title: Nancy Reagan

text: Author Garry Wills has said that Davis was generally underrated as an actress because her constrained part in "Hellcats" was her most widely seen performance. In addition, Davis downplayed her Hollywood goals: promotional material from MGM in 1949 said that her "greatest ambition" was to have a "successful happy marriage"; decades later, in 1975, she would say, "I was never really a career woman but [became one] only because I hadn't found the man I wanted to marry. I couldn't sit around and do nothing, so I became an actress." Ronald Reagan biographer Lou Cannon nevertheless characterized her as a "reliable" and "solid" performer who held her own in performances with better-known actors. After her final film, "Crash Landing" (1958), Davis appeared for a brief time as a guest star in television dramas, such as the "Zane Grey Theatre" episode "The Long Shadow" (1961), where she played opposite Ronald Reagan, as well as "Wagon Train" and "The Tall Man", until she retired as an actress in 1962.


title: Nancy Reagan

text: During her career, Davis served for nearly ten years on the board of directors of the Screen Actors Guild. Decades later, Albert Brooks attempted to coax her out of acting retirement by offering her the title role opposite himself in his 1996 film "Mother". She declined in order to care for her husband, and Debbie Reynolds played the part.


title: Nancy Reagan

text: During her Hollywood career, Davis dated many actors, including Clark Gable, Robert Stack, and Peter Lawford; she later called Gable the nicest of the stars she had met. On November 15, 1949, she met Ronald Reagan, who was then president of the Screen Actors Guild. She had noticed that her name had appeared on the Hollywood blacklist. Davis sought Reagan's help to maintain her employment as a guild actress in Hollywood and for assistance in having her name removed from the list. Ronald Reagan informed her that she had been confused with another actress of the same name. The two began dating and their relationship was the subject of many gossip columns; one Hollywood press account described their nightclub-free times together as "the romance of a couple who have no vices". Ronald Reagan was skeptical about marriage, however, following his painful 1949 divorce from Jane Wyman, and he still saw other women.


title: Nancy Reagan

text: After three years of dating, they eventually decided to marry while discussing the issue in the couple's favorite booth at Chasen's, a restaurant in Beverly Hills. The couple wed on March 4, 1952, at the Little Brown Church in the San Fernando Valley of Los Angeles, in a simple and hastily arranged ceremony designed to avoid the press; the marriage was her first and his second. The only people in attendance were fellow actor William Holden (the best man) and his wife, actress Brenda Marshall (the matron of honor). Nancy was likely already pregnant during the ceremony; the couple's first child, Patricia Ann Reagan (later better known by her professional name, Patti Davis), was born less than eight months later on October 21, 1952. Their son, Ronald Prescott Reagan (later better known as Ron Reagan) was born six years later on May 20, 1958. Reagan also became stepmother to Maureen Reagan (1941–2001) and Michael Reagan (b. 1945), her husband's children from his first marriage to Jane Wyman.


title: Nancy Reagan

text: Observers described Nancy and Ronald's relationship as intimate. As president and first lady, the Reagans were reported to display their affection frequently, with one press secretary noting, "They never took each other for granted. They never stopped courting." Ronald often called Nancy "Mommy"; she called him "Ronnie". While the president was recuperating in the hospital after the 1981 assassination attempt, Nancy wrote in her diary, "Nothing can happen to my Ronnie. My life would be over." In a letter to Nancy, Ronald wrote, "whatever I treasure and enjoy ... all would be without meaning if I didn't have you." In 1998, a few years after her husband had been given a diagnosis of Alzheimer's disease, Nancy told "Vanity Fair", "Our relationship is very special. We were very much in love and still are. When I say my life began with Ronnie, well, it's true. It did. I can't imagine life without him." Nancy was known for the focused and attentive look, termed "the Gaze", that she fastened upon her husband during his speeches and appearances.


title: Nancy Reagan

text: President Reagan's death in June 2004 ended what Charlton Heston called "the greatest love affair in the history of the American Presidency".


title: Nancy Reagan

text: Nancy's relationship with her children was not always as close as the bond with her husband. She frequently quarreled with her children and her stepchildren. Her relationship with Patti was the most contentious; Patti flouted American conservatism, rebelled against her parents by joining the nuclear freeze movement, and authored many anti-Reagan books. The nearly 20 years of family feuding left Patti very much estranged from both her mother and father. Soon after her father's Alzheimer's disease was diagnosed, Patti and her mother reconciled and began to speak on a daily basis. Nancy's disagreements with Michael were also public matters; in 1984, she was quoted as saying that the two were in an "estrangement right now". Michael responded that Nancy was trying to cover up for the fact she had not met his daughter, Ashley, who had been born nearly a year earlier. They too eventually made peace. Nancy was thought to be closest to her stepdaughter Maureen during the White House years, but each of the Reagan children experienced periods of estrangement from their parents.


title: Nancy Reagan

text: Nancy Reagan was First Lady of California during her husband's two terms as governor. She disliked living in the state capital of Sacramento, which lacked the excitement, social life, and mild climate to which she was accustomed in Los Angeles. She first attracted controversy early in 1967; after four months' residence in the California Governor's Mansion in Sacramento, she moved her family into a wealthy suburb because fire officials had labelled the mansion as a "firetrap". Though the Reagans had leased the new house at their expense, the move was viewed as snobbish when the matter was brought to the attention of the general public. Reagan defended her actions as being for the good of her family, a judgment with which her husband readily agreed. Friends of the family later helped support the cost of the leased house, while Reagan supervised construction of a new ranch-style governor's residence in nearby Carmichael. The new residence was finished just as Ronald Reagan left office in 1975, but his successor, Jerry Brown, refused to live there. It was sold in 1982, and California governors lived in improvised arrangements until Brown moved into the Governor's Mansion in 2015.


title: Nancy Reagan

text: In 1967, Governor Reagan appointed his wife to the California Arts Commission, and a year later she was named "Los Angeles Times" Woman of the Year; in its profile, the "Times" labeled her "A Model First Lady". Her glamour, style, and youthfulness,


title: Nancy Reagan

text: made her a frequent subject for press photographers. As first lady, Reagan visited veterans, the elderly, and the handicapped, and worked with a number of charities. She became involved with the Foster Grandparents Program, helping to popularize it in the United States and Australia. She later expanded her work with the organization after arriving in Washington, and wrote about her experiences in her 1982 book "To Love a Child". The Reagans held dinners for former POWs and Vietnam War veterans while governor and first lady.


title: Nancy Reagan

text: Governor Reagan's gubernatorial time in office ended in 1975, and he did not run for a third term; instead, he met with advisors to discuss a possible bid for the 1976 presidency, challenging incumbent President Gerald Ford. Ronald still needed to convince a reluctant Nancy before running, however. She feared for her husband's health and his career as a whole, though she felt that he was the right man for the job and eventually approved. Nancy took on a traditional role in the campaign, holding coffees, luncheons, and talks. She also oversaw personnel, monitored her husband's schedule, and occasionally provided press conferences. The 1976 campaign included the so-called "battle of the queens", contrasting Nancy with First Lady Betty Ford. They both spoke out over the course of the campaign on similar issues, but with different approaches. Nancy was upset by the warmonger image that the Ford campaign had drawn of her husband.


title: Nancy Reagan

text: Though he lost the 1976 Republican nomination, Ronald Reagan ran for the presidency a second time in 1980. He succeeded in winning the nomination and defeated incumbent rival Jimmy Carter in a landslide. During this second campaign, Nancy played a prominent role, and her management of staff became more apparent. She organized a meeting among feuding campaign managers John Sears and Michael Deaver and her husband, which resulted in Deaver leaving the campaign and Sears being given full control. After the Reagan camp lost the Iowa Caucus and fell behind in New Hampshire polls, Nancy organized a second meeting and decided it was time to fire Sears and his associates; she gave Sears a copy of the press release announcing his dismissal. Her influence on her husband became particularly notable; her presence at rallies, luncheons, and receptions increased his confidence.


title: Nancy Reagan

text: Reagan became the first lady of the United States when Ronald Reagan was inaugurated as president in January 1981. Early in her husband's presidency, Reagan stated her desire to create a more suitable "first home" in the White House, as the building had fallen into a state of disrepair following years of neglect. White House aide Michael Deaver described the second and third floor family residence as having "cracked plaster walls, chipped paint [and] beaten up floors"; rather than use government funds to renovate and redecorate, she sought private donations. In 1981, Reagan directed a major renovation of several White House rooms, including all of the second and third floors and rooms adjacent to the Oval Office, including the press briefing room. The renovation included repainting walls, refinishing floors, repairing fireplaces, and replacing antique pipes, windows, and wires. The closet in the master bedroom was converted into a beauty parlor and dressing room, and the West bedroom was made into a small gymnasium.


title: Nancy Reagan

text: The first lady secured the assistance of renowned interior designer Ted Graber, popular with affluent West Coast social figures, to redecorate the family living quarters. A Chinese-pattern, handpainted wallpaper was added to the master bedroom. Family furniture was placed in the president's private study. The first lady and her designer retrieved a number of White House antiques, which had been in storage, and placed them throughout the mansion. In addition, many of Reagan's own collectibles were put out for display, including around twenty-five Limoges Boxes, as well as some porcelain eggs and a collection of plates.


title: Nancy Reagan

text: The extensive redecoration was paid for by private donations. Many significant and long-lasting changes occurred as a result of the renovation and refurbishment, of which Reagan said, "This house belongs to all Americans, and I want it to be something of which they can be proud." The renovations received some criticisms for being funded by tax-deductible donations, meaning some of it eventually did indirectly come from the tax-paying public.


title: Nancy Reagan

text: Reagan's interest in fashion was another one of her trademarks. While her husband was still president-elect, press reports speculated about Reagan's social life and interest in fashion. In many press accounts, Reagan's sense of style was favorably compared to that of a previous first lady, Jacqueline Kennedy. Friends and those close to her remarked that, while fashionable like Kennedy, she would be different from other first ladies; close friend Harriet Deutsch was quoted as saying, "Nancy has her own imprint."


title: Nancy Reagan

text: White House photographer Mary Anne Fackelman-Miner, who was assigned to Reagan, said of her, "She always photographed so easily and was at ease in front of the cameras."


title: Nancy Reagan

text: Reagan's wardrobe consisted of dresses, gowns, and suits made by luxury designers, including James Galanos, Bill Blass, and Oscar de la Renta. Her white, hand-beaded, one shoulder Galanos 1981 inaugural gown was estimated to cost $10,000, while the overall price of her inaugural wardrobe was said to cost $25,000. She favored the color red, calling it "a picker-upper", and wore it accordingly. Her wardrobe included red so often that the fire-engine shade became known as "Reagan red". She employed two private hairdressers, who would style her hair on a regular basis in the White House.


title: Nancy Reagan

text: Fashion designers were pleased with the emphasis Reagan placed on clothing. Adolfo said the first lady embodied an "elegant, affluent, well-bred, chic American look", while Bill Blass commented, "I don't think there's been anyone in the White House since Jacqueline Kennedy Onassis who has her flair." William Fine, president of cosmetic company Frances Denney, noted that she "stays in style, but she doesn't become trendy."


title: Nancy Reagan

text: Though her elegant fashions and wardrobe were hailed as a "glamorous paragon of chic", they were also controversial subjects. In 1982, she revealed that she had accepted thousands of dollars in clothing, jewelry, and other gifts, but defended her actions by stating that she had borrowed the clothes, and that they would either be returned or donated to museums, and that she was promoting the American fashion industry. Facing criticism, she soon said she would no longer accept such loans. While often buying her clothes, she continued to borrow and sometimes keep designer clothes throughout her time as first lady, which came to light in 1988. None of this had been included on financial disclosure forms; the non-reporting of loans under $10,000 in liability was in violation of a voluntary agreement the White House had made in 1982, while not reporting more valuable loans or clothes not returned was a possible violation of the Ethics in Government Act. Reagan expressed through her press secretary "regrets that she failed to heed counsel's advice" on disclosing them.


title: Nancy Reagan

text: Despite the controversy, many designers who allowed her to borrow clothing, noted that the arrangement was good for their businesses, as well as for the American fashion industry overall. In 1989, Reagan was honored at the annual gala awards dinner of the Council of Fashion Designers of America, during which she received the council's lifetime achievement award. Barbara Walters said of her, "She has served every day for eight long years the word 'style.'"


title: Nancy Reagan

text: Approximately a year into her husband's first term, Nancy explored the idea of ordering new state china service for the White House. A full china service had not been purchased since the Truman administration in the 1940s, as only a partial service was ordered in the Johnson administration. She was quoted as saying, "The White House really badly, badly needs china." Working with Lenox, the primary porcelain manufacturer in America, the first lady chose a design scheme of a red with etched gold band, bordering the scarlet and cream colored ivory plates with a raised presidential seal etched in gold in the center. The full service comprised 4,370 pieces, with 19 pieces per individual set. The service totaled $209,508. Although it was paid for by private donations, some from the private J. P. Knapp Foundation, the purchase generated quite a controversy, for it was ordered at a time when the nation was undergoing an economic recession. Furthermore, news of the china purchase emerged at the same time that her husband's administration had proposed school lunch regulations that would allow ketchup to be counted as a vegetable.


title: Nancy Reagan

text: The new china, White House renovations, expensive clothing, and her attendance at the wedding of Charles and Diana, Prince and Princess of Wales, gave her an aura of being "out of touch" with the American people during the recession. This built upon the reputation she had coming to Washington, wherein many people concluded that Reagan was a vain and shallow woman, and her taste for splendor inspired the derogatory nickname "Queen Nancy". While Jacqueline Kennedy had also faced some press criticism for her spending habits, Reagan's treatment was much more consistent and negative. In an attempt to deflect the criticism, she self-deprecatingly donned a baglady costume at the 1982 Gridiron Dinner and sang "Second-Hand Clothes", mimicking the song "Second-Hand Rose". The skit helped to restore her reputation.


title: Nancy Reagan

text: Reagan reflected on the criticisms in her 1989 autobiography, "My Turn". She described lunching with former Democratic National Committee chairman Robert S. Strauss, wherein Strauss said to her, "When you first came to town, Nancy, I didn't like you at all. But after I got to know you, I changed my mind and said, 'She's some broad!'" Reagan responded, "Bob, based on the press reports I read then, I wouldn't have liked me either!"


title: Nancy Reagan

text: After the presidency of Jimmy Carter (who dramatically reduced the formality of presidential functions), Reagan brought a Kennedy-esque glamour back into the White House. She hosted 56 state dinners over eight years. She remarked that hosting the dinners is "the easiest thing in the world. You don't have to do anything. Just have a good time and do a little business. And that's the way Washington works." The White House residence staff found Reagan demanding to work for during the preparation for the state dinners, with the first lady overseeing every aspect of meal presentations, and sometimes requesting one dessert after another be prepared, before finally settling on one she approved of.


title: Nancy Reagan

text: In general, the first lady's desire for everything to appear just right in the White House led the residence staff to consider her not easy to work for, with tirades following what she perceived as mistakes. One staffer later recalled, "I remember hearing her call for her personal maid one day and it scared the dickens out of me—just her tone. I never wanted to be on the wrong side of her." She did show loyalty and respect to a number of the staff. In particular, she came to the public defense of a maid who was indicted on charges of helping to smuggle ammunition to Paraguay, providing an affidavit to the maid's good character (even though it was politically inopportune to do so at the time of the Iran–Contra affair); charges were subsequently dropped, and the maid returned to work at the White House.


title: Nancy Reagan

text: In 1987, Mikhail Gorbachev became the first Soviet leader to visit Washington, D.C. since Nikita Khrushchev made the trip in 1959 at the height of the Cold War. Nancy was in charge of planning and hosting the important and highly anticipated state dinner, with the goal to impress both the Soviet leader and especially his wife Raisa Gorbacheva. After the meal, she recruited pianist Van Cliburn to play a rendition of "Moscow Nights" for the Soviet delegation, to which Mikhail and Raisa broke out into song. Secretary of State George P. Shultz later commented on the evening, saying "We felt the ice of the Cold War crumbling." Reagan concluded, "It was a perfect ending for one of the great evenings of my husband's presidency."


title: Nancy Reagan

text: The first lady launched the "Just Say No" drug awareness campaign in 1982, which was her primary project and major initiative as first lady. Reagan first became aware of the need to educate young people about drugs during a 1980 campaign stop in Daytop village, New York. She remarked in 1981 that "Understanding what drugs can do to your children, understanding peer pressure and understanding why they turn to drugs is ... the first step in solving the problem." Her campaign focused on drug education and informing the youth of the danger of drug abuse.


title: Nancy Reagan

text: In 1982, Reagan was asked by a schoolgirl what to do when offered drugs; Reagan responded: "Just say no." The phrase proliferated in the popular culture of the 1980s, and was eventually adopted as the name of club organizations and school anti-drug programs. Reagan became actively involved by traveling more than throughout the United States and several nations, visiting drug abuse prevention programs and drug rehabilitation centers. She also appeared on television talk shows, recorded public service announcements, and wrote guest articles. She appeared in an episode of the sitcom "Diff'rent Strokes" to underscore support for the "Just Say No" campaign, and in a rock music video, "Stop the Madness" (1985).


title: Nancy Reagan

text: In 1985, Reagan expanded the campaign to an international level by inviting the First Ladies of various nations to the White House for a conference on drug abuse. On October 27, 1986, President Reagan signed a drug enforcement bill into law, which granted $1.7 billion in funding to fight the perceived crisis and ensured a mandatory minimum penalty for drug offenses. Although the bill was criticized, Reagan considered it a personal victory. In 1988, she became the first active first lady invited to address the United Nations General Assembly, where she spoke on international drug interdiction and trafficking laws.


title: Nancy Reagan

text: Critics of Reagan's efforts questioned their purpose, labelled Reagan's approach to promoting drug awareness as simplistic, and argued that the program did not give adequate attention to various social issues associated with increased rates of drug use, including unemployment, poverty, and family dissolution.


title: Nancy Reagan

text: Reagan assumed the role of unofficial "protector" for her husband after the attempted assassination of him in 1981. On March 30 of that year, President Reagan and three others were shot by the attempted assassin 25-year old John Hinckley, Jr as they left the Washington Hilton hotel. Nancy was alerted and arrived at George Washington University Hospital, where the President was hospitalized. She recalled having seen "emergency rooms before, but I had never seen one like this – with my husband in it." She was escorted into a waiting room, and when granted access to see her husband, he quipped to her, "Honey, I forgot to duck", borrowing the defeated boxer Jack Dempsey's jest to his wife.


title: Nancy Reagan

text: An early example of the first lady's protective nature occurred when Senator Strom Thurmond entered the President's hospital room that day in March, passing the Secret Service detail by claiming he was the President's "close friend", presumably to acquire media attention. Nancy was outraged and demanded he leave. While the President recuperated in the hospital, the first lady slept with one of his shirts to be comforted by the scent. When Ronald Reagan was released from the hospital on April 12, she escorted him back to the White House.


title: Nancy Reagan

text: Press accounts framed Reagan as her husband's "chief protector", an extension of their general initial framing of her as a helpmate and a Cold War domestic ideal. As it happened, the day after her husband was shot, Reagan fell off a chair while trying to take down a picture to bring to him in the hospital; she suffered several broken ribs, but was determined to not reveal it publicly.


title: Nancy Reagan

text: During the Reagan administration, Nancy Reagan consulted a San Francisco astrologer, Joan Quigley, who provided advice on which days and times would be optimal for the president's safety and success. Quigley began her work at the White House after the assassination attempt on President Reagan in 1981. Nancy Reagan was told by Merv Griffin that Quigley had predicted that day would be dangerous for President Reagan, causing her to become a regular astrological consultant for the administration. Quigley previously worked on the Reagan campaign prior to serving as their astrological consultant. She volunteered for their campaign in 1980, as she was impressed by his astrological chart. Private lines were set up in the White House and Camp David to assist in phone calls between Nancy Reagan and Joan Quigley, which occurred multiple times a day, and she was paid $3,000 a month for her work.


title: Nancy Reagan

text: White House Chief of Staff Donald Regan grew frustrated with this regimen, which created friction between him and the first lady. This friction escalated with the revelation of the Iran–Contra affair, an administration scandal, in which the first lady felt Regan was damaging the president. She thought he should resign, and expressed this to her husband, although he did not share her view. Regan wanted President Reagan to address the Iran-Contra matter in early 1987 by means of a press conference, though the first lady refused to allow her husband to overexert himself due to a recent prostate surgery and astrological warnings. She became so angry with Regan that he hung up on her during a 1987 telephone conversation. According to the recollections of ABC News correspondent Sam Donaldson, when the President heard of this treatment, he demanded—and eventually received—Regan's resignation. Vice President George H. W. Bush is also reported to have suggested to her to have Regan fired.


title: Nancy Reagan

text: In his 1988 memoir, "For the Record: From Wall Street to Washington", Regan wrote the following about Nancy Reagan's consultations with an astrologer:


title: Nancy Reagan

text: Donald Regan’s memoir went on to cause political discourse, as well as scrutiny of the astrological community, as he exposed the “most closely guarded secret” of the Reagan administration. Although he did not know Quigley’s name at the time, he wrote extensively on her role in the White House. Reagan further claimed that Quigley selected the date of the 1985 Geneva Summit. For her part, Quigley stated in 1998 that she had "'absolutely nothing'" to do with arranging the summit and added that others were "'overemphasizing'" her role; however, in 1990, she released a book in which she asserted that she was "in charge" of the President's scheduling during the Reagan administration.


title: Nancy Reagan

text: Reagan acknowledged in her memoirs that she altered the President's schedule without his knowledge based on astrological advice, but argues that "no political decision was ever based [on astrology]". She added, "Astrology was simply one of the ways I coped with the fear I felt after my husband almost died ... Was astrology one of the reasons [further attempts did not occur]? I don't "really" believe it was, but I don't "really" believe it wasn't."


title: Nancy Reagan

text: In her memoirs, Reagan stated, "I felt panicky every time [Ronald Reagan] left the White House". Following the assassination attempt, she strictly controlled access to the president; occasionally, she even attempted to influence her husband's decision making.


title: Nancy Reagan

text: Beginning in 1985, she strongly encouraged her husband to hold "summit" conferences with Soviet general secretary Mikhail Gorbachev, and suggested they form a personal relationship beforehand. Both Ronald Reagan and Gorbachev had developed a productive relationship through their summit negotiations. The relationship between Nancy Reagan and Raisa Gorbacheva was anything but the friendly, diplomatic one between their husbands; Reagan found Gorbacheva hard to converse with and their relationship was described as "frosty". The two women usually had tea and discussed differences between the USSR and the United States. Visiting the United States for the first time in 1987, Gorbacheva irked Reagan with lectures on subjects ranging from architecture to socialism, reportedly prompting the American president's wife to quip, "Who does that dame think she is?"


title: Nancy Reagan

text: Press framing of Reagan changed from that of just helpmate and protector to someone with hidden power. As the image of her as a political interloper grew, she sought to explicitly deny that she was the power behind the throne. At the end of her time as First Lady, however, she said that her husband had not been well-served by his staff. She acknowledged her role in reaction in influencing him on personnel decisions, saying "In no way do I apologize for it." She wrote in her memoirs, "I don't think I was as bad, or as extreme in my power or my weakness, as I was depicted," but went on, "However the first lady fits in, she has a unique and important role to play in looking after her husband. And it's only natural that she'll let him know what she thinks. I always did that for Ronnie, and I always will."


title: Nancy Reagan

text: In October 1987, a mammogram detected a lesion in Reagan's left breast and she was subsequently diagnosed with breast cancer. She chose to undergo a mastectomy rather than a lumpectomy, and the breast was removed on October 17, 1987. Ten days after the operation, her 99-year-old mother, Edith Luckett Davis, died in Phoenix, Arizona, leading Reagan to dub the period "a terrible month".


title: Nancy Reagan

text: After the surgery, more women across the country had mammograms, which exemplified the influence that the first lady possessed.


title: Nancy Reagan

text: Though Reagan was a controversial first lady, 56 percent of Americans had a favorable opinion of her when her husband left office on January 20, 1989, with 18 percent having an unfavorable opinion, and the balance not giving an opinion. Compared to fellow First Ladies when their husbands left office, Reagan's approval was higher than those of Rosalynn Carter, Hillary Clinton and Melania Trump. However, she was less popular than Barbara Bush and Michelle Obama, and her disapproval rating was double that of Carter's.


title: Nancy Reagan

text: Upon leaving the White House, the couple returned to California, where wealthy friends purchased them a home in the wealthy East Gate Old Bel Air neighborhood of Bel Air, Los Angeles, dividing their time between Bel Air and the Reagan Ranch in Santa Barbara, California. Ronald and Nancy regularly attended the Bel Air Church as well. After leaving Washington, Reagan made numerous public appearances, many on behalf of her husband. She continued to reside at the Bel Air home, where she lived with her husband until he died on June 5, 2004.


title: Nancy Reagan

text: In late 1989, the former first lady established the Nancy Reagan Foundation, which aimed to continue to educate people about the dangers of substance abuse. The Foundation teamed with the BEST Foundation For A Drug-Free Tomorrow in 1994, and developed the Nancy Reagan Afterschool Program. She continued to travel around the United States, speaking out against drug and alcohol abuse.


title: Nancy Reagan

text: Her memoirs, "My Turn: The Memoirs of Nancy Reagan" (1989), are an account of her life in the White House, commenting openly about her influence within the Reagan administration, and discussing the myths and controversies that surrounded the couple. In 1991, the author Kitty Kelley wrote an unauthorized and largely uncited biography about Reagan, repeating accounts of a poor relationship with her children, and introducing rumors of alleged sexual relations with singer Frank Sinatra. A wide range of sources commented that Kelley's largely unsupported claims are most likely false.


title: Nancy Reagan

text: In 1989, the IRS (Internal Revenue Service) began investigating the Reagans over allegations they owed additional tax on the gifts and loans of high-fashion clothes and jewellery to the first lady during their time in the White House (recipients benefiting from the display of such items recognize taxable income even if they are returned). In 1992, the IRS determined the Reagans had failed to include some $3 million worth of fashion items between 1983 and 1988 on their tax returns; they were billed for a large amount of back taxes and interest, which was subsequently paid.


title: Nancy Reagan

text: After President Reagan revealed that he had been diagnosed with Alzheimer's disease in 1994, she made herself his primary caregiver, and became actively involved with the National Alzheimer's Association and its affiliate, the Ronald and Nancy Reagan Research Institute in Chicago, Illinois.


title: Nancy Reagan

text: In April 1997, Nancy Reagan joined President Bill Clinton and former Presidents Ford and Bush in signing the Summit Declaration of Commitment in advocating for participation by private citizens in solving domestic issues within the United States.


title: Nancy Reagan

text: Nancy Reagan was awarded the Presidential Medal of Freedom, the nation's highest civilian honor, by President George W. Bush on July 9, 2002. President Reagan received his own Presidential Medal of Freedom in January 1993. Reagan and her husband were jointly awarded the Congressional Gold Medal on May 16, 2002, at the United States Capitol building, and were only the third president and first lady to receive it; she accepted the medal on behalf of both of them.


title: Nancy Reagan

text: Ronald Reagan died in their Bel Air home on June 5, 2004. During the seven-day state funeral, Nancy, accompanied by her children and military escort, led the nation in mourning. She kept a strong composure, traveling from her home to the Reagan Library for a memorial service, then to Washington, D.C., where her husband's body lay in state for 34 hours prior to a national funeral service in the Washington National Cathedral. She returned to the library in Simi Valley for a sunset memorial service and interment, where, overcome with emotion, she lost her composure and cried in public for the first time during the week. After receiving the folded flag, she kissed the casket and mouthed "I love you" before leaving. During the week, CNN journalist Wolf Blitzer said, "She's a very, very strong woman, even though she looks frail."


title: Nancy Reagan

text: She had directed the detailed planning of the funeral, which included scheduling all the major events and asking former President George H. W. Bush, as well as former British Prime Minister Margaret Thatcher, former Soviet Union Leader Mikhail Gorbachev, and former Canadian Prime Minister Brian Mulroney to speak during the National Cathedral Service. She paid very close attention to the details, something she had always done in her husband's life. Betsy Bloomingdale, one of Reagan's closest friends, stated, "She looks a little frail. But she is very strong inside. She is. She has the strength. She is doing her last thing for Ronnie. And she is going to get it right." The funeral marked her first major public appearance since she delivered a speech to the 1996 Republican National Convention on her husband's behalf.


title: Nancy Reagan

text: The funeral had a great impact on her public image. Following substantial criticism during her tenure as first lady, she was seen somewhat as a national heroine, praised by many for supporting and caring for her husband while he suffered from Alzheimer's disease. "U.S. News & World Report" opined, "after a decade in the shadows, a different, softer Nancy Reagan emerged."


title: Nancy Reagan

text: Following her husband's death, Reagan remained active in politics, particularly relating to stem cell research. Beginning in 2004, she favored what many consider to be the Democratic Party's position, and urged President George W. Bush to support federally funded embryonic stem cell research, in the hope that this science could lead to a cure for Alzheimer's disease. Although she failed to change the president's position, she did support his campaign for a second term.


title: Nancy Reagan

text: In 2005, Reagan was honored at a gala dinner at the Ronald Reagan Building in Washington, D.C., where guests included Dick Cheney, Harry Reid, and Condoleezza Rice.


title: Nancy Reagan

text: In 2007, she attended the national funeral service for Gerald Ford in the Washington National Cathedral. Reagan hosted two 2008 Republican presidential debates at the Reagan Presidential Library, the first in May 2007 and the second in January 2008. On March 25, she formally endorsed Senator John McCain, then the presumptive Republican party nominee for president, but McCain would go on to lose the election to Barack Obama.


title: Nancy Reagan

text: Reagan attended the funeral of Lady Bird Johnson in Austin, Texas, on July 14, 2007, and three days later accepted the highest Polish distinction, the Order of the White Eagle, on behalf of Ronald Reagan at the Reagan Library. The Reagan Library opened the temporary exhibit "Nancy Reagan: A First Lady's Style", which displayed over eighty designer dresses belonging to her.


title: Nancy Reagan

text: Reagan's health and well-being became a prominent concern in 2008. In February, she suffered a fall at her Bel Air home and was taken to Saint John's Health Center in Santa Monica, California. Doctors reported that she did not break her hip as feared, and she was released from the hospital two days later. News commentators noted that Reagan's step had slowed significantly, as the following month she walked in very slow strides with John McCain.


title: Nancy Reagan

text: In October 2008, Reagan was admitted to Ronald Reagan UCLA Medical Center after falling at home. Doctors determined that the 87-year-old had fractured her pelvis and sacrum, and could recuperate at home with a regimen of physical therapy. As a result of her mishap, medical articles were published containing information on how to prevent falls. In January 2009, Reagan was said to be "improving every day and starting to get out more and more".


title: Nancy Reagan

text: In March 2009, she praised President Barack Obama for reversing the ban on federally funded embryonic stem cell research. She traveled to Washington, D.C. in June 2009 to unveil a statue of her late husband in the Capitol rotunda. She was also on hand as President Obama signed the Ronald Reagan Centennial Commission Act, and lunched privately with Michelle Obama. Reagan revealed in an interview with "Vanity Fair" that Michelle Obama had telephoned her for advice on living and entertaining in the White House. Following the death of Senator Ted Kennedy in August 2009, she said she was "terribly saddened ... Given our political differences, people are sometimes surprised how close Ronnie and I have been to the Kennedy family ... I will miss him." She attended the funeral of Betty Ford in Rancho Mirage, California, on July 12, 2011.


title: Nancy Reagan

text: Reagan hosted a 2012 Republican presidential debate at the Reagan Presidential Library on September 7, 2011. She suffered a fall in March 2012. Two months later, she endured several broken ribs, which prevented her from attending a speech given by Paul Ryan in the Reagan Presidential Library in May 2012. She endorsed Republican presidential candidate Mitt Romney on May 31, 2012, explaining that her husband would have liked Romney's business background and what she called "strong principles". Following the death of former British Prime Minister Margaret Thatcher in April 2013, she stated, "The world has lost a true champion of freedom and democracy ... Ronnie and I knew her as a dear and trusted friend, and I will miss her."


title: Nancy Reagan

text: On March 6, 2016, Nancy Reagan died of congestive heart failure at her home in Los Angeles at the age of 94. On March 7, President Barack Obama issued a presidential proclamation ordering the flag of the United States to be flown at half-staff until sunset on the day of Reagan's interment.


title: Nancy Reagan

text: Her funeral was held on March 11 at the Ronald Reagan Presidential Library in Simi Valley, California. Representatives from ten first families were in attendance, including former president George W. Bush and first ladies Michelle Obama, Laura Bush, Hillary Clinton, and Rosalynn Carter. The other representatives were presidential children Steven Ford, Tricia Nixon Cox, Luci Baines Johnson, and Caroline Kennedy, and presidential grandchild Anne Eisenhower Flottl.


title: Nancy Reagan

text: Other prominent individuals in attendance included California governor Jerry Brown and former governors Arnold Schwarzenegger and Pete Wilson, then-former House speaker Nancy Pelosi and former House speaker Newt Gingrich, and former members of the Reagan administration, including George P. Shultz and Edwin Meese. A sizable contingent from the Hollywood entertainment industry attended as well, including Mr. T, Maria Shriver (Schwarzenegger's then-wife), Wayne Newton, Johnny Mathis, Anjelica Huston, John Stamos, Tom Selleck, Bo Derek, and Melissa Rivers. In all there were some 1,000 guests.


title: Nancy Reagan

text: Eulogies were given by former prime minister of Canada Brian Mulroney, former secretary of state James Baker, Diane Sawyer, Tom Brokaw, and her children Patti Davis and Ron Reagan. After the funeral, Nancy Reagan was interred next to her husband.


title: Nancy Reagan

text: Since 1982 Siena College Research Institute has conducted occasional surveys asking historians to assess American first ladies according to a cumulative score on the independent criteria of their background, value to the country, intelligence, courage, accomplishments, integrity, leadership, being their own women, public image, and value to the president. In terms of cumulative assessment Reagan has been ranked:


title: Nancy Reagan

text: In the 1993 Sienna Research Institute survey, the first conducted after Reagan left the White House, Reagan was assessed very poorly by historians, ranking the second-worst, with only Mary Todd Lincoln being given a worse assessment. Reagan was ranked the lowest in half of the criteria (background, value to the country, intelligence, courage, and integrity). Regard for Reagan has improved in subsequent iterations of the survey. In the 2008 Siena Research Institute survey, Reagan was ranked the 4th-highest in value to the president, but was ranked the lowest in integrity. In the 2003 survey, Reagan ranked the 5th-highest in value to the president. In the 2014 survey, Reagan and her husband were ranked the 16th-highest out of 39 first couples in terms of being a "power couple". In the 2014 survey, historians ranked Reagan among 20th and 21st century American first ladies as being the 5th greatest in terms of being a "political asset" and 5th greatest in terms of being a strong public communicator.


title: Nancy Reagan

text: Reagan and her husband have each posthumously experienced continued criticism for having, during their time in the White House, spent years publicly ignoring the HIV/AIDS epidemic, which began during her husband's presidency. The epidemic had initially predominantly impacted the male homosexual community. Reagan's great extended public silence on this matter has been contrasted with her coinciding vocalness against drug use. Reagan's extended failure to give significant public acknowledgement of this epidemic has been seen as one of the greatest detractions in her retrospective public regard. However, there has been reporting to suggest that, privately, Reagan did unsuccessfully urge her husband's administration to address the epidemic.


title: Nancy Reagan

text: As noted earlier, Nancy Reagan was awarded the Presidential Medal of Freedom in 2002 and the Congressional Gold Medal, in the same year.


title: Nancy Reagan

text: As First Lady, Nancy Reagan received an Honorary Doctorate of Laws degree from Pepperdine University in 1983.


title: Nancy Reagan

text: Later, she received an Honorary Doctor of Humane Letters degree from Eureka College in Illinois, her husband's alma mater, in 2009.


title: Nancy Reagan

text: As Nancy Davis, she also made a number of television appearances from 1953 to 1962, as a guest star in dramatic shows or installments of anthology series. These included "Ford Television Theatre" (her first appearance with Ronald Reagan came during a 1953 episode titled "First Born"), "Schlitz Playhouse of Stars", "Dick Powell's Zane Grey Theatre" (appearing with Ronald Reagan in the 1961 episode "The Long Shadow"), "Wagon Train", "The Tall Man", and "General Electric Theater" (hosted by Ronald Reagan).


title: Fluoxetine

text: Fluoxetine, sold under the brand names Prozac and Sarafem, among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used for the treatment of major depressive disorder, obsessive–compulsive disorder (OCD), bulimia nervosa, panic disorder, and premenstrual dysphoric disorder. It is also approved for treatment of major depressive disorder in adolescents and children 8 years of age and over. It has also been used to treat premature ejaculation. Fluoxetine is taken by mouth.


title: Fluoxetine

text: Common side effects include indigestion, trouble sleeping, sexual dysfunction, loss of appetite, dry mouth, and rash. Serious side effects include serotonin syndrome, mania, seizures, an increased risk of suicidal behavior in people under 25 years old, and an increased risk of bleeding. Antidepressant discontinuation syndrome is less likely to occur with fluoxetine than with other antidepressants, but it still happens in many cases. Fluoxetine taken during pregnancy is associated with significant increase in congenital heart defects in the newborns. It has been suggested that fluoxetine therapy may be continued during breastfeeding if it was used during pregnancy or if other antidepressants were ineffective.


title: Fluoxetine

text: Fluoxetine was discovered by Eli Lilly and Company in 1972, and entered medical use in 1986. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2020, it was the 25th most commonly prescribed medication in the United States, with more than 23million prescriptions. Lilly also markets fluoxetine in a fixed-dose combination with olanzapine as olanzapine/fluoxetine (Symbyax).


title: Fluoxetine

text: Fluoxetine is frequently used to treat major depressive disorder, obsessive–compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bulimia nervosa, panic disorder, premenstrual dysphoric disorder, and trichotillomania. It has also been used for cataplexy, obesity, and alcohol dependence, as well as binge eating disorder. Fluoxetine seems to be ineffective for social anxiety disorder. Studies do not support a benefit in children with autism, though there is tentative evidence for its benefit in adult autism. Fluoxetine together with fluvoxamine has shown some initial promise as a potential treatment for reducing COVID-19 severity if given early.


title: Fluoxetine

text: Efficacy of fluoxetine for short-term (acute) and maintenance treatment of major depressive disorder in adults as well as children and adolescents (8 to 18 years) was established in multiple clinical trials. In addition to being effective for depression in 6-week long double-blind controlled trials, fluoxetine was better than placebo for the prevention of depression recurrence, when the patients, who originally responded to fluoxetine, were treated for a further 38 weeks. Efficacy of fluoxetine for geriatric as well as pediatric depression was also demonstrated in placebo-controlled trials.


title: Fluoxetine

text: For children and adolescents with moderate-to-severe depressive disorder, fluoxetine seems to be the best treatment (either with or without cognitive behavioural therapy) but more research is needed to be certain.


title: Fluoxetine

text: Fluoxetine is as effective as tricyclic antidepressants but is better tolerated. Fluoxetine may belong to the group of less effective antidepressants; however, its acceptability is higher than any other antidepressant, except agomelatine.


title: Fluoxetine

text: Fluoxetine is effective in the treatment of obsessive–compulsive disorder (OCD) for adults. It is also effective for treating OCD in children and adolescents. The American Academy of Child and Adolescent Psychiatry state that SSRIs, including fluoxetine, should be used as first-line therapy in children, along with cognitive behavioral therapy (CBT), for the treatment of moderate to severe OCD.


title: Fluoxetine

text: The efficacy of fluoxetine in the treatment of panic disorder was demonstrated in two 12-week randomized multicenter phase III clinical trials that enrolled patients diagnosed with panic disorder, with or without agoraphobia. In the first trial, 42% of subjects in the fluoxetine-treated arm were free of panic attacks at the end of the study, vs. 28% in the placebo arm. In the second trial, 62% of fluoxetine treated patients were free of panic attacks at the end of the study, vs. 44% in the placebo arm.


title: Fluoxetine

text: A 2011 systematic review discussed seven trials which compared fluoxetine to a placebo in the treatment of bulimia nervosa, six of which found a statistically significant reduction in symptoms such as vomiting and binge eating. However, no difference was observed between treatment arms when fluoxetine and psychotherapy were compared to psychotherapy alone.


title: Fluoxetine

text: Fluoxetine is used to treat premenstrual dysphoric disorder, a condition where individuals have affective and somatic symptoms monthly during the luteal phase of menstruation. Taking fluoxetine 20 mg/d can be effective in treating PMDD, though doses of 10 mg/d have also been prescribed effectively.


title: Fluoxetine

text: Fluoxetine is considered a first-line medication for the treatment of impulsive aggression of low intensity. Fluoxetine reduced low intensity aggressive behavior in patients in intermittent aggressive disorder and borderline personality disorder. Fluoxetine also reduced acts of domestic violence in alcoholics with a history of such behavior.


title: Fluoxetine

text: In 2019 a systematic review compared the effects on weight of various doses of fluoxetine (60mg/d, 40 mg/d, 20mg/d, 10mg/d) in obese and overweight adults. When compared to placebo, fluoxetine all dosages of fluoxetine appeared to contribute to weight loss but lead to increased risk of experiencing side effects such as dizziness, drowsiness, fatigue, insomnia and nausea during period of treatment. However, these conclusions were from low certainty evidence. When comparing, in the same review, the effects of fluoxetine on weight of obese and overweight adults, to other anti-obesity agents, omega-3 gel and not receiving a treatment, the authors could not reach conclusive results due to poor quality of evidence.


title: Fluoxetine

text: In children and adolescents, fluoxetine is the antidepressant of choice due to tentative evidence favoring its efficacy and tolerability. In pregnancy, fluoxetine is considered a category C drug by the US Food and Drug Administration (FDA). Evidence supporting an increased risk of major fetal malformations resulting from fluoxetine exposure is limited, although the Medicines and Healthcare products Regulatory Agency (MHRA) of the UK has warned prescribers and patients of the potential for fluoxetine exposure in the first trimester (during organogenesis, formation of the fetal organs) to cause a slight increase in the risk of congenital cardiac malformations in the newborn. Furthermore, an association between fluoxetine use during the first trimester and an increased risk of minor fetal malformations was observed in one study.


title: Fluoxetine

text: However, a systematic review and meta-analysis of 21 studies – published in the "Journal of Obstetrics and Gynaecology Canada" – concluded, "the apparent increased risk of fetal cardiac malformations associated with maternal use of fluoxetine has recently been shown also in depressed women who deferred SSRI therapy in pregnancy, and therefore most probably reflects an ascertainment bias. Overall, women who are treated with fluoxetine during the first trimester of pregnancy do not appear to have an increased risk of major fetal malformations."


title: Fluoxetine

text: Per the FDA, infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn. Limited data support this risk, but the FDA recommends physicians consider tapering SSRIs such as fluoxetine during the third trimester. A 2009 review recommended against fluoxetine as a first-line SSRI during lactation, stating, "Fluoxetine should be viewed as a less-preferred SSRI for breastfeeding mothers, particularly with newborn infants, and in those mothers who consumed fluoxetine during gestation." Sertraline is often the preferred SSRI during pregnancy due to the relatively minimal fetal exposure observed and its safety profile while breastfeeding.


title: Fluoxetine

text: Side effects observed in fluoxetine-treated persons in clinical trials with an incidence >5% and at least twice as common in fluoxetine-treated persons compared to those who received a placebo pill include abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dizziness, dry mouth, dyspepsia, fatigue, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilation, and yawning. Fluoxetine is considered the most stimulating of the SSRIs (that is, it is most prone to causing insomnia and agitation). It also appears to be the most prone of the SSRIs for producing dermatologic reactions (e.g. urticaria (hives), rash, itchiness, etc.).


title: Fluoxetine

text: Sexual dysfunction, including loss of libido, erectile dysfunction, lack of vaginal lubrication, and anorgasmia, are some of the most commonly encountered adverse effects of treatment with fluoxetine and other SSRIs. While early clinical trials suggested a relatively low rate of sexual dysfunction, more recent studies in which the investigator actively inquires about sexual problems suggest that the incidence is >70%.


title: Fluoxetine

text: On 11 June 2019, the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency concluded that there is a possible causal association between SSRI use and long-lasting sexual dysfunction that persists despite discontinuation of SSRI, including fluoxetine, and that the labels of these drugs should be updated to include a warning.


title: Fluoxetine

text: Fluoxetine's longer half-life makes it less common to develop antidepressant discontinuation syndrome following cessation of therapy, especially when compared to antidepressants with shorter half-lives such as paroxetine. Although gradual dose reductions are recommended with antidepressants with shorter half-lives, tapering may not be necessary with fluoxetine.


title: Fluoxetine

text: Antidepressant exposure (including fluoxetine) is associated with shorter average duration of pregnancy (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g), and lower Apgar scores (by <0.4 points). There is 30–36% increase in congenital heart defects among children whose mothers were prescribed fluoxetine during pregnancy, with fluoxetine use in the first trimester associated with 38–65% increase in septal heart defects.


title: Fluoxetine

text: In October 2004, the FDA added a black box warning to all antidepressant drugs regarding use in children. In 2006, the FDA included adults aged 25 or younger. Statistical analyses conducted by two independent groups of FDA experts found a 2-fold increase of the suicidal ideation and behavior in children and adolescents, and 1.5-fold increase of suicidality in the 18–24 age group. The suicidality was slightly decreased for those older than 24, and statistically significantly lower in the 65 and older group. This analysis was criticized by Donald Klein, who noted that suicidality, that is suicidal ideation and behavior, is not necessarily a good surrogate marker for suicide, and it is still possible, while unproven, that antidepressants may prevent actual suicide while increasing suicidality. In February 2018, the FDA ordered an update to the warnings based on statistical evidence from twenty four trials in which the risk of such events increased from two percent to four percent relative to the placebo trials.


title: Fluoxetine

text: On 14 September 1989, Joseph T. Wesbecker killed eight people and injured twelve before committing suicide. His relatives and victims blamed his actions on the Prozac medication he had begun taking a month prior. The incident set off a chain of lawsuits and public outcries. Lawyers began using Prozac to justify the abnormal behaviors of their clients. Eli Lilly was accused of not doing enough to warn patients and doctors about the adverse effects, which it had described as "activation", years prior to the incident.


title: Fluoxetine

text: There is less data on fluoxetine than on antidepressants as a whole. In 2004, the FDA had to combine the results of 295 trials of 11 antidepressants for psychiatric indications to obtain statistically significant results. Considered separately, fluoxetine use in children increased the odds of suicidality by 50%, and in adults decreased the odds of suicidality by approximately 30%. A study published in May 2009 found that fluoxetine was more likely to increase overall suicidal behavior. 14.7% of the patients (n = 44) on fluoxetine had suicidal events, compared to 6.3% in the psychotherapy group and 8.4% from the combined treatment group. Similarly, the analysis conducted by the UK MHRA found a 50% increase in suicide-related events, not reaching statistical significance, in the children and adolescents on fluoxetine as compared to the ones on placebo. According to the MHRA data, fluoxetine did not change the rate of self-harm in adults and statistically significantly decreased suicidal ideation by 50%.


title: Fluoxetine

text: Fluoxetine can affect the electrical currents that heart muscle cells use to coordinate their contraction, specifically the potassium currents "I" and "I" that repolarise the cardiac action potential. Under certain circumstances, this can lead to prolongation of the QT interval, a measurement made on an electrocardiogram reflecting how long it takes for the heart to electrically recharge after each heartbeat. When fluoxetine is taken alongside other drugs that prolong the QT interval, or by those with a susceptibility to long QT syndrome, there is a small risk of potentially lethal abnormal heart rhythms such as torsades de pointes. A study completed in 2011 found that fluoxetine does not alter the QT interval and has no clinically meaningful effects on the cardiac action potential.


title: Fluoxetine

text: Contraindications include prior treatment (within the past 5–6 weeks, depending on the dose) with MAOIs such as phenelzine and tranylcypromine, due to the potential for serotonin syndrome. Its use should also be avoided in those with known hypersensitivities to fluoxetine or any of the other ingredients in the formulation used. Its use in those concurrently receiving pimozide or thioridazine is also advised against.


title: Fluoxetine

text: In case of short term administration of codeine for pain management, it is advised to monitor and adjust dosage. Codeine might not provide sufficient analgesia when Fluoxetine is co-administered. If opioid treatment is required, oxycodone use should be monitored since oxycodone is metabolized by the cytochrome P450 (CYP) enzyme system and fluoxetine and paroxetine are potent inhibitors of CYP2D6 enzymes. This means combinations of codeine or oxycodone with fluoxetine antidepressant may lead to reduced analgesia.


title: Fluoxetine

text: In some cases, use of dextromethorphan-containing cold and cough medications with fluoxetine is advised against, due to fluoxetine increasing serotonin levels, as well as the fact that fluoxetine is a cytochrome P450 2D6 inhibitor, which causes dextromethorphan to not be metabolized at a normal rate, thus increasing the risk of serotonin syndrome and other potential side effects of dextromethorphan.


title: Fluoxetine

text: Patients who are taking NSAIDs, antiplatelet drugs, anticoagulants, omega-3 fatty acids, vitamin E, and garlic supplements must be careful when taking fluoxetine or other SSRIs, as they can sometimes increase the blood-thinning effects of these medications.


title: Fluoxetine

text: Fluoxetine and norfluoxetine inhibit many isozymes of the cytochrome P450 system that are involved in drug metabolism. Both are potent inhibitors of CYP2D6 (which is also the chief enzyme responsible for their metabolism) and CYP2C19, and mild to moderate inhibitors of CYP2B6 and CYP2C9. "In vivo", fluoxetine and norfluoxetine do not significantly affect the activity of CYP1A2 and CYP3A4. They also inhibit the activity of P-glycoprotein, a type of membrane transport protein that plays an important role in drug transport and metabolism and hence P-glycoprotein substrates such as loperamide may have their central effects potentiated. This extensive effect on the body's pathways for drug metabolism creates the potential for interactions with many commonly used drugs.


title: Fluoxetine

text: Its use should also be avoided in those receiving other serotonergic drugs such as monoamine oxidase inhibitors, tricyclic antidepressants, methamphetamine, amphetamine, MDMA, triptans, buspirone, ginseng, dextromethorphan (DXM), linezolid, tramadol, serotonin–norepinephrine reuptake inhibitors, and other SSRIs due to the potential for serotonin syndrome to develop as a result.


title: Fluoxetine

text: Fluoxetine may also increase the risk of opioid overdose in some instances, in part due to its inhibitory effect on cytochrome P-450. Similar to how fluoxetine can effect the metabolization of dextromethorphan, it may cause medications like oxycodone to not be metabolized at a normal rate, thus increasing the risk of serotonin syndrome as well as resulting in an increased concentration of oxycodone in the blood, which may lead to accidental overdose.


title: Fluoxetine

text: A 2022 study which examined the health insurance claims of over 2 million Americans who began taking oxycodone while using SSRIs between 2000 and 2020, found that patients taking paroxetine or fluoxetine had a 23% higher risk of overdosing on oxycodone than those using other SSRIs.


title: Fluoxetine

text: There is also the potential for interaction with highly protein-bound drugs due to the potential for fluoxetine to displace said drugs from the plasma or vice versa hence increasing serum concentrations of either fluoxetine or the offending agent.


title: Fluoxetine

text: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and does not appreciably inhibit norepinephrine and dopamine reuptake at therapeutic doses. It does, however, delay the reuptake of serotonin, resulting in serotonin persisting longer when it is released. Large doses in rats have been shown to induce a significant increase in synaptic norepinephrine and dopamine. Thus, dopamine and norepinephrine may contribute to the antidepressant action of fluoxetine in humans at supratherapeutic doses (60–80 mg). This effect may be mediated by 5HT receptors, which are inhibited by higher concentrations of fluoxetine.


title: Fluoxetine

text: Fluoxetine increases the concentration of circulating allopregnanolone, a potent GABA receptor positive allosteric modulator, in the brain. Norfluoxetine, a primary active metabolite of fluoxetine, produces a similar effect on allopregnanolone levels in the brains of mice. Additionally, both fluoxetine and norfluoxetine are such modulators themselves, actions which may be clinically-relevant.


title: Fluoxetine

text: In addition, fluoxetine has been found to act as an agonist of the σ-receptor, with a potency greater than that of citalopram but less than that of fluvoxamine. However, the significance of this property is not fully clear. Fluoxetine also functions as a channel blocker of anoctamin 1, a calcium-activated chloride channel. A number of other ion channels, including nicotinic acetylcholine receptors and 5-HT receptors, are also known to be at similar concentrations.


title: Fluoxetine

text: Fluoxetine has been shown to inhibit acid sphingomyelinase, a key regulator of ceramide levels which derives ceramide from sphingomyelin.


title: Fluoxetine

text: Fluoxetine elicits antidepressant effect by inhibiting serotonin reuptake in the synapse by binding to the reuptake pump on the neuronal membrane to increase serotonin availability and enhance neurotransmission. Over time, this leads to a downregulation of pre-synaptic 5-HT1A receptors, which is associated with an improvement in passive stress tolerance, and delayed downstream increase in expression of brain-derived neurotrophic factor, which may contribute to a reduction in negative affective biases. Norfluoxetine and desmethylfluoxetine are metabolites of fluoxetine and also act as serotonin reuptake inhibitors, increasing the duration of action of the drug.


title: Fluoxetine

text: The bioavailability of fluoxetine is relatively high (72%), and peak plasma concentrations are reached in 6–8 hours. It is highly bound to plasma proteins, mostly albumin and α-glycoprotein. Fluoxetine is metabolized in the liver by isoenzymes of the cytochrome P450 system, including CYP2D6. The role of CYP2D6 in the metabolism of fluoxetine may be clinically important, as there is great genetic variability in the function of this enzyme among people. CYP2D6 is responsible for converting fluoxetine to its only active metabolite, norfluoxetine. Both drugs are also potent inhibitors of CYP2D6.


title: Fluoxetine

text: The extremely slow elimination of fluoxetine and its active metabolite norfluoxetine from the body distinguishes it from other antidepressants. With time, fluoxetine and norfluoxetine inhibit their own metabolism, so fluoxetine elimination half-life increases from 1 to 3 days, after a single dose, to 4 to 6 days, after long-term use. Similarly, the half-life of norfluoxetine is longer (16 days) after long-term use. Therefore, the concentration of the drug and its active metabolite in the blood continues to grow through the first few weeks of treatment, and their steady concentration in the blood is achieved only after four weeks. Moreover, the brain concentration of fluoxetine and its metabolites keeps increasing through at least the first five weeks of treatment. For major depressive disorder, while onset of antidepressant action may be felt as early as 1-2 weeks, the full benefit of the current dose a patient receives is not realized for at least a month following ingestion. For example, in one 6-week study, the median time to achieving consistent response was 29 days. Likewise, complete excretion of the drug may take several weeks. During the first week after treatment discontinuation, the brain concentration of fluoxetine decreases by only 50%, The blood level of norfluoxetine four weeks after treatment discontinuation is about 80% of the level registered by the end of the first treatment week, and, seven weeks after discontinuation, norfluoxetine is still detectable in the blood.


title: Fluoxetine

text: Fluoxetine and norfluoxetine may be quantitated in blood, plasma or serum to monitor therapy, confirm a diagnosis of poisoning in hospitalized person or assist in a medicolegal death investigation. Blood or plasma fluoxetine concentrations are usually in a range of 50–500 μg/L in persons taking the drug for its antidepressant effects, 900–3000 μg/L in survivors of acute overdosage and 1000–7000 μg/L in victims of fatal overdosage. Norfluoxetine concentrations are approximately equal to those of the parent drug during chronic therapy, but may be substantially less following acute overdosage, since it requires at least 1–2 weeks for the metabolite to achieve equilibrium.


title: Fluoxetine

text: The work which eventually led to the discovery of fluoxetine began at Eli Lilly and Company in 1970 as a collaboration between Bryan Molloy and Robert Rathbun. It was known at that time that the antihistamine diphenhydramine shows some antidepressant-like properties. 3-Phenoxy-3-phenylpropylamine, a compound structurally similar to diphenhydramine, was taken as a starting point, and Molloy synthesized a series of dozens of its derivatives. Hoping to find a derivative inhibiting only serotonin reuptake, an Eli Lilly scientist, David T. Wong, proposed to retest the series for the "in vitro" reuptake of serotonin, norepinephrine and dopamine. This test, carried out by Jong-Sir Horng in May 1972, showed the compound later named fluoxetine to be the most potent and selective inhibitor of serotonin reuptake of the series. Wong published the first article about fluoxetine in 1974. A year later, it was given the official chemical name fluoxetine and the Eli Lilly and Company gave it the trade name Prozac. In February 1977, Dista Products Company, a division of Eli Lilly & Company, filed an Investigational New Drug application to the U.S. Food and Drug Administration (FDA) for fluoxetine.


title: Fluoxetine

text: Fluoxetine appeared on the Belgian market in 1986. In the U.S., the FDA gave its final approval in December 1987, and a month later Eli Lilly began marketing Prozac; annual sales in the U.S. reached $350 million within a year. Worldwide sales eventually reached a peak of $2.6 billion a year.


title: Fluoxetine

text: Lilly tried several product line extension strategies, including extended release formulations and paying for clinical trials to test the efficacy and safety of fluoxetine in premenstrual dysphoric disorder and rebranding fluoxetine for that indication as "Sarafem" after it was approved by the FDA in 2000, following the recommendation of an advisory committee in 1999. The invention of using fluoxetine to treat PMDD was made by Richard Wurtman at MIT; the patent was licensed to his startup, Interneuron, which in turn sold it to Lilly.


title: Fluoxetine

text: To defend its Prozac revenue from generic competition, Lilly also fought a five-year, multimillion-dollar battle in court with the generic company Barr Pharmaceuticals to protect its patents on fluoxetine, and lost the cases for its line-extension patents, other than those for Sarafem, opening fluoxetine to generic manufacturers starting in 2001. When Lilly's patent expired in August 2001, generic drug competition decreased Lilly's sales of fluoxetine by 70% within two months.


title: Fluoxetine

text: In 2000 an investment bank had projected that annual sales of Sarafem could reach $250M/year. Sales of Sarafem reached about $85M/year in 2002, and in that year Lilly sold its assets connected with the drug for $295M to Galen Holdings, a small Irish pharmaceutical company specializing in dermatology and women's health that had a sales force tasked to gynecologists' offices; analysts found the deal sensible since the annual sales of Sarafem made a material financial difference to Galen, but not to Lilly.


title: Fluoxetine

text: Bringing Sarafem to market harmed Lilly's reputation in some quarters. The diagnostic category of PMDD was controversial since it was first proposed in 1987, and Lilly's role in retaining it in the appendix of the DSM-IV-TR, the discussions for which got under way in 1998, has been criticized. Lilly was criticized for inventing a disease in order to make money, and for not innovating but rather just seeking ways to continue making money from existing drugs. It was also criticized by the FDA and groups concerned with women's health for marketing Sarafem too aggressively when it was first launched; the campaign included a television commercial featuring a harried woman at the grocery store who asks herself if she has PMDD.


title: Fluoxetine

text: In 2010, over 24.4 million prescriptions for generic fluoxetine were filled in the United States, making it the third-most prescribed antidepressant after sertraline and citalopram.


title: Fluoxetine

text: In 2011, 6 million prescriptions for fluoxetine were filled in the United Kingdom. Between 1998 and 2017, along with amitriptyline, it was the most commonly prescribed first antidepressant for adolescents aged 12-17 years in England.


title: Fluoxetine

text: Fluoxetine has been detected in aquatic ecosystems, especially in North America. There is a growing body of research addressing the effects of fluoxetine (among other SSRIs) exposure on non-target aquatic species.


title: Fluoxetine

text: In 2003, one of the first studies addressed in detail the potential effects of fluoxetine on aquatic wildlife; this research concluded that exposure at environmental concentrations was of little risk to aquatic systems if a hazard quotient approach was applied to risk assessment. However, they also stated the need for further research addressing sub-lethal consequences of fluoxetine, specifically focusing on study species' sensitivity, behavioural responses, and endpoints modulated by the serotonin system.


title: Fluoxetine

text: Fluoxetine similar to several other SSRIs induces reproductive behavior in some shellfish at concentrations as low as 10 M, or 30 parts per trillion.


title: Fluoxetine

text: Since 2003, a number of studies have reported fluoxetine-induced impacts on a number of behavioural and physiological endpoints, inducing antipredator behaviour, reproduction, and foraging at or below field-detected concentrations. However, a 2014 review on the ecotoxicology of fluoxetine concluded that, at that time, a consensus on the ability of environmentally realistic dosages to affect the behaviour of wildlife could not be reached. At environmentally realistic concentrations, fluoxetine alters insect emergence timing. Richmond "et al.", 2019 find that at low concentrations it accelerates emergence of Diptera, while at unusually high concentrations it has no discernable effect.


title: Fluoxetine

text: Several common plants are known to absorb fluoxetine. Several crops have been tested, and Redshaw "et al." 2008 find that cauliflower absorbs large amounts into the stem and leaf but not the head or root. Wu "et al." 2012 find that lettuce and spinach also absorb detectable amounts, while Carter "et al." 2014 find that radish ("Raphanus sativus"), ryegrass ("Lolium perenne") – and Wu "et al." 2010 find that soybean ("Glycine max") – absorb little. Wu tested all tissues of soybean and all showed only low concentrations. By contrast various Reinhold "et al." 2010 find duckweeds have a high uptake of fluoxetine and show promise for bioremediation of contaminated water, especially "Lemna minor" and "Landoltia punctata". Ecotoxicity for organisms involved in aquaculture is well documented. Fluoxetine affects both aquacultured invertebrates and vertebrates, and inhibits soil microbes including a large antibacterial effect. For applications of this see .


title: Fluoxetine

text: During the 1990 campaign for Governor of Florida, it was disclosed that one of the candidates, Lawton Chiles, had depression and had resumed taking fluoxetine, leading his political opponents to question his fitness to serve as Governor.


title: Fluoxetine

text: Beginning 5 April 2010, fluoxetine became one of four antidepressant drugs that the FAA permitted for pilots with authorization from an aviation medical examiner. The other permitted antidepressants are sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). These four remain the only antidepressants permitted by FAA


title: Fluoxetine

text: Sertraline, citalopram and escitalopram are the only antidepressants permitted for EASA medical certification, as of January 2019.


title: Fluoxetine

text: The antibacterial effect in described above () could be applied against multiresistant biotypes in crop bacterial diseases and bacterial aquaculture diseases. In a glucocorticoid receptor-defective zebrafish mutant ("Danio rerio") with reduced exploratory behavior, fluoxetine rescued the normal exploratory behavior. This demonstrates relationships between glucocorticoids, fluoxetine, and exploration in this fish.


title: Fluoxetine

text: Fluoxetine has an anti-nematode effect. Choy "et al.", 1999 finds some of this effect is due to interference with certain transmembrane proteins.


title: Kowloon Walled City

text: Kowloon Walled City was an ungoverned and densely populated "de jure" Imperial Chinese enclave within the boundaries of Kowloon City, British Hong Kong. Originally a Chinese military fort, the walled city became an enclave after the New Territories were leased to the United Kingdom by China in 1898. Its population increased dramatically following the Japanese occupation of Hong Kong during World War II. By 1990, the walled city contained 50,000 residents within its borders. From the 1950s to the 1970s, it was controlled by local triads and had high rates of prostitution, gambling, and drug abuse.


title: Kowloon Walled City

text: In January 1987, the Hong Kong government announced plans to demolish the walled city. After an arduous eviction process, and the transfer of "de jure" sovereignty of the enclave from China to Britain, demolition began in March 1993 and was completed in April 1994. Kowloon Walled City Park opened in December 1995 and occupies the area of the former walled city. Some historical artefacts from the walled city, including its yamen building and remnants of its southern gate, have been preserved there.


title: Kowloon Walled City

text: The history of the walled city can be traced back to the Song dynasty (960–1279), when an outpost was set up to manage the salt trade in the area. Little took place for hundreds of years afterward, although 30 guards were stationed there in 1668. A small coastal fort was established around 1810 after Chinese forces abandoned Tung Lung Fort. In 1842, during Qing Emperor Daoguang's reign, Hong Kong Island was ceded to Britain by the Treaty of Nanking. As a result, the Qing authorities felt it necessary to improve the fort to rule the area and check further British influence. The improvements, including the formidable defensive wall, were completed in 1847. The walled city was captured by rebels during the Taiping Rebellion in 1854, before being retaken a few weeks later. The present walled city's "Dapeng Association House" forms the remnants of what was previously Lai Enjue's garrison.


title: Kowloon Walled City

text: The Convention for the Extension of Hong Kong Territory of 1898 handed additional parts of Hong Kong (the New Territories) to Britain for 99 years, but excluded the walled city, which at the time had a population of roughly 700. China was allowed to continue to keep officials there as long as they did not interfere with the defence of British Hong Kong. The following year, the governor, Sir Henry Blake, suspected that the viceroy of Canton was using troops to aid resistance to the new arrangements. On 14 April 1899, British forces attacked the walled city, only to find the viceroy's soldiers gone, leaving behind only the mandarin and 150 residents. The Qing dynasty ended its rule in 1912, leaving the walled city to the British.


title: Kowloon Walled City

text: Though the British claimed ownership of the walled city, they did little with it over the following few decades. The Protestant church established an old people's home in the old "yamen" (Chinese administrative office) as well as a school and an almshouse in other former offices. Aside from such institutions, however, the walled city became a mere curiosity for British colonials and tourists to visit; it was labelled as "Chinese Town" in a 1915 map. In 1933, the Hong Kong authorities announced plans to demolish most of the decaying walled city's buildings, compensating the 436 squatters that lived there with new homes. That same year in 1933, the Nationalist Chinese government protested against the plan, and claimed jurisdiction over the city. The Nationalist Chinese government continued to make claims on its jurisdiction throughout 1935, 1936, and the first half of 1937, until the war between China and Japan started.


title: Kowloon Walled City

text: By 1940, only the yamen, the school, and one house remained. During the World War II occupation of Hong Kong, the Japanese occupying forces demolished the city's wall and used the stone to expand the nearby Kai Tak Airport.


title: Kowloon Walled City

text: After Japan's surrender in 1945, China announced its intent to reclaim the walled city. In November 1946, Nationalist Chinese officials created the "Draft Outline Plan for Reinstatement of Administration" of the area, which included an office, schools, police, and other functions. Refugees fleeing the Chinese Civil War post-1945 poured into Hong Kong, and 2,000 squatters occupied the walled city by 1947. After a failed attempt to drive them out in 1948, the British adopted a 'hands-off' policy in most matters concerning the walled city. On 8 January 1948, the Nationalist Chinese government sent a memorandum to the British Ambassador, stating "The Ministry of Foreign Affairs now formally declare to the British Embassy that, in accordance with the provisions of the said Convention, the Chinese Government enjoys jurisdiction over the City of Kowloon and that they have no intention whatsoever of renouncing this jurisdiction." The British Foreign Office, on 4 February 1948, considered a variety of solutions (including turning the site into a Nationalist Chinese Consulate-General), and ultimately recommended that the British "accept the principle of Chinese jurisdiction over Kowloon Walled City but the Chinese agree not to attempt to exercise that jurisdiction in practice." Additionally, the British Foreign Office said that "A public garden controlled by the municipal authorities of Kowloon Leased territory offers such a solution and so would a Chinese consular compound, if the Chinese could first be induced to agree in principle to the appointment of a Consul General."


title: Kowloon Walled City

text: In January 1950, a fire broke out that destroyed over 2,500 huts, home to nearly 3,500 families and 17,000 total people. The disaster highlighted the need for proper fire prevention in the largely wooden-built squatter areas, complicated by the lack of political ties with the colonial and Chinese governments. The ruins gave new arrivals to the walled city the opportunity to build anew, causing speculation that the fire may have been intentionally set.


title: Kowloon Walled City

text: With no government enforcement from the Chinese or the British aside from a few raids by the Royal Hong Kong Police, the walled city became a haven for crime and drugs. It was only during a 1959 trial for a murder that occurred within the walled city that the Hong Kong government was ruled to have jurisdiction there. By that time, however, the walled city was virtually ruled by the organised crime syndicates known as triads.


title: Kowloon Walled City

text: Beginning in the 1950s, triad groups such as the 14K and Sun Yee On gained a stranglehold on the walled city's numerous brothels, gaming parlours, and opium dens. The walled city had become such a haven for criminals that police would venture into it only in large groups. It was not until 1973 and 1974, when a series of more than 3,500 police raids resulted in over 2,500 arrests and over of seized drugs, that the triads' power began to wane. With public support, particularly from younger residents, the continued raids gradually eroded drug use and violent crime. In 1983, the district police commander declared the walled city's crime rate to be under control.


title: Kowloon Walled City

text: The city also underwent massive construction during the 1960s, with developers building new modular structures above older ones. The city became extremely densely populated and "a world unto its own," an enclave, with over 33,000 people in 300 buildings occupying little more than . As a result, the city reached its maximum size by the late 1970s and early 1980s; a height restriction of 13 to 14 storeys had been imposed on the city due to the flight path of planes heading toward Kai Tak Airport. As well as limiting building height, the proximity of the airport subjected residents to serious noise pollution. Eight municipal pipes provided water to the entire structure, although more could have come from wells. A few of the streets were illuminated by fluorescent lights, as sunlight rarely reached the lower levels due to the outstanding disregard to air rights within the city. Although the rampant crime of earlier decades diminished in later years, the walled city was still known for its high number of unlicensed doctors and dentists who could operate there without threat of prosecution.


title: Kowloon Walled City

text: Although the walled city was for many years a hotbed of criminal activity, most residents were not involved in any crime and lived peacefully within its walls. Numerous small factories and businesses thrived inside the walled city, and some residents formed groups to organise and improve daily life there. An attempt by the government in 1963 to demolish some shacks in a corner of the city gave rise to an "anti-demolition committee" that served as the basis for a kaifong association. Charities, religious societies, and other welfare groups were gradually introduced to the city. While medical clinics and schools went unregulated, the Hong Kong government provided some services such as water supply and mail delivery.


title: Kowloon Walled City

text: The quality of life in the city—sanitary conditions in particular—remained far behind the rest of Hong Kong. The Sino-British Joint Declaration in 1984 laid the groundwork for the city's demolition. The mutual decision by the two governments to tear down the walled city was announced on 14 January 1987. On 10 March 1987, following the announcement that the walled city would be converted to a park, the Secretary for District Administration formally requested the Urban Council to take over the site following demolition. Owing to the presence of numerous other green spaces in the area, the Urban Services Department doubted the need for "yet another park" from a planning and operations point of view, but the council agreed nonetheless to accept the government's proposal on the condition that the government bear the cost of park construction.


title: Kowloon Walled City

text: The government distributed some () in compensation to the estimated 33,000 residents and businesses in a plan devised by a special committee of the Hong Kong Housing Authority. Some residents were not satisfied with the compensation and were forcibly evicted between November 1991 and July 1992. While it was deserted, the empty city was used to film a scene in the 1993 movie "Crime Story".


title: Kowloon Walled City

text: After four months of planning, demolition of the walled city began on 23 March 1993 and concluded in April 1994. Construction work on Kowloon Walled City Park started the following month.


title: Kowloon Walled City

text: The area where the walled city once stood is now Kowloon Walled City Park, adjacent to Carpenter Road Park. The park was completed in August 1995 and handed over to the Urban Council. It was opened officially by Governor Chris Patten a few months later on 22 December. Construction of the park cost a total of .


title: Kowloon Walled City

text: The park's design is modelled on Jiangnan gardens of the early Qing dynasty. It is divided into eight landscape features, with the fully restored yamen as its centrepiece. The park's paths and pavilions are named after streets and buildings in the walled city. Artefacts from the walled city, such as five inscribed stones and three old wells, are also on display in the park. The park was designed by the Architectural Services Department, which won a "prestigious award" from the Central Society of Horticulture of Germany for the redevelopment.


title: Kowloon Walled City

text: The Antiquities and Monuments Office conducted archaeological examinations as the walled city was being demolished, and several cultural remains were discovered. Among them were the walled city's yamen and remnants of its South Gate, which were officially designated declared monuments of Hong Kong on 4 October 1996.


title: Kowloon Walled City

text: The South Gate had originally served as the walled city's main entrance. Along with its foundation, other remains included two stone plaques inscribed with "South Gate" and "Kowloon Walled City" from the South Gate and a flagstone path that had led up to it. The foundations of the city's wall and East Gate were also discovered. The Hong Kong government preserved the South Gate remnants next to a square in front of the yamen.


title: Kowloon Walled City

text: The yamen building is made up of three halls. Originally the middle hall served the Assistant Magistrate of Kowloon's administrative office, and the rear block was his residence. After the government officials left the area in 1899, it was used for several other purposes, including an old people's home, a refuge for widows and orphans, a school, and a clinic. It was restored in 1996 and is now found near the centre of the park. It contains a photo gallery of the walled city, and two cannon dating back to 1802 sit at the sides of its entrance.


title: Kowloon Walled City

text: The walled city was located in what became known as the Kowloon City area of Kowloon. In spite of its transformation from a fort into an urban enclave, the walled city retained the same basic layout. The original fort was built on a slope and consisted of a plot measuring about . The stone wall surrounding it had four entrances and measured tall and thick before it was dismantled in 1943.


title: Kowloon Walled City

text: Construction surged dramatically during the 1960s and 1970s, until the formerly low-rise city consisted almost entirely of buildings with 10 storeys or more (with the notable exception of the yamen in its centre). However, due to the Kai Tak Airport's position south of the city, buildings did not exceed 14 storeys. The two-storey Sai Tau Tsuen settlement bordered the walled city to the south and west until it was cleared in 1985 and replaced with Carpenter Road Park.


title: Kowloon Walled City

text: The city's dozens of alleyways were often only wide, and had poor lighting and drainage. An informal network of staircases and passageways also formed on upper levels, which was so extensive that one could travel north to south through the entire city without ever touching solid ground. Construction in the city went unregulated, and most of the roughly 350 buildings were built with poor foundations and few or no utilities. Because apartments were so small—a typical unit was —space was maximised with wider upper floors, caged balconies and rooftop additions. Roofs in the city were full of television antennas, clothes lines, water tanks, and rubbish, and could be crossed using a series of ladders.


title: Kowloon Walled City

text: Kowloon Walled City's early population fluctuated between zero and a few hundred, and began growing steadily shortly after World War II. However, there is no accurate population information available for much of the walled city's later existence. Official census numbers estimated the walled city's population at 10,004 in 1971 and 14,617 in 1981, but these figures were commonly considered to be much too low. Informal estimates, on the other hand, often mistakenly included the neighbouring squatter village of Sai Tau Tsuen. Population figures of about 50,000 were also reported.


title: Kowloon Walled City

text: A thorough government survey in 1987 gave a clearer picture: an estimated 33,000 people resided within the walled city. Based on this survey, the walled city had a population density of approximately in 1987, making it the most densely populated spot in the world.


title: Kowloon Walled City

text: In response to difficult living conditions, residents formed a tightly knit community, helping one another endure various hardships. Within families, wives often did housekeeping, while grandmothers cared for their grandchildren and other children from surrounding households. The city's rooftops were important gathering places, especially for residents who lived on upper floors. Parents used them to relax, and children would play or do homework there after school.


title: Kowloon Walled City

text: The yamen in the heart of the city was also a major social centre, a place for residents to talk, have tea or watch television, and to take classes such as calligraphy. The Old People's Centre also held religious meetings for Christians and others. Other religious institutions included the Fuk Tak and Tin Hau temples, which were used for a combination of Buddhist, Taoist, and animist practices.


title: Kowloon Walled City

text: The absence of an administration and the physical and psychological isolation from the greater Hong Kong area produced a unique culture of both crime and community that existed only within the city. The widespread criminal activity in the city did not apply exclusively to triads alone; police would also conspire with the triads to profit from the illicit trades happening within the city. Both police and residents spoke of the endemic corruption that was rife within the city. However, during the 1970s greater police involvement helped to reduce the crime rate, and the city mostly became a haven for people hoping to avoid business regulations and taxes. Thus, the city developed a form of "anarchic urbanism", in which the physical proximity led to a cultural interconnectedness and reliance between community residents, which has contributed to its modern appeal.


title: Kowloon Walled City

text: While the city was shunned in its early existence, it has now become a point of pride for many Hong Kong residences alike. The rising publicity around Hong Kong following the 1997 handover sparked a re-emergence in the public interest of Kowloon Walled City and its disappearance, and the cultural memory of the space has become more sanitised, with crime and corruption in the background. In the modern era, the city has begun to be portrayed with a romantic dystopian identity, and many forms of modern media have borrowed the city's culture in their own works. Kowloon Walled City has experienced a 'second life' in which many popular media and game outlets portray the city in a more nostalgic and romanticised version.


title: Kowloon Walled City

text: Many authors, filmmakers, game designers, and visual artists have used the walled city to convey a sense of oppressive urbanisation or unfettered criminality. In literature, Robert Ludlum's novel "The Bourne Supremacy" uses the walled city as one of its settings. The City appears as a virtual reality environment (described by Steven Poole as an "oasis of political and creative freedom") in William Gibson's Bridge trilogy, and as a contrast with Singapore in his "Wired" article "Disneyland with the Death Penalty". In the manga "Crying Freeman", the titular character's wife travels to the walled city to master her swordsmanship and control a cursed sword. The manga "" uses the walled city as the setting for a series of murders. The walled city finds an extensive mention in Doctor Robin Cook's 1991 novel "Vital Signs". The filth, squalor and the crime-oriented nature of the area is described vividly when the characters Marissa and Tristan Williams pass by the back-lanes. The later part of episode 3 and episode 4 of the anime "Street Fighter II V" are set in the Kowloon Walled City, depicted as a dark and lawless area where Ryu, Ken and Chun-Li have to fight for their lives at every turn, being rescued by the police once they reach the walled city's limits.


title: Kowloon Walled City

text: The 1982 Shaw Brothers film "Brothers from the Walled City" is set in Kowloon Walled City. The 1984 gangster film "Long Arm of the Law" features the walled city as a refuge for gang members before they are gunned down by police. In the 1988 film "Bloodsport", starring Jean-Claude Van Damme, the walled city is the setting for a martial arts tournament. The 1992 non-narrative film "Baraka" features several highly detailed shots of the walled city shortly before its demolition. The 1993 film "Crime Story" starring Jackie Chan was partly filmed in the deserted walled city, and includes real scenes of building explosions. A walled neighbourhood called the Narrows in the 2005 film "Batman Begins" was inspired by the walled city. The 2006 Hong Kong horror film "Re-cycle" features a decrepit, nightmarish version of the walled city, complete with tortured souls from which the protagonist must flee. The 2016 TVB martial arts drama "A Fist Within Four Walls" takes place in the triad-ridden walled city in the early 1960s.


title: Kowloon Walled City

text: A few of the people who spent time in Kowloon Walled City have written accounts of their experiences. Evangelist Jackie Pullinger wrote a 1989 memoir, "Crack in the Wall", about her involvement in treating drug addicts within the walled city. In his 2004 autobiography "Gweilo", Martin Booth describes his exploration of the walled city as a child in the 1950s. Gordon Jones, a District Officer of Kowloon City District at the time also published his recollections of the city during his time in office.


title: Kowloon Walled City

text: Kowloon Walled City is depicted in several games, including "Kowloon's Gate" and "Shenmue II". The game "Stranglehold", a sequel to the film "Hard Boiled", features a version of the walled city filled with hundreds of Triad members. In the games "Fear Effect" and "Fear Effect 2", photographs of the walled city were used as inspiration "for moods, camera angles and lighting." Concept art for the MMORPG "Guild Wars Factions" depicts massive, densely packed structures inspired by the walled city. The pen-and-paper RPG "Shadowrun" and CRPG "" include a crime-ridden, rebuilt version of the Walled City set in 2056. The walled city also features in the 2010 game "." The 2022 video game "Stray"'s environment is influenced by the walled city as well.


title: Kowloon Walled City

text: A partial recreation of the Kowloon Walled City existed in the Warehouse Kawasaki, an amusement arcade that operated from 2009 to 2019 in the Japanese suburb of Kawasaki, Kanagawa. The atmosphere of the walled city was reflected in the arcade's narrow corridors, electrical wires, pipes, postboxes, sign boards, neon lights, frayed posters, and various other small touches.