for why you have chosen this subject and how it has affected your life.  
• Expand this discussion by then describing your own biases and/or assumptions regarding the use of medications for psychological distress generally, and/or their use for this particular issue.  
• Next, briefly describe any significant life experiences you might have had that inform these biases/assumptions, and any factual information or opinions that you perhaps base these on (by ‘factual information’ is meant information that you assume to be true, that you recall reading about, etc.; it is not necessary to do any fresh research for this part of the paper).  
• Then, develop a dialogue, in which a ‘biased figure’ is being challenged to confront their assumptions about medications generally, and/or for this particular area. Imagine that the one who is challenging the biased figure is an objective third party, tremendously knowledgeable about psychopharmacological treatments and their disadvantages and advantages. (Note that if you cannot locate such a biased figure because you cannot locate any biases or nonobjective assumptions within, you may instead personify a figure who is grateful for the wonders of ‘better living through chemistry’). In this dialogue, clearly convey the third party’s scientific knowledge in their efforts to challenge the biased one’s entrenched positions, and provide superscript numbers at each scientific point made by the knowledgeable one, leading to specific end notes.  
• To close this portion of the paper, please discuss how aspects of your own multiplicity relate to these biases or assumptions, and any insights you are left with as a result of this writing process. 

Part Two:  

Please discuss the necessity, advantages, disadvantages, and possible side effects of psychopharmacological treatment for this area of distress. This second half of the paper needs to draw on each of the course texts, at least four resources (articles, videos, etc.) embedded in the course, and at least two other sources beyond the course texts. (6 -7 pages). 

Sources : Reading

·        Preston, John. Handbook of Clinical Psychopharmacology for Therapists, 10th ed.. Oakland, CA:  New Harbinger Publications, 2025.Handbook of Clinical Psychopharmacology for Therapists: Chapters 9, 10, 12, and 19.

·        Solomon, Andrew. The Noonday Demon. New York:  Scribner, 2001.The Noonday Demon and How to Change Your Mind: Continue reading.

·        Anatomy of an Epidemic: Chapter 7.

https://www.youtube.com/watch?v=_qo4uPxhUzU

https://www.youtube.com/watch?v=S8FNcOBkhN4

https://www.youtube.com/watch?v=-eBUJ-1vcjk

https://www.youtube.com/watch?v=bTwI4AUZS8g

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Principles of Psychopharmacology

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Anxiety: A personal reflection on psychological distress and Medication Use

Anxiety has been a personal subject for me. I chose to focus on anxiety because it has shaped my perception on mental health, self-control and reliance. From early adolescent, I experienced seasons of intense worry which often appeared without warning. At this time my heart was beating faster than I could and had a lot of thoughts which I would not relate to any ordinary situation that I had experienced in the past. Since I had no idea on what was happening, I felt that I was “too sensitive” and overthinking. However, as I grew older, I started relating the events with what psychology defines as anxiety. Based on psychology, anxiety is a mental health condition which results to excessive fear, apprehension and affects the normal functioning of the body. Based on this definition and reading articles from psychology, I realized that anxiety had significantly affected not only my emotions but also compromised how I interacted with others, how I make decisions and how I perceived the environment around me. Based on this incident, I realized that being mentally stable is a privilege hence I should show compassion to other people who are struggling to handle challenges associated with anxiety.

I chose to work on anxiety because I felt that this condition has had some impact to my personal journey and it will help me appreciate myself better going forward. Besides, I chose this condition because I felt that it had root in biology and psychology hence it will give me a chance of delving in this area. I also learned that anxiety is a complex mental health condition that is contributed by various factors including environmental factors, genetics and personal temperament. I grew up in a family where I had no chance of expressing my emotions and feelings. Therefore, I had no chance of sharing my fears and what worries me. I though expressing myself especially to my peers or persons elder than me was a weakness. Little did I know that not sharing this would worsen my situation. I vividly recall that anxiety in me made me to always strive to be perfect in everything I did especially on my academics and relationships. I was keen on ensuring that I was perfect. The fears that I had was to fail and not getting approval from persons around me. Although being perfect made me to be successful in my academics, I did not realize that this would compromise not only my physical body but also thinking and making informed decisions. Physically, my body responded to the anxiety through insomnia, congested chest and loss of appetite.  I thought I was nervous and this contributes to the sleep, loss of appetite and chest congestion, little did I know that it was anxiety. It took me years to know that indeed it was anxiety. Therefore, in studying anxiety, I will understand how my mind works especially when am exposed to mental health challenges such as anxiety. Through this, I can help myself identify the risk factors, the presenting symptoms and help others who could be handling anxiety challenges.

When I consider my bias and assumptions, one of them is on the medications offered to psychological conditions.  I appreciate that threats on medications used for psychological issues such as anxiety have evolved over the years. Notably, I was not sure about medications used to treat anxiety. This is because I though mental health challenges including anxiety are not treated using conventional medicine. Instead, it is treated by subjecting one to religious rituals, believes in God and supernatural powers. Also, it could be handled by controlling oneself especially personal thoughts and emotions. My perception was that using conventional medicine was a sign of failure and it would not yield any positive results. Consequently, I could not seek medical intervention.  I believe that my perception of synthetic medication was also in line with other individuals from other communities who believed that using medication would not yield significant impacts.  Besides, they associated medical interventions to weakness and would make them rely on this medication even when it is not needed. All these myths sunk into my mind and I unconsciously absorbed them. Intellectually, I knew that anxiety could be explained biologically.

In this bias, one of the things that challenged my thoughts was the side effects associated with synthetic medications. I believed the medications were only managing the presenting symptoms instead of addressing the cause of anxiety. Also, it did not address the emotional and spiritual aspect of healing. I believed that the emotions and spirituals aspects could be corrected by alternative interventions such as therapy, self-awareness and changing individual lifestyle.

The bias that I had regarding medical interventions were influenced by other factors. For instance, when I was in college one of my friends believed to have mental health challenge had visited a doctor and was given a prescription of selective serotonin reuptake inhibitor (SSRIs) which is often given to individuals with generalized anxiety disorder. In the first months, she complained that the medication was worsening her health. This is because she was experiencing nausea, fatigue and emotional numbness. To me, it looked like an approval of my fears. I felt that the medication was compromising authenticity at the expense of having comfort which can be short-lived. After keenly observing her while using the medication, I made a conclusion that medication my not be good for human use. However, what surprised me is that with time, my friend recovered and was able to function just like before the sickness. This felt like contradictions in my mind because on one hand, I was scared of the medication but on the other hand, I was seeing positivity through my friend.

Another formative experience came from my encounter with anxiety medication. This happened in one of my stressful year and I had to visit a psychiatrist who listened to my story and suggested that he can prescribe a group of drug categorized as mild benzodiazepine. The psychiatrist believed that this medication could help me manage panic attacks. I agreed and I was given the medication although I was frightened by the sense of sedation. I experienced this for some days and I could not continue hence I stopped immediately. Since then, I developed skepticism and I changed my mind towards use of therapy, mindfulness and lifestyle changes as remedies to mental challenges including insomnia.

I agree that I was not sure of medication used to treat anxiety but one thing that I admire is role of science in explaining why individuals would consider therapy and other interventions over synthetic medications. Based on this, I thought it would make some sense if I imagine a dialogue between biased self whom named Skeptic” and an observe expert who is knowledgeable hence named “Knowledgeable” I believe knowledgeable was deeply rooted in psychopharmacology and he will help me understand the myths, the biology and science associated with mental health conditions particularly anxiety.

The Dialogue

Skeptic: In my opinion most medications particularly those used to treat anxiety are overprescribed. I think individuals have developed a habit of depending medication to cope with stress and other mental health challenges believed to compromise the brain chemistry.

Knowledgeable:  Thank you for this concern, I hear you.  However, I would wish to let you know that mental health conditions such as anxiety disorder has more other than what you are regarding as stress. It emanates from dysregulation in neurotransmitter systems especially serotonin, norepinephrine and gamma-aminobutyric acids (GABA) some medications such as SSRIs help restore balance to these systems, reducing excessive neutral activity associated with anxiety.

Skeptic: But it does not numb emotions instead of solving the problem?

Knowledgeable: Not necessarily. The goal is not emotional numbness but regulation. Research has shown that using medication improves the cognitive ability of the affected person, and allows the person to interact and actively participate in the prescribed therapy. When anxiety is severe, it can impair concentration and learning thus making therapy less effective without pharmacological support.

Skeptic: Still, I worry about side effects and dependency especially with benzodiazepines.

Knowledgeable: That is a valid concern. Benzodiazepines can cause dependence if misused, which that is why they are prescribed for short-term relief but SSRIs and SNRIs which is first line treatment for chronic anxiety do not cause addiction. They may have transient side effects but most diminish within weeks as the brain adjust.

Skeptic: I have also heard that once you start, you can never stop taking them.

Knowledgeable: I think what you are saying is something that I have heard and I would say it is a misconception regarding anxiety. For many patients, medication plays a critical role in stabilizing the patient and act as a bridge between the current condition and improved mental health. Based on clinical evidence, use of medication improves the patient conditions and once the symptoms have stabilized, the patient can be subjected to therapy that is strong and sustainable, allowing the patient cope in an event of potential risk factors. It should be noted that this is different from one patient to other. Some patients might require long-term treatment especially in patients with pre-existing health conditions such as diabetes and hypertension while some may be short term

Skeptic: Let me seek a clarification from you, whatever you are saying is medication which only treats the presenting symptoms instead of the root cause. Is that true?

Knowledgeable: I wish to differ from you. Prescribed medication is part of the treatment plan given to patients. The cause of anxiety can be explained by biological risk factors and environmental factors that trigger this condition. Synthetic medication are mainly meant to tackle the biological aspect while psychotherapy helps in handling the environmental factors that trigger this condition. Also, it addresses the emotional and cognitive components of anxiety. In most cases, a good prognosis is reported when synthetic medication is combined with psychotherapy.

Skeptic: I think there is a lot of information that the society is overmedicating. What are the implications? I think medication is used as a misused especially in providing comfort even in situations that does not warrant medical interventions.

Knowledgeable: I agree with you. I wish to let you know that that is a cultural critique. However, there is a need to differentiate between medication misuse and legitimate use. I wish to emphasize that overmedication affects health of the affected person but I wish to let you know that stigmatization is equally harmful. Research done on this shows that if anxiety is not treated, it can occasion other mental health complications such as depression and cardiovascular disease. It should be noted that when medications are prescribed correctly, it will not occasion any complications.

Skeptic: Okay. Another think that I have in mind is that use of medication compromises my authenticity. I fear that it may change my personality.

Knowledgeable: I wish to differ please. Medication does not personal identity. For a   fact, it helps you regain the lost confidence and constant fears.  

Knowledgeable: That is a valid cultural critique but we should differentiate between misuses and legitimate use. Overmedication is a problem but on the other hand denying effective treatment due to stigma is equally harmful. Previous research has consistently reported that untreated anxiety increases the risk of depression, substance use and cardiovascular disease. Properly described medication can prevent such complications.

When I reflect on this conversation, I realize that my initial thoughts and perception of synthetic medication were influenced by emotions rather than rely on scientific evidence.  I think the bias were mainly because of the fears, cultural stigma and limited understanding of the importance of medical interventions in treating anxiety. I must agree that I did not have an idea on how medications work. Participating in this dialogue opened my mind and made me appreciate that science is reliable and can be used instead of cultural myths and norms. Also, medication does not compromise my personal strength nor my spirituality. I also noted that synthetic medication does not exclude other interventions such as psychotherapy, instead it complements them. A perfect example is a combination of mindfulness and pharmacological treatment helps in improving the mental health condition while reducing any potential relapse. Also, it promotes sustained emotional stability (Guo et al. 2022).  This conversation was useful mainly because it helped me erase my thoughts and believes which had made me think that mental health was personal failure and can only be treated by therapy. In an event medication is used, it is considered as a weakness.

Additionally, when I analyze my bias and assumptions, I realized that they were occasioned by various factors including my cultural background, education and spirituality. I grew up in a society which upholds faith and I though personal emotions are controlled through prayers and reading the bible. At no point did I consider medical intervention as a solution. However, I had some insights from my scientific education which taught me to rely on evidence and valid reasons when making a conclusion. Faith and science work hand in hand because it creates cognitive dissonance especially when approaching mental health. I have learned that there is a balance between faith and medication. Appreciating these aspects made me agree with the idea that mediation stabilizes a mental health of a mentally compromised person. Also, it gives me a chance to understand others with different mental health challenges.

Writing this paper was one of the most enlightening moment. It made me realize the root of my bias and shaped my understanding of anxiety treatment particularly combining psychopharmacotherapy and psychotherapy. I appreciated that anxiety is not about character but a neurobiological condition that is explained by science. Based on this reflection, I appreciated that I need to read, learn and enhance my education especially on how to deal with stigma and anxiety treatment. I concluded that if populations understood the science behind various mental health conditions including anxiety, they would not be ashamed, instead courageously seek medical intervention each time they need. This would have gone a long way in reducing mental health cases which are currently on the rise.  Lastly, I appreciated that healing is a process that involves trusting the science and self-awareness which coexist to ensure that an individual has the desired mental health.

PART 2

Necessity, Advantages, Disadvantages and Side Effects of Psychopharmacological Treatment for Anxiety

Anxiety is one of the most pervasive psychological disorders worldwide that has been reported to affect millions of individuals across different age groups and cultural contexts. While psychotherapy remains a cornerstone treatment, pharmacological interventions have become significantly important especially in reducing physiological and cognitive symptoms that are associated with anxiety.  Based on evidence, anxiety disorder presents hyperarousal of nervous system, intrusive worry and somatic manifestations such as palpitations, tremors and gastrointestinal distress. The symptoms can be serious and many individuals especially those with non-pharmacological treatment alone may not suffice.  (Preston 2025)  in is handbook of Clinical Psychopharmacology for Therapists, medications for anxiety are designed to moderate neurological imbalances within the brain especially those involving serotonin, norepinephrine and gamma-aminobutyric acid (GABA). The goal is not merely to numb emotion, but to restore neurobiological equilibrium which allows patients to effectively engage in psychotherapy and daily functioning. The need for pharmacological treatment for anxiety because it has the ability to stabilize the biological foundation of emotional regulation while creating physiological state in which cognitive and behavioral interventions can succeeds.

The need for using medication to treat anxiety is mainly from the fact that anxiety disorders are not solely cognitive or environmental phenomena but it is also deeply biological in nature (Chorpita and Barlow 2018).  According to Preston book specifically chapter nine and ten, the limbic system within the brain especially amygdala and hippocampus plays a vital role in threat perception and emotional processing. In persons with anxiety, the neural circuits are hyperresponsive which results in exaggerated reaction to fear even in situations which are not threatening (Hofmann, Mundy, and Curtiss 2015). Psychopharmacological interventions such as serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are essential in targeting these neural pathways through enhancement of neurotransmission and reducing overactivity in the fear circuity. Medications such as Sertraline (Zoloft), escitalopram (Lexapro) and Venlafaxine (Effexor XR) are some of the commonly prescribed drugs for generalized anxiety disorder, panic disorder and social anxiety disorder. Based on Preston book, there are various benefits associated with SSRIs and SNRIs which includes reduced physiological hyperarousal, improved mood stability and diminished cognitive distortions related to perception of threat.  Without the pharmacological stabilization, many patients find it challenging in participating meaningfully in a cognitive behavioral therapy (CBT) or mindfulness-based interventions because their psychological fear overwhelm coping mechanisms.

The advantages of psychopharmacological interventions are mainly on their ability to interrupt the cycle of chronic stress response and restore functional balance. In individuals with anxiety that interferes with their occupational and social functioning, medication provides biochemical support for recovery. The video “Understanding Anxiety and Its Treatment” (YouTube, 2023) emphasizes that medication is important and can help in bridging the gap by enabling patient regain their lost cognitive clarity and emotional regulation that often anxiety erodes. On the other hand, (Solomon 2014) in his article (Noonday Demon and how to change your mind”, notes that medication provides hopes to those who have long suffered in silence. Similarly, he indicated that previously he had used antidepressants and anxiolytics and noted that the medication did not fully eliminate his problem but gave him an opportunity of rebuilding his life. this information from him provides an overview on use of medication to stabilize mental health conditions. notably, he indicated that medication does not transform personality but it restores mental   health of a person, making it functional as it should be.

Despite its benefits, medications face significant challenges. One of the disadvantages is the possibility of overuse without consideration of its psychological, social and spiritual dimensions of this distress. The documentary “Anatomy of an Epidemic” and its corresponding chapter seven provides a sobering critique of the widespread use of psychiatric drugs in modern society ( Whitaker 2005). In this chapter, he argues that while medications provide short-relief, they can also contribute to long-term dependency and physiological adaptations that make discontinuation difficult. He argues that medications which are industry-made most of the time prioritizes management of symptoms over true healing hence it results to a cycle where patients become dependent on external substances for regulations of their emotions. This perception challenges human distress medication, hence it suggests that over prescription of psychotropic drugs can obscure the social and existential factors which increases anxiety. While Whitaker critique may not invalidate the real benefits of medication, it reminds clinicians and patients to approach pharmacotherapy as one component of a holistic treatment plan instead of stand-alone cure.

Additionally, psychopharmacological medication is constrained by the variance in responses of these medications. (Preston 2025) in his chapter 12   indicated that no two brains are identical and what works for one patient may be ineffective or even counterproductive for another. Some individuals report significant improvements while some endure several months of trial before they find the right medication and the dosage.  Using synthetic medication for a prolonged duration is emotionally draining and lowers the patient confidence. On the other hand, if a patient has to stop using the medication, they will need careful management since abrupt withdrawal may worsen the existing anxiety problem and prompt other symptoms such as dizziness, irritation and flu-like symptoms.

One of the key component that is vital in understanding the psychopharmacological treatment for anxiety is recognizing the potential side effects. While SSRIs and SNRIs are tolerated by most patients, it has some risks. The common side effects include gastrointestinal disturbances, insomnia, sexual dysfunction and initial increased anxiety before the therapeutic effects sets in. These side effects are transient in that it will resolve within months of treatment but can occasion premature discontinuation of the medication. Benzodiazepines are rapid in response by enhancing GABA activity and produce immediate culming effects. However, the YouTube video titled “The Downside of Benzodiazepines” (2023) explains that their usage carriers significant risk for tolerance, dependence and cognitive impairment especially when it is used for a prolonged duration. Continued use results to withdrawal symptoms resembling the anxiety that was intended to treat. Therefore, most clinicians reserve these drugs for short-term crisis management while relying on SSRIs, SNRIs or busprine for long-term anxiety regulations.

The neurobiological mechanism underlying these medications are supported by extensive research in neuropsychopharmacology. According to (Baldwin, Waldman, and Allgulander 2011) in the Lancet Psychiatry article, SSRIS and SNRIs are not only the most effective but also safest long term pharmacological treatments for anxiety disorder with significant improvement in upto 60 percent of the patients compared to placebo. A combination of medication and psychotherapy yields superior outcomes to either modality alone. Similarly, the video “How Antidepressants Work” (YouTube, 2023) explains that SSRIs increases serotonin availability in synaptic clefts leading to neural placidity that gradually reshapes emotional and cognitive processing.  These biological effects align with (Solomon 2014) who indicated that psychopharmacological interventions are not for dull emotions but explains emotional resilience by recalibrating which is the response of the brain to stress.

Based on existing evidence, medication alone may not address all dimensions of anxiety. Psychological and environmental factors such as trauma, chronic stress and social isolation often sustain anxiety even when neurochemical balance is restored hence need for integrated treatment approaches.  Combining medication with psychotherapy, mindfulness and behavioral strategies stabilizes a patient with anxiety and at the same time it lowers potential for relapse. Besides, it improves patient self-awareness and reduce sides because it regulates emotions. The combined effect of synthetic medication and non-pharmacological options highlights the need for developing an individualized medication for each patient instead of generalization. It recognizes anxiety is not only biochemical imbalance but also a lived human experience that is influenced by various factors such as individual thoughts, behavior and environment.

Despite the benefits associated with medication, its use is constrained by ethical and clinical challenges. When considering medication, there is a need to factor severity of symptoms, patient history, potential side effects and potential for misuse. According to (Stephen 2000) ethical prescribing involving these medications should ensure that the participants give their informed consent, and there is patient collaboration and regular reassessment. Often, medications are prescribed based on reflexively without validation. As indicated by the video “Are We Overmedicating Society?” (2023), there is a cultural norm influencing individuals to use the medications for comfort instead of addressing underlying psychosocial issues such as poverty, trauma and social disconnection. Therefore, while psychopharmacological treatment remains essential for many, there is a need for a holistic framework that integrates biological, psychological and social perspectives.

The use of medication for anxiety depends on various factors particularly accessibility and equity. It is worth noting that not all persons with mental health challenges can have equal access to medication or psychiatric care. Additionally, access to these services is constrained by limited resources. persons with adequate finances can access it while those from low income backgrounds are unable to access. This widen the medication access disparities also, there is aspect of stigmatization. When affected person is stigmatized, they may not have the courage to seek medical intervention. They feel less of themselves and may not be reintegrated back to their families and society. The YouTube documentary “Breaking the Stigma: Understanding Mental Health Treatment” (2003) demonstrates, affected persons are unable to seek medical interventions because they fear the perception of others in the society.  Therefore, addressing stigmatization goes a long way in improving perception of medications for mental health condition treatments. Besides, there is a need for educating the public to reduce the stigma and myths surrounding anxiety. It is also important to educate them the need of relying on evidence rather than assumptions. 

References

Baldwin, David S., Sarah Waldman, and Christer Allgulander. 2011. ‘Evidence-Based Pharmacological Treatment of Generalized Anxiety Disorder’. International Journal of Neuropsychopharmacology 14 (5): 697–710. https://doi.org/10.1017/S1461145710001434.

Cambridge, Robert Whitaker. 2005. ‘Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America’. Ethical Human Psychology and Psychiatry 7.

Chorpita, Bruce F., and David H. Barlow. 2018. ‘The Development of Anxiety: The Role of Control in the Early Environment’. The Neurotic Paradox, October, 227–64. https://doi.org/10.4324/9781315619996-2.

Guo, Hui Rong, Jun Ru Wang, Ya Li Wang, Bai Ling Huang, Xu Huan Yang, and Yu Ming Ren. 2022. ‘The Effectiveness of Mindfulness-Based Cognitive Therapy Combined with Medication Therapy in Preventing Recurrence of Major Depressive Disorder in Convalescent Patients’. Frontiers in Psychology 13 (August): 882006. https://doi.org/10.3389/FPSYG.2022.882006/BIBTEX.

Hofmann, Stefan G., Elizabeth A. Mundy, and Joshua Curtiss. 2015. ‘Neuroenhancement of Exposure Therapy in Anxiety Disorders’. AIMS Neuroscience 2 (3): 123. https://doi.org/10.3934/NEUROSCIENCE.2015.3.123.

Preston, John. 2025. ‘Handbook of Clinical Psychopharmacology’. Handbook of Clinical Psychopharmacology for Therapists: 2025. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Preston%2C+John.+Handbook+of+Clinical+Psychopharmacology+for+Therapists%2C+10th+ed..+Oakland%2C+CA%3A++New+Harbinger+Publications%2C+2025.Handbook+of+Clinical+Psychopharmacology+for+Therapists%3A+Chapters+9%2C+10%2C+12%2C+and+19.&btnG=.

Solomon, Andre. 2014. ‘The Noonday Demon: An Atlas Of Depression - Andrew Solomon - Google Books’. 2014. https://books.google.com/books?id=JBJ5BAAAQBAJ&printsec=frontcover&dq=noonday+demon&hl=en&sa=X&ved=0ahUKEwjtwaOt_oDjAhVNxVkKHV01BzkQ6AEIKDAA#v=onepage&q=noonday demon&f=false.

Stephen M., Stahl. 2000. ‘Essential Psychopharmacology: Neuroscientific Basis and Practical Applications - Stephen M. Stahl - Google Books’. 2000. https://books.google.nl/books?hl=en&lr=&id=HkA0Q31YDhAC&oi=fnd&pg=PR7&dq=.+Essential+psychopharmacology:+neuroscientific+basis+and+practical+applications.+2nd+ed.+Cambridge,+UK:+Cambridge+University+Press%3B+2000.&ots=dWxoZaBKSf&sig=qJqaFOonIV1AgxhuJxUdRq.